Jan 29, 2015Mind Over Menu
When advising athletes about their eating habits, you shouldn’t just talk carbs, calories, and calcium. You also need to address the psychology behind their relationship with food.
By Laura Ulrich
Laura Ulrich is a contributing writer for Training & Conditioning. She can be reached at: [email protected].
Nutritionists who counsel the general population often focus on the mental side of eating. They help clients understand how thoughts and feelings affect eating behaviors, and explain concepts like “emotional eating” and “comfort food.” When it comes to the average person trying to eat right, nutritionists know that much of the process takes place in the mind.
However, nutrition advice aimed at athletes tends to take a very different tone, focusing instead on grams of carbohydrate and protein, percentages of body fat and muscle, and technical advice for exactly what to eat and when. Since athletes are eating for their sport, it’s assumed they aren’t subject to the same cognitive struggles over food as the rest of us.
“Sometimes we forget that athletes are human, too,” says Lisa Dorfman, MS, RD, CSSD, LMHC, Sports Nutritionist at the University of Miami. “On the one hand, performance nutrition is about the science–on paper, it does come down to grams and ounces. But an athlete’s thoughts and emotions can interfere with the wonderful formula you give them. Unless you address the psychological side of eating, you’re not going to be successful.”
In fact, Ingrid Skoog, MS, RD, Director of Sports Nutrition at Oregon State University, believes the emotional side of sports nutrition is actually the most difficult training challenge her student-athletes face. “If an athlete shows up to training and practice and puts in their best effort, they’re done for the day,” she says. “But food decisions have to be made all day long. Each scenario poses different psychological hurdles for making the right choices.”
FOOD TRAJECTORIES
Dealing with the emotional side of the nutrition formula starts with educating athletes about how their thoughts and feelings play a big role in the food choices they make. “It’s critical to help them understand that there’s a lot more going on with eating than meets the eye,” says Dorfman. “Nearly every time we select a food, emotions play a large role in that choice.”
Dorfman refers to this concept as “food trajectories.” “Food trajectories are the feelings, connections, and ideas we bring to the table with us,” she says. “They operate below the surface to influence our food choices and how we feel when we eat particular foods. An individual’s food trajectories are shaped by their family, their culture, and their own experiences.”
For example, Dorfman recently worked with a swimmer who reported regularly veering from her eating plan to indulge intense cravings for chocolate. “She had recently moved to the U.S. from Switzerland,” Dorfman says. “For her, chocolate meant home and happiness. It was perfectly obvious to me why she wanted to eat it often, but as far as she was concerned, it had simply become an off-limits food that she craved and then felt guilty for eating.”
Counseling this athlete focused on helping her see the psychological connection. “I explained to her there is absolutely nothing wrong with having food connected to emotions–it’s human,” Dorfman says. “And once we uncover the association, we can make a conscious decision about how we handle it.
“We decided that after a big meet or heavy training, there is nothing wrong with her having some chocolate,” Dorfman continues. “But I also told her, ‘If you’re going to do it, don’t settle for cheap drug store chocolate–go out and buy the best chocolate you can find and enjoy it. Acknowledge that it’s making you feel closer to home and relish the feeling. If you do that with awareness, just a small amount will satisfy you.'”
The problems arise when athletes don’t realize why they crave the foods they do. “Instead of understanding that they want apple pie because it reminds them of home and going and getting a great slice of pie,” explains Dorfman, “they end up eating apple tarts from a vending machine and then feeling guilty about it.”
One of the best ways to help athletes realize when their emotions are compromising their nutritional goals is asking them to track what they eat and how they feel while they’re eating. “I ask almost all of the athletes I work with to keep this kind of log,” says Nancy Rodriguez, PhD, RD, Sports Nutritionist at the University of Connecticut. “Seeing it on paper can really help them identify any emotional component to their diet.
“For example, an athlete may come in and tell me they ‘blow’ their eating plan every night by snacking on chips or ice cream while they study,” she continues. “If they log how they’re feeling when they eat, they may discover that’s the time of day when they really miss their family. Then we’ll talk about things they can do at those times instead of snacking, like calling someone from home.”
At Oregon State, an athlete who had lost 20 pounds asked Skoog what he could do to lower his body fat even more. Because the athlete had been trying to lose weight, Skoog was impressed. But when she found out that a breakup with his girlfriend had lead to restricted eating, she changed her advice from scientific to psychological.
