Dr Meghan Bentley

Problematic Low Energy Availability (LEA)* and Relative Energy Deficiency in Sport (REDs)* are threats to athlete health, wellbeing, and performance (*see Figure 1 for definitions). The prevalence of LEA/REDs in athletes ranges from 23% – 80% (females) and 15% – 70% (males) (1). Whilst scientific advances in LEA/REDs have strengthened understanding of how to identify, detect, and treat LEA/REDs (1), shifting focus upstream to preventing LEA/REDs is warranted.

Designing and implementing successful dietary interventions is integral to the role of sports nutrition professionals. Despite this, no review has evaluated sports nutrition interventions and consequently their active ingredients are not defined. This systematic review aimed to identify the behavioural strategies used in sports nutrition interventions and to explore any relationship between the strategies employed and intervention effects. SPORTDiscus, MEDLINE, CINAHL, PubMed, and SCOPUS were searched for behavioural interventions that aimed to change athletes' dietary behaviour. Behavioural interventions were eligible for inclusion provided pre and post-measures of dietary intake were reported. The protocol adheres to Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocols (PRISMA-P). Each study was coded against the “Template for Intervention Description and Replication” (TIDieR) checklist and the Behaviour change technique (BCT) taxonomy v1. Only 19 BCTs are currently employed within sports nutrition interventions suggesting that 80% of the available BCTs are not being used. Only three studies were theory informed and the standard of reporting across all studies requires substantial improvement. However, the majority of studies reported changes in athletes’ dietary behaviour post-intervention. This review highlights an absence of evidence-informed approaches defining the professional practice of sports nutrition and illuminates a limited application of BCTs within the sports nutrition field. Consequently, the authors provide a framework and guide for intervention development to increase rigour and effectiveness of future sports nutrition interventions. PROSPERO registration number: CRD42018072283.

Qualitative research can facilitate an understanding of the richness and complexity of human experience, shedding light on multifaceted relationships that exist within sporting environments. Within the field of sport nutrition, such immersive methods are not commonplace. Yet could offer a significant contribution to our understanding and help practitioners navigate their values and identity within the challenging world of high-performance sport. The first author, a neophyte sport nutrition researcher-practitioner, reflects upon her experience over a four-year period of integrating into a high-performance organisation and embarking upon a research programme and career as a sport nutritionist. Drawing on field notes, reflexive journal entries, and regular research team discussions, three moments of discovery are shared: 1) Navigating the transition into high-performance sport, 2) Understanding the performance pressures and emotional burden experienced by athletes, and 3) Negotiating collaboration in the nutritionist-athlete relationship. Through this confessional tale, we recognise the development of a sport nutritionist’s values and identity is unlikely to be smooth or linear. Instead, it may be a bumpy voyage of self-inquiry and discovery, shaped by diverse cultural experiences. To help future sport nutrition researcher-practitioners entering the field, we offer three meaningful development activities including 1) engaging in reflexive practice with critical friends to explore the dilemmas and uncertainties that may impact personal and professional development, 2) fostering intellectual candour when engaging in reflexive practice to facilitate self-discovery and growth, and 3) prioritise reading the growing literature on sport and organisational culture to inform and influence the delivery of sport nutrition practice.

