Treating Athletes With Eating Disorders with Kate Bennett, PsyD | Koopcast Episode 103

trail and ultra runners what is going on what's happening welcome to another episode of the KoopCast as always i'm your humble host coach Jason Koop i'm happy everybody is here with me today because as the title indicates we're going to talk about athletes that have eating disorders or exhibit disordered eating and how we as coaches we as friends we as professionals and colleagues can help those athletes on the podcast today i have the incredible dr kate bennett who just has a new book out that i'm absolutely infatuated with those of you that are watching the youtube version of this can already see i've got it dog-eared bookmarked and i've got a couple of post-it notes in it as well the title of her new book is treating athletes with eating disorders in the subtitle which i absolutely love is bridging the gap between sport and clinical worlds which i think is a bridge that has not been built yet until this book came out truth be told this is an area that i have felt inadequately prepared for up until the past several years and even when i talk to kate i still feel like i'm inadequately prepared i've made it one of my missions over the last several years to become more competent and more literate in this area and if i'm being honest i've kind of lacked the

resources i've lacked the people to reach out to and i've also lacked the manuals speaking to this book that i can lean on in order to make myself more proficient and make no mistake people who work with athletes whether they're a coach or some other part of their circle that they happen to work with athletes they need to be literate in this area because the consequences of not being so are great and we go through some of those statistics at the early onset of this podcast i had this was really insightful i encourage a lot of listeners to go back and listen to the first conversation i had with kate uh when we previewed this book a little bit and talked about some of the aspects that we revisit on this particular podcast but as always i learn a lot whenever i get uh with professionals like kate in this area and i personally want to continue to learn more and make myself a better coach specifically in this regard before i step out of the way in an effort of full disclosure there are going to be a couple of audio faults in this particular podcast we had some issues with kate's internet connection and you combine that with the fact that i have some construction people over here doing work on my deck we're going to clean it up as much as possible none of that should stand in the way of the content itself because it is absolutely fantastic and for those of you that are watching the youtube version we shut her uh we shut her video down part way through the podcast so that we can focus on the audio quality content but once again the information is great i really appreciate kate coming on and sharing her expertise links to where you can find

her book as well as any of the relevant research that we talked about are all going to be in the show notes you guys go check that out it's going to be a worthwhile one i'm going to get right out of the way now here we go here's my conversation with dr kate bennett i was gonna just ask you like author to author like what's it like getting this thing out in the space first you know it was funny i put i i have my copy right here too um but i uh i pulled it out of the box and i was like it's so small i was so disappointed to see how small it was like all of the hours that i spent pouring into this book but it's but it's it's dead still i mean you can already see like i've got a few uh post-it notes for pertinent things that i kind of want to come back to when i'm using it so don't trust trust me i know what that's like i know what it's like having hours and hours and hours of time of your life show up on a page and you're like that's it really you know like so trust me the value is not necessarily in the volume it's in the it's in the content so that's cool what's the reaction been like from like your peers and colleagues and things like that that you that you've uh interfaced with um a lot of support i have many you know both with regards to professionals in the sport world but also people in the clinical world who are just super excited to have this book out there and addressing hard topics things that people either want to learn

about and don't have access to that resource or um you know people who have similar training as me with regards to being in the eating disorder and athletes world and just happy to have a voice out there that people can go reference and find solid information and so you know i would say from professionally i've received a ton of and then guards to athletes they're super excited too to start to have representation in this world and feel like other clinicians and providers will start to understand them a bit better i didn't realize how uh perfect the subtitle actually was when you sent me the pdf version i don't know whether i just didn't pay much attention to it or whether i was just being an idiot that day and didn't kind of realize the the full like context of it so to give the like the listeners a little bit of a preview that the title of your book is treating athletes with eating disorders and then the subtitle which i think is brilliant is bridging the gap between sport and clinical worlds we discussed this a little bit on the first podcast and i was really surprised to hear that that bridge doesn't exist even in an educational setting and that was a large motivation behind you writing this correct yes yeah you know like i said in that first podcast my career has really been trying to have my arms in two different worlds clinically and sport worlds and so i i've always felt like i've been a bridge and i when i got i didn't get to name the book per se the publisher did but i got to add the subtitle and that subtitle

