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Your child is showing signs of an eating disorder... now what? How a Sports Dietitian can help.

If you are concerned that your child athlete has, or is developing, disordered eating behaviors you may be wondering who to turn to for help.


The natural go-to is a pediatrician. They may perform a few basic tests to ensure your child isn't at immediate risk, prescribe a daily dose of Ensure as a high energy nutritional shake, and recommend seeing a dietitian. Perhaps they even give you information of an eating disorder clinic or specialist.


So now you are asking yourself...

Do we dive head first into an eating disorder clinic? Is it that serious? Will they have to give up running? How much will this cost us? What if it doesn't help? What if my child hates it? Would working with a regular dietitian suffice? Can I handle this on my own?

Perhaps your child is anxious over the thought of a "clinic" and argues that they can't give up their upcoming track season. You agree that this seems extreme... but you also want to do the right thing as a parent.


Or maybe you know that your child's health IS of immediate concern because of their declining body weight or dangerous purging behaviors. But unfortunately, your child is completely resistant to any help at all. They are in denial of any problems and are refusing to make a change.


On the other hand, you might think nutrition education may do the trick to positively influence your child. Unfortunately, the dietitians nearby seem to only work with medical conditions like diabetes and obesity and it doesn't seem like the right fit for your teenager.


In many of these instances, I believe a sports dietitian could be the key that opens the door towards a healthier future for your child. Here's why:


Sports dietitians focus on using food as fuel which will motivate your child to follow through with the nutrition suggestions in order to continue their passion of running.


  • In my experience, I often begin working with runners whom I know need more support from an eating disorder specialist, a clinic, or a psychologist. However the child is only motivated by running. They start working with me as a means to improve their running performance. Once they begin implementing my nutrition tactics, they recognize improvement in many areas, and are now more receptive to additional help or support. Learning to use food as fuel is often the first step to replace a few bad behaviors with positive ones and get health back on track enough before diving deeper into the additional support.


Sports dietitians use a non-diet approach.

  • Sports dietitians can encourage the appropriate amount and types of food without restricting any foods or talking about calories. In my blog post What does a Sports Dietitian do? I talked about the differences between a sports dietitian and a health and wellness professional. Many dietitians work with diets (makes sense!) and many "health" professionals still focus on calories, restriction, weight loss, or obtaining a certain body image or shape. These messages can be harmful to any teen, child, or young adult as they can encourage disordered eating behaviors, low self esteem, and can greatly impair an athletes potential. Therefore, a sports dietitians non-diet approach will avoid these pitfalls and provide your child with the knowledge and tools to use nutrition to boost performance, self-esteem, and confidence in food choices without dieting. In fact, we are very comfortable with the concept of more energy, more fuel, and more hydration which is unlike many diet and health professionals today.


Sports dietitians encourage listening and paying attention to the body's signs and symptoms of physical energy, hydration, under-fueling, or over-fueling which provides life-long skills to a healthy lifestyle.

  • The "listen to your body" approach is similar to intuitive eating which encourages nurturing the body without meal plans, diets, or willpower. However the roots of intuitive eating are still ingrained in weight management as a way to lose weight by differentiating cues of hunger and appetite. A sports dietitian uses intuitive eating with respect to fueling the body for what it needs to sustain performance. While an intuitive eater might not eat a meal until they are hungry, a sports dietitian would promote eating in preparation for a run or workout, in preparation for what the body will need. The skills of learning what the body needs in different scenarios, and listening to its cues creates greater understanding of how to mange one's health for performance and throughout a lifetime.


Sports dietitians are very familiar with working with teens and young adults.

  • Considering most athletes reach athletic prime before age 30, sports dietitians are very comfortable working with children, teens, and college students. They will speak in terminology that relates to your child. Many sports dietitians, myself included, were athletes in their younger years and continue to practice what they preach so they will relate well to the struggles and situations that your runner is facing.


Though I may be tooting my own horn as a sports dietitian, I will be the first to let a parent know if a runner's situation or condition requires support outside of my scope of practice.


In many situations, there is high value in seeing eating disorder specialists or clinics as the first step.


You should CONSIDER see an eating disorder specialist or eating disorder clinic if your child ....

. . . is less than 5th percentile of the expected healthy body weight*

. . . has acute weight decline with food refusal**

. . . needs 80-100% food supervision

. . . has suicidal thoughts or ideas

. . . has an existing psychiatric disorder

. . . has daily use of purging or compensatory behaviors which requires supervision before and after all meals, exercise monitoring, and bathroom monitoring

... is lacking emotional support due to family conflict problems, or absence of family members able to provide structure in the home


*For any given individual, differences in body build, composition, bone structure, and other physiological variables may result in differences a to what constitutes a "healthy body weight." It is difficult to provide healthy weight ranges for children and teens because the interpretation of body mass index (BMI) depends on weight, height, age, and sex. From previous national surveys, the CDC growth charts have deemed normal or healthy weight status based on BMI between the 5th and 85th percentile. You can use the CDC growth charts for boys and for girls to get an estimation of whether your child is underweight (less than 5th percentile) or normal weight. However these interpretations should be used with one or more criteria in order to determine if the weight is of concern for intensive medical treatment. I recommend seek additional guidance from a health professional regarding what constitutes a "healthy body weight."


**Acute weight loss in children is defined as 5% body weight loss within 6 months. For a 100- pound teenager this would be dropping to 95 pounds. Though it may not seem like much weight to an adult, children and teens are suppose to be gaining weight as they continue to grow and develop, and as such, even a small weight loss is concerning. At the same time, athletes can experience acute weight fluctuations due to changes in hydration status, or fluid retention for menstruating females, which may or may not be indicative of disordered eating. Again, these numbers should not be interpreted alone and should be used with one or more criteria to determine if the weight loss is of concern for intensive medial treatment.


Disordered eating may start as small concerns over food intake, weight, appearance, or performance. If you notice any unusual behaviors including food refusal, restrictive dieting, excessive hydration, frequent weighing on a scale, consider working with a sports dietitian or eating disorder specialist. The earlier an eating disorder is diagnosed and the sooner treatment is initiated, the better a persons chance of full recovery without residual medial complications.

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© 2019 by Lindsey Elizabeth Pfau MS RD CSSD LD/N