The Athletic Trainer's Role in Modifying Nutritional Behaviors of Adolescent Athletes: Putting Theory into Practice

Abstract

Nutritional practices influence athletic performance and recovery from injury. The athletic trainer is ideally positioned to effect dietary changes with adolescent athletes-a group at high-risk for nutritional imbalances. Research shows that young adults generally do not change dietary practices when given factual nutrition and health information. This article provides a variety of behavior change strategies, based on models derived from health education and health psychology, which are likely to influence dietary choices. Promoting self-efficacy by enhancing perception of choice and control, peer modeling, cooperative support networks, goal-setting techniques, and behavioral self-monitoring may provide the motivational framework necessary to enhance dietary compliance. Dietary behavior change techniques are a valuable part of an athletic trainer's resources.

Full text

The
Athletic
Trainer's
Role
in
Modifying
Nutritional
Behaviors
of
Adolescent
Athletes:
Putting
Theory
into
Practice
Robert
M.
Hackman,
PhD
Jane
E.
Katra,
MS
Susan
M.
Geertsen,
MS,
ATC
ABSTRACT:
Nutritionalpractices
influence
athletic
performance
and
recovery
from
injury.
The
athletic
trainer
is
ideally
posi-
tioned
to
effect
dietary
changes
with
ado-
lescent
athletes-a
group
at
high-risk
for
nutritional
imbalances.
Research
shows
that
young
adults
generally
do
not
change
dietary
practices
when
given
factual
nutri-
tion
and
health
information.
This
article
provides
avariety
ofbehaviorchange
strat-
egies,
based
on
models
derivedfrom
health
education
and
health
psychology,
which
are
likely
to
influence
dietary
choices.
Pro-
moting
self-efficacy
by
enhancing
percep-
tion
of
choice
and
control,
peer
modeling,
cooperative
support
networks,
goal-setting
techniques,
and
behavioral
self-monitor-
ing
may
provide
the
motivational
frame-
work
necessary
to
enhance
dietary
compli-
ance.
Dietary
behavior
change
techniques
are
a
valuable
part
of
an
athletic
trainer's
resources.
E
ncouraging
high
school
athletes
to
eat
well
is
achallengefor
athletic
trainers,
because
improvements
of
dietary
behavior
really
are
the
only
means
to
enhance
nutri-
tional
status.
Athletic
trainers
know
the
value
of
optimal
nutrition
in
sports
perfor-
mance
and
rehabilitation,
and
may
wish
to
add
new
skills
to
help
athletes
change
their
dietary
behaviors.
After
briefly
reviewing
the
context
of
nutrition
for
young
athletes,
Robert
Hackman
is
an
associate
pro-
fessor
of
nutrition
at
the
University
of
Oregon
in
Eugene,
OR.
Jane
Katra
is
a
doctoral
candidate
at
the
University
of
Oregon.
Susan
Geertsen
is
an
athletic
trainer
at
Pleasant
Hill
High
School
in
Pleasant
Hill,
OR.
this
article
provides
a
theoretical
basis
and
practical
suggestions
for
incorporating
nu-
tritioneducationanddietarybehaviorchange
into
a
comprehensive
training
program.
Nutrition
Issues
for
Athletes
and
Athletic
Trainers
Making
dietarychoices
consistentwith
optimal
physical
and
mental
performance
is
an
integral
part
of
an
athlete's
training
program.
The
impact
of
nutrition
on
ath-
letic
performance
is
significant
during
ado-
lescence,
because
physiological
and
bio-
chemical
systems
have
not
yet
fully
ma-
tured
and
the
need
for
exogenous
support
of
growing
tissue
is
greater
than
in
adulthood.
Unfortunately,
most
young
athletes
regu-
larly
make
poor
nutritional
choices.
Ath-
letic
trainers
can
provide
young
athletes
with
the
needed
evidence
of
enhanced
per-
formance
and
recovery
from
injury
that
is
attainablethroughawell-chosennutritional
program.
They
also
can
motivate
them
to
incorporate
good
nutrition
into
their
overall
training
program.
