What Coaches Can Do to Prevent Eating Disorders (Q&A with Paula Quatromoni, Part 3)

This is Part 3 of the Q&A with leading specialist in eating disorders and sports, Paula Quatromoni. You can also read Part 1 and Part 2 of this series.

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, our resource guideRunning 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!

Q: One running program forbids athletes to talk about or even post about food on social media because they think it will help stop the spread of eating disorders. What are your thoughts?

A: To me, this is silly. Eating habits, food behaviors, and attitudes about food are contagious in our culture regardless of social media. A different approach for the leadership in this program could be to invest in educating their athletes about responsible use of social media and working to build a supportive team culture where there is zero tolerance for food shaming, body shaming, or promotion of restrictive eating or dieting culture. Social media posts and open discussions about food, if managed strategically and with some ground rules, can be quite positive and can role model healthy strategies for fueling athletes and sharing evidence-based recommendations.

Many nutrition professionals have an active presence on social media. An athlete who re-tweets a post by sports nutrition expert Nancy Clark about how to incorporate protein into their recovery nutrition snack is doing a service to their teammates by sharing those tips with other members of the club. The coach could advise his/her athletes that he/she is following them on social media and that if he/she sees anything that is negative in connotation, promoting restriction or bulimia, judgmental (shaming) towards others, etc, that they will be called into the coach’s office to discuss. The “ban it altogether” approach is not going to stop the spread of eating disorders. This coach is focusing on one tiny branch of a tree with very deep roots.

Of course, another strategy to help prevent eating disorders is to bring in a nutrition expert to talk with the athletes about the basics of nutrition and fueling for sport, providing opportunity for them to ask questions and get advice that is tailored to their sport, their position, and their individual life situation. Having ongoing access to the nutrition professional is even more effective, for this allows a trusted relationship to be built. Should a problem arise in the future, the likelihood of the athlete reaching out for help is heightened because of the accessibility of a nutritionist who is now a part of their sport family.

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For more on What an Athletic Staff Can Do, please download this PDF. This resource guide was created by Paula Quatromoni and her colleagues in the Walden GOALS program at Walden Behavioral Care, serving the greater Boston area.

Paula highly endorses books like Running in Silencethe blog posts on this websiteand Nancy Clark’s Sports Nutrition Guidebook as helpful resources for coaches and athletes.

Paula Quatromoni, DSc, MS, RD, LDN



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 decade 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 recently 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.

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