What if an Athlete Denies Having a Possible Eating Disorder? Q&A with Dr. Paula Quatromoni

This Q&A was originally part of the second Q&A here, but is republished below to separate and make it easier to find questions/topics. This is part of a Q&A series with the leading expert in eating disorders and sports and registered dietitian, Dr. Paula Quatromoni. For more Q&As click here.

Q: What do you do if an athlete denies having an eating disorder, but the coach (or anyone else) really feels that something is wrong?

You should fully expect denial and you should prepare for it. The tips suggested here are the keys to the conversation: state your concerns, stick to the facts, rely on your own observations, and make your referral to talk to an expert. When the athlete denies and refuses, simply return the conversation with authority and confidence to what it is you recommend: a conversation with the athletic trainer (AT).

Let the AT do the rest of the work by fully assessing the situation. The AT has access to screening tools that can help discern the scope of the problem and bring awareness to the athlete and to the parents. ATs are trained to assess, treat, and refer athletes for appropriate interventions. This is their job.

Refrain from talking about rumors, things you’ve heard from teammates or other teachers, or things the AT confided in you. Do not pile on second-hand information that will feel like a truckload of accusations to the athlete. This will cause more damage than good and may actually increase despair and contribute to resistance to coming forward for help. You don’t want to make the athlete feel ganged up on, as if everyone is talking about him/her and “everyone knows!” Imagine the humiliation that would induce. It would only make the athlete feel more isolated and desperate than they already are.


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.