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SCAN’S
PUL SE
APublication for Sports, Cardiovascular, and Wellness Nutritionists Summer 2008
® Vol. 27, No. 3
A Model for Nutrition Education for Use
with Female Collegiate Athletes
CONTENTS
by Avital Pato Benari, MS, RD, and athletes are particularly vulnerable to
6,13,14
Paula A. Quatromoni, DSc, MS, RD these as well as other risks.
AModel for Nutrition Education Although nutrition education is
for Use with Female Collegiate It has long been recognized that advocated for female athletes, only a
Athletes 1 sound nutrition practices are a few studies have involved collegiate
fundamental component of every athletes.15 Most educational
From the Editor 3 athlete’s training program,1-4 but interventions have not been
misinformation abounds. Student successful at helping athletes adopt
CPE article—Not All Dieting Is athletes are a unique population, healthier eating habits, perhaps
Bad: The Relationship Between having the dual demands of both because of a lack of understanding
5
Dieting and Eating Pathology 5 academic and athletic performance. about the specific nutritional needs,
Good nutrition can help them achieve attitudes, values, and beliefs of
success in both domains. Proper athletes.12 The purpose of this study
Dietary Guidance to Prevent nutrition leads to peak performance, was to determine what female
Cancer: A Commentary on whereas suboptimal eating practices collegiate athletes perceive as their
“Food, Nutrition, Physical can compromise performance, delay needs and desires for effective
Activity, and the Prevention 6
recovery, and contribute to injury. nutrition interventions.
of Cancer: A Global Perspective” 9 Other evidence demonstrates that
cognitive performance is boosted by Research Methods
From the Chair 11 7
consumption of breakfast and Six female student-athlete members
healthful snacks.8 of a National Collegiate Athletic
Conference Highlights 12 Athletes seek nutrition advice from Association (NCAA) Division 1
various sources including magazines, rowing team volunteered to
Reviews 16 television, the Internet, peers, participate in this study. Women crew
coaches, trainers, nutritionists, and members are relatively frequent users
Sports Dietetics USA 5,9-11 16
other specialists. Since many of of nutrition services on our campus.
Research Digest 18 these sources can be unreliable, They were selected for this pilot
athletes are at risk of succumbing to study because their interests in
SCAN Notables 20 inadequate or unhealthy dietary nutrition were not limited solely to
practices. Factors that include weight control, but rather included a
Of Further Interest 22 performance expectations and sport- genuine interest in nutrition
specific and social influences may education for athletic performance
Upcoming Events 24 encourage athletes to experiment and overall wellness. Research
with fad diets and nutritional protocols were approved by the
supplements in the hopes of Boston University Institutional
achieving a competitive edge or a Review Board in the School of
12
desired body weight. Female Education. Because research
SCAN’S PULSE Summer 2008
ADADietetic Practice Group of Sports, involving the athletes’ perspectives their food choices, the code assigned
Cardiovascular, and Wellness Nutritionists on nutrition education is novel and was “budget.”
(SCAN) not well described in the literature, The next step involved “axial
SCAN Web site: http://www.scandpg.org qualitative research methods were coding,” which grouped together
SCAN Office used in this pilot study. open codes that shared a similar
Pamela Cramer, CAE, Executive Director
800/249-2875 or 847/441-7200 Private interviews, using a scripted conceptual meaning. For example,
pcramer@thepmcgroup.com discussion guide, were conducted when several athletes identified
Chair with each of the six female crew relatives, athletic trainers, and sport
Hope Barkoukis, PhD, RD
Brecksville, OH athletes. The interviewer was not the psychologists as salient and reliable
216/368-2441 sports nutritionist who provides sources of nutrition information, the
Hope.Barkoukis@case.edu
Chair-Elect nutrition services on campus; all code of “trustworthy advisor” was
Gale Welter, MS, RD, CSSD, CSCS interviews were conducted by a assigned.
