The preceding chapters have provided us with an overview of the key concepts in sports nutrition. While there are common themes, concepts and athlete goals, there are also individual challenges in translating these concepts into meaningful, practical sports nutrition advice. In this chapter, we will explore how to turn theoretical sports nutrition information and food knowledge into practical, individualised sports nutrition advice in various settings. We will also look at the roles of sports dietitians as well as other sport and nutrition professionals in providing nutrition advice and support for athletes.
LEARNING OUTCOMES
Upon completion of this chapter you will be able to:
• understand the role of a sports dietitian within the team of support people for an athlete
• describe the skills needed to work as a sports dietitian with individual athletes
• describe the skills needed to work as a sports dietitian with team sport athletes and within a team sport environment
• recognise the various roles of support staff in the implementation of team sports nutrition practices.
THE ROLE OF A SPORTS DIETITIAN: MORE THAN JUST DIETARY ADVICE
Sports dietitians are highly trained and specialised nutrition professionals. In Australia, accreditation as a sports dietitian requires completion of at least a four-year university degree in dietetics, additional training in sports nutrition and several years of practical experience. The environments in which sports dietitians work are varied and include private clinics, sports institutes, sports teams, universities, research and industry. In this chapter, we will focus on the two most common environments: private clinical practice and team sports.
There are many challenges to working as a sports dietitian, but the need to work independently, often as a sole practitioner, is perhaps the most common.
Communication and organisational skills are as important as clinical knowledge and skills. High-level communication skills are critical for building rapport with the athlete, as well as for detailed nutrition assessment and implementation of plans, and, perhaps even more importantly, for involving other members of the athlete support team in these processes. While there are equipment and technologies that can enhance what a sports dietitian does, none can replace good communication skills.
The ability to manage time, prioritise workflows and adjust to unexpected situations are skills common to many professional people, but critical to success as a sports dietitian, as we will explore below.
NON-TEAM ENVIRONMENT
One of the biggest challenges working in the private clinical setting is being remote from the other members of the athlete support team.
There are advantages to working within a sports medicine clinic, where the other professionals in the clinic are also involved with the same or similar athletes or sporting teams. However, this is not always possible so a thorough training history, medical history, analysis of goals, objectives and timelines, and body composition assessment are as important as a diet history (see Chapters 7 and 8 for more detail about dietary assessment and dietary counselling).
Understanding the roles of the other clinicians and being able to ask questions about non-nutritional management is helpful when planning nutrition interventions. For example, liaising with the athlete’s physiotherapist during injury rehabilitation can guide periodisation of energy and protein intakes during the different phases of the rehabilitation program. In addition, including other members of the multidisciplinary team in the nutritional planning conversation can increase the athlete’s support and adherence, as well as being a valuable source of insight into the athlete’s progress and challenges, particularly between consultations.
Importantly, the athletes who come to private clinical practice are often highly motivated, even if they do not compete at an elite level. In fact, some age group and recreational athletes may be more motivated to optimise their nutrition practice than elite or professional athletes, and may come with unique needs not seen in elite athletes.
Where possible, it is useful to encourage the athlete to come to their appointment prepared with training diaries or plans and even a multi-day food record. Unfortunately, in private clinical practice it is not always possible to know much about a client until they walk through the door; however, it pays to research the athlete’s chosen sport/event in advance, if possible. If it is a sport with which you are unfamiliar, it is far better to recognise the limitations of your knowledge and invest time asking questions of the athlete (or spending time doing some research) than to pretend to know (and demonstrate your lack of knowledge) and lose the client.
Take time to understand what it is that the athlete wants from you. It may be a complete nutrition assessment and eating pattern overhaul; it may be some targeted questions or a competition or race-day plan; or it may be a new clinical issue (such as diagnosis of diabetes or other health concern) that requires reassessment of current training nutrition strategies.
