The Nutrition Management Team

1
The Nutrition Management Team

• Elizabeth Swann, PhD, ATC
• Nova Southeastern University
• Fort Lauderdale, Florida

2
Warm Up Questions

• How many disordered eating patterns did you
  identify in the past year?
• Do you have mandatory educational sessions for
  athlete?
• What type of routine body assessments do you
  perform?
• Do you have written protocol in place?

3
Managing Nutrition

• Athletes with significant disordered eating
  patterns.
• Clinical history of diagnoses of an Eating
  Disorder.
• Self Report
• Suggested follow-up by coaches, teammates, etc.

4
Subclinical Eating Disorder

• Preoccupation with food, calories, and body
  weight
• Distorted body image
• Intense fear of gaining weight or becoming fat
• Attempting to reduce body weight and maintain low
  body weight
• Restrict energy intake
• Excessive exercise
• Pathogenic weight control methods
• Menstrual dysfunction

5
Female Triad
6
Eating Disorder Screening

• Questionnaire during pre-participation exam
• Reproductive History
• Dietary Habits
• In the last year, Highest and Lowest Weight
• Ideal weight, Red Flag 156 ½ lbs
• Eating Disorder Examination Interview
• One on One
• Eating Attitudes Test (EAT-26)
• http//www.ace-network.com/eatdis/EATtest.htm
• Physiologic Screening Test for Eating Disorders
• Black, Larkin, Coster, Leverenz, Abod
• JAT 200338(4)286-297

7
Eating Disorder Screening

• Physical Examination
• Vitals
• Visual Observation
• Body Mass Index (BMI)
• Body Composition Assessment
• Waist Hip Ratio
• Thyroid Evaluation
• Cardiac Evaluation

8
Treatment Approaches

• Under Direction of Team Physician
• Multidisciplinary Team Approach
• Intervention Program
• Nutrition Counseling
• Stress Management Counseling
• Behavioral Contracting
• Therapy
• Education

9
Multidisciplinary Approach

• Involves
• Nutritionist
• Psychologist or Psychiatrist
• Team Physician
• Certified Athletic Trainer
• Senior Womens Administrator
• Coach
• Family and Significant Others
• Other appropriate campus officials
• Establishes an intervention program

10
Objectives of an Intervention Program

• Deliver educational programming
• Establish non-threatening location where athlete
  can receive assistance and information
• Provide guidelines for coaches regarding
  communication with athletes!
• Maintain confidentiality among team members
• Establish a single, consistent intervention for
  each athlete (Written Protocol Procedure)

11
Real World Example

• Initial evaluation
• Weight/height history
• Exercise history
• 3-day dietary analysis
• Body composition measurements
• Visits to sports nutritionist
• Education regarding appropriate nutrition for
  sport
• Identifies goals for calorie and nutrient intake
• Discuss how to choose healthy foods, shopping and
  cooking tips, and eating on the road

12
Example cont.Individuals Involved

• Academic Advisor
• Athletic Trainer
• Coach
• Eating Disorder and Addiction Specialist
• Exercise Physiologist
• Family Counselor
• Nutritionist

• Sport Psychologist
• Sport Sociologist
• Strength and Conditioning Coach
• Student Counseling Center Psychologist
• Team Physician

13
NCAA Sports Medicine HandbookPlan of Action

• Meet with concerned individuals to gather
  information regarding the behavior of the athlete
• Initiate contact with the athlete to discuss
  concerns and identify the following steps
• No intervention may be taken but the
  athlete will be monitored
• Request that the athlete be evaluated by
  athletic trainer and team physician
• Suspension from participation

14
NCAA Sports Medicine HandbookPlan of Action

• If intervention is necessary, develop a plan to
  present to an Eating Disorders Intervention
  Team.
• Athlete may or may not be cleared for
  participation.
• Develop a plan and compliance contract

15
Treatment ApproachesEducation FIRST

• Nutrition to fuel Performance
• Weight loss/gain practices
• Developing attitudes toward body
• Changing attitudes toward fat and eating
• Misconceptions about good or bad foods
• Low carb
• Low fat
• Focus on health, not weight loss

16
Treatment ApproachesNutrition Counseling

• Establish regular pattern of eating through meal
  planning
• Proper nutrition and weight control
• de-emphasize weight
• Instill healthy eating habits
• Present facts not myths

17
Prevention Strategies

• Set objective and obtainable goals for body
  composition
• Discourage rapid weight loss methods and fad
  diets
• Initiate weight loss or gain with guidance
• Body composition and assessments should be
  private and confidential
• Facilitate education regarding nutrition and
  weight loss

18
Policy Behavioral Contracting

• Allow time for the development of a therapeutic
  relationship.
• Involve the athlete in the development of final
  document.
• Include appropriate outcomes and goals in
  contract.
• Provide a mechanism for monitoring progress
  toward goals.
• Carry out consequences with consistency.

19
Procedures

• Initial Assessment
• Pre-participation physical exam
• Lifestyle questionnaire
• Drug testing/alcohol policy
• Observed behaviors by ATC, Team Physician
• Identified level of risk
• No Risk
• Nutrition and Educational Seminars
• Possible Risk
• Further Assessment

20
Policy Development

• Athlete must be under the care of a physician
• If not by team physician, athlete should sign
  release of information form.
• Athlete must follow through with all assessments
• Athlete must attend scheduled appointments
• Establish consequences if miss a specified number
  of appointments
• Approval for competition and practice is
  determined by team physician

21
NSU Current Process

• Gathered The Crowd
• Presented research and immediate needs
• Gained Support from Administration
• Polished Protocol with Team Physician
• Educational Sessions, (Team of 3)
• Coaches first
• Athletes second
• Currently, interviewing nutritionists to find the
  best fit.

22
Take Home Points

• Administrative Support is necessary.
• Financial support is a BONUS!
• Team Physician Support is Crucial
• Observe and Report
• The Nutrition Management Team, togetherness.

23
Questions and Discussion