This study investigates elite coaches' attitudes toward eating disorders (ED), knowledge about ED, and early intervention skills when confronted with possible ED in their female athletes. We interviewed 18 coaches in Sweden responsible for athletes representing national teams in the three sports categories most at risk for ED: aesthetic, weight class, and endurance. The interviews revealed that, although most coaches knew athletes with ED, they did not perceive ED as a problem in their sport. The majority of coaches cited difficulties in identifying ED symptoms, especially symptoms associated with bulimia nervosa. Coaches also described several barriers in approaching the athletes, including the athletes' denial of ED, lack of female colleagues on the team and the lack of easily accessible resources for treatment referral on both the national sports federation and the club levels. This study reveals that elite coaches have insufficient capacity to identify ED and conduct early intervention, resulting in delayed treatment.
INTRODUCTIONNot all athletes are at elevated risk for developing eating disorders (ED), but for those who are, early intervention by coaches can be crucial. High prevalence rates of ED have been documented in aesthetic, endurance, and weight class sports [1][2][3][4]. High prevalence rates may be a result of specific demands placed on athletes. For example, success in aesthetic sports such as rhythmic gymnastics requires a low body weight and lean appearance, which may lead to pressure to maintain a thin figure from judges, coaches, and parents. In a study of female figure skaters competing in pair skating and ice dancing, all skaters, though lean, reported trying to lose weight [5]. In response to the question "Do you think that there are pressures associated with figure skating to lose weight or maintain a below average weight?" 92.7% of figure skaters responded "yes". The same pattern occurred in a study of elite rhythmic gymnasts, members of the Norwegian national team [6]. Likewise, in endurance sports, where leanness is deemed key to optimal performance, and in weight class sports, where an athlete's body weight determines her/his classification in competition, dieting and disordered eating practices are highly prevalent [3]. Gender is one risk factor for ED among athletes, with female athletes especially at risk [7][8][9]. Another risk factor is the level of performance, with athletes at the highest levels of competition being at the highest risk [10][11][12]. Factors that contribute to risk, both environmental (e.g., the intense pressure to be thin) and attitudinal (e.g., persistence, perfectionist tendencies), are common in elite athletes [13]. Collectively, as female athletes performing on elite levels in aesthetic, endurance, and weight class sports have been found to engage in disordered eating behaviors and attitudes more frequently than non-elite athletes in the same sports, and more frequently than elite athletes in other sports [10], continuous research is needed to pro...