Adolescent
athletes
may
risk
their
nu-
trition
and
health
status
due
to
poor
dietary
practices,
inadequate
nutrition
knowledge,
frequent
intake
of
inappropriate
dietary
supplements,
and
a
propensity
to
follow
dietary
fads
(12,
24).
At
the
high
school
level,
the
typical
male
athlete
eats
a
great
deal
of
food
while
many
female
athletes
eat
too
little.
Even
when
sufficient
calories
are
consumed,
diets
may
be
marginally
defi-
cient
in
micronutrients
such
as
iron
(27),
magnesium
(11),
and
zinc
(16),
which
are
essential
to
perform
optimally
in
sport
or
to
support
normal
physical
development.
In
several
male-dominated
sports,
weight
manipulation
has
been
associated
with
nonrecommended
dietary
practices,
such
as
rapid
weight
loss
used
in
wres-
tling,
and
for
substantially
increased
body
mass
in
football
(1).
The
female
athlete
whose
caloric
intake
is
below
her
caloric
expenditure
is
typically
suffering
from
the
social
pressures
that
promote
women
to
diet
and
exercise
compulsively
in
an
attempt
to
conform
to
an
unrealistic
stan-
dard
of
slenderness
(10).
Coaches
may
exacerbate
this
dieting
pressure
by
urging
young
women
and
men
to
achieve
a
target
body
weight
inconsistent
with
normal
growth
and
development,
which
ignores
their
genetically
endowed
body
type.
An
additional
factor
that
may
enhance
an
adolescent's
drive
toward
thinness
is
the
perceived
benefit
of
competing
in
a
sport
where
weight
may
be
a
disadvantage
(eg,
distancerunning,
gymnastics,
swimming,
diving,
wrestling,
cheer-leading).
The
combination
of
high
physical
demands
and
dietary
restrictions
places
many
fe-
male
and
male
athletes
at
great
risk
of
nutritional
deficiencies
and
the
possibil-
ity
of
developing
an
eating
disorder
(10).
An
athlete's
beliefs
about
his
or
her
body
can
also
motivate
his
or
her
behavior.
A
positive
body
image
can
build
self-es-
teem
and
help
an
athlete
achieve
goals
consistent
with
optimal
sports
performance
and
a
healthy
lifestyle.
On
the other
hand,
body
image
dissatisfaction
or
a
negative
body
image
can
lead
to
self-destructive
behaviors
(20).
Body
image
is
an
intense
emotional
issue
with
many
high
school
athletes,
especially
girls.
How
they
see
themselves
and
how
they
think
others
see
them
profoundly
influence
their
nutritional
choices.
Adolescents
are
at
nutritional
risk
be-
cause
of
both
physiological
and
psycho-
social
influences
(30).
Dramatic
increases
in
physical
growth
and
development
create
a
high
demand
for
vitamins,
minerals,
pro-
tein,
and
energy.
Psychosocial
changes
such
as
the
search
for
independence
and
262
Volume
27
a
Number
3
m
1992
*
Journal
of
Athletic
Training

identity,
concernfor
appearance,
and
active
lifestyles
can
have
a
strong
impact
on
nutri-
ent
intake.
Highly
nutritious
meals
and
snacks
may
be
secondary
considerations,
because
teenagers
tend
to
base
their
food
choices
on
convenience,
taste,
affordability,
time,
and
peer
influence
(8,
19,
22,
23)
rather
than
on
exercise
and
recovery
needs.
Nutritional
choices
of
high
school
ath-
letes
may
be
affected
by
a
concern
for
body
image
(10).
Adolescents
at
this
age
often
feel
a
need
to
maintain
a
particular
social
image,
which
could
translate
nutritionally
into
the
foods
they
eat
in
front
of
their
peers
(12).
Many
may
believe
it
is
inappropriate
or
embarrassing
to
eat
carrot
sticks
or
pears
in
the
presence
of
friends
and
teammates.
Athletes
may
perceive
that
eating
a
bag
of
chips
or
cookies
could
bring
much
more
popularity
than
eating
salads
or
fresh
fruit.
One
way
athletic
trainers
can
help
male
athletes
find
a
healthful
balance
in
the
foods
they
eat
is
to
promote
the
act
of
sharing
snacks.