“He’d discovered that restricting his food and losing weight were things he could focus on to avoid his feelings,” she explains. “The connection between food and feelings is something more often discussed with women, but men encounter the same issues.”
Whether the issue is with calorie restriction or binging, Skoog works to help athletes understand that when negative emotions hit, food is a temporary distraction and not a permanent fix. “I talk with them about what’s going on in their lives and I tell them, ‘Let’s not get this confused with food,'” she says. “Food cannot cure depression or anxiety or lack of sleep. To fix any problems, we need to address the real issue.”
BATTLING BODY IMAGE
In addition to emotions, another psychological factor driving athletes’ food choices is how they feel about their bodies. When an athlete is struggling with body image issues, it can present a big hurdle to implementing performance nutrition advice.
“I see this issue frequently,” Skoog says. “Female athletes in particular can feel that the body they are being asked to have for their sport is at odds with the body they want. They compare themselves to their peers and decide they are too big or too muscular. They’re eating 1,200 calories a day and trying to get thinner, and when I tell them they need to eat 2,200 calories a day, they’re afraid to do it.”
In sports where being thin is desirable, athletes can be at increased risk. “If they’re one of the larger athletes on the team, they look at the thinner athletes and decide they should look like that,” says Amy Freel, MS, RD, CSSD, Director of Sports Nutrition at Virginia Tech. “How body conscious the sport is and the type of uniform the team wears are factors. We see a lot of this among distance runners, volleyball players, soccer players, swimmers, and gymnasts.”
Skoog has also noticed an increase in the number of male athletes battling body image issues. “It’s a disturbing trend,” she says. “I have more men coming in and comparing their body shape to that of their teammates. It’s even happening in sports you wouldn’t expect–I’ve had this issue come up recently with football players and golfers.”
Freel says there are ways to tell whether an athlete’s body image is getting in the way of his or her fueling habits. For example, self-reported eating patterns help find the symptoms: In addition to restricting calories, an athlete may hesitate to eat after working out and go long periods without eating during the day.
Discussions with these athletes should center on helping them change their self-perception and appreciate their own body, and must be approached with sensitivity and compassion. “I focus on praising their body type and emphasizing the positives of it,” Freel says. “I help them think about the benefits that come from their shape and size–I might say, ‘Maybe it’s why you’re so good at your position.’
“I keep the focus solely on performance and try to get them to not dwell on appearance,” she continues. “Athletes with body image issues are often struggling to accept themselves on a very basic level and you need to be very sensitive to that and help them through it.”
Skoog has another tactic that works well. “I point to role models who don’t fit the body stereotype–an athlete who has gone before them on their team or a professional athlete they respect,” she says. “I ask them to think about the self-confidence that athlete embodies, and I tell them they can get there, too.”
OTHER HURDLES
Sports nutritionists point to several other mental stumbling blocks athletes face. Each comes with its own set of solutions.
Eating perfectionism: Some athletes actually try too hard to eat exactly right. “These athletes become very preoccupied with the numbers,” Skoog says. “They get into the minutiae of weight and counting things. Male athletes can become very focused on their exact body comp–four percent body fat is okay, five percent is not.
“The athlete with food perfectionism may not end up having anorexia or bulimia,” she continues. “But they’re obsessing about food, and as a result they’re not thinking about other things.”
To help, Skoog addresses the issue head-on. “I’ll ask them point-blank if they consider themselves a perfectionist,” she says. “Usually, they’ll say yes. It’s an aspect of their personality they’re proud of. Then we talk about what benefits it has for them. Most of them believe it causes them to work harder than they otherwise would.
“From my experience, though, eating perfectionism is rooted in a deeply held belief that they are not worthy–that it’s a fluke that they’re successful,” she continues. “They secretly believe that if they let up even a little bit, everything will fall apart. They believe if they’re not 100 percent perfect, they’ll be a 100 percent failure.”
Many times, simply helping an athlete uncover and articulate their subconscious beliefs about perfection and failure helps them relax eating rules. “It can take a while, because this is a deeply rooted way of seeing themselves and the world,” Skoog says. “My job is to convince them that they have a lot more to lose by obsessing over being a perfect eater than they have to gain. I encourage them to try having some flexibility.”
