Coaches are in an excellent position to detect suspicious patterns, but too few do
Track and field athletes are one group of frequently overlooked persons at risk of developing disordered eating and eventually an eating disorder. Track and field athletes usually compete in sports where leanness and restricting calories are viewed as conferring a competitive advantage. Coaches are ideally situated to identify EDs in athletes. How well do coaches identify an athlete at risk and, if so, what treatment advice would they offer?
A group from the School of Psychological Science at the University of Western Australia, Perth, took a creative approach to investigating how well coaches might suspect an athlete was at risk of disordered eating or an eating disorder, and if so, the action they would take (BMJ Open Sport Exerc Med. 2022.8 e001333.doi:10.1136/bmjsem-2022-001333).
Dr. Margaret Catherine Macpherson and colleagues created vignettes of fictitious track athletes that portrayed symptoms consistent with anorexia nervosa (AN) and bulimia nervosa (BN), and then used these profiles to survey 185 British and Irish coaches. They compared the results with those of a community control group of 105 non-coaches, who were surveyed about their ability to recognize and respond to symptoms of an eating disorder. The final group of vignette-participants included 99 males (53.5%) and 84 females (45.4%). One participant was identified as “Other” and 1 had missing data (both <1.0%).
Disordered eating is a key contributors to Relative Energy Deficiency in Sport (RED-S), a clinical syndrome that “can lead to severe long-term health consequences,” according to the authors. The results of one study estimated that one element of RED-S, the prevalence of low energy availability, affected an estimated 22% to 58% of track athletes, including elite athletes (Nutrients. 2020. 12:835).
Coaches vs. non-coaches
Overall, the coaches were no more likely than non-coaches to identify an athlete with symptoms of AN or BN. One exception involved identifying symptoms of BN, where coaches more successfully identified disordered eating; this was not the case for RED-S, where very few coaches correctly identified those with symptoms (7 identified the AN vignette and 2 identified the BN vignette). Coaches were significantly more likely than non-coaches to recommend professional treatment for an athlete who had symptoms of AN. They were less successful with BN symptoms, and were no more likely than non-coaches to detect suspicious signs of BN. Among the coaches, two factors that affected their ability to refer an athlete to professional treatment were their degree of mental health literacy (MHL) and years of coaching experience.
Suggestions for improving detection and referral of athletes at risk
The authors suggest that MHL programs focusing on disordered eating and eating disorders in athletes be added to national and international coaching qualifications. In addition, education and intervention should emphasize that male athletes, as well as female athletes, are at risk of developing disordered eating and an eating disorder. Irrespective of an athlete’s gender, coaches have a duty to identify such symptoms among all their athletes.
