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Running on Empty: EDIN Curriculum for Coaches

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Curriculum Emory Group

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Transcript of Running on Empty: EDIN Curriculum for Coaches

Running on Empty:
EDIN Curriculum for Coaches

Curriculum Outline
Introduction
Module 1:
Disordered Eating in Athletes
Module 2:
Communication Strategies
Module 3:
Supporting the Recovery Process
Module 4:
Preventing Disordered Eating
Optional Certification Exam

Introduction
Welcome to the EDIN online curriculum for coaches!

The material in this curriculum is intended to provide you with the information you need to identify and support your middle and high school aged athletes who may be struggling with disordered eating.

This section will give a short introduction on how to use this curriculum.

The home button located on the right side of the screen will zoom out so you can see the entire curriculum.

Click on any slide and hit the next button at the bottom to keep navigating through.
Navigation
The pencil and text bubble is used to denote a write-in section. Write your responses to these sections on a piece of paper to save for later!
Write-in Boxes
Module Quizzes and the Certification Exam
The modules contain a short quiz at the end. The module quizzes are not required for certification, but are highly recommended!
The
certification exam
is located on the EDIN website at
www.myedin.org
. The online exam will be submitted directly to EDIN, and a representative will contact you with your finalized certification materials.
Module 1: Disordered Eating in Athletes
Module 1: Disordered Eating in Athletes
1.1
Overview of Eating Disorders
1.2
Anorexia
1.3
Binge Eating
1.4
Bulimia
1.5
Orthorexia
1.6
Relative Energy Deficiency in Sport (RED-S)
1.7
Athletic Subculture
1.8
Test Yourself!
Module Outline
1.1 Overview of Eating Disorders
1.2 Anorexia
1.3 Binge Eating
1.4 Bulimia
1.5 Orthorexia
1.7 Athletic Subculture
1.6 Relative Energy Deficiency in Sport (RED-S)
1.8 Test Yourself!
1.1 What do I need to know about disordered eating?


Why are athletes at risk of developing an eating disorder?

Athletes are under multiple pressures such as:

comparing themselves to teammates
varying messages from coaches and/or trainers
pressure to consistently perform well athletically

Eating disorders are prevalent among athletes.



1.1 Test your Knowledge
What percentage of athletes have symptoms of an eating disorder?




1 out of every 5

(or 20%)
athletes have symptoms of an eating disorder


1.1 Common Eating Disorders

Some common eating disorders include:

• Anorexia

• Binge Eating

• Bulimia

• Orthorexia


These eating disorders will be covered in more detail on the following slides.


What is anorexia?

Anorexia is the restriction of food intake that leads to a low body weight, a fear of gaining weight, and an altered perception of body size.


1.2 Anorexia
1.2 Anorexia: Symptoms and Signs

Preoccupation with Weight and Shape:

• Frequently weighs self

• Body checking (pinching stomach, thighs)


1.2 Anorexia: Symptoms and Signs

Preoccupation with Food:

• Cuts out whole food groups or nutrients

• Inflexible about what, when, and how much to eat



1.2 Anorexia: Symptoms and Signs

Physical Signs:

• Dizziness

• Thinning hair, dry skin, brittle nails


1.2 Anorexia: Symptoms and Signs
Secretive Behaviors:

• Consistent excuses to avoid eating with mealtimes (“I already ate.”)

• Hides or throws away food

• Food rituals that make it look like they’re eating (rearranging food on plate, excessive chewing)

• Concealing weight changes (wearing baggy clothing)


1.3 Binge Eating

What is binge eating?

Binge eating is a lack of control over food consumption and eating a larger than normal amount of food.

It occurs at least once a week for 3 months.

1.3 Binge Eating: Symptoms and Signs

Eating:

• Quicker than usual

• Until feeling uncomfortably full

• Large amounts of food when not hungry

• Alone


1.3 Binge Eating: Symptoms and Signs

Feeling:

• Disgusted with oneself, depressed or very guilty afterward

• Embarrassed about how much you have eaten


1.3 Binge Eating: Symptoms and Signs

Other Signs:

• Disappearance of large amounts of food in short periods of time

• Many empty food containers/wrappers around the house or car indicating the consumption of large amounts of food



What is bulimia?

Bulimia is a lack of control over food consumption, eating a larger than normal amount of food, and preventing weight gain by using laxatives, vomiting, or over-exercising.

It occurs at least once a week for 3 months.

1.4 Bulimia
1.4 Bulimia: Symptoms and Signs

Ways Athletes May Prevent Weight Gain:

• Forcing themselves to vomit

• Laxatives

• Diuretics

• Fasting

• Excessive exercise


1.4 Bulimia: Symptoms and Signs

Signs of Vomiting:

• Frequent trips to the bathroom or showering after meals

• Discoloration or staining of the teeth

• Bloodshot and/or watery eyes after using the bathroom

• Sores, scars or calluses on the knuckles caused by self-induced vomiting


1.4 Bulimia: Symptoms and Signs

Signs of Other Purging Methods:

• Presence of wrappers or packages of laxatives and diuretics

• Exercises to compensate for eating

• Exercises at all costs, despite weather, illness, injury, other commitments


Eating Disorders Side-by-Side Answer Key
Eating Disorders Side-by-Side
1.4 What are some symptoms of an eating disorder to be aware of in your athletes?

Other signs and symptoms:

• Performance declines

• Small injuries that do not heal fully

• Amenorrhea (female athlete has not gotten her menstrual cycle in 3+ months)





Personal Reflection
Think of a time when you have seen some of these symptoms or signs in an athlete. How did you handle it?

How much do you remember? Fill in the blanks!
Individuals obsessed with “clean eating” or eating healthy may be masking an eating disorder.

If an athlete only eats specific foods, is limiting their consumption of essential nutrients, they may have an eating disorder.

1.5 Orthorexia
1.6 Relative Energy Deficiency in Sport (RED-S)
Relative Energy Deficiency in Sport (RED-S) is a new umbrella term that has replaced the commonly-referenced term, Female Athlete Triad.

It acknowledges that
males
are affected by eating disorders as well.

1.6 Relative Energy Deficiency in Sport (RED-S)

RED-S is an umbrella term for undernourishment in athletes that leads to decreased athletic performance and negative health implications.

Effects include:

• Increased injury risk

• Decreased endurance performance


Case Study 1

Carrie is an amazing cross country runner. This season, she has been running slower than usual. Carrie got a stress fracture during the last race. What are these symptoms indicative of?

Case Study 1 Answer Key
Carrie is an amazing cross country runner. This season, she has been running slower than usual. Carrie got a stress fracture during the last race. What are these symptoms indicative of?
RED-S
Carrie may be exhibiting symptoms of Relative Energy Deficiency in Sport (RED-S) as showcased by decreased endurance performance and increased injury risk.

1.7 Athletic Subculture

Specific sports have higher prevalence rates for athletes developing an eating disorder. These sports can be grouped into 4 categories.

1. Aesthetic sports

2. Weight-based sports

3. Sports in which lower body fat and weight are associated with increased athletic performance.

4. Sports in which strength and size are important.


1.7 Aesthetic Sports

In Aesthetic Sports, an athlete’s
physical appearance
is factored into a score in competitions.

