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.


Dr. Quatromoni is a senior consultant for Walden Behavioral Care, and one of the nation’s top minds on the intersection of sports nutrition and eating disorders. As a registered dietitian, she has more than a dozen years of experience working with athletes with disordered eating and has published several papers on both clinical experiences and qualitative research on recovery experiences of athletes. Dr. Quatromoni is the Department Chair of Health Sciences and a tenured associate professor of Nutrition and Epidemiology at Boston University where she maintains an active, funded research program. In 2004, she pioneered the sports nutrition consult service for student-athletes at Boston University. Dr. Quatromoni was named a 2016 Outstanding Dietetics Educator from the Nutrition and Dietetic Educators and Preceptors (NDEP) Council. 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.