What Questions About Nutrition and Weight Should High School Athletes Ask College Coaches?

I was asked by an athlete what questions she could ask a coach she was considering running for in college. After being directed to some great questions NOT to ask, with helpful re-frames provided here: https://www.ncsasports.org/blog/2018/05/23/19-questions-college-coaches-hate/, it sparked my own questions. How can athletes assess whether the college coach they want to compete for has a healthy attitude toward nutrition and weight? How could they ask about resources available on campus or inside athletics should an athlete struggle or need guidance down the road?

So I went right to collegiate nutrition expert Paula Quatromoni for advice about navigating this important and delicate topic. She stated that often, these important questions are not asked because athletes (and parents) are focused on training and performance expectations, scholarships, the recruitment process, etc. and don’t necessarily think about the culture around food, nutrition and weight up front. Athletes may get other advice on this topic (from any source, really; not just a coach) and they should thoughtfully consider which questions are best suited to their individual circumstances and personalized needs when having conversations to evaluate a good fit with a coach, program, team or university. She suggested asking the following questions specific to nutrition and weight:

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What Can You Do if a Coach is Uncomfortable Addressing Eating Disorders? (Q&A with Paula Quatromoni)

This is part of a Q&A series with the leading expert in eating disorders and sports, Paula Quatromoni. For more Q&As click here.

Q: There is suspicion that there are girls struggling with eating disorders on a high school sports team. The coach hasn’t addressed these issues even though he is concerned and is aware that it’s a problem. A mom, amongst a few other parents, brought this up and feels eating disorders/body image should be addressed. Should parents bring it to the attention of the athletic trainers next? Bring in the school counselor?

A: It sounds like this mom has a concern about the culture on this team in relation to body image and unsafe dieting practices, and she wants it addressed. That the coach is aware and reportedly concerned but is not taking action is a red flag to me. The coach sets the tone for team culture and, to a certain extent, is responsible for the safety and well-being of his athletes in relation to how he coaches, communicates, and interacts with them. By ignoring his concerns, he is silently (or maybe actively) condoning the culture that endorses, perpetuates and sustains unhealthy behaviors. This puts athletes at risk of injury and other physical and emotional consequences.

Don’t Accept Inaction

There are several possible scenarios, but none condone inaction. It could be that the coach is uneducated about the dangers of eating disorders and the risks of this culture to his athletes’ well-being. It could be that the coach actually holds and role models the common yet faulty belief system that thinness is the key to athletic performance. If the coach is giving his athletes advice about nutrition that includes weight loss, fad diets or restrictive eating, he is creating a potentially dangerous situation for his athletes. No matter how well-intentioned, the coach is not likely a trained nutrition professional qualified to give accurate and appropriate nutrition advice. Through his behaviors and/or his words, he could be setting expectations either overtly or covertly that are driving disordered eating behaviors in his athletes. It could also be that the coach simply has no idea how to address eating disorders, is afraid of doing the wrong thing, or believes it is not his “turf,” so he is opting not to intervene.

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How Can a Coach Support an Athlete With an Eating Disorder? Paula Quatromoni Q&A

This is part of a Q&A series with leading expert in eating disorders and sports, Paula Quatromoni. For more Q&As click here.

Q (Anonymous): I’m a coach with an athlete who told me she is struggling with an eating disorder and is getting treatment. She asked me to keep her accountable. How can I do this? Should I monitor her weight and food?

Accountability

A (Paula Quatromoni, DSc, MS, RD, LDN): I would ask the athlete, “What do you mean by “keep me accountable?” Can you say more about specifically what you are asking of me?” I would not make any assumptions about what the athlete means. It is very important to set some boundaries and clear expectations about what the coach can and cannot do related to appropriate kinds of support for an athlete with an eating disorder. Leaving expectations vague leaves room for misunderstanding, misinterpretation and misplaced responsibility. Clear expectations and ground rules are best!

Experts Needed

First, let’s be clear about this: it is not the coach’s responsibility or within the scope of a coach’s training and expertise to monitor an athlete’s weight or food intake. This is particularly dangerous in the case of an athlete with an eating disorder because it could delay timely diagnosis and proper intervention. Anything that delays timely diagnosis and treatment of an eating disorder escalates the health risks for the athlete, increases risk of injury, and lowers the likelihood of recovery.