Tucson, AZ
520/621-4550 neutral person who was unknown to The final analytical step involved
welterg@comcast.net the athletes. Each interview lasted 20 “selective coding,” in which codes
Past Chair to 50 minutes, was digitally recorded, were clustered and mapped to reveal
Roberta Anding, MS, RD, CSSD, CDE
Houston, TX and later transcribed. Discussion three main theoretical constructs:
832/822-4005 topics queried athletes’ perceptions of Understand Me, Gain My Trust, and
randing@houstontexans.com need for nutrition education services, Interact with Me. In this way, the
Treasurer
Richard E. Hall II, MS, RD sources of nutrition information, analytical process moved inductively
Anthem, AZ influences on personal nutrition from the “grounded” transcriptions
602/284-4607
Rick.hall@asu.edu behavior, beliefs about nutrition and towards theme development.
Secretary performance, and recommendations
Kelly White, MS, RD for effective nutrition interventions. Defining the Model
Starkville, MS
kwhite@och.org Participants were given the The three main themes were then
Partnerships Co-Directors opportunity to ask questions and used to generate a model for planning
Julie Upton, MS, RD Jenna Bell-Wilson, PhD, RD, contribute additional commentary. All and delivering nutrition education
Tiburon, CA CSSD
917/863-9152 Arlington, MA participants agreed to follow-up interventions for female collegiate
julieupton@gmail.com 781/777-2799 contact. athletes (see figure). The components
jennabw@gmail.com
Member Services Director Interview transcripts were of our dynamic model—Understand
Tara Coghlin Dickson, MS, RD, CSSD analyzed using grounded theory Me, Gain My Trust, and Interact with
Mill Valley, CA methodologies.17 Because the primary Me—are closely interrelated.
650/723-5094
Tara.dickson@chw.edu purpose of grounded theory is to Understand Me. This component
Continuing Education Director generate an explanatory model of of our model refers to the athletes’
Pamela Nisevich, MS, RD human behavior that emerges from basic need to have nutrition providers
Beavercreek, OH
937/641-3434 qualitative data, this approach was understand fully who they are—as
Pamela.nisevich@hotmail.org well-suited to the goals of this individuals, as athletes in their
Public Relations Director exploratory research. Participant specific sport, and as college-age
(to be appointed)
Sports Dietetics USA Director responses were coded to identify women with the unique demands,
Michele Macedonio, MS, RD, CSSD underlying themes and common stressors and realities associated with
Loveland, OH patterns using established methods those multiple roles.
513/683-1405
M_A_Macedonio@fuse.net for qualitative research.17 The analysis
2008 Symposium Chair moved inductively from theoretical Figure.Theoretical Model of Nutrition
Enette Larson-Meyer, PhD, grounded transcriptions towards
MS, RD, CSSD Education Needs of Female
Laramie, WY theme development to characterize Collegiate Athletes
307/766-4378 behavioral patterns, belief systems,
Enette@uwyo.edu
PULSE Editor-in-Chief and unmet needs conveyed by study
Mark Kern, PhD, RD, CSSD participants in response to the
San Diego, CA discussion topics presented.
619/594-1834
kern@mail.sdsu.edu The first step in the analysis
ADAPractice Manager involved “open coding,” in which
Frances Austin, RD participants’ statements, descriptions,
120 South Riverside Plaza, Suite 2000
Chicago, IL 60606-6995 and ideas were grouped into codes
800/877-1600 ext. 4813 representing common themes
312/899-4812 – f
faustin@eatright.org embedded in the interview
■ ■ ■ ■ ■ transcripts. For example, when
2 multiple participants described the
cost of food as a major determinant of
SCAN’S PULSE Summer 2008
The Understand Me construct
speaks to the importance of a FROM THE EDITOR
thorough needs assessment before
delivering an intervention. In our
study, this theme emerged from three Please Do Not Read This
subcategories: 1) specific needs; 2) Stop right now! You can come back to read my letter later if you want, but
inhibiting factors, and 3) life right now you should be reading our feature articles and the contributions
experiences. Dietitians must in our usual departments, because that’s where the real scoops lie. In case
understand the unique sport-specific you’re like most SCAN members and not easily swayed by the opinions of
and position- or event-specific needs one person, I’ll go ahead and describe what you’re missing.