Sharing
a
submarine
sandwich
cut
into
one-
or
two-inch
individual
servings,
a
bunch
of
grapes
or
other
popular
fruit,
or
a
bag
of
bagels,
are
all
possible
health-
and
performance-enhancing
behaviors
that
ath-
letic
trainers
can
promote.
Young
male
athletes
can
discover
that
they
are
able
to
eat
healthfully,
be
popular,
and
maintain
a
strong
image
all
at
the
same
time.
Many
adolescent
athletes
have
been
informed
about
good
health
and
nutrition
practicesfromteachers,nurses,
andcoaches
(2,30),
as
well
as
from
numerous
articles
in
reputablepopularmagazines
(29,30).
How-
ever,
knowledge
alone
is
rarely
sufficient
to
promote
behavior
change,
and
a
discrep-
ancy
between
teenagers'
health
knowledge
andtheirbehaviorhasbeenfrequentlynoted
(6,21,26).
Although
adolescents
may
be
generally
well-infonred
about
good
health
practices,
this
knowledge
often
is
poorly
translated
into
their
daily
lives
(30).
Rather
than
focusing
nutrition
education
programs
solely
onfoodfacts
and
knowledge,
educa-
tors
and
athletic
trainers
must
address
the
additional
factors
of
attitudes
and
values
to
help
create
the
desired
outcome
of
motiva-
tion
and
dietary
behavior
change
(7).
People
change
their
health
behaviors
when
they
perceive
areason
for
the
change
or
when
they
know
that
the
change
will
make
a
positive
difference
in
their
lives
(9,
15).
Among
the
potential
benefits
resulting
from
optimal
food
choices
are
an
increase
in
the
level
of
athletic
performance,
a
de-
crease
in
healing
time
after
injury,
a
greater
assurance
of
optimal
physical
development,
an
increase
in
the
athlete's
self-concept,
and
the
establishment
of
long-term
eating
pattns
that
will
likely
contribute
to
robust
health
later
in
life.
Self-Efficacy
A
theoretical
rationale
for
identifying
goals,
outcomes,
or
expectations
is
based
on
self-efficacy
theory
(15).
Self-efficacy
is
a
situation-specific
form
of
self-confi-
dence,
or
the
belief
that
one
is
competent
and
can
do
whatever
needs
to
be
done
in
a
specific
situation
(14).
This
sense
of
"I
can
do"
refers
to
a
personal
judgment
of
how
well
one
can
organize
and
implement
pat-
tens
of
behavior
in
situations
that
may
contain
certain
novel,
unpredictable,
or
stressful
elements
(3).
Bandura
(5)
has
suggested
four
sources
of
self-efficacy
at-
tainment
for
behavior
change,
which
form
a
model,
inpart,
forthe
ideaspresented
inthis
paper.
Self-efficacycanbe
achievedthrough
the
following
four
methods:
1.
Guided
practice
of
the
desired
behav-
ior
(enactive
attainment
through
skill
mastery)
2.
Vicariousexperiences
of
success
(mod-
eling
of
peers,
athletic
trainers,
and
significant
others,
and
reflecting
on
past
successes)
3.
Social
persuasion
(bulletin
boards,
sharing
of
ideas
and
menus,
rewards,
involvement
of
thefamily
and
coaches
in
the
social
support
network,
and
tes-
timonials
of
success),
and
4.
Ability
to
monitor
physiological
changes
(increase
positive
behavioral
cues,
decrease
negative
cues,
active-
role-playing
of
desiredbehavior
in
dif-
ficult
situations,
goal-setting,
and
be-
havioral
self-monitoring)
Social
leaming
theory,
used
inrelation
to
self-efficacy,
suggests
that
a
person's
learning
and
social
experiences,
coupled
with
his
or
her
values
and
expectations,
influence
behavior
(1,4,31).
Social
learn-
ing
theorists
contend
that
adolescents
will
model
behavior
according
to
three
things:
(1)
the
reactions
they
receive
from
others,
(2)
the
behavior
of
those
adults
with
whom
they
are
in
close
contact,
and
(3)
the
behav-
ior
they
view
on
TV
and
in
movies
(31).