Examples of Aesthetic Sports include:

• Diving

• Gymnastics



• Wrestling

• Rowing

• Jockeying
1.7 Weight-based Sports
Case Study 2

Chris is a dedicated wrestler. Lately, you have noticed that he has been hoarding snacks in his backpack. Which eating disorder could be present?


Chris is a dedicated wrestler. Lately, you have noticed that he has been hoarding snacks in his backpack. Which eating disorder could be present?

Case Study 2 Answer Key
Chris may be exhibiting symptoms of a binge eating disorder.
1.7 Sports in which Lower Body Fat is Associated with Increased Performance
In sports in which
lower body fat and weight
are associated with increased performance, athletes may feel additional pressure.

Examples of these sports include:

1.7 Sports in which Strength and Size are Important
In sports in which strength and size are important, athletes may feel additional pressure.

Examples of these sports include:
1.7 Matching Exercise
Match each athletic subculture with the appropriate sport.
1.7 Matching Exercise Answer Key
Match each athletic subculture with the appropriate sport.
1.8 Test Yourself!

True or False?

1. Eating disorders are a mental illness.




1.8 Test Yourself! Answer Key
1. Eating disorders are a mental illness.


True.

Eating disorders are a diagnosable mental illness.


1.8 Test Yourself!

True or False?

2. Only females have eating disorders.


1.8 Test Yourself! Answer Key
2. Only females have eating disorders.


False.

Both males and females are at risk of developing an eating disorder.



1.8 Test Yourself!

Multiple Choice.

3. What percentage of athletes are affected by eating disorders?

a. 15%
b. 20%
c. 50%
d. 5%
1.8 Test Yourself! Answer Key
3. What percentage of athletes are affected by eating disorders?

a.
b.
20%
c.
d.
1.8 Test Yourself!

Multiple Choice.

4. This eating disorder is marked by use of laxatives or throwing up after eating a large amount:

a. Anorexia
b. Bulimia
c. Binge eating
d. Overeating
1.8 Test Yourself! Answer Key
4. This eating disorder is marked by use of laxatives or throwing up after eating a large amount:

a.
b.
Bulimia
c.
d.
1.8 Test Yourself!

Multiple Choice.

5. Which of these sports are associated with a higher prevalence of an athlete developing an eating disorder?

a. Gymnastics
b. Wrestling
c. Cross Country
d. All of the above


1.8 Test Yourself! Answer Key
5. Which of these sports are associated with a higher prevalence of an athlete developing an eating disorder?

a. Gymnastics
b. Wrestling
c. Cross Country
d.
All of the above
Module Summary:

The information in this module is intended to provide you with general information about common eating disorders that affect athletes including symptoms and signs that are indicators of an eating disorder.

In addition, you will be given information about specific sports in which athletes are at a higher risk of developing an eating disorder.

1.2 Anorexia
1.4 Bulimia
In this section, you will learn about the common signs and symptoms of bulimia, a common eating disorder.
In this section, you will learn about the common signs and symptoms of anorexia, a common eating disorder.
1.8 Test Yourself!
In this section, you will have an opportunity to take a quiz based on the content you have learned throughout this module.
1.7 Athletic Sub-Culture
In the section, you will learn about sports where athletes are at an increased risk of developing an eating disorder.
1. 6 Relative Energy Deficiency in Sports (RED-S)
In this section, you will learn about the effects of undernourishment and common indicators of energy deficiency in athletes.
1.5 Orthorexia
In this section, you will learn about a newer eating disorder called orthorexia.
1.3 Binge Eating
In this section, you will learn about the common signs and symptoms of binge eating, a common eating disorder.
Module Outline
2.1
The Importance of Your Role
2.2
Before the Conversation Begins
2.3
Starting the Conversation
2.4
Directing the Conversation
2.5
Putting It All Together
2.6
Talking to Parents
2.7
Module 2 Quiz

2.1 The Importance of Your Role
Why should you talk to an athlete about abnormal eating and exercise behaviors?

Your opinion may be more influential than you realize.

A coach often serves as a role model for athletes.

Athletes perceive negative pressure and judgment about their weight from their coaches (even when it isn't intended).

This perception increases the likelihood of disordered eating and over-exercise.
2.1 The Importance of Your Role
What if I say the wrong thing and make things worse?
In most cases,
saying nothing is more dangerous
than starting a conversation about eating disorders.

Starting a conversation lets your student know that you care about them.

Just as a single conversation is unlikely to erase their problems, it is also unlikely to make them significantly worse.

2.2 Before the Conversation Begins
Think about how you prepare to have a conversation with a student about their academic or athletic performance.
2.2 Before the Conversation Begins
Plan ahead

Talk to a school counselor to get more information on how to approach the conversation.

Be aware of any privacy restrictions for your district.

Visit the EDIN website (www.myedin.org) to learn more about disordered eating.
Manage your expectations

Athletes may be defensive or angry when you approach them about getting help.

You may not get the outcome you want, but it’s important to keep trying to reach the athlete and let them know that you care.

2.2 Before the Conversation Begins
Remember:
Change doesn't happen overnight! Recovering from an eating disorder is a long and difficult process
Think about location

Find a place where the athlete feels comfortable and less defensive.

Select a location that allows you to talk in private:
2.2 Before the Conversation Begins
Focus on performance, not weight
Regardless of how you phrase it, focusing your statements on weight can trigger unhealthy behaviors.
How can you change “You’re looking too thin” or “You’ve lost a lot of weight” into performance-based statements?
Sample responses:

“I’ve noticed you seem more tired recently”

“I’m concerned because you seem to be performing at a different level than you used to. You’re an important part of this team, and I want to help you meet your performance goals”

2.3 Focus on Performance, Not Weight
Use "I" statements
Using “I” statements instead of “you” statements avoids the connotation of blame, and shifts pressure away from the athlete.
How can you change the following statement into an “I” statement? “You are making me concerned.”
2.3 Use "I" Statements
Sample responses:

“I’m worried about you."

“I’m concerned about you."

2.4 Directing the Conversation
This section contains information on using active listening and responding to denial.

In this section, you will learn:

Check-in with your student during the conversation to make sure what you said isn’t misinterpreted by the athlete.
Why do you think it's important to check in with your athlete during the conversation?
2.3 Avoid Misinterpretation
"You're looking sick and seem to tire quickly" as a statement of
concern
.
"I need to work harder and restrict more to improve" and interpret it as a
criticism
.
2.3 Avoid Misinterpretation
What is one statement you can use to avoid misinterpretation?
Sample responses:

“How do you feel about what I just said?”

“How did you interpret my comments?”

2.3 Misinterpretation
2.4 Responding to Denial


An athlete may be angry or defensive during your conversation and deny that there is a problem.

Responses to denial should emphasize the importance of health in general and the impact having a health problem may have on performance.