When working in private practice, it is highly recommended to get involved with the local sports medicine community. Being visible within the sports medicine community has many advantages. Involvement in professional meetings, conferences and professional development sessions can raise your profile and lead to increased referrals and other opportunities with athletes, teams and organisations that other sports medicine professionals are involved with, as well as providing a better understanding of the roles of other members of the athlete support team. Having professional networks for support is critical to effective private practice so that you know who to call or email when you need support. Another benefit is gaining insights into training, medical and nutritional practices from other sports and other practitioners, which can often be applied or adapted to other athletes.
TEAM ENVIRONMENT
There are common elements to working in private clinical practice and working in sporting teams, institutes or sporting organisations, but there are also many additional considerations and roles when providing support to a team or squad. The individual client/athlete nutrition assessment and advice are essentially the same regardless of the setting; however, the structures in place in a team or organisation add both advantages and complexity to the implementation.
Access to other members of the athlete support team is likely to be easier, or at least more clear and consistent, in a team environment, but communication is essential for success. Within a sporting team environment, a sports dietitian would commonly interact with many other individuals including:
• players and athletes
• administrators and administrative staff
• sponsorship and marketing staff
• coaches
• physical performance staff/sports science staff
• support staff (team managers, trainers, volunteers)
• medical staff
• other allied health professionals (physiotherapy, psychology, massage)
• food service and catering suppliers, food companies
• supplement companies, representatives
• universities and academic researchers.
Starting in a new team environment can be daunting, particularly if there has been a lack of nutrition services provided previously. The team is likely to have expectations of the role, although these may not necessarily align with your own expectations, skills and abilities. In many situations, budget constraints may mean there is a specific focus area while other aspects of nutrition are considered less important or optional extras. When starting out, it is important to get a clear role description and familiarise yourself with governance structures, communication and reporting lines and the areas considered high priority. Then you need to identify who everyone is, what their roles are, where everything is and how everything is currently working. Oh, and as quick as you can please!
Box 26.1: Tips for sports dietitians starting out in a new team
• Make as many friends as you can by listening to all of the people involved and understanding the team dynamics.
• Make as many notes as you can and be prepared to report back.
• Pick off low-hanging fruit as far as problems go—look for easy fixes and efficiencies that can quickly build your credibility.
• Be prepared to be flexible and deal with issues at short notice. It is not uncommon to be asked to change a plan after a team loss or a coaching observation, even though it may not always appear rational or a high priority.
Unless you’re starting out with a newly created club, there are likely to be established systems and structures that have developed over many years. Some of these may have evolved over time, others remain unchanged because no one remembers why things are done a certain way, and others are compromised due to limited resources, personnel, skills or time. Be prepared to invest time in observation, thinking about how you see an ideal set up and assessing what is and what is not working. Talk to as many of the support staff as you can to gather information about how well they think systems work, and be prepared to explore the history of how the team/club/organisation has evolved to better understand how things work.
WORKING WITH PLAYERS AND ATHLETES
Invest time learning who the players are, their experience levels, those perceived to be good at what they do and those who need work. With this knowledge in mind, remain objective and be prepared to assess.
In any team there will be leaders and influencers who other athletes will look to, observe or aspire to be. Invest time figuring out who the ‘influencers’ and ‘early-adopters’ are and get to know what they do that can be used to guide other players/ athletes. If you are trying to implement a new strategy or change an existing practice, you can make good use of the ‘early-adopters’ to help sell what you are trying to do. The dietitian’s role is often linked with weight reduction or the need to reduce skinfolds, and in some teams it is seen as a negative or ‘being in trouble’ to get a dietitian’s input. Being seen to work with the ‘good’ athletes who others consider not to need your input is a valuable way to build credibility and reduce anxiety of ‘having to see the dietitian’!
Ultimately, the sports dietitian’s goal is to create an environment in which athletes feel comfortable asking for nutritional advice to improve their performance.