Background Despite the increasing presence of chefs in professional football and their influence on nutrition provision, evidence on the specific roles and responsibilities of chefs remains limited. This study aimed to explore the role(s) of chefs and describe the characteristics of catering services within English professional football. Methods Sixty-two chefs (56 males, 6 females) in club supervisory positions within the top four divisions of the English male football pyramid were surveyed during the 2022–2023 season. Results Participants were predominantly male, aged 35–44 years, and employed on full-time permanent contracts. Sixteen participants had the term ‘performance’ in their contracted job title. Participants averaged 24 years of chef work experience, 8 years of football-specific experience, and 45 working hours per week. Twenty-nine participants had responsibility for providing nutrition advice to players, whereas the vast majority used nutritional supplements and produced bespoke nutritional items as part of the catering services provided. Most participants rated their sport nutrition knowledge from ‘good’ to ‘excellent’ although only 18 had undertaken formal sport nutrition training. Fifty-one participants frequently followed a periodised nutrition approach, however 31 lacked defined nutrition targets. Tasks such as travelling to fixtures, hotel menu planning, and hotel food provision were most frequent in the Premier League. Catering services in the Premier League mostly operated year-round, seven days a week, employing 4 or more chefs, and spending £6,000 or more per week, with declining operations, costs, and staffing towards the lower divisions. Forty-nine services covered male academy teams alongside the male senior team. Only 15 covered female senior teams, of which 7 extended coverage to female academy teams. Conclusions Chefs undertake key roles both at and away from the club training ground to implement sport nutrition strategies. Inconsistencies in strategy implementation and catering practices were identified, along with league disparities and gender inequalities in service provision. Our findings underscore the need for a quality-assurance framework for accreditation and increased opportunities for chef-tailored sport nutrition education. We advocate for the title ‘sport chef’, and the establishment of a regulatory body to support the practice of chefs working in professional football.

Objectives: Poor adherence to nutritional guidance by athletes may compromise their health and performance. Enhancing adherence is therefore an important performance and welfare strategy. The aim of this study was to qualitatively explore the barriers and enablers of elite athletes' adherence to nutritional guidelines. Design: Underpinned by our constructionist epistemological position and our relativist ontology, we conducted a qualitative study using focus groups. Methods: We used the Capability, Opportunity, and Motivation Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) to conduct focus group discussions with a purposive sample of 39 UK-based funded athletes (mean age = 23 ± 3.81), participating in either Olympic and Paralympic sport (n = 30) or professional sport (n = 9), who had access to a nutritionist. Data were analysed using reflexive thematic analysis. Results: Athlete adherence to nutritional guidance was seasonal and included inadequate energy intakes and episodes of binge eating. Underpinning these behaviours, athletes' emotional barriers (motivation) are reinforced through their social interactions within the high-performance environment (opportunity) and athletes' training environment limits developmental opportunities for food planning (capability). However, a holistic-developmental approach by the sports nutritionists (opportunity) supports athlete wellbeing and nutritional adherence. Conclusion: These findings advance theoretical understanding of the barriers and enablers of nutritional adherence amongst elite-level athletes in high-performance sport and present a number of significant implications for athlete support personnel seeking to enhance performance in demanding sporting contexts. Drawing on the Behaviour Change Wheel (BCW), recommendations include the need to 1) train and educate sports nutritionists in human behaviour, 2) update regulations for sports nutrition profession practice to acknowledge the skills required to support athletes' emotional wellbeing, 3), educate coaches on the sensitivity of body weight and composition and develop guidelines for monitoring athletes' body weight and composition in sport, 4) persuade influential leaders to develop culture guidelines that shift the performance-narrative of high-performance (i.e., environmental restructuring).

Background Despite the importance of evidence-based nutrition in elite football, Premier League players often exhibit sub-optimal dietary behaviours, highlighting the need for improved guideline implementation. Purpose This study used the COM-B model and Theoretical Domains Framework (TDF) to explore sport nutritionists’ perceived barriers and enablers to applying the UEFA Consensus Statement on Nutrition. Method Twelve lead sport nutritionists from English Premier League clubs took part in semi-structured interviews (1 hour ± 44 mins). The interviews were structured using the COM-B and TDF and analysed thematically. Results Six key themes were identified, representing six barriers and two enablers, encompassing all three components of the COM-B model and seven TDF domains. Psychological capability barriers included challenges in changing players’ dietary behaviours. Reflective motivation was hindered by doubts regarding the scientific basis of carbohydrate and body composition guidelines, alongside concerns over players’ ability to practically adhere to carbohydrate recommendations. Physical and social opportunity barriers involved restricted time and support for ongoing personal and professional development. Practitioners desired greater autonomy over the nutrition service, which was either enabled or constrained by the club’ social environment. As an enabler, female practitioners’ strong interpersonal skills (psychological capability) supported implementation; however, they also faced gender-related challenges navigating male predominate environments, making the social opportunity for implementation more complex. Conclusion Implementing nutrition guidelines in elite football is challenging. Overcoming barriers-by boosting practitioner confidence, belief in guidelines, professional development support, and autonomy-is key to improving uptake of UEFA recommendations and enhancing player dietary adherence in the English Premier League.