Peer pressure: Wanting to fit in with friends can pose another hurdle to performance nutrition. “Athletes tell me, ‘My friends go out for ice cream three nights a week and I want to go with them to be part of the group, but I know it’s causing problems for my nutritional goals,'” Freel says. “That’s a hard one. You want them to be social–that’s really important.”
Dorfman encounters the same issue. “A football player trying to manage his weight who goes out for pizza with his teammates isn’t going to want to stick out by just ordering a salad,” she says. “So we work on options: He can eat fewer slices, or take the cheese off the second slice, or cut back a little bit during the day to leave room. I don’t recommend that on a daily basis, but occasionally it’s okay.”
Ingrained misinformation: This is the athlete who holds strongly to certain beliefs about food that aren’t accurate. “Maybe he believes all carbohydrates are bad, tries to avoid all fats, or refuses to eat after 6 p.m.,” Dorfman says. “They’ve picked up a message and bought into it, and as a result, they aren’t open to hearing accurate nutrition advice.”
Rather than arguing with an ingrained belief, Skoog first asks the athlete to evaluate his or her own performance. “If an athlete tells me she follows a low-carb or low-fat diet, I’ll ask, ‘How is that working for you? How do you feel after a workout?'” she says. “A lot of times athletes who are following these nutrition myths are performing below their high school level. When they analyze how their nutrition is affecting them, I can start to debunk the myths.”
Rodriguez has had success by showing misguided athletes scientific studies that help dispel myths, particularly ones that reveal how their mistaken belief can damage performance. “When they can see the evidence right there in front of them, most will let go of the myths,” she says.
Too many temptations: Today’s college campuses attract students by boasting of their great dining halls, but for student-athletes, the plethora of choices and easy access to comfort foods can be hard to resist. At UConn, athletes receive shopping lists, cookbooks, and handouts on making healthy choices when eating in dining halls. “Overcoming this hurdle is about making sure athletes are prepared,” Rodriguez says.
Dorfman counters the problem by telling her athletes to plan ahead. “It’s hard to resist the temptation to eat a bag of chips when you’re hungry and it’s all you have around,” she says. “I teach my athletes to pack for the day like they’re going on a trip, and I give them lists of foods to put in their bags–a banana, a protein bar, pudding, a shake, an electrolyte drink. I make sure they have a collection of protein, carbohydrate, and fat and that the foods appeal to them. You can’t ignore the taste factor. If the dining hall offers their favorite comfort foods and what’s in their bag is unappealing, it’s going to stay in their bag.”
RECOGNIZING RED FLAGS
If it’s common for athletes to face mental challenges to eating right, how do you know when that challenge represents a serious psychological problem? “Psychological issues with eating and genuine eating disorders exist on a continuum,” explains Gary Bennett, PhD, Sports Psychologist at Virginia Tech. “It starts with a small issue and culminates in a diagnosable disorder.
“An athlete who has taken the first step on the path to an eating disorder is usually struggling with body image and restricting calories or counting everything they eat and engaging in eating perfectionism,” he continues.
That’s why it’s critical to quickly identify an athlete who is struggling and step in. “It’s incredibly important that these athletes get help early on,” Bennett says. “It’s much easier to help an athlete when their mental obstacle is still small. The longer the issue goes on, the harder it is to change.”
Bennett suggests looking for certain red flags that indicate when an athlete’s food issues need immediate attention. “Look for lists of forbidden foods or rigid, highly specific lists of foods an athlete will and won’t eat,” he says. “When you’re eating with athletes on the road, that can be a good time to spot problems. Also look for athletes who are doing additional workouts on their own.”
Other warning signs include performance that is highly variable and preoccupation with nutritional supplements, Skoog says. Shying away from social contexts involving food should also trigger concern.
When Freel suspects an athlete’s food struggles range into disordered eating territory, she gathers as much information as she can. “I get input from the athletic trainer, the strength coach, and the sport coach about what they’re seeing with the athlete,” she says. “Often, teammates will speak up with concerns as well. If I have any suspicion that the issue goes beyond my expertise, I refer out immediately to our on-staff counselor.”
Skoog is quick to refer as well. “It’s far better to err on the side of caution,” she says. “If I have any doubts at all, I get them connected with a therapist. I tell them, ‘It’s just like when you go to practice and coach teaches you a new skill. Therapists have a box of tools they can share with you–it just happens in an office instead of on the field.’ Athletes tend to be very receptive to counseling when you present it that way.”