speaks to my heart well the title's easy i mean so you you did the heavy lifting on that so ask for a little bit more commission from rutledge who's the publisher right yes they are yes i mean i wouldn't you know how people want all these like really creative titles out there and i totally get i mean when you want to learn about treating athletes with eating disorders it's nice to have a book named exactly that i think the subtitle should be the title that's just my two cents i actually advocated for that seriously but they weren't down for that idea what do they know anyway well congratulations i i hope that uh it sees kind of success out in the uh out in the world i realize i i'm always appreciative of first movers right people who kind of can like move into a space that obviously you like didn't invent any of these spaces but building the bridges between uh spaces is not something that is very commonplace and that always takes a little bit of a leap of faith and so i just kudos to you for for taking that leap thank you thank you i appreciate that um one of the reasons that i'm really appreciative of this work is because it's an area that over the past several years i've felt really deficient in and i i i have worked with over the course of my coaching career a tremendous amount and i would guess it's anywhere between a quarter and a third of the athletes that i've worked with that have worked

through or are working through some type of eating disorder and i found that as a like a really stark percentage until i ran on these stats that you and i bounced back and forth uh back and forth uh in advance of the podcast and i'm not going to go over like every single one of them kind of like ad nauseam but what it brought what it really brought to my attention is the fact that practitioners need to get it right there's so there's such a high penalty for failure and the prevalence and what i mean by that is is is people and athletes that are going through some type of disordered eating or eating disorder have such higher mortality rates and other forms of disease that kind of prop up with our mental disease physical disease or combination of everything that when you are trying to identify this with a friend a colleague or in my professional career an athlete you better freaking get it right otherwise that athlete is they're not that they're doomed but it's very very hard to to to kind of course correct and i i kind of like took it upon myself like shit i need to become literate in this in in this area otherwise my athletes are really are really kind of poorly served and so i kind of want to started to start to set the landscape with or start to set the conversation with that with how how important this aspect is within specifically an athletic population and why is it so important that

we get these diagnostic and treatment elements correct with with athletes and what the consequences are for kind of screwing it up yeah so as you mentioned you know i think eating disorders are problems everywhere but especially you know being in the endurance world they're so common and um the disorder behaviors are so normalized that somebody could be practicing an eating disorder right in front of you but because uh restricting certain types of food or because weighing your food or weighing yourself or checking your body composition is such a normal practice within the sport world and particularly the endurance world it's easy to overlook these athletes like you said though when we overlook a serious eating disorder you know whether anorexia or osped which is other specified feeding or eating disorder these people have significant medical consequences and they can be like you said morbid consequences they can lead to death and they can lead to infertility they can lead to really serious lifelong consequences osteoporosis and so um it's easy to say oh they're just doing what we do normally in our sport or in our culture or they have a history of an eating disorder but they say they're okay so they must be okay and trusting them for that but what can happen is the sport especially competitive sport can become a guise for practicing an eating disorder people might say i used to have anorexia but now i don't i found running and i'm good and what has happened is they went from restricting the intake to eating perhaps a normal intake but

exercise to such an extent that that is how they measure or how that is how they maintain their body composition in a way that is tolerable for them um so when you say as a coach you want to get better at being able to understand identify detect and and support these athletes i agree it's critical because for so long we've overlooked these behaviors as just a common part of the sport culture and now we're starting to realize that yes some people practice these and they can practice these in a healthy way and some people practice these and they're not doing it in a healthy way and in fact psychologically and medically they're quite compromised and if we're not making sure they're getting the support they need then we become complicit in their development and maintenance of their eating disorder which is i don't think a responsibility any coach wants to have and to set set the landscape of the of this a little bit more i'm going to bring up some of those stats that we just talked about so in a survey of division one ncaa ncaa athletes so all athletes up over one third of female athletes reported attitudes and symptoms of placing them at risk for anorexia nervosa and then you go into the specifics of each of the different like types of sport where in the aesthetic sports that starts to bump up into the 40s and then it just kind of goes on and on and on and on but then like one of the most telling things is they're trying to like that you can really that you can really survey the landscape with is okay if all of these all of these athletes or a big percentage of these