2.4 Responding to Denial
"I don’t have any health problems!"
During a conversation with your athlete, he says:
What can you say in response to this statement?
2.4 Responding to Denial
Sample response:

“I hope that’s correct, but only a professional can make that assessment. Health evaluations are a normal part of sports participation, and can only help you perform better.”
2.5 Putting It All Together
Read the following sample scenario, and fill in the blanks in the communication guide in the next two slides.
How can you start a conversation? Complete the sample script below:

"I’m concerned about you because _________________. You’re an important part of this team, and I want to ______ __________________. I want to encourage you to talk with the ________________ and have a physical to __________________. Your position on the team _________________. Would you be willing to let me help you take steps to improve your health?"

2.5 Putting It All Together
2.5 Putting It All Together

"I’m concerned about you because
you seem to be getting tired more quickly
. You’re an important part of this team, and I want to
make sure you're not pushing yourself too hard
. I want to encourage you to talk with the
school nurse
and have a physical to
make sure there are no health problems
. Your position on the team
will not be affected by your decision to seek medical advice
. Would you be willing to let me help you take steps to improve your health?"
2.5 Putting It All Together
How can you respond to denial?
Jesse says:
"I don’t need to talk to the nurse. I’m just working harder to improve my speed and there’s nothing wrong with me."
What can you say to respond to Jesse’s statement?
2.5 Putting It All Together
Sample response:

"A health evaluation is a normal part of participating in a sport. The nurse can help you identify ways to improve your performance and make sure you stay healthy. If you’re pushing your body in the wrong ways, you won’t be able to achieve your goal of improving your speed."
2.6 Talking to Parents
Before talking to parents about their child

Check the privacy regulations your school district may have in place.

Talk with your colleagues, such as school nurses or administrators about the appropriate next steps to take before you approach the parents.

Before talking to parents about their child

Consider the social and cultural environment of the family, and what impact talking to the parents could have on the athlete.

Be aware that parents may be offended and angry at the suggestion that their child has an eating disorder.
What cultural or social factors could affect the parents in your school district?
2.6 Think About:
Religion
Gender norms
Stigma surrounding mental health
2.6 Talking to Parents
Stick to the facts
Don’t use any official diagnoses such as anorexia or bulimia.



Avoiding terminology can help reduce the stigma surrounding the behaviors, and may make it easier for parents to accept help.

Since you are speaking as a coach and not a therapist, offering any diagnoses would be premature.
2.6 Talking to Parents
Parents need time to think through the information you’ve given them.

Acknowledge that this is a difficult subject to talk about.

Suggest they talk to someone they feel more comfortable with, such as a doctor.
2.6 Talking to Parents
Keep the door open

Let parents know that you are available to speak with them whenever they want, and that you care about their child.

It’s okay to end a hostile or angry conversation
2.6 Talking to Parents
“We are concerned about
[student’s name]
’s recent behavior. They seem more tired lately and appears to have lost a lot of weight quickly. They are also making frequent negative comments about their weight and appearance. I was wondering if you have noticed any behaviors that seem out of character, or if you have any concerns about
[student’s name]
.”
Sample Conversation Starter
2.7 Test Yourself!
Read the following scenario before responding to the Module 2 Quiz questions:
Jennifer is a cross-country runner who has been on the track team for two years. She’s a perfectionist, and is one of your fastest runners. However, lately, you’ve noticed that she’s been looking thinner. You’ve seen her running more and more outside of practice, but her mile time has been increasing instead of decreasing. You suspect she may be restricting her calorie intake, and you want to talk to her about her concerning behaviors.
2.7 Test Yourself!
1.

List at least two steps you can take before you approach Jennifer about her behavior.
2.
What can you say to Jennifer to start the conversation about your concerns?
2.7 Test Yourself!
2.7 Test Yourself!
3.
What are three statements or questions you can use when talking with Jennifer that will help her feel validated and understood?
4.
How could the following statement impact Jennifer?


“You’re looking too thin and your performance is worse than others on the team.”

2.7 Test Yourself!
2.7 Test Yourself!
2. Answer:
“I’ve noticed you seem more tired after practice, and I’m concerned that you may be pushing yourself too hard. You are a valuable team member, and I want to help you.”

2.7 Test Yourself!
4. Answer:
Using “you” statements instead of “I” statements can make the athlete feel blamed and exacerbate disordered eating behaviors.
By comparing her performance to the rest of the team, Jennifer is also likely to feel as though she needs to restrict or exercise more to improve.

2.2 Before the Conversation Begins

Jesse is a female swimmer who has recently begun exhibiting signs of an eating disorder. During the summer, the swim team had a competition to get in shape. Since then, Jesse has become increasingly withdrawn, and no longer attends team dinners. Her weight has been dropping, and she has been spending more time swimming laps than she used to. Despite all of her practice, she appears to tire more quickly than she used to.

Providing support can be difficult, especially when dealing with an athlete who may be uncomfortable discussing disordered eating behaviors with you.


Defined as attentively listening to and understanding someone's words,
active listening
can help you direct the conversation and make sure the athlete feels supported.
2.4 Practice Active Listening
2.4 Paraphrase
Sometimes, our personal opinions and judgments can change how we interpret someone else's comments.

Restating or paraphrasing what an athlete has said to you can help avoid misinterpretation.

Sample statements:

“What I’m hearing from you is that you think…”
“If I understand you correctly, you’re saying…”

2.4 Reflect and Validate
2.3 Start with a Question
It’s not always easy to tell what someone else is thinking. However, if they’re willing to talk to you, you can ask questions to start the conversation.
Sample Questions:
“You seem a little upset. Would you like to talk about it?”
“How did you feel when….?”
“What bothers you the most about it?”

2.4 Silence
While silence can be uncomfortable during the course of a conversation, it can also:

Give an athlete the chance to think over what has been said
Push an athlete to fill in the silence
2.4 Conversational Characters to Avoid
The Super Solver
While, it’s tempting to offer advice, it’s not always the best way to handle a conversation.

By offering a “simple” solution, you’re showing that:

You don’t understand their problem.
You’re simplifying their struggle.
2.4 Conversational Characters To Avoid
The Reporter
"Why” questions can be harmful during a conversation about difficult topics, because they can also make listeners feel accused:
Compare:
Why
are you exercising so much?
Vs.
How
do you feel about your level of exercise?
It’s a subtle difference, but the first question can sound more
judgmental
to the listener than the second.
2.3 Avoid Misinterpretation
As a coach, you are in an ideal position to talk to your students about eating disorders:
What are some additional factors you might want to consider when preparing for a conversation about concerning eating or exercise behaviors?
2.1 The Importance of Your Role
You may be the first to notice changes to a student’s physical performance.

Changes such as excessive exercising can be early warning signs.

As a coach, you may notice these changes before a parent or a counselor.
As a coach, you are in an ideal position to talk to your students about eating disorders:
2.2 Before the Conversation Begins
Think about the content of the conversation

Do you want to ask the athlete to talk to the school nurse?

Do you want to tell the athlete you want to talk with their parents?
2.2 Before the Conversation Begins
Think about timing

Starting an emotional conversation before they start a game may make them feel more pressure to perform.