It is important to learn the player schedules to find times to fit in appointments. These may be small windows of opportunity, sometimes just to complete an assessment before a training session with a plan to follow up after the training session. These conversations may be in an office or quiet room, changerooms, corridors, warm-up areas, the gym, the race, recovery stations, over lunch or with a coffee or on the training ground. Some players may be quite comfortable having a discussion in front of teammates, others may only be comfortable in a quiet room away from prying eyes. It is always a good idea to offer a quiet space and ask what the player would prefer. There are many factors that may affect a player’s ability on a daily basis to keep an appointment time, so be flexible, reschedule as needed, remind (and remind again), be in a place the players can easily find you and let other staff know you have an appointment so they can also remind the player.
Importantly, when setting up appointments, ask or learn how the players prefer to be contacted or notified, as this is likely to vary. Phone calls, text messaging and social media applications may be more effective than emails. Appointment times on a prominent noticeboard can be helpful if the players know to look there, but useless if not. It is prudent not to assume a player will remember their appointment.
Not every conversation is formal or takes place in a consultation room. While appointments generally make life easier to perform more detailed assessments and provide education, it is equally important to be visible and to ‘float’ around so as to be available to ask questions. Being at training, or key positions such as recovery stations, often leads to conversations that develop rapport and allow you to demonstrate what you do in a more ‘public’ space. Sometimes overhearing player conversations (or players overhearing your conversations) encourages other individual or group discussions, initiated by the players or the dietitian.
Obviously, individual nutrition assessment and education are a major part of a sports dietitian’s responsibilities, but there are many other aspects to the role that may take up as much or more time.
The amount of time dealing directly with administrators and administrative staff will vary from role to role and the size of the club/team/organisation. There are likely to be meetings and committees set up to deal with budgets and expenditure, policy and procedural issues, and often integrity issues, which are now commonplace in major sporting competitions. You may be asked to complete accreditation procedures before being employed or to work in specific competitions. Where teams travel for competition, a good working relationship with the person organising the travel is essential to ensure that arrangements for meals are consistent with the principles you are applying in individual consultations, and that individual needs (intolerances, beliefs, goals) and team philosophies are appropriately catered for.
WORKING WITH ADMINISTRATIVE AND COACHING STAFF
Sponsorship and marketing is a key role in any major sporting organisation. There are times when sponsorship opportunities arise that may be beneficial to the nutrition program and the club, but there will also be times where a sponsorship opportunity may conflict, so it is important to build a solid relationship with the sponsorship and marketing team. In addition, the sponsorship and marketing team will be interested in what you might need for the team and can help leverage a deal. Often the dealings will be for sports nutrition supplements or food products, where knowledge of the product and doping risks is crucial to signing a deal. A deal that adds no value to what you do or causes major conflicts needs to be addressed with care. When sponsorship deals are done, it is important to understand details such as the value of the deal (including contraindications or agreed spends), sponsor expectations (such as product placement during games) and club expectations (such as product batch-testing, product availability and ordering/purchasing arrangements).
Coaches will bring their own attitudes and philosophies to a team, and this includes beliefs about nutrition and nutrition services. Some coaches will have worked with sports dietitians before, while others may have had limited exposure to the role. Experiences may have been both positive and negative, so it is wise to establish rapport with coaching staff, learn their expectations and explain your role. Governance structures will vary. Some coaches like to have direct communication with the dietitian, while others may prefer to communicate through an intermediary such as a high-performance manager. A coach’s personal philosophies around nutrition may not always align with current or optimal sports nutrition practices and can conflict with individual advice you give to a player—just another challenge for a sports dietitian in the team environment.
It is common for a sports dietitian to report to a manager of high performance or sports science and be included in the sports science team. Developing an open relationship with the high-performance manager is critical for the success of both roles but can be challenging if philosophies are not aligned. Be prepared to be challenged to find small performance gains through practice efficiencies, education and nutritional supplement strategies. Be prepared to defend nutrition strategies with evidence, but also to propose and trial new practices in a strategic way. The physical performance team will expect a level of innovation but be mindful if innovation becomes more important than getting basic practices right.
