How to help someone with an Eating Disorder – Autonomy and Boundaries

One thing that can easily get blurred with an eating disorder are our boundaries. When family is involved, it is particularly easy for these to be encroached upon as emotions can begin to cloud our judgement. It is easy to offer a concession from time to time, especially when someone we love begins to plead with us. We also know that any individual with an eating disorder who can learn to make their own decisions, will do better throughout recovery. That said, allowing someone with an eating disorder to do entirely what they want will rarely result in a positive outcome. We must balance an individual’s autonomy with firm boundaries around what is acceptable with regards to their behaviour.
An image of a tennis ball right next to the line on a court
It is vital we establish clear boundaries relating to behaviours around eating disorders
In general, when it comes to controlling behaviours around food, allowing individuals to eat alone, allowing them to eat 'special' foods differently to everyone else, and allowing them to refuse that others cook for them are just some of the things we might want to look out for. These will be individual to each person, but it is these types of behaviour that will be perpetuating their problems. For these we will want to draw a line in the sand. We will need to learn to say - NO. Because of their situation, it is vital that they accept that some things will be non-negotiables for them. Yes, other people might be allowed these 'luxuries', but for this person, right now, they need to understand that somethings are not helpful and that they must make and effort to change. This can be hard for many of us to enforce, but developing this assertiveness is often exactly what is needed in this type of environment

How to help someone with an Eating Disorder – Dealing with Denial, Focus & Honesty

What problem?

It is often common for the person you believe to have an eating disorder to deny they have a problem at all. This is where things get tricky. You certainly don't want to engage in a futile and often inflammatory battle of wills, but nor should you completely surrender to their denial. In learning about eating disorders, you will come to understand that this denial, and subsequent anger or refusal to seek help is a part of their illness. They will likely be ashamed of their situation and moreover, fear that by seeking help that they will lose control of their own weight.

Denial
Denial that there is a problem is particularly common in those with an eating disorder

To compromise, you might want to offer up information or point them in the direction of resources that could help them. Allow them to deal with these in their own time. If receptive, you could also offer to go to 'just one' appointment with a doctor, eating disorder specialist or nutritionist with them. This might help start to turn things around without demanding a commitment to ongoing treatment.

Where possible, focus on the person too

When someone's behaviours around food seems problematic, it can be very easy to focus only their eating habits when you speak with them. Likewise, it can be very hard to bite your tongue when someone is blatantly not looking after themselves. Understand that these problems are more about their own emotional battles and difficulties with self-worth than they are about fats and carbs. If and when you do talk about food, make sure you balance it with your concerns about them as an individual.

Be honest, be brave

picture of eggshells
Don't walk on eggshells with an eating disorder, but be careful about how you deliver your message

There is a very fine line between being honest about your feelings relating to someone's behaviour and emotionally unloading your problems onto them. For people with eating disorders, it is good for you to model for them that it is both important and acceptable to get in touch with feelings that might be the source of shame or feel dangerous. Let them know what behaviour or action they have taken you want to discuss, how it has made you feel, and how you are going to personally deal with it. Explaining to them how you have taken the time to learn about eating disorders and just listening to them are great ways of showing them you care without making it seem like you are forcing them to change

Rugby Tour – Lessons learned

What a few days I have had. I'm finally on my way home after a very long week that began with a stag-do in Wales before heading straight to Switzerland to meet up with my brother and join his school's Rugby tour. It was an enjoyable if tiring week and I thought I'd use the flight home to reflect upon the experience.

Prepare (to be flexible)

I'd made several attempts in the months and weeks leading up to the tour to try to work out exactly what they wanted from me in terms of S&C.  As time progressed, it became clear that things might be subject to change. Even on arrival, as we discussed the week ahead with the helpful reps at Brown's Sport an Leisure, things were shifting. We originally had two slots in the gym, both on the same day.  We managed to secure a third, but that was the day before the double gym day, and the day after both of the sides on tour had their first game of rugby. So in addition to a lack of clarity on the exact calibre of individuals I'd be working with, there was also uncertainty around the the condition they would be in.  All that was clear was that the timetabling was far from ideal.
The ISZL Junior Varsity Rugby Team preparing for their game in Seville
The ISZL Junior Varsity Rugby Team preparing for their game in Seville

In addition to delivering the gym sessions with them, I was also in charge of getting them prepared for their games and training sessions. The first session a great time to assess what I would be working with. I think that warm ups not only serve as a great way to do this, but can provide insight into the character strengths of the group. When you set them a novel physical challenge, how do they respond? Who gives it a go no matter what, who doesn't even attempt it?  This week I used Dan John's 'get back up' warm up for part of the first warm up. It requires minimal instruction, and as well as a good laugh, when you ask 33 adolescents to do a straight arm plank with their arms behind their back, you start to see who the more determined and creative really are. Unsurprisingly, there was a real mix of physical and character-based competency in the group.