A time that has fewer performance and time constraints will place less stress on the athlete.
2.3 Starting the Conversation
Now that you have considered your goals for the conversation, this section introduce ways to:

1. Begin a conversation about disordered eating

2. Avoid misinterpretation during the conversation

2.3 Starting the Conversation
2.4 Sample Statements for
Reflective Listening
“It sounds like you feel like…”

“If I understand correctly, you’re feeling…”

“I hear you saying that you feel…”

“So you felt ______? Is that correct?”
2.4 The Super Solver
Although the solution seems obvious to you, (“just stop exercising as much!”), your athlete needs a different kind of support from you.
Instead , stick with the active listening strategies we outlined earlier.
2.6 Talking to Parents
After talking with the athlete, you may want to have a meeting with the athlete’s parents. This section provides ideas on how to prepare for and conduct the meeting, along with a sample conversation starter.

You will:

2.6 Talking to Parents
2.1 The Importance of Your Role
1. Highlighting the importance of your role

2. Explaining the importance of starting the the conversation
This section will introduce the communication module by:
2.2 Before the Conversation Begins
Before you speak with an athlete about their concerning behaviors, it's a good idea to think about what you want to say, and how you want to convey your concerns.

In this section, you will learn how to :

2.3 Starting the Conversation
2.4 Directing the Conversation
2.5 Putting It All Together
2.5 Putting It All Together
This section helps you put all the communication strategies you’ve learned together.

You will be able to:

1. Develop a sample script

2. Practice responding to denial
2.6 Talking to Parents
2.7 Test Yourself!
It's important to check in with you athlete because your statements might be turned into a negative criticism of performance or worth.
Module 2: Communication Strategies
2.3 Starting the Conversation
2.4 Practice Your Active Listening Skills: Part 1!
James says:
"I can't believe I came in third in the race. I've been spending so much time trying to improve my speed. Steven doesn't put in as much effort as me, but somehow he always comes in first."
Which of the following are examples of reflective responses?
Select all that apply.

1. I'm sure you'll get better soon!
2. It sounds like you're getting frustrated with your performance.
3. I'll bet Steven is practicing just as much as you.
4. So you're feeling frustrated and tired? Is that correct?

2.7 Test Yourself!
1. Answer:
Talk to a school counselor
Think about what the content of the conversation should be:
You want Jennifer to start scaling back her exercise and speak with a therapist.
Think about when you want to talk to her:
After practice in your office, without calling attention to the fact that you’re pulling her aside to speak.
3. Answer:
“How did you interpret my concerns about your recent performance?”
"It seems like you're feeling a lot of pressure to improve your performance right now. Is that correct?"
“I understand that you must be feeling stressed right now”
“What can I do to help you meet your goals?”
"I can understand how important your performance is to you."
2.7 Test Yourself!
Module Summary:

The information in this module is intended to help you identify the best ways to talk to your athletes about disordered eating behaviors, help you practice language strategies, and highlight ways to prepare for and conduct a conversation with a parent regarding an athlete’s concerning behavior.

Module 2: Communication Strategies
Module 3: Supporting the Recovery Process
Module Summary:

The information in this module is intended to help you understand various ways to support the athlete's disordered eating during the recovery process without stepping outside of your role as an unprofessional.


Module Outline
3.1
Introduction
3.2
Provide Resources
3.3
Returning to Exercise
3.4
Relapse
3.5
Be Aware of the Environment

3.1 Introduction
As a coach, there may be instances where you feel unprepared to provide guidance to an athlete who is recovering from an eating disorder.

Your duty is not to diagnose or treat the athlete but to be more
supportive.
You can be the person who points him or her in the right direction.
3.1 Introduction
3.1 Stages of Change
3.1 Stages of Change
The
stages of change
are:
complex
cyclical rather than linear

Some athletes may be within multiple stages at once.

The goal is to avoid
relapse
and remain in the
maintenance
stage.
3.1 Stages of Change


3.2 Provide Resources
Your duty is not to diagnose or treat the athlete. Your role can be more supportive. You can be the person who points him or her in the right direction.

You can begin by keeping a
resource list
containing

various licensed professional resources that you may refer to athletes.
Jeremy and his therapist initiate a plan that includes several strategies that Jeremy can take to resist his risky behavior. Jeremy has successfully stuck to the plan for six months. He begins to eat a more balanced diet to replace the laxatives and sauna.

The recovery process for disordered eating is not simple. It is made up of various aspects of life. The substance abuse and mental health administration recognizes some basic components.






Keep in mind:

the stages of change that occur in the recovery process

what stage of change a recovering athlete is entering or leaving

Can you remember their order? Try inserting the stages listed in into the circles.
Pre-contemplation
Pre-contemplation
: No intention on changing the behavior

Action:
Active modification of the behavior

Relapse:
Fall back into old patterns of behavior

Maintenance:
Sustained changed; new behavior replaces the old

Preparation:
Intent on taking action to address the problem

Contemplation:
Aware a problem exists but with no commitment to action
Stages of Change
3.1 Introduction
Now that we have discussed the components of the recovery process and stages of change, let’s discuss what you can do!
3.2 Provide Resources
3.2 Provide Resources
3.2 Provide Resources
This module discusses
steps
that you can take to help provide resources on your
resource list
:


STEP 1:

Check with your school or organization’s on hand resources

Many useful professionals can be found right in the school or training facility

School or facility nurses, dieticians and counselors may not only coach the athletes, but they can also be a pathway to external resources for you and the athlete.

STEP 2: Be knowledgeable about your school, district or organization’s protocol for privacy and medical referrals

It is important to follow the administrative rules when dealing with athletes.
Your job may be much easier if your school or organization already has a protocol for dealing with medical issues.

Let’s take a look at an example...
3.2 Provide Resources
3.2 Provide Resources
3.2 Provide Resources
EXAMPLE:


Warren County Schools in Ohio has a specific protocol for mental health resource referrals posted on their website. Your school or facility may have something similar.

Here is a replication of the Warren County protocol...
STEP 3: Make external connections with professionals in advance


As mentioned, you may retrieve these resources from your organization or school.

Or you can do your personal research and create lasting relationships. Just be sure that you receive permission.

Here is an example...

EXAMPLE:
Warren County schools also posts an external mental health resource directory on their website that may be a guide to yours.

Notice how the district posts the
address
and
phone numbers
of each resource. For your own resource list, you may also consider posting
website
links.

3.2 Provide Resources
3.2 Provide Resources
3.2 Provide Resources
3.3 Returning to Exercise
3.3 Returning to Exercise
3.3 Returning to Exercise
3.3 Returning to Exercise
3.3 Returning to Exercise
3.3 Returning to Exercise
STEP 4:

Consider posting the resource list.

The resource list can be made available in a private setting like a website or bathroom.

Or it can be more visible such as within the main training facility or the locker rooms.

Posting the book in both types of settings can be useful.
Below is a comprehensive list of possible resources for athletes that may be placed on the resource list. Ensure that the professionals are experienced in working with eating disorders and RED-S

Nurse
Counselor/therapist
Psychiatrist
Dietician
Physician- Pediatrician or Internist with experience working with eating disorders
Physical therapist



FINAL THOUGHTS

Creating a team of supporters
who are in constant communication with one another can lead to the best outcomes.

