How Do Coaches Deal with Athletes with Disordered Eating?

Elite athletes, especially those participating in sports that emphasize leanness, are at higher than usual risk of developing disordered eating. The results of one study showed that nearly 20% of elite female athletes and 8% of elite male athletes were at increased risk of developing an eating disorder (Clin J Sport Med 2004; 14:25). The combination of reduced energy intake and high-intensity events is a recipe for menstrual disturbances, reduced bone mineral density, stress fractures, and other injuries.

C.R. Plateau and a team of researchers at Loughborough University, Loughborough, UK, recently interviewed 11 experienced track and field coaches (10 male, 1 female) to learn how they interact with athletes they suspect might be developing an eating disorder (Scand J Med Sci Sports 2014; doi: 10.1111/sms.12286).

The coaches reported having a number of challenges; for example, they were concerned about exacerbating an eating problem among vulnerable athletes and complained of a lack of sufficient resources and support. All of the coaches had encountered disordered eating or clinical eating disorders among female athletes during their coaching careers; 1 had seen problems among male athletes, and 6 were currently working with an athlete with disordered eating.

The authors’ semistructured interviews with the coaches revealed that the coaches generally took one of three major approaches to dealing with disordered eating: supportive, avoidant, or confrontational.

Supportive coaches

Coaches who used a supportive approach had a proactive strategy, and frequently formed a “working partnership” with the athlete. These coaches felt they could motivate the athlete to seek treatment, to moderate overly intense activity, and to find additional support for the athlete when needed. The supportive coachers took an active role in finding professional help for the athlete, often first online, then from other coaches, and finally by finding clinical psychologists with expertise in treating eating disorders. The supportive coaches often altered the athlete’s regular program to moderate exercise and reduce training time to protect the athlete’s health with changes in the training program determined by weight loss. They also sought professional help for the student

Avoiders

A second group of coaches “lacked a clear approach to dealing with eating problems among their athletes.” Some flatly refused to deal proactively with an athlete with a potential eating disorder—this took the form of explaining away the behavior or expressing a lack of knowledge about eating disorders, which they said fell outside their “level of expertise.” Denial was predominant—these coaches preferred to consider other reasons for weight loss than disordered eating. For example, weight loss was frequently attributed to an athlete’s lifestyle or training habits; one coach even attributed one athlete’s extreme weight loss to “poor time management.” Several of these coaches described a lack of accessible resources or knowledge of where an athlete could seek help. These coaches were also anxious about doing or saying anything that might trigger the disorder or make it worse.

Confronters

The third group involved coaches who used confrontational approaches, marked by coach-athlete conflict over the need to seek treatment and also to reduce the intensity of training. These coaches often used “scare tactics” and imposed strict new conditions for weight gain or training. One coach had body fat limits imposed for female athletes, and drew parallels between disordered eating and poor athletic performance. Some coaches had an authoritarian style, for example; setting strict weight targets and rules driven by opinion rather than by empirical medical knowledge.

When the athlete did not comply with the coach’s wishes, major conflicts arose. As in the case of the avoidant coaches, this group expressed concern about their lack of knowledge about eating disorders, and did not know when an athlete should stop training to protect his or her health. And often, when the coach stopped the athlete’s training, the athlete would continue over-training on his own.

Challenges facing all the coaches

Coaches typically felt that the typical path of referring athletes to a primary care physician was not always adequate– general practitioners often had little knowledge or understanding about the special needs of athletes. Club-based coaches of “sub-elite” athletes noted that they had problems locating and accessing athlete-specific support; unlike elite athletes, who sometimes had many more support options.

Another major challenge was helping an athlete to acknowledge that he or she had a pattern of disordered eating. This was particularly hard in the case of adult athletes, where parental involvement and support were lacking or minimal at best. Nearly all the coaches found it very difficult to confront athletes, male or female, to urge them to seek help for an eating problem.

Despite all the challenges, the authors noted that the coaches actually have a built-in advantage because of their relationship with athletes. This often-close relationship can enable a coach to identify the problem of a potential eating disorder, and to intervene. The authors stressed that better training and knowledge of eating disorders is the key to helping coaches feel empowered to intervene when they suspect an athlete has a pattern of disordered eating.