By the time we reached their third and final gym session of the week, they were all physically quite tired and mentally exhausted. It was a hot day and so I moved the session more to a theory based one. I took them through some of the considerations of a warm up, the basic movement patterns of the human body and how they might construct a workout when they next go to the gym. To test their learning, we challenged them to take their own warm up the next morning. I was pleased to say that they delivered a RAMP-based protocol that would bring a smile to the face of even the sternest UKSCA assessor.
With the information available prior to the tour, it would have been hard to plan much more than I did. In hindsight, what was useful however was condensing and integrating an ongoing assessment process into the work I was doing with the boys. Challenging them early and often. Talking to them to find out how they responding. Observing at them at breakfast and lunch and dinner to see how spritely or exhausted they might be. Most importantly being prepared to change and acting on that feedback.

Developing Strength (of character)

Like many S&C coaches, developing strength in those I work with is a high priority. Sometimes however, this might not be in a physical sense. The tour was sharing the facilities at Browns with Leicester Tigers Academy and I managed to sneak a couple of opportunities (via the medium of beer) to talk to some of the guys at Leicester. I was intrigued to know what they looked for in their academy players from a physical standpoint. While not ignoring the basic physical requirements of the game at the elite level, their coach, however referred more to the importance of strength of character as something they look for in their players. A goal of the tour was for the boys to develop as rugby players. I think many of them did. As a group of highly priveleged individuals however, several of them also had a lot to learn about independence, humility, and respect too. As a rugby team, at their level, arguably these qualities might be even more important than their physical prowess when if comes to team performance.
The ISZL Varsity rugby team completing their warm up under flood-lights
The ISZL Varsity rugby team completing their warm up under flood-lights
To me, the gym environment is as much a place to learn about these character strengths as it is one's physicality. This I think was exampled well with their first main session in the gym. I had a sit down with the boys at the beginning of the session in to find out what they did when (if) they went to the gym. As you can imagine, many of their responses were characterised by bicep curls and precious little consistency in rep schemes or attendance. When I asked them what they wanted to get out of the sessions, they said they wanted to learn how to bench. Running with it, I asked them how many pressups they thought they could do. One responded with forty, many with 15-20. Then a student came out with 'he means the ones he showed us' (i.e. proper ones). At which point many of the students revised their estimates downwards by 10-15.  I then asked them to get into a straight arm plank, cueing them as necessary to reach a good position. Once they were all in position, I stood there, just calling out small adjustments to individuals who started to deviate from good form. Within a minute more than half of them had dropped to their knees. Some of the bigger and older boys in the team were also somewhat upstaged by their significantly younger counterparts. The exercise was not meant to be humiliating for anyone involved and I don’t think it was. They were all tired, and many of them struggled. Having bonded well throughout the week, it was great to see a healthy dose of humility amongst them. I think in that moment they began to learn the principle of 'earning the right’ and what it really means to ‘leaving your ego at the door’ They certainly won’t have gained much of a physical stimulus from the session, nor would I have wanted them to considering their timetable.

Creating a culture and opportunities for growth

As I’ve alluded to, a big part of the tour was about creating and exposing the boys to an environment in which they could develop. I have to commend my brother and Mark Newman for bringing it all together. But as good a job as was done on this in clearly explaining what was expected of each and every one of them, outlining the tour ethos and providing ample feedback, some individuals were just not as ready as others. Everyone’s personal journey is not something that cannot be forced. I think its entirely natural for any coach to want the best for their charges, but the bottom line is, some either lack the self-awareness or confidence to take the first steps on that journey. It has made me reflect upon in my own sessions that I coach, am I doing my best to culture an environment for the development of those that I work with. I know I can do better, and it will be something I will be working on over the coming sessions, weeks and months.
Huelva rugby team wanted to take this photo to support Alberto Aláiz - a Spanish rugby player who suffered a serious spinal injury this month playing the game he loves
Huelva rugby team wanted to take this photo to support Alberto Aláiz - a Spanish rugby player who suffered a serious spinal injury this month playing the game he loves. To me this is what rugby and sport is all about.

How to help someone with an Eating Disorder – Labels and Solutions

Don't label

When you know someone has an eating disorder it can be quite natural to try to label the problem. By giving it a name it can help us to make sense of it, and to mentally partition it as a separate issue. This is not particularly useful for the person involved, and it can be quite dehumanising. We should never label them, or argue with them that there is a problem. If you find yourself becoming accusatory in tone, try to reframe what you say to be more compassionate and understanding. Let them know, that problem or no problem, you are still worried for them and are there to help them find a solution.

eating disorder label
Labelling someone with an eating disorder can be dehumanising

No one-size-fits-all solution

When it comes to helping people with an eating disorder, its as simple as this - there is no one-size-fits all solution. An eating disorder has no single cause, and will be multifactorial in nature. They are complex issues. As a friend or family member of someone with an eating disorder, first do your best to learn as much as you can about eating disorders. If necessary, speak with a qualified therapist to learn more. Those with eating disorders can have a deep ambivalence and resistance to change which might seem at odds with other things they say. Make sure you've done your due diligence before you try to engage with them in depth.