Even if one of these professionals can’t meet the athlete's exact needs, they can help refer them to the most suitable expert.

Be involved with these professionals with permission of the athlete.

Each week there may be different steps involved to ensure successful recovery. You can be the facilitator of these steps to phase the athlete back into training.

There are
phases
involved in recovery that are separated by week. Let’s take a look at each one!

Phase (Week 1)
Phase (Week 2)
Phase (Week 3 & 4)

Phase (Week 1)

Implement light activity


Spread out sessions

Monitor heart rate



Maintain or gain weight before moving to second phase

Phase (Week 2):


If weight is stable, slightly increase duration and frequency


Continue spreading out sessions




Continue evaluating heart rate


Maintain or increase weight before moving to third phase

Phase (Week 3 & 4):


May return to normal and healthy exercise plan if weight is stable

Decrease monitoring if demonstrates healthy mindset about exercise

No more than five activity sessions per week and one hour per session

Encourage alternation between cardio and strength for optimal recovery time


3.4 Relapse

3.4 Relapse

3.3 Relapse
Practice: True or False
If an athlete becomes dizzy or light headed during exercise, continue at a slower pace and wait to see if it gets better.
True or False
Practice: True or False
If an athlete becomes dizzy or light headed during exercise, continue at a slower pace and wait to see if it gets better.
False
If an athlete becomes dizzy or light headed during exercise, it is crucial that you halt exercise immediately and consult a medical professional.
Practice: True or False
During phase 1 of returning to exercise, it is appropriate for the athlete to train 4 back to back days in the week such as Monday, Tuesday, Wednesday and Thursday.
True or False
Practice: True or False
During phase 1 of returning to exercise, it is appropriate for the athlete to train 4 back to back days in the week such as Monday, Tuesday, Wednesday and Thursday.
False
During phase 1 of returning to exercise, the athlete should only be exercise 1-2 times per week sporadically (ex. Mon/Wed, Tu/Th)

Relapse is a common part of the recovery process where the athlete returns to some or all disordered behaviors.

Here are some signs that you may notice or that your athlete may discuss with you:



If you notice any of these signs or your athlete presents them to you, it may be time to have a conversation and refer him or her to a professional on your source list.
Can you list 5 relapse behaviors?
1.
2.
3.
4.
5.
3.5 Be Aware of the Environment

STEP 1: Be alert if your sport is
high-risk
for the development of disordered eating.

These may be sports with:

Aesthetic judging (gymnastics)

Weight classifications (wrestling, crew)

Endurance variables (cross country)

Module 3.1 Introduction
Module 3.2 Provide Resources
Empowering
:
the person may strive to gain control over his or her own future

Holistic:
various aspects including mind, body, spirit, and community are incorporated into recovery
Non-linear:
recovery may not always be step-by- step. It is a learning experience for growth
3.1 Stages of Change

A scenario will be presented about an athlete named Jeremy.

Then, the stage of change that Jeremy is undergoing in the scenario will be listed below.
3.1 Case Study: Jeremy
3.1 Case Study: Jeremy
3.1 Case Study : Jeremy

Jeremy’s team member, Sean notices his behavior. Sean tells Jeremy a story about a friend who ended up in the emergency room after being in the sauna for several hours. Jeremy brushes it off.

When Jeremy gets home he can’t help but be worried about what Sean said. He researches about it on the internet and finds out about the risks. He begins to reconsider the sauna and laxatives but continues to engage in both.

3.1 Case Study : Jeremy
Jeremy meets with his trainer and feels much better. His trainer points him in the direction of various resources. He has schedule weekly appointments with a therapist who helps him create a solid plan to resist spending hours in the sauna and taking laxatives.

The next season, Jeremy becomes nervous again about his weight and is facing a great deal of stress at school. He finds himself using laxatives again to remain in a lower weight category.








Luckily, Jeremy’s trainer notices his behavior changes and encourages him to talk about it with his therapist. Jeremy and his therapist modify their strategies to get Jeremy back on track.






3.1 Introduction: Stages of Change
Notice that Jeremy entered each stage of change throughout his disordered eating journey.

Yet he was still able to backtrack and enter the action stage a second time.

An athlete alternate between the

action
and
relapse

stages many times. Each athlete is different.
3.1 Stages of Change


Check your answers.
Pre-contemplation
Pre-contemplation
: No intention on changing the behavior

Action:
Active modification of the behavior

Relapse:
Fall back into old patterns of behavior

Maintenance:
Sustained changed; new behavior replaces the old

Preparation:
Intent on taking action to address the problem

Contemplation:
Aware a problem exists but with no commitment to action
Stages of Change
Contemplation
Preparation
Action
Maintenance
Relapse
3.2 Warren County Example: Replication
Module 3.4 Relapse
Module 3.3: Returning to Exercise
3.4 Relapse

Obsessive exercising
Frequent weighing
Perception of overweight/obesity
Skipping meals
Guilt or shame after eating
Avoiding events involving food
Binge eating


3.4 Relapse

Sometimes, as role models, we may not be aware that what we say and do has a strong impact on our mentees.

Being aware of our actions and risky behavior can go a long way in preventing eating disorder behaviors.
3.5 Be Aware of the Environment
3.5 Be Aware of the Environment
3.5 Be Aware of the Environment

STEP 2: Be conscious of
your own comments and behaviors
related to size and shape.


3.5 Be Aware of the Environment

Examples of derogatory language include:

You’ve gained some weight!
You need to lose weight.


These phrases may seem subtle, but even they can exacerbate disordered eating behaviors:

Your uniform doesn’t fit you quite the same.
What have you been eating lately?
When was the last time you weighed yourself?

3.5 Be Aware of the Environment

STEP 3: Pay attention to the
team dynamic
.


3.5 Be Aware of the Environment

STEP 4: Notice possible discomfort with
uniforms
:

Some may find their uniform too form fitting or revealing

Consider new attire if you notice that the uniforms are creating unhealthy body dissatisfaction or comparisons

3.5 Be Aware of the Environment

STEP 5:
De-emphasize weight

Discourage dieting
Replace weight with positive ways to enhance performance such as:
Strength
Endurance
Physical skills training
Emphasize mental and emotional health
Be supportive and open during weigh-ins

3.5 Be Aware of the Environment


Try flipping the following phrases into positive ones:

Do not lag behind the rest of the team!

I don’t like the way your uniform looks on you.

You aren’t training enough.

3.5 Be Aware of the Environment
3.5 Be Aware of the Environment

Test Your Knowledge

What does a successful recovery of an eating disorder look like to you?


Module 3: Supporting the Recovery Process
3.1 Introduction
This section will :

1. Discuss key components in the recovery process

2. Cover the
stages of change
involved in recovery

3. Provide a case study that demonstrates the
stages of change
3. 5 Be Aware of the Environment
This section will :

Discuss various aspects of the athletic environment that you can be aware of to promote healthy eating and exercising habits during recovery.