athletes let's just call it a quarter right because these surveys are are are subject to a lot of bias but just let's say it's one in four right one in four collegiate athletes are are at risk for having some type of eating disorder one that's a lot i mean you go on a normal cross-country team of 12 or 18 people right that's six people right there i mean that's that's a lot that's you look to your left and look to your right and you're going to find somebody right there i mean that that's how actually that's how common it is but when they talk to the people who are are at the coalface of interfacing with these athletes and it's athletic trainers and coaches and and people that work and they do this in a collegiate setting because it's easier to study you can get kind of get into the population a little bit better only 27 of those professionals feel confident that they can identify an eating disorder and i'll say that half of those are lying half of those people are don't have the diagnostic skills of actually figuring that and i raise my hand as the people i'm in that percentage where i couldn't i can i don't have a good kind of nose for that i want to know like when you hear things like that like what do you think is as a professional is that how you see the landscape right now or is it slightly skewed i think that no that is how i see it you know we have a lot of conversations coming out about awareness of eating disorders um you know whether it's athletes speaking out and wanting to share their stories and their cases to support other athletes or hopefully prevent other eating disorder cases um but we still don't have i would say you know kind of quote unquote the infrastructure

to educate all of the professionals surrounding the athletes and so um while we are coming of an era where we talk about mental illness whether it's an eating disorder anxiety or depression and we put it out there educationally we're still years behind lagging with regards to providing adequate resources and training and education to the support people the people closest to the athletes yeah and that's what i find as well is that we all in the in fact that's the tagline right like make sure you have the conversation right as part of the tagline with a lot of mental disorders but there's a big leap of faith between having the conversation that is absolutely necessary i'm not downplaying that there's a big conversation or there's a big leap of faith between that and it being able to diagnose and actually treat the people who are being affected by these things right you know interestingly it's not the coaches or the athletic trainers job to diagnose the eating disorder but it is your responsibility to have awareness of these behaviors and then be able to like you said have that conversation to be able to say wow this is what i'm observing and i'm worried about you and not just once but two and three and times because it's easy to blow the conversation off once but if your coach continues to say wow i'm still seeing that you never take a rest day despite the fact that i give you rest days and we've talked about the importance of rest days or you know we've talked about eating more carbs and i see that you still aren't eating more carbs despite the amount of conversations we've had continuing to follow up is where then maybe the athletes will start to hear what you have to say and so um you know realizing it's not your job to diagnose anybody but it is a responsibility to those athletes that if you see

something say something and say it more than once because the first time it's going to be in one ear out the other yeah and the way one of my colleagues would put it is that the coaches they need to be literate in those subjects versus being experts in those subjects and the way you are literate is you educate yourself on on finding those warning signs and being able to sniff out kind of what's going on and then absolutely you turn it over to the professionals and that's where i'm trying to get myself in that state of where i can take my where i can first be able to find some of the initial warning signs second provide some initial counsel and then third reach out to the network of professionals like yourself to really do the heavy lifting if we if i do have an athlete that's in that uh scenario for the listeners that are hearing this noise above me that's people those are people working on my deck right now so there's not kind of there's not gonna be a lot i could do about it but i'm gonna try to scrub it out as much as i can in post-production but you'll have to uh forgive me uh uh for the for the noise in the background um so there was a recent there was a recent happening that i think illustrates this discrepancy between coaches be coaches being able to identify these things and being literate in it and that happened with the university of oregon and their track and field program and it just came out that they were using a lot of what i'll call advanced tools to evaluate athletes they're using dexa scans to to to to look for uh body fat percentage and they're using body weight

or they're tracking body weight and trying to intentionally reduce body weight and body fat in order to in order to affect performance and it came out in this really kind of sick way where a lot of the particularly the women in that program developed eating disorders and some of them have since left the program a local here katie reinsberger who you know won a number of state state titles okay you probably remember her her mother lisa um who we both yes so she was part of that program and she transferred and it brought to light this whole conversation of the appropriateness of using some of these tools in an athletic context and i wanted to get your perspective as a professional about where where kind of the where should the boundaries be when we're using these and i want to i want to put like a broad umbrella on it because it's not just limited to dexa scans right and it's not just limited to body fat calipers there's a whole array of tools that coaches and athletes can use to inform what's going on either on a physiological level or from a training perspective or from a performance perspective and the way that you utilize those tools can have effects outside of the aq use of them right so in this case right they're trying to analyze for bone density and body fat and it has a effect on their mental well-being right i wanted to get your perspective on on those types of use cases like how should coaches and athletes view all of these different pieces of technology that