Strength and Conditioning Coaches, Professional Boundaries & Eating Disorders

I recently came across the description of some disturbing behaviour from a young client with an eating disorder. It related to two behaviours of the strength and conditioning coach staff at their training facility. i) The S&C coaches had encouraged the athletes not to eat pudding at lunch. As far as the athlete was concerned there was also ii) the threat that should the coaches see an athlete eating pudding at lunch, they'd come and take it away from them.

image of burger and drink in red danger sign
Banning types of food is a bad idea

Its actually hard to know where to start with this. Now I'm not here to dissect what was actually said, as it doesn't really matter. The NLP presupposition 'the meaning of your communication is the response you get' its a useful one in this instance though.  I hope that the paragraph above makes you at least feel uncomfortable. Either way, I'll try to explain how, and why this sort of rhetoric can be utterly destructive to an athlete, and why it should not be a problem that occurs at all.

The weight of an athlete and performance

Undoubtedly, these comments were uttered with a positive intent. Yes, weight plays a role in athletic performance. Yes, eating less processed foods, and eating more, colourful, fresh fruits and vegetables is going to have a broadly positive impact on health, well-being, body composition and on athletic performance. Yes, the S&C coach wants to help improve many if not all of these things in their athletes.

However...

This is a population of potentially vulnerable individuals. Of individuals with perfectionist tendencies. These people will often struggle to appropriately process and assimilate information regarding any sort of food restraint.

There is a very fine line between advice around food restraint and being a food bully. I think this falls on the wrong side of that line. Coaches must respect that their words come from a position of authority, and carry more weight. What implications might this approach have for someone with lower self esteem, or poor body image. We want to build our athletes up, not break them down.

Consider the shame and embarassment and even fear that would be created from such an statement or the environment it creates. Not exactly conducive to 'high performance'.  There is a place for almost any food (in moderation) in a healthy and balanced diet. It almost goes without saying that we don't want to be linking any food group or type to negative emotional states. The generality of this unguarded comment has clearly been misconstrued and has unfortunately resulted in almost the opposite of the intended effect.

Few S&C coaches are actually adequately trained and qualified to dispense appropriate nutritional advice on weight loss. Just because weight and body composition is related to athletic performance, S&C coaches MUST NOT be mistaken in thinking they can or should advise on the matter. If you do think its something worthwhile changing, engage with qualified professionals. I've said this before, but unless you understand the physiological and psychological consequences of such advice, its best to keep your mouth shut. Now I don't know if these coaches were qualified or not to dispense such advice, but I'd argue that if the individuals involved had been qualified, they probably wouldn't have delivered the 'advice' it in the way they did. Food choices, although we might not be aware, can extremely personal to us and carry or convey underlying values and meaning. Quarrel with these at your own peril.

Ultimately, the overriding issue is that the mental health of an athlete must be prioritised before performance, especially if performance is your end goal. Perhaps this is a statement that not all of you will agree with, but without this hierarchy, I believe we’ll be seeing a few more Phyrric victories than necessary. Remember, we’re people first, and everything has a cost!

Codes of Conduct

Be honest, how many of you know any of the codes of conduct of your professional organisation? Whether accredited with the UKSCA or not, I would strongly urge you to all revisit your professional or personal codes of conduct from time to time. I know at least one coach at the organisation involved in the above anecdote to be UKSCA accredited, and while this is not a whistleblowing exercise, there are arguably several points within the UKSCA codes of conduct that have been disregarded from just one seemingly innocent throwaway comment. I’ve copied out some of the most relevant ones to this situation below, but please take the time to read through the rest though, it’ll certainly be worthwhile:

  • Not to exceed my own competence, expertise and qualifications in any aspect of any services I may provide, and not to carry out work above my level, as in the Scope of Practice document.
  • To refer to an appropriate professional any matter which appears to lie or does lie within another specialist’s area of expertise.
  • To seek appropriate advice in any situation where I may lack the necessary experience or competence.
  • I agree at all times that I will act in the best interest of the athlete/client.
  • To comply with all Child Protection, Vulnerable individuals, Racial, Sexual and Disability Discrimination legislation.

The UKSCA Codes of Conduct

When it comes to eating disorders, just one comment can be the precipitant for someone developing lasting problems. So when it comes to nutrition, unless qualified, you really are best off following Kelvin Giles' advice:

In coaching you will have thousands of opportunities to keep your mouth shut. Take advantage of all of them.

Know your ethical and professional boundaries. Respect them. For adolescents and their nutrition, they are perhaps best left largely alone. If you must do something, broadly educate them on what constitutes a balanced diet, be emphatic when it comes to the serious risks of underrating or purging behaviour. Only once they are older, and when they have consistently demonstrated they have no problems with food, should a qualified and trained professional begin to approach them with more specific or targeted dietary interventions (with caution) IF necessary.