Athlete adherence to nutritional guidance is critical for optimal health and performance, yet little is known about the barriers and enablers to athletes’ dietary behaviours within high-performance sport. To advance understanding, we applied a theoretical lens derived from the Capability, Opportunity, Motivation–Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) to explore the qualitative accounts of sports nutritionists. Five focus groups comprising sports nutritionists working in Olympic and Paralympic sport (n = 14), professional sport (n = 6), or both (n = 6) were undertaken. Thematic analysis was conducted and the interpretations of the findings were guided by COM-B and the TDF. To achieve nutritional adherence, the behavioural analysis identified the need to intervene across all three COM-B components and at least five associated TDF domains (e.g., decision-making processes, reinforcement, social influences, behavioural regulation and environmental context and resource). For the first time, the findings illustrate the complex interplay of the training setting with the capabilities, opportunities, and motivation of the practitioners, athletes and coaches. By applying established behavioural science theories to sports nutrition, the foundations for the development of targeted and multifaceted behavioural interventions addressing athlete dietary adherence in high-performance sport have been laid.

Background Adolescent male academy footballers often fail to meet nutritional recommendations, placing them at increased risk of compromised growth, health, and performance. Guided by the Behaviour Change Wheel, this study aimed to select and specify dietary behaviours to underpin a sport nutrition service within an English Football League Championship academy. Two Nominal Group Technique (NGT) workshops (mean duration = 2 h 20 min) were conducted with four experienced sport nutritionists, three of whom were currently employed at the club, and one recently employed. Participants generated, ranked, and refined behaviours through structured group discussion, and a follow-up questionnaire. Audio data were descriptively analysed to provide contextual insight into behaviour selection and prioritisation. Results Twenty-four behaviours were generated, from which a prioritised top 10 were identified. The three highest-ranked behaviours were: (1) consuming ≥ 3 main meals (≥ 900 kcal or 13 kcal·kg⁻¹) and 2 snacks daily (≥ 350 kcal or 5 kcal·kg⁻¹); (2) consuming ≥ 3 carbohydrate portions (40–50 g or 0.5–0.75 g·kg⁻¹) per main meal, and ≥ 1 per snack; and (3) consuming a protein portion (25–30 g or 0.4 g·kg⁻¹) at ≥ 4 eating occasions daily. Collectively, these behaviours formed the “meal frequency and portion size guidance.” Additional behaviours ranked within the top 10 included fruit and vegetable intake, attendance at club-provided meals, hydration practices, and cooking from the club recipe app. Practitioners reported challenges conceptualising behaviours, often defaulting to macronutrient prescriptions, and found prioritisation difficult given the number of valuable behaviours identified. Nonetheless, the iterative NGT process facilitated consensus and provided actionable, evidence-based nutritional guidance. Conclusion This study demonstrates the suitability of the NGT for co-producing and prioritising dietary behaviours in male academy footballers. The approach effectively structured practitioner insights to identify priority areas for sport nutrition service delivery. However, the time-intensive nature of the behavioural analysis highlights the need for greater behavioural science capability within sport nutrition practice. Defining what athletes should do, rather than just focusing solely on nutrient-based prescriptions, is essential for designing effective, theory-informed behavioural interventions. These findings provide a foundation for designing targeted interventions to support the health, wellbeing, and performance of male academy footballers.