Eating disorders and elite female athletes

Although not an exhaustive list, here are some things that might indicate an athlete is struggling with an eating disorder...

• Excessive training, exceeding coaches’ recommendations 
• Poor body image, preoccupation on weight and shape
• Body checking, inspection, critical self-evaluation
• Changes in body shape, weight, mood
• Inability to take rest days without feeling guilty 
• Isolation from team-mates
• Performance decrements in sport and/or school
• Rigid food rules, eating beliefs, and/or rituals around eating

 

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WSC: How can a coach sensitively approach this topic with a player?

RN: It is recommended that a coach privately express concerns to an athlete in a manner that communicates concern, but also compassion.

A coach can communicate noticeable emotional and behavioral changes they have observed from the athlete while avoiding labels - don’t say, for example, "I think you have an eating disorder".

Additionally, coaches can be reminded that an eating disorder is a psychiatric illness and, as such, over-simplified solutions to restore health can unintentionally feel dismissive and invalidating to an athlete.

 

WSC: As you have suggested there, the language we use with players in this area is very important. What advice can you give to coaches on the phrases to avoid to not put pressure on their players to feel they need to look a certain way?

RN: Language is incredibly important. Coaches want athletes to optimize performance and “looking a certain way” is not performance enhancing in ways that might be perceived.

Coaches who have knowledge and sensitivity in this area often use language that is free of judgment, while neutralizing comments specifically about food, weight and body composition.

Language that is supportive and encourages athletes to leverage available support when needed - from a mental health professional, sports dietitian or physician - is most advantageous to support an athlete’s mental and physical health.

WSC: How can a coach effectively support a player who is suffering with an eating disorder?

RN: It is of utmost importance that coaches support the recommendations of the athlete’s multidisciplinary treatment team - mental health provider, physician, dietitian.

It must be specific to modifications to an athlete’s training and sport participation, as these modifications are frequently needed to support treatment targets that are intended to restore an athlete’s health.

Athletes often find it helpful when coaches ask how they can be supportive during an eating disorder and corresponding treatment.

 

"Coaches who have knowledge in this area use language that is free of judgement..."

This type of communication will allow a coach to best understand how they can respond in a manner that is attuned to an athlete’s needs, similar to when an athlete has a physical injury.

 

WSC: How can coaches support a struggling player’s team-mates? And, in turn, how can they help those team-mates support the player in question?

RN: There are aspects of an athlete’s eating disorder treatment that are confidential and coaches may or may not be privy to this information.

Respecting an athlete’s confidentiality is critical. As such, it is advised that coaches defer to the athlete as to what information, if any, they feel comfortable being shared with the team.

Additionally, coaches can reassure an athlete’s team-mates that the athlete is receiving care from qualified providers and encourage them to ask the athlete directly as to how they can be supportive.

 

WSC: Where can coaches go to gain more understanding of eating disorders?

RN: The [US-based] National Eating Disorders Association and Project RED-S are good resources for coaches.

There are good books, too, such as. Finding Your Sweet Spot: How to Avoid RED-S By Optimizing Your Energy Balance, by Becca McConville, and Treating Athletes with Eating Disorders by Kate Bennett. 

Additionally, we at Mind Body Endurance are excited to virtually host our annual Eating Disorders in Sport: A Treatment Playbook for Providers on July 21, offering training for coaches and athletic personnel to enhance the identification and treatment of athletes with eating disorders.

 

WSC: Where can coaches signpost players for more support in this area?

RN: Coaches should be aware of appropriate resources and referrals to qualified eating-disorder providers in-house, such as within a college athletic department, locally, virtually and nationally.

Our Mind Body Endurance team is happy to provide care or help connect athletes with qualified providers.