Adolescents
particularly
are
more
likely
to
model
what
they
see,
rather
than
what
they
hear
people
say.
Therefore,
seeing
other
important
people,
such
as
parents,
coaches,
teammates,
and
athletic
trainers
eating
well
and
talking
about
the
value
of
nutrition
and
sports
performance
is
likely
to
influence
the
young
athlete
(25).
Enhancing
Perception
of
Choice
and
Control
A
perceived
sense
of
control
may
be
one
of
the
most
important
elements
influ-
encing
an
adolescent's
food
choices.
Per-
ception
of
control,
orthe
belief
that
one
can
exercise
personal
choice
(21),
creates
a
sense
of
competence,
usefulness,
and
pur-
pose.
At
their
critical
stage
of
psychologi-
cal
development,
adolescents
begin
to
ex-
perience
a
sense
of
freedom
and
personal
selection
regarding
lifestyle
choices
(18).
By
enhancing
a
perception
of
control,
the
athletic
trainer
assists
in
the
athlete's
per-
sonal
development.
Linking
perception
of
control
with
health-promoting
dietary
choices
is
a
skill
that
may
be
viewed
as
part
of
the
athletic
trainer's
equipment.
En-
hanced
perception
of
choice
and
control
can be
achieved
through
a
positive
context
of
nutrition
education,
peer
modeling,
ad-
vice
by
role
models,
the
observation
of
behaviors
of
significant
others,
marketing
and
advertising
messages,
goal-setting,
and
the
voicing
of
a
commitment.
A
Positive
Context
for
Nutrition
Education
Nutrition
education
that
employs
a
positive
context
to
promote
healthful
eat-
ing
is
likely
to
be
more
useful
than
a
pro-
gram
that
uses
a
fear-based
warning
ap-
proach
(24).
People
react
to
positive
mes-
sages
much
better
than
to
negative
ones.
An
athletic
trainer
has
a
better
chance
of
influencing
an
athlete's
nutritional
behav-
ior
by
emphasizing
the
relationship
be-
tween
optimal
nutrition
and
the
athlete's
performance
and
recovery,
rather
than
by
instilling
guilt
and
fear
with
warnings
about
what
to
avoid
(19).
Continually
promot-
ing
"what
to
do"
and
diminishing
dialogue
about
"what
not
to
do"
will
help
young
athletes
learn
an
optimistic
approach
to
nutrition
(28).
Emphasizing
immediate
or
short-term
benefits
also
is
morelikely
to
be
effective
than
simply
linking
the
nutrition
message
with
some
distant
view
that
one
will
"feel
better."
Increasing
perception
of
choice
also
will
help
ensure
success.
An
adolescent
who
is
told
what
nutritional
changes
to
make
will
not
respond
as
well
as
an
athlete
who
is
given
anumber
of
options
that
would
result
in
positive
change.
Encouraging
young
athletes
to
choose
their
own
dietary
goals
and
practices
increases
their
sense
of
ownership
and
responsibility
for
their
di-
etary
choices.
The
athletic
trainer will
have
greater
success
if
the
athlete
is
presented
Volume
27
u
Number
3
*
1992
.
Journal
of
Athletic
Training
263

with
a
number
of
nutritional
options,
all
of
which
would
be
beneficial,
rather
than
pre-
scribing
one
specific
dietary
change.
For
example,
the
athletic
trainer
could
identify
ftree
options,
such
as
increasing
complex
carbohydrate
intake,
consuming
more
vita-
min
C-rich
fnits
andvegetables,
ordiinking
morewater.
Then,let
theathletechoosewhich
of
the
tee
goals
to
concertrate
on
first.
Peer
Modeling
Peer
modeling
is
another
effective
method
of
enhancing
perception
of
choice
and
control.
Students
are
more
responsive
to
the
influence
of
peers
who
share
similar
values
and
interests
than
to
the
influence
of
students
with
dissimilar
values
(13).
In
the
high
school
setting,
athletes
often
eat
what
their
peers
eat.
If
the
athletic
trainer
can
influence
the
"leaders"
on
the
team
to
eat
more
nutritionally,
other
athletes
are
more
likely
to
follow
the
example
being
set.
