An Interview with Paula Quatromoni, DSc, MS, RD, LDN
You’re one of the nation’s top experts on the intersection of nutrition, eating disorders and athletes. What drew you to this field?
I’ve always had a passion for sports. I was a runner and a dancer through high school and college. My three kids are athletes. As a mom, a nutrition professional and an athlete, I realize that I have a special combination of professional and life experiences to have an impact in this niche of the field. As a researcher, I have an added opportunity to contribute to this field beyond my impact as a clinician.
You’ve worked with hundreds of athletes, many having come to the realization of the critical importance of sound nutrition in sports. Talk about that…
There are few things more rewarding than facilitating a journey of self-discovery and personal growth. As a university professor, I’ve been privileged to influence the academic achievements and mentor the career paths of my students. My work with high school and college athletes is particularly high impact because of the transitional life stage these emerging adults are in. Teaching athletes about their nutritional needs for sport and helping them to become competent eaters provides them with skills that will serve them well for a lifetime.
When it comes to nutrition and sport, what are 2-3 things most athletes may be surprised to know?
First, good nutrition doesn’t just happen. It takes work, purposeful focus, planning and some basic cooking skills. But it’s worth the investment because the benefits of proper nutrition for an athlete are as important as the benefits of training and conditioning for sport. Not everyone realizes that. Too much emphasis on training without an appreciation for nutrition undermines an athlete.
Second, most athletes don’t truly realize how much food and nutrition they actually need. In fact, most are surprised at the required amounts when a Registered Dietitian helps them plan a personalized fueling strategy to meet their nutritional needs.
Finally, even on rest days or when an athlete gets injured, they still need to feed themselves! Many athletes make the mistake of thinking that they only need to eat to fuel their workouts. That is a fallacy! When injured or after surgery, athletes need proper nutrition to heal and recover, participate in physical therapy, and get through long days at work or at school. And even on rest days, while the volume of food may be smaller, it’s important to keep the nutritional quality high and sustain the frequency of eating.
Let’s talk about eating disorders. They’re a big, yet often hidden, issue among athletes. Why do you think there’s so much misunderstanding around them?
It surprises me when I talk about my work and people respond, “Really? I didn’t know athletes get eating disorders!” Athletes are perceived as invincible, often super-human. But many of the characteristics that make an elite athlete so successful are the same traits that fuel an eating disorder. A commitment to sport requires discipline and athletes work to control as much as possible about their training conditions, schedules, fitness, strength and conditioning, skills or technique, nutritional intake, and sleep. Yet in sport, there is a very fine line between dedication and compulsion. Particularly when aspects of sport feel out of control, like when an athlete gets injured, when there are conflicts between players and coaches, or when performance pressures are exceptionally high, athletes who lack effective coping skills to manage stress are vulnerable to eating disorders. In a sport environment where athletes are told to “suck it up” and “just do it,” pushing through pain (be it physical or emotional) is expected and often rewarded. Admitting you are struggling is not easy when you are expected to be invincible; and even more difficult when a teammate is waiting to take your spot on the field or when a college scholarship is on the line. The stakes are high and there are many barriers to treatment, especially for men facing the stigma that only women get eating disorders.
GOALS is an intensive outpatient program for competitive athletes struggling with disordered eating and/or nutritional deficiencies. How is this program so unique?
GOALS is unique because it is a program designed specifically for athletes. That means that athletes are in program alongside other athletes, creating a “team” environment within the treatment program. Athletes support one another in their recovery efforts, just like their teammates support them in sport. All of the lessons, discussion topics, and activities in GOALS are specifically designed to help athletes build skills to confront, address and cope with the pressures, people and stressors in the sport environment. I find the collaborative interactions between the mental health and nutrition providers in GOALS particularly effective, allowing us to provide comprehensive and integrated care in every session.
You bring quite the unique background. You’re a registered dietitian, university professor, researcher, and now, consultant to the GOALS Program. How are you leveraging your impressive experience to help athletes facing eating disorders?
I built the sports nutrition consult service for student-athletes at Boston University 12 years ago. That clinical experience directly informs what we do in GOALS. As a researcher, I work with my sports psychology colleague, Dr. Jessyca Arthur-Cameselle, to elucidate risk factors for onset of eating disorders in sport identify obstacles to treatment and define factors that facilitate recovery among athletes. The evidence base from our research combined with others’ provides the rationale for athlete-specific programming like GOALS. One of the ways I contribute to helping athletes with eating disorders is by publishing my work in professional journals and presenting to diverse audiences of sports medicine professionals at conferences nationally and internationally. The dissemination of our research, intervention strategies and successful outcomes from the care we provide to athletes not only raises awareness of eating disorders in sport, but trains other professionals on best practices in eating disorder prevention and treatment services to help athletes in their own communities.
What’s next, in terms of more resources for athletes facing eating disorders?
I believe we are on the brink of a surge in awareness and attention to the problem of eating disorders in sport. Athletes are courageously speaking out, sharing their stories about eating disorders in sport and providing a voice for the millions who suffer in silence. Male athletes are joining the conversation, making it known that men suffer from eating disorders too. The NCAA’s initiative, Mind, Body and Sport, provides a multidisciplinary framework for addressing the mental health needs of student-athletes, including prevention and treatment for eating disorders in collegiate sport. The research on treatment of athletes with eating disorders is extremely limited. At GOALS, we are well-positioned to contribute to this evolving story with evidence of positive outcomes achieved from our program. With research, better treatment will be delivered and more full recoveries will be achieved. More jobs for dietitians and mental health providers in sport will be created as the evidence base for prevention and treatment is more firmly established.
What do you enjoy most about working with athletes?
I enjoy the athletes. They are among the most motivated of clients I have worked with in my 30-year career as a dietitian. They are hardworking, focused and goal-driven. Once they place their trust in the treatment team and commit to doing the work, the path towards recovery unfolds in partnership. My work on eating disorders in sport has been among the most meaningful work of my career.
What are you most proud of in your work?
I am most proud that my work changes lives. I have helped athletes recover from eating disorders, restore their health and achieve their goals in sport. I have helped athletes find balance in their lives and go on to live as healthy, productive and successful adults where they are thriving in all aspects of life. I stay connected to many of the athletes I’ve treated over the years. Several reach out from time to time when they need support, encouragement or resources. A couple have lent their voices to tell their stories through lectures, events, news features and published articles so that others may benefit from their experiences from disorder to recovery. I am extremely proud that my children understand my work, value the importance of nutrition in their own athletic careers, and see the impact of my work on the lives of others.
Dr. Quatromoni is a senior consultant for Walden Behavioral Care, and one of the nation’s top minds on the intersection of sports nutrition and eating disorders. As a registered dietitian, she has more than a decade of experience working with athletes with disordered eating and has published several papers on both clinical experiences and qualitative research on recovery experiences of athletes. Dr. Quatromoni is the Department Chair of Health Sciences and a tenured associate professor of Nutrition and Epidemiology at Boston University where she maintains an active, funded research program. In 2004, she pioneered the sports nutrition consult service for student athletes at Boston University. Dr. Quatromoni was recently named a 2016 Outstanding Dietetics Educator from the Nutrition and Dietetic Educators and Preceptors (NDEP) Council. She earned her B.S. and M.S. degrees in Nutrition from the University of Maine at Orono and her Doctorate in Epidemiology from the Boston University School of Public Health.