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Q&A: “I’m a Runner Who is Binge Eating and I Need Help”

Note: I feel this email reflects many of the questions/emails I often receive, and it is shared here with permission. The behaviors described may be triggering to some, but I do not include numbers. I wanted to share this to show how common the issue is, how many are silent about eating disorders they may be experiencing due to shame, fear, and stigma, and what you can do if you find yourself in a similar situation. Note that I am only speaking from my experiences with an eating disorder and recovery. I am not a dietitian, therapist, counselor, eating disorder specialist, or any kind of medical professional, but encourage anyone to seek out these professionals as I describe below.

Q: I recently bought your book and am currently reading it. I have never related to something so much in my life. I have been crying reading it realize how bad my eating has become. I have been controlling what I have been eating for the past years so severely, thinking it will help me with my running.

I was coming off a great cross country season and ready for an even better track season. That’s when I suddenly started experiencing intense pain and just found out this week that I have a stress fracture in my femur. I am so crushed that I cannot run anymore. I have already taken weeks off and still have at least six more to go. I feel like I have lost such a huge part of my identity.

Since I haven’t been running, my eating has been out of control. I no longer follow the healthy eating plan my nutritionist gave me and I binge every single day. I started counted the calories during these binges and they are over X calories. I feel like I just cannot stop eating until the package of food is completely empty.

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Bringing Mental Health Education to Coaches and Athletes in Michigan

As many of you might know, I coach high school cross country and track in Michigan and I’m required to take trainings on the sports rules and how to spot concussions. These trainings are run by the MHSAA, which is also a member of the National Federation of State High School Associations. Of course, with my eye for mental health and eating disorders, I noticed that there were no required trainings on how to identify mental health issues in our athletes (something I’ve already witnessed in the few years of coaching).

But when I went to the Stomp Out Stigma walk a few weeks ago, I spoke with Christy Buck, CEO of the Mental Health Foundation of West Michigan, who shared the great news that there would now be an Action Plan implemented by the MHSAA to educate coaches on how to spot possible mental health issues in their athletes. It’s my greatest hope that we can get more trainings like this in all athletic/coaching programs, and I’m so thankful the MHSAA took this on, that I had to learn more and share:

Representing the Michigan Eating Disorders Alliance with Director Gail Hall just before Christy Buck told us about the Action Plan for the MHSAA

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How Should Eating Disorder Recovery Stories Be Shared? Q&A with Dr. Quatromoni

This is part of a Q&A series with leading expert in eating disorders and sports, Paula Quatromoni. For more Q&As click here.

Q: How should eating disorder recovery/stories be shared in presentations? How do we share properly, avoid triggers, address concerns, and raise awareness?

A (Paula Quatromoni, DSc, MS, RD, LDN): I was recently looking for something on-line and came across some “guidelines” for eating disorder prevention talks in schools and one of the top recommendations was to not bring in an individual to tell their recovery story. I wish I could remember the source of that ‘tip,’ but clearly, I dismissed it because in my opinion, “it depends” entirely on the audience and also on the individual sharing their story.

I do not believe in making a hard and fast “no, don’t do it” declaration. At the same time, I would not give an unconditional, “do this!” recommendation either. What works for one person and in one setting may not work for another. There are never any guarantees that what we deliver in an educational session will meet everyone in the audience’s needs. One speaker may do a great job and a different speaker may not do the topic justice at all. That is true in any educational setting and the same can be said of teachers, in general. It is also true of counselors, therapists, dietitians, doctors, etc. Some patients or clients may describe their interactions with a health professional as “outstanding” or “super helpful,” but others may find their interactions to be not very therapeutic, effective or individualized to their personal needs.

What we do need to ensure is that first, we “do no harm.” So there are some important considerations and a need for heightened sensitivity when a recovery speaker is planning to address a school community.

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Coaches in the Dark: What Can Athletic Staff Do in Eating Disorder Situations?

Having had an eating disorder as an athlete, I’ve been hyper-aware of the signs to look for in the athletes I coach. I knew, from my eating disorder experience, that if I suspected an athlete was struggling, it was my responsibility to refer them to a mental health professional and/or a dietitian for a proper evaluation. I even started doing homework to look for available resources in our area.