kind of bleed over into the psychological elements specifically with potentially developing eating disorders you know it's interesting because with the oregon case you know i've read the the press coverage of it and i truly believe that the head coach meant to do no harm right like he was just trying to figure out how to bring his athletes to be to meet their greatest potential but in doing so you know and i think this is the danger of any scientific approach is when we think about the human body it's not robotic and so when we try to apply mathematical equations to every single human body we lose out on the unique genetic variables that influence the human health and so you know i think the danger is when we put numbers in and we say like oh if you do this you'll be at 12 body fat and you will perform the best you ever will however that person might have genetics that wants them to be at 15 they simply can't be healthy at 12 body fat and i think you know true is the danger is when we try to reduce the human genetics and heritage and how those variables influence our mental health and our physical health well i keep going back to who knows what the intent of whether the coach is trying to do harm or not do harm i don't think that he's intentionally trying to do it although that might be a consequence of it from a coaching perspective it's lazy coaching that's neither here nor there within this within this within this no seriously i

mean whenever you're relying on that math that mathematical modeling in order to drive the predominance of performance as you just mentioned i think that that's just lazy coaching you're using you're using those equations as an excuse to cover up for some sort of coaching deficiency but the the kind of the root of what i want to get to with you as as a professional in this area is that we we do have all of these tools available to us and some of them are as simple as you know our wristwatch will tell us where you know or can't our wristwatch will try to tell you is your vo2 max going up or down is your fitness going up or down all the way to the really sophisticated more sophisticated types of tools that collegiate programs have access to and a lot of athletes have access to this with our health care provider where they're trying to do dexa scans and even blood you know blood biomarkers and things like that what do you i want to take this from a coaching perspective although the most of this audience is going to be athletes what do the coaches need to take an account when they're in introducing those types of analyses and interventions to the to to to their athletes and what are the kind of some of the red flags that they need to watch out for you know i truthfully i think it's it's as basic as reminding athletes that they're still human beings and so talking about how science can help inform the practice with regards to coaching and performance but at the end of the way at the end of the day the human body is going to be a better indicator of how we are

recovering and how we are feeling than any number or statistic or measurement ever will be and so you know i think it's as much about looking at training plans and looking at the workouts that they log into whatever program that they're using but also then the qualitative experience which is so often overlooked because we can't measure it and we live in a society that loves to measure and have results and outcomes and quantify everything but truly you know when we think about health and well-being it's quite intuitive we know when we're tired we know when we're not recovering we know when we feel heavy or slow or lethargic we also know when we feel elevated and strong and powerful and so if we're teaching our athletes something that matters are the numbers they forget to check in with themselves and they don't relay that information back similarly you know if we start to talk with athletes about hunger and you know if they're saying i'm constantly hungry i'm constantly hungry and we just keep looking at their numbers we're not teaching them like hey your body's maybe not where it needs to be maybe it's under nourish and let's talk about nutrition today instead of the outcomes of your workout or the outcomes of your race and so you know i think we need to give voice to the intuition of the body and coaches need to learn how to listen to the quality of the experience not just look at the numbers and the outcomes that's so pertinent dr bennett i cannot i cannot tell you how many times i've had that conversation in a variety of different flavors with our coaches that that work with us

but as well as the athletes that we start to work with where normally they are coming to us because they they say oh i want you to scientifically look at my training program i want you to tell me what the data is saying and things like that and my coaching course correction to that is just like okay that'll take care of itself you push the stop button on your watch and everything's gonna you know zip you know through the cloud and on to training peaks in the background and you don't have to put any effort into that but you should put effort into to use your vocabulary describing the quality of the athletic experience that you just had how did you feel on that workout how did you feel during the day during the night during these intervals and things like that and putting kind of that piece into context i look at that first i mean i i'm doing this for the people that are watching the youtube video because the post activity uh email that i get from training peaks has the metrics first and the comments second and i always tell them i want to switch it i want to see the comments first and the metrics second but your notion for practitioners to to pay attention to what the athletes are saying and what their experience is i think is a really relevant one because in going back to the university of oregon case you're having the data you know the data tail wag the human dog and it shouldn't be that way right the human should be the one wagging the tail is that the way the analogy goes yeah something like that i think people will know what you're talking about people people got to get it um okay um one of the other aspects that we talked a little bit about in the first podcast and i

