What Coaches Can Do to Prevent Eating Disorders: 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: What can coaches do to build a healthy culture and prevent eating disorders?

A: First, I’d recommend education. There is a lot that coaches can do to educate themselves and increase awareness on the topic of eating disorders in sport. They can turn to Walden GOALS materials, Running in Silence and Running in Silence blog posts, Nancy Clark’s Sports Nutrition Guidebook, and credible websites like NEDA, etc. They can also attend lectures, events, and coaching conferences to engage in continuing education on the topic. Armed with this information, coaches can address concerns that they see on their teams in a one-on-one conversation and a referral to the AT like we were talking about in that last Q&A.

Second, coaches can collaborate with the school nurse, AT or health/wellness teachers in their school district to plan some health and nutrition education opportunities for student-athletes. In other words, every coach and every team does not necessarily have to do this on their own. My school district hosts a program for athletes and parents at the beginning of Fall, Winter and Spring sports seasons where some basic education on proper nutrition, injury prevention, sleep, and hydration is provided. Take this opportunity to acknowledge that athletes sometimes experience an eating disorder and identify the expert support professionals in the school (AT, school nurse, or guidance counselor). Including these topics in the conversation tells athletes that coaches and athletics administration are as concerned about preventing and treating eating disorders as they are with concussions, for example. This model also allows these important messages to be delivered to student-athletes in all sports, not just female athletes and not just teams where ED risk is stigmatized as “more likely.”

Finally, coaches can invest their energy in creating a team culture they are proud of:

• Create a culture that is supportive, kind, positive, and performance-focused, not weight-focused.
• Eliminate weight-focused language, choose not to weigh athletes, and do not make recommendations to athletes to drop weight.
• Focus coaching feedback on performance and skill, not on body shape, size or weight.
• Have zero tolerance for body shaming or “fat talk.”
• Prioritize nutrition and encourage fueling for sport by encouraging athletes to eat and to feed themselves.
• Encourage athletes to eat breakfast, lunch, dinner, and snacks.
• Advocate for the U.S. Dietary Guidelines (Choose my Plate) as a good starting point for a balanced eating plan.
• Avoid conveying the myth that food/meals/snacks/treats must be “earned” through hard workouts and training. In other words, remind athletes that their hard-working bodies need to be fed and deserve to be fed, no matter what.
• Be a role model by eating healthy foods in front of your athletes and “walk the walk” yourself.
• Promote recovery nutrition by having food (fresh or dried fruit, nuts, granola bars, peanut butter crackers) available after practice or the game, for the long bus rides, and long meets or double-headers.
• Address any negative energy that you see or hear in the locker room, on the sidelines, on the bus or at team dinner and demonstrate zero tolerance for comparing, judging, or teasing athletes about food, food choices, eating behaviors or body shape/size/weight.
• Remove under-fueled or exhausted, over-training athletes from training and competing.
• Address all of these situations consistently, directly, and with authority.

These activities go a long way towards ED prevention without even having to address the signs and symptoms of an eating disorder to the athletes. Instead, helping athletes to build the life skills of fueling, food selection, body appreciation, rest days and a positive mindset offers them protection from EDs!

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Paula Quatromoni, DSc, MS, RD is a registered dietitian, academic researcher, and one of the country’s leading experts in the prevention and treatment of eating disorders in athletes. Dr. Quatromoni is a tenured associate professor of Nutrition and Epidemiology, and Chair of the Department of Health Sciences at Boston University where she maintains an active program of research. She publishes widely on topics including clinical treatment outcomes and the lived experiences of athletes and others with and recovering from eating disorders. In 2004, she pioneered the sports nutrition consult service for student-athletes at Boston University, and in 2016, she led the creation of the GOALS Program, an athlete-specific intensive outpatient eating disorders treatment program at Walden Behavioral Care where she serves as a Senior Consultant. Dr. Quatromoni is an award-winning educator. She earned her B.S. and M.S. degrees in Nutrition from the University of Maine at Orono, and her Doctorate in Epidemiology from the Boston University School of Public Health.