of an individual athlete that First, right now you could be earning a free continuing professional
distinguish her from both the education unit (CPEU) by reading the article that was masterfully crafted
“average female” and the “average by Hollie Raynor, PhD, MS, RD, and then answering a few questions about
female-athlete.” For example, whether dieting is likely to develop into a pathology. You’ll also find that
appropriate interpretation of body Norman Hord, PhD, MPH, RD, has provided an excellent commentary on
mass index data and energy the recent “Food, Nutrition, Physical Activity, and the Prevention of Cancer:
requirements for student-athletes is AGlobal Perspective.” I’m still surprised by some of what he discusses.
essential, because guidelines for the Our cover article is a special treat. This original research article, written
general population do not readily by Avital Pato Benari, MS, RD, and Paula A. Quatromoni, DSc, MS, RD,
18
apply to competitive athletes. describes a model that they developed for educating female collegiate
Several athletes voiced this specific athletes.
concern, as reflected in the following Elsewhere in this issue—in our “Conference Highlights”—we have
comment: provided summaries of just a few of the many presentations that captured
“When... sports nutritionists talk to attendees’ interest at the recent SCAN Symposium. Here you’ll also find a
us... they say “for the average female who report on a fascinating conference sponsored by Tufts University. And don’t
weighs 130 pounds, this is how many forget to peruse our latest resource reviews, check out the research digest
calories she needs.” What? That’s of contributed by Sports Dietetics-USA(SD-USA), and read about the notable
absolutely no relevance to me. I weigh accomplishments of our members.
170 pounds. Like, that’s really great. I’m guessing that you’re wishing you’d gone right to the heart of things,
That’s not me. So make sure that it but if you didn’t and you started with this letter, hopefully this has whetted
[nutrition advice] is relevant to the team your appetite and you’re ready to read on.
or to the individual.”
Insights into individualized sport
requirements, training regimens in- Mark Kern, PhD, RD, CSSD
season and off-season, performance Editor-in-Chief
expectations, values and belief
systems, personal food rituals, and
practice commitments that interfere Inhibiting factors that prevent even need to be understood to maximize
with daily eating routines are crucial well-informed athletes from eating effective interventions.
to understanding the individual well need to be understood by the Gain My Trust. This construct
athlete. As illustrated in the nutritionist. These factors include reflects the fact that athletes are often
participant comment below, this kind limited time, lack of cooking skills, skeptical of nutrition information that
of insight allows the nutritionist to and limited financial resources that comes from sources outside of their
support the athlete who has become frequently determine food choice and immediate sport environment or
empowered to link nutritious pre- consumption, as noted consistently in social network. Thus, the Gain My
game food choices with good 11,19
performance; it also provides the other research. Trust theme illuminates the highly
opportunity for clarification and Finally, student-athletes want valued role of trustworthy
guidance if the athlete’s rituals are nutritionists to understand their life individuals and sources of nutrition
dangerous or if belief systems are experiences and key factors that information from persons who
faulty. influence their eating behaviors. interact daily with athletes. Advice is
“The day before a race, I want to have Parents, roommates, teammates, considered valuable and meaningful
rice because before I raced at the New coaches, trainers, cultural if it is trusted.