A CONSISTENT MESSAGE
Because the psychological side of nutrition can go under the radar, nutritionists’ last piece of advice is to get everyone in the athletic department on board with the program. One key is for everyone who communicates with athletes to realize the power of the messages they send.
“I have had athletes tell me, ‘My high school coach said I was fat, and I’ve been struggling with that ever since,'” Bennett says. “High school and college athletes are incredibly sensitive to what is said to them about their bodies, whether it comes from a coach, athletic trainer, or strength coach.
“One of the biggest mistakes a coach or athletic trainer can make is to talk about the athlete’s size, shape, or weight,” he continues. “Instead, talk about performance. Does the athlete need to be stronger or faster? If so, how can he or she accomplish that?”
Skoog believes nutrition advice must be consistent, whether it comes from a coach or an athletic trainer. “Everybody has to do a better job of working together to present a single, coherent message,” she says, “and everybody needs to work together on what they want that message to be.”
At Virginia Tech, that effort includes a multidisciplinary team called the Nutrition and Performance Committee, which was formed about five years ago. Freel and Bennett sit on the committee along with the team physician, members of the athletic training staff, strength and conditioning coaches, and sport coaches.
“We meet monthly to share information, and anyone who has noticed an athlete struggling with food can bring it up,” Bennett says. “Anyone outside the committee who has noticed an issue can attend and talk about it as well.”
In addition to their monthly meetings, the group works to educate the rest of the staff. “For example, we’ll give a presentation on eating-related issues during a monthly head coaches’ meeting,” Bennett says. “It really helps us make sure we’re all sending the same message about food–that the priority is fueling for performance.”
And fueling for performance, instead of emotion, will get athletes eating right for life. “Most of our student-athletes won’t go on to play professional sports, but all of them will keep making eating decisions for the rest of their lives,” says Rodriguez. “If they leave our programs with an understanding of how their psychology affects those decisions, we’ve given them a wonderful tool.”
Sidebar: FOCUS ON FROSH
Perhaps no other group of student-athletes faces more mental challenges when it comes to eating than college freshmen. “For the first time, these young people are completely responsible for deciding what to eat,” says Amy Freel, MS, RD, CSSD, Director of Sports Nutrition at Virginia Tech. “And at the same time, fueling for performance has suddenly become much more important, since they’re facing a higher level of competition.”
Stress is also at its peak for freshmen, increasing the odds they’ll succumb to over-indulging in comfort foods or not be able to control negative eating habits. Female athletes can find their post-puberty bodies easily gaining fat and weightroom work adding muscles they don’t like the look of. “And social relationships take on a new importance in college, which can lead to a new level of concern over physical appearance,” says Gary Bennett, PhD, Sports Psychologist at Virginia Tech.
The dynamics of college athletics can pose another hurdle. “In the preseason, they start training heavily, and they become leaner,” says Lisa Dorfman, MS, RD, CSSD, LMHC, Sports Nutritionist at the University of Miami. “Then the competition season starts, and if they’re on the bench, they might actually start gaining weight. That can be a risky time for young athletes who have issues with food and eating.”
Helping freshmen establish healthy relationships with food and their bodies means sending them the right messages as soon as they hit campus. It also entails quickly identifying individuals who are struggling with eating-related concerns and getting them the help they need.
Freel meets with all incoming freshmen during orientation. “I introduce myself and give them a lot of written information on fueling for performance and eating on campus,” she says. “I also make sure they know how to find me and that I am available if they have any concerns.”
“One of my focuses with freshmen is to get them connected with counseling if they have any eating concerns,” says Ingrid Skoog, MS, RD, Director of Sports Nutrition at Oregon State University. “The right counselor can help them see the issue clearly right off the bat and confront it, and then we have three or four years to help them hone those mental skills.”
Nancy Rodriguez, PhD, RD, Sports Nutritionist at the University of Connecticut, has three registered dieticians who screen athletes for eating concerns at pre-participation physicals. She also asks her school’s strength and conditioning staff to address the freshmen. “I like them to hear the same information again from the strength and conditioning coaches, so I’ve checked off on a presentation they give,” she says.
“It’s important for everyone who works with freshman athletes to be aware of and empathetic to the pressure they’re under,” Rodriguez continues. “That pressure can set them up for eating-related issues, but with the right help and tools, those issues can be addressed quickly, before they become true stumbling blocks to health and performance.