3. 2 Provide Resources
This section will :

1. List various resources you can recommend to your athlete
2. Provide ways you can refer resources
3. Demonstrate examples of another school district's method to providing resources



This section will :

1. Begin with several key steps to consider implementing throughout the athlete's recovery process

2. Give a specific week by week recovery plan

3. Maintain ongoing medical monitoring as athlete advances in sport


This section will :

List various relapse behaviors to look out for


3.4 Relapse

Stage:
Contemplation- aware a problem exists but with no commitment to action
Each of these resources can be external or within the school or organization!
Step 2
Fill out the mental health checklist for the appropriate age level. These checklists can be found on the website: www.warrencountysc.com under student programs. For help filling it out, consult your school mental health professional.
Step 3
Consult with the mental health professional in your building or school district. They can provide ideas for the classroom, conduct mental health interventions, or make appropriate community referrals.
Step 4
Talk to parents to share concern, gather their perspectives and to add to information about the situation.
Step 5
If issues are impacting the child's functioning at the school even after early intervention effort, proceed to your school's problem solving team (IAT, RTI, etc.), The team can help everyone involved make decisions about next steps-- referring to a outside source or developing interventions for home or school.
Step 1
Recognize the possibility of a mental health concern. When looking for red flags, consider multiple perspectives. If it is an emergency (ex.-- thoughts of suicide or self-harm) do not leave the child unattended. Get a school-based mental health professional involved immediately.
Dieting
Hiding behavior
Irritable about food topics
Perfectionism
Hopelessness
Concerned with looks rather than healthiness
Rapid weight loss

Dieting
Hiding behaviors
Irritable about food topics
Perfectionism
Hopelessness
Concerned with looks rather than healthiness
Rapid weight loss

Obsessive exercising
Frequent weighing
Perception of overweight/obesity
Skipping meals
Guilt or shame after eating
Avoiding events involving food
Binge eating


Protoctol

Stage:
Relapse- fall back into old patterns of behavior

Stage:
Action- active modification of the behavior
Jeremy is a wrestler at his high school. He would like to lose a few pounds so that he can be matched with someone at a lower weight class.

He hears about some wrestlers at another school that take laxatives and sit in the sauna for hours to lose water weight. He tries it out and thinks it seems pretty easy and normal. He continues it throughout the season.
Stage
:
Pre-contemplation-
No intention on changing the behavior
3.1 Case Study : Jeremy
3.1 Case Study : Jeremy
3.1 Case Study : Jeremy
Module 4: Preventing Disordered Eating
Module Summary:

The purpose of this module is to provide you with ways that you can prevent disordered eating among your athletes through adequate fueling and healthy training practices.

Module Outline
4.1
Sports Nutrition Practices
4.2
Eating and Hydration Guidelines for Before and After Activity
4.3
Creating an Environment that Encourage Adequate Fueling and Training

Module 4: Preventing Disordered Eating
Module 4.1 Sports Nutrition Practices
4.1 Sports Nutrition Practices
Regardless of the sport or the athlete, there are some general nutritional practices that all athletes should engage in.

This section will:

1. Provide you with information regarding general nutritional practices that athletes should engage in and practices that should be avoided

2. Discuss how to address misconceptions regarding dietary fat and other food groups that are often perceived as unhealthy



4.1 Sports Nutrition Practices
As a coach or trainer, you should encourage and ensure that your athletes:

• Eat at least 3 nutritious meals a day and have healthy snacks throughout the day

• Eat breakfast every day

• Hydrate with at least 10-12 cups (1 cup = 8 fluid oz)
of non-caffeinated fluids per day

• Have 6-8 ounces per day of complete protein sources

• Take in at least a tablespoon of vegetable fat daily

• Consume at least 2, 1- cup servings of dairy/day for calcium

• Consume 18 mg/day of iron for female and 10 mg/day for male


Encourage your athletes to avoid these following practices that can lead to disordered eating:


Purposely skipping meals for dieting purposes
Overeating
Any restrictive diet (especially those that limit whole food groups)
Excessively counting calorie intake
4.1 Dietary Fat
Most athletes have a negative perception regarding fat intake.

However, for a healthy nutritional balance, athletes
need at least 1 tsp. of vegetable fat per meal (3–6 times per day)
.
4.1 Addressing Dietary Fat
Two ways you can address negative attitudes regarding dietary fat are:

1. Explain to your athletes the positive functions of fat in their body and why it is important

2. Provide athletes with examples of healthy
sources of essential fat that can be included in their diet

This approach can also be used to address other unhealthy diets that restrictive certain food groups.

Explain to your athletes the positive functions of fat in athletes' body and why it is important.

For example you body needs fat:

For energy

To maintain a healthy immune system

To manufacture hormones

To regulate metabolism

As a source of antioxidant vitamins
Healthy sources of essential fat include:

Fish high in omega-3 fatty acids, such as mackerel, lake trout, herring, salmon
4.1 Practice Questions
1. What are the 4 nutritional practices that should be avoided by athletes?
4.1 Practice Questions
Answer:

1. Overeating
2. Purposely skipping meals for dieting purposes
3. Excessively counting calorie intake
4. Any restrictive diet
4.1 Practice Questions
2. What are the 2 ways to address negative attitudes regarding dietary fat ?
4.1 Practice Questions
Answer:

1.Explain to your athletes the positive functions of fat in their body and why it is important

2.Provide athletes with examples of healthy sources of essential fat that can be included in their diet


4.1 Practice Questions
3. How many cups of water per day are needed for an athlete to remain hydrated?
a. 5 to 7 cups
b. 8 to 9 cups
c. 10 to 12 cups
d. 13 to 15 cups

4.1 Practice Questions
Answer:

c. 10 to 12 cups of water is needed per day to stay hydrated

4. How many mg of iron per day should females and males consume?

a. 18 mg/day for male and 10 mg/day for female
b. 10 mg/day for male and 18 mg/day for female
c. 16 mg/day for male and 10 mg/day for female
d. 10 mg/day for male and 16 mg/day for female

4.1 Practice Questions
4.1 Practice Questions
Answer:

b. Males should consume 10 mg of iron/day and females should consume18 mg of iron/day

5. How many oz of protein is recommended per day?
a. 2 to 4 oz
b. 5 to 8 oz
c. 6 to 10 oz
d. 12 to 14 oz

4.1 Practice Questions
4.1 Practice Questions

Answer:

c. 6 to 10 oz protein is recommended per day*

Module 4.2 Eating and Hydration Guidelines for Before and After Activity
4.2 Eating and Hydration Guidelines for Before and After Activity
This section will :

1. Cover eating and hydration guidelines for before and after activity that can be used by athletes to ensure that they are meeting their bodies nutritional needs.

2. Provide examples of appropriate meals for fueling.

4.2 Eating and Hydration Guidelines
Sample breakfast
Bagel with peanut butter and banana or oatmeal

Water

Sport beverage
Sample Lunch
Turkey sub or grilled chicken sandwich with mustard

Saltine crackers or
pretzels

Apple or banana

1 cup of milk

Sport beverage or water
Sample Snacks
Fruit yogurt or banana

1 cup or 8 oz of water

1 high carbohydrate energy bar – Clif, Powerbar types (> 30 gms carb, < 10 gms protein), or salty snack – i.e. pretzels

16 oz. sport drink

4.2 Post-Activity Recovery Guidelines
4.2 Pre-Activity Guidelines
Post activity, athletes should eat foods and drink fluids that replenish muscle energy and electrolytes lost during activity.

