Stay alert for signs that an athlete may be struggling. Problems can show up in the ways the athlete behaves, talks, or performs in their sport. Some things you might see include: • Training more than recommended by the coach • Skipping meals or snacks with the team • Big dietary changes that often exclude entire food groups • Changes in how an athlete dresses – specifically wearing too many clothes for the weather or “covering up” their bodies • Consistent overuse injuries • Muscle weakness • Loss of enjoyment in the sport • Training in dangerous situations, such as running alone at night or when injured or sick • Anxiety if they are unable to practice or train • Decreased endurance, speed, coordination, or energy • Increased fatigue, muscle cramps, dizziness, or irritability • Isolation from other teammates • Frequent weighing • Negative comments about their body or weight.

The best thing you can do for an athlete is to not stay silent -- express your concern and open up a conversation. Sometimes coaches notice problematic behaviors or attitudes in an athlete even before the athlete’s family and friends do. Unless you are a qualified health provider you can’t make a diagnosis, but you can open up a conversation and encourage help-seeking behavior. When planning a talk with an athlete about concerns, consider the following: • Setting – Meet individually with the athlete in a confidential and comfortable space. • What to Say – Focus on neutral observations shared with caring “I” statements. Help the athlete inform others (such as parents) who may need to know. • How to Say It – Be sensitive and empathetic while also direct and specific about observations. • What to Avoid – Avoid simple solutions (“just eat more”) or threats (“you’re going to get benched if things don’t change”). They don’t work and could make things worse. A sample conversation might look like the following: “Emma, I value you as a team member, and appreciate the determination, hard work , and leadership you provide at every practice. However, I am concerned. I have noticed lately that you have been having a hard time focusing and are getting injured more often. I’m worried that you are becoming overly restrictive in your eating and training excessively. I think you could benefit from seeing a nutritionist as well as someone who can evaluate if there is a problem. Would you be willing to explore this idea with me?” Many people with eating problems will deny a problem exists. They may tell you not to worry or say that they are fine, even if they are very ill. If this occurs, gently press the issue. You might consider saying something like: “You may be right. It may not be a problem, and I hope that is true. But we can’t know that for sure until you get evaluated by an appropriate healthcare professional. If the evaluation indicates no cause for alarm, we will all breathe a sigh of relief. If the evaluation does indicate an issue, I will work with you as you seek help. I have a listing right here of providers who can provide an assessment.” If an athlete continues to deny a problem or seek an evaluation and you are truly concerned, you may need to press further for an evaluation. This can be hard to do, but you are not alone –consult with your athletic department personnel, school counseling office, or an eating disorder specialist to discuss next steps. Sometimes, withholding sport participation until the athlete has received a professional evaluation may be necessary. You might say something like: “Your overall health and well-being is the most important thing to me – way more important than your sport performance or participation. I need to know that you are safe to participate before you can join us at practice.”

Congratulations! It is often incredibly difficult for somebody struggling with eating or over-exercise to acknowledge a problem. The fact that they shared with you is a sign that they trust you. Early intervention increases the likelihood of recovery and decreases the possibility of serious or long-term medical consequences, and even death. Take their struggle seriously and promptly offer to help. Ways you can help include: • Encourage a professional assessment– A trained physician, dietitian, or therapist can provide an evaluation to help determine the athlete’s needs. The AKEDA website include a listing of Alaskan providers who can help. https://www.akeatingdisordersalliance.org/alaska-treatment-options • Make sure parents are in the loop – It is important for parents to know if their child is struggling. Develop a plan with the athlete for how to share this information with them. • Share resources with the athlete’s parent – Parents can experience a variety of emotions when they hear their child is struggling -- shock, fear, anger, or even disbelief. Help the parent understand that eating concerns are serious yet treatable, and that they require prompt medical and psychological follow up. Point them to the AKEDA website at: https://www.akeatingdisordersalliance.org

Coaches have tremendous power to influence athletes. Your actions and words matter! Cultivate a positive team culture and attitudes towards size, shape, weight, and food by considering the following: • Emphasize non-weight performance factors –Praise things like grit, effort, sleep, flexibility, mental preparation, “heart” and other key factors influencing performance rather than weight or body shape. • Avoid body-related comments – Even remarks that might be considered a compliment like “You are looking fit” can be harmful. A person may look “fit” while still suffering from an eating disorder or disordered eating. • Minimize weigh-ins – If weigh-ins are required for weight class sports, make them private. Otherwise, consider ditching them altogether. • Don’t encourage weight loss—Coaches are influential. Even the slightest suggestion that an athlete’s weight is too high, or that they “should” lose a few pounds can prompt unhealthy diet behaviors and attitudes towards food. • Have a zero-tolerance policy for body talk on the team— Eating disorders can become “contagious” and spread quickly and rampantly on a team. Enforcing a policy against body talk, “body jokes,” and body criticism can reduce this risk.

Recovery is hard work and your athlete may need time away from sport to participate in either outpatient treatment or an inpatient eating disorder program. Assure the athlete that they are welcome on the team whenever their treatment team gives the okay, emphasizing that recovery is the top priority. The issue of whether an athlete must take a break from sport, and for how long, is an individualized one based on a variety of factors. This decision should be made by the athlete’s medical and behavioral health providers. Request a recommendation from the athlete’s providers about when the athlete may participate again, and whether there are any modifications required. Most of all, offer the athlete emotional support. They may be afraid that taking time off from their sport will harm their performance goals. Their sense of identity may also be heavily impacted by their perception of themselves as an “athlete,” further complicating the need to give top priority to recovery. Reassure the athlete that they are more than their sport and that you support them 100% in their recovery efforts.