WORKING WITH NUTRITION SUPPORT STAFF
A sports dietitian is the best person to oversee team nutrition strategies, but the sports science team is critical to the implementation of team nutrition practices, with many roles not exclusive to sports dietitians. Sports science tasks may include taking anthropometric measurements such as skinfolds and organising DXA scans, monitoring hydration practices with urine specific gravity measurements, fluid balance and sweat studies, organising and monitoring recovery nutrition practices, helping with game-day nutrition practices, chasing player preferences and feedback, and providing feedback on team meals, particularly when teams travel without a dietitian. While sports dietitians in larger teams (such as AFL or rugby teams) will often assume these roles, in smaller teams with limited sports dietitian time these will often fall to sports science professionals (including students) instead. In most teams, the sports science staff will have far more frequent interactions with players and are well placed to observe practices, interpret training data, overhear conversations, monitor stock levels and usage, and liaise with coaches to provide valuable insights for the team sports dietitian.
Other support staff, such as team managers, trainers, volunteers, medical staff and other allied health professionals (physiotherapy, psychology, massage, player welfare), are important to engage in team-focused nutrition philosophies and strategies. An effective working relationship with all of these people will have a major impact on how successful team nutrition strategies are, as they will often be involved in the implementation. Involving support staff in decision-making and implementation of nutrition strategies is a great way to demonstrate your knowledge, skills and value within the team environment. Perhaps even more importantly, many of these staff are likely to be present in the team environment more often than the sports dietitian, so be mindful that the support staff will be crucial to maintaining nutrition strategies when the dietitian is not around.
Support staff are often able to provide significant observational feedback on individual practices and team nutrition strategies. Major sporting teams may take a sports dietitian when travelling for competition; however, this is a luxury for smaller teams, so a sports dietitian will rely on the game-day or competition-day observations of support staff.
Player welfare staff are often employed by sporting teams and can provide valuable insight into player living situations, personal relationships, mental health and coping strategies and other personal insights that can assist a sports dietitian to work effectively with individuals within a team environment. This insight can help the sports dietitian to be sensitive to personal issues that may impact on an athlete’s ability to implement nutrition strategies and to identify issues that the athlete may disclose in a nutrition consultation.
A sports dietitian in a team environment will also spend a significant amount of time in contact with food service and catering suppliers, food companies, supplement companies and representatives. The range of activities can vary from arranging team meals during the training week and team meals for away trips, catering for club events, organising cooking sessions for players, sourcing new products for sampling and supply, and clarifying nutrition information. Good food product knowledge as well as knowledge of commercial cooking practices is essential for these roles. Cooking food in commercial quantities is very different from cooking at home, and products commonly used at home may not be available to commercial caterers. Catering for individual needs can be challenging with commercial catering but being prepared, having realistic expectations and investing time speaking with caterers can save unnecessary stress and negative feedback.
It is common for the sports dietitian in a team environment to be provided with samples of new products that need to be assessed for suitability. Endorsement by association is a common goal of product sales and marketing people, but remain objective and utilise other staff within the organisation to make decisions about new products.
It is common in elite sporting teams to have significant links with universities and academic researchers. Not only are these relationships valuable for keeping abreast of the latest research, they can also be useful for researching and validating nutritional interventions, and supporting students to complete projects and clinical placements within the team environment.
SUMMARY AND KEY MESSAGES
After reading this chapter, you should be familiar with the role of a sports dietitian in private practice and in team settings, and be able to describe a number of strategies for working with athletes and other members of sports organisations. You should also be familiar with the nutrition-related roles of other support staff in team environments. For more information about the differences in scope of practice for sport and nutrition professionals, refer to the Introduction.
Key messages
• Sports dietitians are highly trained and specialised nutrition professionals who work in a variety of settings.
• Communication and organisational skills are integral to successful practice in both one-on-one and team settings.
• It is important to invest time to observe and understand current practices when implementing change.
• Sports dietitians should understand the roles of other staff in the athlete support team and utilise their knowledge and skills to enhance their practice.
• There are a number of staff within sporting organisations who play a role in improving nutrition practices.