England championships I had rice and I backgrounds, food preferences, Our participants identified family
had a really good race and I don’t know if values, and personal belief systems members, sport psychologists, and
it affected [the outcome], but it makes me were described as central components
believe that I can affect it.” of the athletes’ life experiences that ■ ■ ■ ■ ■
3
SCAN’S PULSE Summer 2008
their trainers and coaches as trusted athletes should be interactive, be built behavioral change. While pieces of
individuals. These persons are on open communication, address the evolving theory were previously
considered trustworthy because they individual and team goals, published, our model is novel in that
are known by the athlete, they are incorporate specific activities, and it depicts dynamic interrelationships
accessible on a regular basis, and they allow for follow-up. between three equally important
understand the athlete in her sport Athletes want practical components: understanding, trust,
and show concern. The following information that will teach them how and interaction. This work is
comment illustrates this: nutrition can maximize and enhance preliminary, limited by its small
“If the strength coach is there...I mean, their performance. Interactions that sample size. The model warrants
personally I think of my strength coach as are skills-based and help athletes additional investigation and
somebody who has always been concerned overcome barriers to healthy eating exploration among larger groups of
with health, nutrition, proper diet, proper such as cooking demonstrations and athletes from diverse sport environ-
rest, recovery... So if I have a quick budget-conscious shopping advice ments. Nonetheless, our observations
question about something, you know, I are highly valued, even when they reinforce the call to action by
might be inclined to ask him, rather than are informal and less structured. Rosenbloom4 to work to define the
seeking out an appointment with someone Team-based interactions that best nutrition education approaches
else who’s not a part of my daily extend beyond individual services to effectively serve athlete popula-
schedule.” can effectively address team tions and lessen the burden of nutri-
For a nutritionist to have a similar dynamics, group norms, and the tional risk among female athletes.
impact, he or she must earn the sport environment that potentially
athlete’s trust, express empathy, and impact nutrition behaviors and goals. Avital Pato Benari, MS, RD, is a
be easily accessible. Only one other For example, athletes want help in nutritionist, doctoral student, and
study noted trust as an essential making healthier choices when instructor in the Department of
factor for delivering nutrition Curriculum and Teaching at Boston
20
interventions to competitive athletes. University’s School of Education. Paula
In the Gain My Trust theme, daily or “For a nutritionist Quatromoni, DSc, MS, RD, is an
weekly contact that is convenient and assistant professor of nutrition in the
unstructured appears central to trust. to have a similar Department of Health Sciences and a
Interact with Me. This component impact, he or she must sports nutritionist at Boston University’s
of the model characterizes the desire Sargent College of Health and
of athletes to have relevant, earn the athlete’s trust, Rehabilitation Sciences.
meaningful, and ongoing working
relationships with nutrition express empathy, and References
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nutrition professionals to provide be easily accessible.” study of university athletes’ dietary
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creative combinations of group and traveling for competition, including Nutrition education for elite female
individual strategies. Consider this recommendations for making runners. The Physician & Sport
comment from one participant: selections from restaurant menus and Medicine. 1998;16:124-139.
“It can’t really be a lecture, because if packing nutritious snacks for long 3. Jacobson BH, Aldana SG. Current
you give a lecture you’re once again being bus rides. nutrition practice and knowledge of
told what to do and you’re not allowed to, Finally, athletes want ongoing varsity athletes. J Appl Sport Sci Res.
like, ask questions about why you should follow-up and monitoring. They need 1992;6:232-238.
do it and, you know…like just a evidence that their plan is working or 4. Rosenbloom CA, Skinner R.
conversation between two people while the opportunity to refine their plan if College athletes. In: Rosenbloom CA,
cooking…I don’t want somebody to tell it is not. ed. Sports Nutrition: A Guide for the
me how to eat. I want to have a dialogue Professional Working with Active People.
about why I should eat it and how it can Significance of this Model 3rd ed. Chicago, IL: American Dietetic
help me.” This work is unique in that it Association; 2000:283-294.
provides the first model for effective 5. Abood DA, Black DR. Health
Summarizing the Results nutrition intervention derived from education prevention for eating
In short, we found that nutrition the athletes’ perspective. Achterberg disorders among college female
education services for student & Miller21 claim that although athletes. Am J Health Behav.
■ ■ ■ ■ ■ numerous theories are currently used 2000;24:209-211.
4 in nutrition education, none of them 6. Beals KA, Manore MM. Nutritional
can fully predict behavior or status of female athletes with
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