They can do so by:

Breakfast/lunch should be eaten 2 to 3 hours before activity

While, snacks should be eaten 30 minutes to 1 hour prior

Prior to activity, athletes should have at least one meal to fuel their body.

Consuming carbohydrates, protein, electrolytes, and fluids preferably within 30 minutes post activity

Replacing 150 percent of body fluids lost or consume at least 20 oz. hydrating fluids per pound of weight loss within 2 hours of activity.

Consuming easily digestible protein source 30-40 minutes post activity
Sample post-activity recovery meals include:

1- 2 cups of Chinese-steamed rice with vegetables and chicken stir-fry
1-2 cups pasta with marinara sauce (light in meat and fat content) & 1-2 slices of garlic bread (light on margarine, butter)
4.2 Guidelines for Hydration
When it comes to hydration, athletes should:
Limit/avoid caffeinated beverages (iced teas, coffee, and colas) especially right before and after activity to avoid additional fluid loss

Have a minimum of 2 liters of either water and/or sports drink available during activity

Consume enough fluids throughout the day so urine is a "lemonade" or pale yellow color before activity

Drink 17 to 20 oz. of hydrating fluid within 2 hours pre-activity, ideally sports drink, fruit juices, and even chocolate milk
4.2 Guidelines for Selecting a Beverage
Athletes should select the type of beverage to consume based on the duration and intensity of the activity.

For workouts that are
low to moderate intensity
and lasting
less than an hour
For workouts that are
moderate to high intensity
and
lasting longer than an hour
4.2 Practice Questions

1. Ashley has a game today at 5pm. How long before the game should she have lunch?

a. 30 minutes to 1 hour
b. 1 to 2 hours
c. 2 to 3 hours
d. 3 to 4 hours

4.2 Practice Questions
Answer:
c. Ashley should have lunch 2 to 3 hours before the game
4.2 Practice Questions
2. Ashley has a game today at 5pm. How long before the game should she have a snack?

a. 30 minutes to 1 hour
b. 1 to 2 hours
c. 2 to 3 hours
d. 3 to 4 hours

Answer:

c. Ashley should have a snack 30 minutes to 1 hour before the came
4.2 Practice Questions
3. You have a two hour, high intensity practice planned for your athletes. What is the best type of beverage should athletes bring to consume after practice?

a. Water
b. A beverage with 3 to 4 % of carbohydrate
c. A beverage with 5 to 7 % of carbohydrate
d. A beverage with 6 to 8% of carbohydrate

4.2 Practice Questions
4.2 Practice Questions
4. You have a two hour, high intensity practice planned for your athletes. What are 2 ways that your athletes can replenish muscle energy and electrolytes lost during activity?
4.2 Practice Questions
Answer:
d. After a two hour, high intensity practice,
the best type of beverage to consume is a beverage with 6 to 8% of carbohydrate
4.2 Practice Questions
Sample Answers:
Consuming carbohydrates, protein,electrolytes and fluid preferably within 30 minutes
Drinking a liquid protein source (i.e. chocolate milk)
Eating a meal high in carbohydrates that also contains a moderate protein source
Consuming enough hydrating fluid to replace body fluid lost
4.2 Practice Questions
5. You have a two hour, high intensity practice planned for your athletes. Give an example of 2 pre-practice and 2 post-practice meals that would be best for your athletes.
4.2 Practice Questions
Sample Answers:
Pre-practice: bagel with peanut butter, banana, oatmeal, turkey sandwich, grilled chicken sandwich, saltine crackers or apple.

Post-practice: pasta with marinara sauce and garlic bread, salad or steamed rice with chicken stir-fry.
Module 4.3 Creating an Environment that Encourage Healthy Eating and Training Practices
Module 4.3 Creating an Environment that Encourage Adequate Fueling and Training Practices
In this section:

Examples will demonstrate ways that you can help facilitate an environment that encourages adequate fueling and training practices among your athletes.
As a coach or trainer, what are some ways that you have worked to create an environment that encourages adequate fueling and training practices among your athletes? Provide at least 4 examples.
4.3 Encouraging Adequate Fueling Practices
To encourage adequate fueling practices, you can:
Be mindful of how you discuss topics regarding body image, weight, and dieting.

Use communication techniques discussed in Module 2 to intervene when there are unhealthy discussions among your athletes.
Create an atmosphere where “body shaming” or body comparisons among athletes is discouraged.
Do not weigh athletes in groups; focus on health not a number on the scale.
4.3 Encouraging Adequate Fueling Practices
4.3 Practice Question
4.3 Encouraging Adequate Fueling Eating Practices
Emphasize the importance of remaining fueled and hydrated
in order to meet the body’s
performance need, optimize performance, prevent injury
and expedite recovery.
Remind athletes that focusing on weight and dieting does not lead to improved performance and can do more harm than good.

Educate your athletes on the health risks of low body weight and excessive dieting which may include: loss of endurance, decreased reaction time, and increased susceptibility to injuries.

Look back at the list you made at the beginning of this section regarding ways that you have worked to create an environment that encourages adequate fueling and training practices among your athletes. Now that examples have been provided, list 3 additional ways that you can encourage
adequate fueling practices
among your athletes.
4.3 Encouraging Healthy Training Practices
Remind your athletes that sports should be fun and enjoyable and while competition is part of sports, unhealthy competition can lead
one to adopt unhealthy eating and training practices.
Avoid having a “win at all cost attitude,” rather emphasize skill development.

De-emphasize weight and focus
on other areas such as strength
and endurance conditioning or mental toughness that athletes can work on to improve performance.
Remind your athletes that excessive training can be detrimental to health and they need to give their bodies optimal time to recover.
To encourage healthy training practices, you can:
4.3 Encouraging Healthy Training Practices
4.3 Practice Question
Look back at the list you made at the beginning of this section regarding ways that you have worked to create an environment that encourages adequate fueling and training practices among your athletes. Now that examples have been provided, list 3 additional ways that you can encourage
healthy training practices
among your athletes.
4.3 Encouraging Healthy Training Practices
Make sure that you and your athletes have realistic, attainable goals and expectations that won’t lead to unhealthy practices.








Evaluate your goals, expectations and coaching behaviors through feedback from other coaches or athletes.
Now look at your final list, take 4 items on your list and create Specific, Measurable, Achievable, Realistic and Timely goals for encouraging adequate fueling and training practices among your athletes. We encourage you to share these goals with your team!
One way to prevent uniform discomfort is to involve the individual, take a team vote during team uniform selections, or offer alternatives.
Don’t
stay up late


Get
plenty of sleep tonight
Stop
eating cake

Eat
plenty of vegetables
3.5 Be Aware of the Environment
For example:
STEP 6: Use
positive messaging
and phrasing

Tell the athlete what they CAN DO.










One way to avoid negative phrasing is to flip the phrase into a positive one

using
action-oriented
words like "
do
," "
eat
," and "
have
.
"


Using
action-restricting
words such as “
don’t
,” “
no
” and “
not
” can have a negative impact on athletes and lead to unnecessary pressure.
Do not lag behind the rest of the team!

