In this Q&A series, Dr. Paula Quatromoni (DSc, RD) answers some of the biggest questions coaches and athletic staff have to help prevent or address eating disorders in athletes and assist athletes who may be struggling. Sign up for our email list to get the next link to the newest Q&A right to your inbox.
Question: Our strength trainer has a scale near the entrance of the high school weight room. Is this okay? I worry that athletes may focus too much on the scale, weigh themselves too often (and in public), and struggle with body image concerns. Should I ask our strength trainer about this? If the strength trainer is weighing athletes, is this okay, or should it only be done by a medical professional?
Answer: Absolutely, your concerns are valid. I support your desire to have a conversation with the strength coach about what you observe and what you’re concerned about.
The short answer to this question is this:
To be most weight-inclusive and body positive, and to lower the risk of an undue emphasis being placed on body weight, shape, size, or appearance as a contributing factor to sports performance or an athlete’s value (a common risk factor for dieting, disordered eating, and eating disorders), it would be best to remove the scale from the open space in the school’s weight room.
I appreciate, however, that not everyone sees or appreciates the universality or the severity of this risk. For that reason, I would approach this conversation with the strength coach from a place of curiosity and as an opportunity to ask questions, hear the coach’s philosophy, policies, and procedures around the use and placement of the scale in the weight room, and provide a perspective (and perhaps some resources) that the strength coach might not be aware of but hopefully will be open to.
Invite a conversation by asking for a meeting. “I’m curious about the recent appearance of the scale at the entrance to the weight room. I’d love to learn from you about your philosophy, policies, and procedures for using it in the high school setting.”
This opener acknowledges your appreciation that the strength coach is a trained professional (hopefully, they are credentialed as a Certified Strength and Conditioning Specialist (CSCS)) and gives them the benefit of the doubt that they have thoughtfully placed the scale where they did, having created some guidelines or supervision practices for its use. If they have, let them educate you on where they are coming from, perhaps informed by their professional training, and how they are operationalizing the use of the scale. If they have not, you can share your concerns and the following professional guidelines as you ask them to more broadly discuss this with their colleagues on the sports medicine team to define a strategic plan of action.
According to the Position Statement from the National Athletic Training Association (NATA), monitoring of athlete’s body weight should be supervised by a professional and done on a planned, scheduled basis according to an identified rationale. Placing a scale in the open gym encourages public, random, unsupervised, and overly-frequent weigh-ins that are not at all consistent with the NATA best-practice guidelines below. This incongruity is what increases the risk of dieting and unsafe, unsupervised weight management practices among student-athletes.
One key rationale for monitoring an athlete’s body weight, according to the NATA, is to evaluate hydration needs based on sweat loss. This is particularly relevant to football athletes:
During preseason activities that involve equipment that could increase sweat loss or prevent adequate cooling in warmer and more humid climates, body weight should be reassessed at least daily because of the increased risk of dehydration and heat-related illness. Daily weigh-ins, before and after exercise, can help identify excessive weight loss due to dehydration.*
However, as described in a recent blog post by our colleague, Rebecca McConville MS RD LD CSSD CEDRD-C, there are five other strategies for evaluating hydration that do not involve the scale. The extent to which those alternatives are accessible or used in the high school setting likely depends on a variety of factors, including costs and budgets.
Another rationale for the use of the scale is for athletes in weight-class sports such as wrestling or crew:
Athletes in weight classification sports should not gain or lose excessive amounts of body weight at any point in their training cycles. Athletes and clients should attempt to maintain levels that are close to their weight and body composition goal when not competing and maintain their goal weight and body composition during competition. Excessive fluctuations in body weight or body composition (or both) can negatively affect the body. Athletes in weight classification sports should have individual monitoring plans, such as assessments at least once per month in the off-season and at regular intervals, not to exceed once per week, to monitor for weight fluctuations.*
Certainly, a strength coach is qualified to weigh a student-athlete. If there is a clear rationale for anyone to weigh an athlete, it is preferred that a certified Athletic Trainer (ATC) or a CSCS conduct the weight, rather than a head coach or assistant coach of the team the athlete plays for. But the first question is, what is the rationale for monitoring the athlete’s weight? Who decides that, and in consultation with whom? It is advisable to have the ATC in on this conversation as the school’s sports medicine expert.
The next question is, what is done with the weight data? Who is it shared with, under what circumstances, and for what purpose?
It is generally not advised to share athlete weight data with the team coaches. Those data should only be shared with members of the sports medicine team, ie. the Athletic Trainer in the high school setting. For this reason, moving the scale to the ATC’s office is advisable. Having a scale out in the open gym not only risks overuse and improper use, it risks a violation of confidentiality involving both coaches and teammates. It further runs the risk of weight-based bullying and discrimination. These risks provide a strong and indisputable rationale to move the scale (if it is retained in the gym at all) to a private location where only the athlete and the measurer are in the room and weights are taken, recorded, discussed, and processed in private.
The bigger question is, is the strength coach qualified to give advice to the athlete based on the body weight data, and is the advice consistent with best-practices and the ethical principles of “do no harm?”
That may be the more controversial piece if the strength coach believes they are qualified to give weight management advice and is operating without the consultative advice of a registered dietitian nutritionist (RDN) and/or the ATC.
Again, according to that same NATA position statement on weight management for student-athletes:
Individual body composition and dietary needs should be discussed privately with appropriately trained nutrition and weight management experts. Athletic trainers and other health professionals, such as registered dietitians, should provide nutritional information to athletes and clients. A Board-Certified Sports Dietitian (CSSD) is a registered dietitian who has earned the premier professional sports nutrition credential from the [Academy of Nutrition and Dietetics]. Coaches, peers, and family members should not provide information on diet, body composition, weight, or weight management practices and should refrain from making comments on or participating in the monitoring of body composition and weight.*
REFERENCES:
*Turocy PS, DePalma BF, Horswill CA, Laquale KM, Martin TJ, Perry AC, Somova MJ, Utter AC; National Athletic Trainers’ Association. National Athletic Trainers’ Association position statement: safe weight loss and maintenance practices in sport and exercise. J Athl Train. 2011 May-Jun;46(3):322-36. doi: 10.4085/1062-6050-46.3.322. PMID: 21669104; PMCID: PMC3419563.
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Paula Quatromoni, DSc, MS, RD is a registered dietitian, academic researcher, and one of the country’s leading experts in the prevention and treatment of eating disorders in athletes. Dr. Quatromoni is a tenured associate professor of Nutrition and Epidemiology, and Chair of the Department of Health Sciences at Boston University where she maintains an active program of research. She publishes widely on topics including clinical treatment outcomes and the lived experiences of athletes and others with and recovering from eating disorders. In 2004, she pioneered the sports nutrition consult service for student-athletes at Boston University, and in 2016, she led the creation of the GOALS Program, an athlete-specific intensive outpatient eating disorders treatment program at Walden Behavioral Care where she serves as a Senior Consultant. Dr. Quatromoni is an award-winning educator. 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.