encourage all the listeners to go back to back to that podcast because that was really insightful and i got i got a lot of really good feedback on that is this notion of when does disordered eating turning turn into an eating disorder and endurance athletes and in particular this audience ultramarathon athletes we are notorious for taking things to the nth degree you know if if the number one is prescribed we're going to take it to the number 10 like that's just kind of built it built in our nature but endurance athletes as a whole they will do things and manipulate their diet during training and as a as an observer looking that at that it's easy to look at that and say oh that's a problem that person is going to develop you know some sort of bad habit that they're going to carry on with them for the rest of their lives and that's a hard area to navigate as well and so i want to kind of start out with that like where like where does it start to become problematic within an athletic spectrum when athletes are training for a race they're doing things from a nutritional perspective very specifically how does that eventually translate into something that they need to watch watch for later on down the line that's a great question and there's not one very specific concrete answer to it it really is a qualitative experience with regards to um you know i think we're kind of talking a bit more about restricting and controlling intake so if you know if that were the case this idea that i'm hungry and i'm trying to find myself food because i i need to lose weight but my body continues to be hungry and i

continue to push through the hunger thinking that this is the better outcome for me um when i think about athletic training and the pursuit of performance there's this periodization to it and maybe there is a period where where athletes are pushing themselves but then they're able to come out of that if they are constantly denying their hunger and they're constantly living in the state of starvation that is concerning if the idea of actually eating more food to take care of hunger is is you know creates anxiety or distress that is concerning so it really is about this intuition and the ability to take care of the body um and in this rhythm where maybe i go through a period of i actually a bit harder with nutrition to try and achieve body composition for the sake of performance but i know that peak event i'm able to healthier lifestyle and i'm able to take care of my body and nourish my body intuitively and when i'm hungry i eat and when i'm full i stop you know and the other pieces is athletes who restrict all day and then binge that that also is concerning because that's telling us that the body is probably starving all day long and the only way to nourish it is really out of binge which leads to shame and guilt and embarrassment you know and so um really it's this ability i would say the concern is and it's it's such a precipice you know for the athletes with regards to being them to realize like i have this under control i'm under control but this ability to intuitively know i'm going too far or i can't stop this and i need some help so that moment where they either realize i'm going too far but i'm going to keep pushing that would that would be that that moment in time

where this is this is dangerous a slippery slope with regards to an eating disorder um or likewise like i know i should stop but i don't want to i like the results of this or i'm pushing past this um truthfully nobody ever chooses an eating disorder right so every well-intended athlete who says i'm going to work on my nutrition and body composition for the sake of performance nobody has ever raised their hand and say hey i'm going to sign up for an eating disorder today whether that's anorexia or bulimia or an eating disorder but what happens is we create such chronic states of deprivation or um such chronic states in our body with regards to how we're trying to use food and exercise to manipulate our body composition that all of a sudden those start to create shifts in our neurotransmitters those start to create shifts in our hormones and our hunger fullness cues and we've lost control of the behaviors we're trying to use to help ourselves you know we we tend to talk about eating disorders in this with this context of almost like total calorie content right that's that's the best way i can describe it right total calorie content is either adequate or or or somehow they're they're they're malnourished from an absolute amount of calories that they're taking in relative to their energy expenditure but when you're looking at things clinically do you also take into consideration the manipulation of the macronutrients and an over focus on that potentially leading to to either disordered eating or an eating disorder because this is a topic that starts to get