Do your best to keep up with the team!





I don’t like the way your uniform looks on you.

I think you could move with more ease if you tried a different uniform.





You aren’t training enough.

Some additional training can enhance your performance.

3.5 Be Aware of the Environment
These are some environmental factors that you may want to pay attention to in order to support the recovery process.



Be alert if your sport is
high-risk
for the development of disordered eating.

Be conscious of
your own comments and behaviors
related to size and shape.

Pay attention to the
team dynamic

Notice possible discomfort with
team uniforms

De-emphasize
weight

Use
positive
phrasing


Personal Reflection
List some things you might change about how you handled that situation.

Image source: http://homelesshub.ca/toolkit/subchapter/stages-change
Image source: http://homelesshub.ca/toolkit/subchapter/stages-change
Stage:
Action- active modification of the behavior
One day, after spending time in the sauna for a couple of hours, Jeremy passes out. Luckily he wakes up but becomes afraid of the health consequences. He decides to set up a meeting with his trainer to talk about what happened.


Stage:
Preparation- intent on taking action to address the problem
Stage:
Maintenance- sustained changed; new behavior replaces the old
Knowing when and how to continue training with an athlete after diagnosis can be tricky. Here are some general steps to consider:

4.3 Practice Question
4.3 Practice Question
Thank You for Completing
Running on Empty:
EDIN Curriculum for Coaches

Please go to
https://docs.google.com/forms/d/e/1FAIpQLScU_atAX4ss4Ttm97zyxyM5g3pvJOt0MM1zxBN3FMrfIMcKWQ/viewform?usp=sf_link
to complete the certification exam. The online exam will be submitted directly to EDIN, and a representative will contact you with your finalized certification materials.
Healthy sources of essential fat include:

Legumes: black beans, black-eyed peas, lentils, garbanzo beans, kidney beans, navy beans, pinto beans nuts and seeds
Vegetable oils: olive, safflower, sunflower, peanut, corn, canola, flaxseed, soybean, cheese, avocados, olives

Peanut butter and
other nut butters
Dairy products: cheese and milk
In general, athletes should select meals and snacks that are:

Familiar and known to settle hunger

High in complex carbohydrates to supply energy for muscle reserves

Moderate in protein

Low in fat

Can be quickly digested (not too high in fiber or fat)

Post activity, athletes should eat foods and drink fluids that replenish muscle energy and electrolytes lost during activity.

They can do so by:
Eating a high-carbohydrate meal (at least 60 gms carb)
Must contain a moderate protein source (between 10 to 20 gms of protein)
Meal ideally should contain liquid protein source such as chocolate milk.

Eating within 1.5 to 2 hours after activity
This maximizes muscle glycogen recovery and support protein synthesis in the muscles

Photo credit: Portland State University. http://www.pdx.edu/mentoring-research/mentoring-youth
Reflective listening and validation show the listener that:

You understand their feelings
Their feelings are not abnormal or wrong
2.4 Reflective Listening
Reflective listening is a communication strategy that you can use to help your athlete deal with problems and cut down on miscommunication.

It consists of 2 steps:

1.
Understanding
the person’s main point and the emotions underlying their words.

2.
Paraphrasing
their words and emotions to make sure you understand what they’re saying.
2.4 Validation
Validation is a strategy that goes beyond reflective listening, showing that you relate to or understand a person's feelings.
“I can understand feeling like…”
“I can understand why…is really important to you.”
“I would feel the same way in your situation.”
Sample validating statements:
Which of the following are validating responses?
Select all that apply.

1. I would feel just as upset in your situation.
2. Why do you think Steven is doing better than you?
3. I can understand why your performance is so important to you.
4. It’s just one race. Try putting things in perspective!
2.4 Practice Your Active Listening Skills: Part 2!
James says:
"I can't believe I came in third in the race. I've been spending so much time trying to improve my speed. Steven doesn't put in as much effort as me, but somehow he always comes in first."
Which of the following are validating responses? Select all that apply.

1. I would feel just as upset in your situation.
2. Why do you think Steven is doing better than you?
3. I can understand why your performance is so important to you.
4. It’s just one race. Try putting things in perspective!
2.4 Practice Your Active Listening Skills: Part 2 Answers!
2.4 Practice Your Active Listening Skills:
Part 1 Answers!
Which of the following are examples of reflective responses? Select all that apply.

1. I'm sure you'll get better soon!
2. It sounds like you're getting frustrated with your performance.
3. I'll bet Steven is practicing just as much as you.
4. So you're feeling frustrated and tired? Is that correct?

2.4 Responding to Denial

You can also respond to denial by speaking with your school counselor regarding next steps or by reaching out to an eating disorder specialist.
RED FLAG:

An athlete gets a
stress fracture
In weight based sports, maintaining a
certain weight
is required for competition.

Examples of Weight-based Sports include:
• Cross Country

• Swimming

• Track

• Ballet

• Body Building

• Football

• Basketball
1. Prepare the content and expectations for the conversation

2. Think about location and timing for a conversation
A conversation in the locker room where others can overhear won't be as effective.
You might say:
They might hear:
1. Active listening strategies

2. Conversational characters to avoid

3. Ways to respond to denial
Sample Scenario
1. Learn steps to take before speaking
with parents

2. Read a sample conversation starter
Instead, identify the specific behaviors that have made you concerned.
Check with your school or organization’s on-hand resources

Be knowledgeable about your school, district or organization’s protocol for privacy and medical referrals

Make external connections with professionals in advance

Consider posting the sourcebook
Receive medical clearance to begin exercise
Keep track of heart rates/blood pressure with a medical professional
Determine whether previous exercise habits were excessive
Monitor that athlete is maintaining a healthy weight when training
Help approach exercise in a non-dieting manner
Supervise exercise sessions in the beginning and check-in throughout
Range should be within 50–60% of max heart rate
Halt activity if athlete becomes dizzy or lightheaded
Refer to nurse or doctor
Example: Mon/ Wed or Tue/ Thu
Example: 1–2 exercise sessions of light cardio or strength training (20 - 45 min.)
You can eliminate derogatory comments about weight, even if they are in a joking or subtle manner.
Continue to promote positive self-image.
Create an accepting and supportive environment.
If you notice members are commenting on each other’s weight, take a stand.
Educate members about the dangers of comparisons.
water or low sugar sport beverage
beverages high in carbohydrates (about 6% to 8%) such as sports drinks
Check-in with your athletes regarding their personal goals for performance.

If those goals emphasize weight loss or gain, talk to them about ways of achieving those goals through adequate fueling and careful management of exercise routines.
Increase from 1-2 sessions to 2-3 sessions per week
Do not exceed one hour of exercise
Consult with doctor or nurse
Example: Mon./Wed./Fri. or Tue./Thu./Sat.
Increase to 50–70% of maximum heart rate
Sample response:
* actual amount needed varies based on athlete's size and training level
1-2 cups rice in medium sized burrito with beans, vegetables, and guacamole
*Chips optional if higher carbs needed
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