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The Nutrition Management Team

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Title: 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
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