i mean it seems like every four or five years it starts to get a lot of attention and endurance circles where people are radically manipulating the percentage of carbohydrate protein and fat that they're taking in in order to achieve some sort of athletic result whether it's weight loss or fat utilization or something like that is that something that you're also seeing from from like from a clinical perspective in the same sense of they're you know they're literally starving themselves they're avoiding themselves you know of total calories and things like that is it is it similar or is there some or there's some wrinkles to it yeah no i would say that that's one of those ones where when i said earlier like maybe somebody's practicing some sort of disorder eating or i would say you know nutritional control or manipulation and it's easy to overlook because you're like oh they're just really focused on their macros yeah but what can happen is they focus on two macros at the expense of a third macro and and that third macro usually carb usually fat for some reason proteins never cut out we always see protein as the most important just wait though wait just wait mark my word just wait like four or five years because these things go in cycles the next cycle will be somehow cutting out protein yes but yeah so but that idea that all of a sudden all i eat are carbs and protein or all i eat are fats and protein and carbs are no longer necessary and that can create a state of deprivation because our body's not getting the nutrition it needs with you know carbohydrates being one of our most important fuel sources

so yes i would say cutting out a macro is as dangerous as trying to just restrict to a very low calorie intake are the behavioral patterns that you see very similar as well like if you're trying to if you're trying to like diagnose somebody or put somebody into you know one of the criteria that you're looking for or is it is it a similar process between somebody who's like let's just say like restricting carbohydrates which is kind of all the rage right now right versus somebody who's restricting the total amount of calories i would say that it's easy yes it is easier to pick up on somebody's restricting their total intake um i've been doing this for so long that it's easy for me to to not be fooled but i could see where somebody's like oh well they eat blank amount of calories every day so they should be fine whereas i'm like oh but they won't even touch the third macro that's really concerning so for me it's easy to pick up but i think for other people it's easy to rationalize that they eat so much other food they're okay and they don't realize the distress and the psychological component of the restriction of that third macro that's what's super important because i do think that like once again talking about getting the conversation out there we're kind of like lagging in that piece of it where we're we will look at it as okay this person is not at risk or doesn't have disordered eating or an eating disorder because they're eating enough calories but they have this what you would diagnose clinically as some sort of issue because they won't touch a carbohydrate exactly yes i want to get your take kate on this aspect of influencers and this is related to what i just kind of what i just mentioned to you i want to see what you're seeing in the clinic in terms of athletes and other and other like i'll just say celebrities

of influence being being the proverbial influencer and not really recognizing how much influence they have when they're putting things out on social media out on instagram and things like that are you seeing people like coming into your clinic or into other people's clinics either in part or in whole as a byproduct of looking at this the social media landscape and saying oh i either want to be like that or or oh such and such says that this is okay yeah you know i don't think anybody ever shows up with being able to identify social media or any media influencer as the you know the culprit for their eating disorder but when we when i always have this kind of this conversation with them about culture at large and how does culture influence the development or our awareness of body image and our experience of body and what we should look like or how we should be as an athlete um and oftentimes there are either there are certain they have certain feeds that they cultivate on their social media that constantly reinforces a certain type of body or a certain type of nutritional habit or a certain type of exercise pattern that that continues to perpetuate and continues to feed into their disordered behaviors and you know their maladaptive behaviors um i have some people who come in and they allow social media influencers to create their workout programs and their nutritional programs and their nutritional programs and it's really interesting to me that we trust strangers on social media because they have thousands of followers and they seem really upbeat and happy and they have the body we want and so it is really concerning to me that these people get out there with no street credentials and and they just put on the face and create a following that gives them you know apparently a lot of knowledge well it's always allowed influencers have always

leverage social media to punch above their leverage to punch above their their their i'm going to say intellectual but somebody's going to freaking crucify me for that their their professional capacity to give advice right they're always like stepping outside of their scope of practice is what we would say in the in the in the practitioner or kind of the clinical world social media has allowed people to do that where if they've got a good face if they've got a good body they know how to kind of manipulate the algorithms and things like that they can really punch above their weight in a lot of areas and and and and and what and some of those might be problematic right and i think some of those some of those social media influencers are very cognizant of that and some of them are not or they just don't care right they just don't care about the actual impact that their behaviors are kind of having on other people i want to get to the flip side of that and this kind of comes back to the people like me and my in my in my coaching colleagues we went through at the beginning of this podcast like some of the things that we can do to kind of suss out if we if we need to get somebody into into somebody into a real professional like you into their hands what advice would you give to my coaching colleagues to the coaches that are listening out there or people who are just interested if they need to get somebody into a professional setting how would you recommend that they do that yeah so um you know i think first and foremost in the words of jerry lynch who's a friend and a colleague of mine he's a sports psychologist as well