But I still felt like I was in the dark. Was I following all the right steps? How did other coaches know what to do in these situations? It wasn’t until a year ago that I realized that athletic trainers—staff right within the school—have formal education and training to recognize, screen and triage signs and symptoms of eating disorders in sport. In fact, most use an eating disorder protocol to begin the evaluation process, make referrals for intervention, and guide decisions about whether and when it is safe to participate in sport.

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What Can Parents Do if They Notice Eating Disorder Behaviors? Q&A with Dr. Quatromoni

This is part of a Q&A series with leading expert in eating disorders and sports, Paula Quatromoni. For more Q&As click here.

Q: My daughter started running and quickly developed a highly restrictive diet. She tries to eat no carbs. She has lost so much weight, but it’s never enough for her. She enjoys running, but I’m afraid she is using it as a punishment and has to do “workouts” in the morning and before bed. I am very worried about her, but she doesn’t want to talk about eating as a problem, because anything that helps her lose weight is a “good thing”. What can I do?

A (Paula Quatromoni, DSc, MS, RD, LDN): You are right to be concerned. This is a place where you have to trust your intuition and continue to observe the warning signs: restrictive eating, food rules (no carbs), substantial weight loss with a continued, strong, driven mission to lose more, and what could be compulsive exercise. This young woman is dieting and exercising, yet is not fueling properly to meet her nutritional demands. This creates a condition called “relative energy deficiency in sport” (RED-S). The consequences of RED-S are far-reaching and put her physical health, her emotional well-being, and her sports performance at risk. The fact that she “doesn’t want to talk about eating” is a hallmark of the denial that anything could possibly be of concern.

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How Can Coaches Help Underweight Athletes Gain Weight? Q&A with Dr. Quatromoni

This is part of a Q&A series with leading expert in eating disorders and sports, Paula Quatromoni. For more Q&As click here.

Q: I’m a high school coach. I have an elite runner who needs to gain weight/body fat. She is not intentionally losing weight but is very active with either running or other workouts like core and strength work. She never really slows down and on top of that just doesn’t eat enough to offset her exercise. She has seen a dietitian, but they haven’t really given her a strategy. She knows what needs to happen and her parents are working on it as well. My immediate thoughts are that she needs to record her intake and maybe that shows her just how much it is and shows ways to increase it. It could also show me how much she can run so as not to create a deficit each day.

A (Paula Quatromoni, DSc, MS, RD, LDN): It sounds to me like maybe she hasn’t seen the right dietitian who truly understands sport and the importance of a fueling strategy for an elite runner, because she reportedly came away from that interaction (was it only one session?) without one. I am betting that the RD (Registered Dietitian) she saw was not credentialed and experienced as a sports dietitian; not all registered dietitians have the additional training or qualifications to work in sports nutrition or eating disorder treatment. She needs an expert capable of designing a fueling strategy for an elite athlete. She should look for someone with the CSSD credential (Certified Specialist in Sports Dietetics) on top of the RD credential; or at least an RD who states on her practice website or is known to the local sports community as experienced working with and customizing nutrition plans for athletes.

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When a Coach Suggests Athletes “Drop a Few Pounds”: Q&A with Dr. Quatromoni

This is part of a Q&A series with leading expert in eating disorders and sports, Paula Quatromoni. For more Q&As click here.

A coach of an adult, co-ed triathlon team sent out a training guide offering athletes advice on “top 5 ways to become a faster cyclist.” One of the “lessons”:

Lesson B: Dropping a few pounds
When it comes to biking, we can all stand to lose a few pounds.

Q: How can athletes advocate for themselves and their teammates to tell a coach they are uncomfortable with recommendations being put forth to the team about weight loss?

A (Paula Quatromoni): For several reasons, this is a dangerous message for coaches to deliver to athletes, and it is a dangerous way in which to deliver it.

First, this advice endorses the “thinner is faster” mentality. Bodyweight is not the best indicator of athletic performance, so this advice overemphasizes dieting and weight loss as solutions and oversimplifies the many factors that influence performance.

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