he's big into coaching and culture and he says the influence of the coach the influence of the coach is never neutral and so realizing that the influence that you have over every single athlete has an impact so if you say something that influences them and if you say nothing it still influences them and so realizing how impactful everything you do and everything you don't do actually influences the athletes that you are working with um so it can be like well i'm just gonna you know i think we live sometimes in a society where like hands off like well i'm just not going to touch body image and i'm not going to talk about weight and nutrition and therefore i won't influence eating disorders however by not touching it then we could also inadvertently not pick up on athletes who really need some education and need some help and so first and foremost realize that what you do and you don't do is going to influence your athletes so then you need getting comfortable with your own conversation right knowing the facts that you feel comfortable with and whether it's just realizing that being able to have a conversation with your athlete of you know what i know that we exist in a sport that has a lot of weight biases and my goal is to make you the healthiest most competitive athlete as possible and so to do that we're going to use science but we're also going to use intuition you know and so create a culture around your athletes that gives them space to say this works for me this doesn't work or i'm trying to do this what do you think or you being able to say like hey i've noticed this about you qualitatively speaking how's that going so really creating that culture to encourage your

athletes to tune in with their bodies um but ultimately you know like i said earlier today just even that awareness that if if i mentioned that i'm worried about you and they say yeah yeah coach i got it and nothing changes and you bring it up again yeah coach i've got it and nothing changes that's really where i would say take that next step to hey i'm worried about you we've addressed this two or three times i'm not seeing a change it seems like there might be some sort of clinical issue going on why don't you contact a professional or let me help you find a professional in your area so that you can talk to them and see what's going on and and so it really comes down to what the world like hearing confrontation being able to say i'm worried about you let's get you hooked up to somebody and make sure there's nothing serious going on and maybe there is and if there is i totally support you and if there's not then i'm glad that we know that there's nothing there okay this just gave me all the excuse in the world to get more fired up about this because i mean your statement no no i mean your statement of is what you say and what you don't say really matters from a coaching perspective is really really poignant and i've lived that out and throughout the last 20 years of my of my coaching career and i kind of keep coming back to the coaches need the coaches and people who are also part of the athlete support network need to be literate in these things in order to in order to serve the athletes the best because if they're not they're just doing a disservice and you kind of kind of it your your statement of of saying nothing can equal can be as equally harmful

if you're just burying your head in the sand or if you're just being flippant about it and saying oh just go eat a pizza or just you know you know go you know just go eat this or just go eat that or whatever like you can't be being flippant about it and this is my opinion correct me if i'm wrong on this but being flippant about it is just as egregious of an error as not saying anything because you're acknowledging your ignorance from the get-go and it's not serving the athlete very well in the first place right i would say it's worse than not saying anything really that's super interesting because it yeah it's shame right because truly i i can guarantee you that if people could choose to just eat a pizza and gain weight and not have an eating disorder they would right it's it's not that simple choice and so when we reduce it to just go eat the pizza there's so much shame and guilt of why can't i figure this out why why is it this my problem why can't i just eat a pizza like a normal person i uh you you'll find you'll find you'll find this appalling but i'm gonna tell the story anyway um i i uh just started working with a new athlete uh i was working with another coach uh before me who will remain nameless and i was reviewing this athlete's kind of previous training program and kind of baked into the baked into the training program like on the rest days was eat a pizza eat a burger eat a whatever and i asked the athlete i'm like what is this just like randomly kind of like put in here and and the athlete was like yeah it's just kind of part of the whole gist of things and it just struck me as an odd piece of advice because it really didn't

have any like background or athletic context and the the context with the context with this athlete is he was kind of struggling with his weight and so i was just like once again being super flippant about it and i was i was treating as just burying your head in the stand but now that i know it's worse this even fires me up even more that you can't just say well just go do this and it'll be fine right yeah no if it was a simple choice i would not have a job and my book would have no place in this world okay perfect all right let's bring it full circle back to the book kate um so you wrote it and now it's starting to get out in the got get out in the wild you've received a lot of feedback from it ultimately what what do you want to hear from athletes and coaches that come that come back to you that have experienced the book like what's going to give you fulfillment or what are the few things what are the few kind of like big like heavy hitters from the book that you really want to communicate to people that are working with athletes um you know i would say number one really people understanding this the consequences of eating disorders and disordered eating you know so whether somebody has truly a clinical eating disorder where they they can't get out of it on their own or somebody practices disordered eating um and they can kind of puritize their way through it but they continue to do it starting to understand what those choices mean with regards to their long-term

health and well-being you know way back in the day when i was a intern at cts and i remember talking about amen or you i was like oh just get on the pill and it was no big deal like no no one was concerned it was just like a thing you do versus here we are 20 years later saying like that's terrifying you don't just get on the pill you have to figure out how to change your energy balance just restore not only your menstrual cycle but also your bone health and your cardiovascular health and so you know truly i think number one is really awareness for athletes to understand the long-term consequences of what they're doing to try and achieve performance or trying to improve their performance through manipulating their size and shape their nutrition their exercise patterns um so number one would just really be to to create awareness about that because i think the medical consequences of disordered eating are often overlooked and under discussed number two would be really for providers to develop some competencies with regards to being able to you know for for coaches and athletic trainers to be able to understand and do a better job detecting eating disorders but for clinicians also to find more effective ways to support athletes in their culture and their sport and their athletic identity because you know so often athletes are kind of put in a position of having to choose recovery or their athletic identity and and there's a place for both and some athletes ultimately retire from sport in their recovery and some athletes return to sport and recovery but having more providers out there that can support that process and let that be a decision

of the athletes versus a recommendation of the treatment team um and then third you know just creating awareness for athletes as we've talked about there is you know there are a lot more conversations today about mental health and eating disorders and depression and suicide amongst the athletic population um but really for them starting to realize that you you know and i think this is my really stated in my neurobiology chapter that you can't choose or unchoose an eating disorder so like you said let's stop the flippant comments let's encourage athletes to understand that it's a serious issue and providers to understand that there are you know there are things in there that we just can't unchoose we can't unchoose the aberrant activity of a neurotransmitter pattern and so really starting to figure out how do we support athletes where they're at versus assume just because they're mentally tough and they know how to suffer they'll figure the way out of this one on their own well kate i hope that this is a little bit of an instigator for people like myself to become more literate and more competent in this space as i as i shared to you previously i'm gonna purchase a copy of myself for uh for our coaching staff you don't have to give me one i'm not gonna take your i'm not gonna take a free book from you i'm gonna buy it off of amazon just like everybody else and i'm gonna manipulate the amazon rankings for you um but uh but the but the effort of that as much as i'd love to support you is really i want our coaching staff to to to be literate in this area because it is something that that is becoming

more and more important for them to be uh for them to be competent in and i hope more coaches and more people that interface with athletes will take that will take that same tact and that this book is a is a conduit to that end you have left a tremendous legacy oh thank you i appreciate that i mean it like i said my goal was just to get out there and create a space and a voice that needs to be heard and a platform for athletes to get the treatment that they need and deserve so thank you for supporting the book and helping me to get this message out there oh the thanks all goes to you you're doing everybody else a favor here all right kate i appreciate you coming on the podcast and spending some time sorry for the construction going on behind me but uh uh it is a wonderful book kate i'll have links to the show notes uh to for people to go and get it and i wish you the best with it awesome thank you all right folks there you have it there you go much thanks to kate for coming on the podcast today and more importantly than that thank you kate for producing a resource that professionals like me and other professionals that work with athletes can start to understand your world of working with athletes that have eating disorders just a little bit better this is a topic that i absolutely think that we need to get right we need to get right we need to have the right tools in front of us we need

to say the right things and not say the and not say the wrong things and say something as we talked about during the course of this podcast because the consequences of getting things wrong are so high so i encourage anybody who's out there who wants to raise their game raise their literacy rate a little bit and particularly those of you that are working with athletes directly like my coaching colleague professionals go and check kate's book out i'm not just saying that to help her out i love to help her out because she's a great person but it really is a great resource for all coaches and all individuals and all professional professionals that work with athletes that's all i'm going to plug for today i'm not going to plug anything else as you guys know we have no sponsors or endorsers or anything else of this podcast just go check kate's book out that's how you can help the podcast out today appreciate the heck out of each and every one of the listeners and as always we will see you out on the trails video Thank you.