The
advice
and
behavior
of
others-
such
as
personal
friends
and
authority
fig-
ures
such
as
coaches,
teachers,
parents,
older
siblings,
and
accomplished
athletes-
are
significant
factors
influencing
people
to
makefavorable
dietarybehaviorchanges
(9).
The
behavioral
intention
model
(1)
suggests
that
people's
perceptions
of
the
attitudes
of
"important
others,"
toward
a
given
behavior
or
set
of
behaviors,
are
important
influences
of
their
own
behav-
ior.
Perceptions
can
be
derived
from
the
observation
of
actions
and
the
acquisition
of
knowledge
from
influential
persons.
In
most
cases
the
athletic
trainer
is
afriend
as
well
as
an
authority
figure,
and
has
aregu-
lar
influence
on
athletes.
To
function
as
an
effective
role
model,
the
athletic
trainer
must
be
knowledgeable
and
feel
comfort-
able
with
presenting
nutrition
information
to
athletes.
In
addition,
the
athletic
trainer
must
practice
the
desired
behaviors
that
he
or
she
hopes
will
be
adopted
by
the
athletes
(23).
In
a
more
figurative
manner,
athletic
trainers
and
health
educators
are
encour-
aged
to
follow
the
words
of
Gandhi:
"We
must
be
the
change
we
wish
to
see
in
the
world."
A
Cooperative
Systems
Approach
In
addition
to
modeling
health-pro-
moting
eating
behavior
and
influencing
the
nutritional
practices
of
key
opinion-leader
teammates,
the
athletic
trainer
can
incorpo-
rate
the
athletes'
coaches
and
parents
into
nutrition
education
programs.
A
coopera-
tive
systems
approach,
as
shown
in
Figure
1,
is
one
way
to
illustrate
the
dynamic
interactions
of
people
who
can
influence
adolescent
athletes'
food
choices
on
a
daily
basis.
Coaches,
parents,
and
other
family
members
are
important
components
of
the
student's
support
network
and
can
be
ac-
tively
encouraged
to
participate
in
a
sys-
temic
effort.
behaviors
stimulates
social
support
and
self-
efficacy
in
the
young
atflete.
Marketing
Nutrition
to
Athletes
Marketing
and
advertising
messages
appear
to
have
a
strong
influence
on
teen-
agers'
nutritional
behaviors
(8, 9).
Ado-
ATHLETIC
TRAINER
ADOLESCENT
COACH
4-
*
STUDENT-
ATHLETE
4
&-
PEERS
PARENTS
Fig
1.-A
cooperative
systems
approach
that
can
influence
dietary
choices
of
adolescent
athletes
The
systems
approach
can
be
con-
sciously
encouraged
by
athletic
trainers
in
a
variety
of
ways.
The
athletic
trainer
is
in
a
unique
position
to
invite
the
parents
and
coaches
to
attend
sports
nutrition
work-
shops
with
athletes.
Coaches,
parents,
and
other
family
members
may
be
encouraged
to
participate
in
joint
nutrition
goal-setting
activities.
Discussion
among
parents,
ath-
letes,
and
coaches
concerning
how
they
may
support
the
athlete
in
attaining
his
or
her
nutrition
goals
can
be
facilitated
at
school
meetings
or
potluck
dinners
that
are
sponsored
by
the
athletic
trainer,
coach,
or
principal.
Awards
can
be
offered
by
the
athletic
trainer
to
family
and
team
members
who
submitrecipes,
such
asforthe
"tasty-carbo-
quick-meal-of-the-week"competitionorfor
the
"low-fat,
fruit-based
dessert"
contest,
or
evento
eachteammember
who
meets
his
or
her
nutrition
goals.
Credit
can
be
given
to
athletes
who
try
a
new
carbohydrate
snack
or
substitute
carbohydrates
inplace
of
high-
fat
foods.
Public
sharing
of
ideas
and
pro-
motion
of
efforts
to
try
new
foods
or
eating
lescents
model
the
behaviors
of
"star
ath-
letes,"
and
advertisers
capitalize
on
this
notion
by
hiring
sports
heros
to
sell
ath-
letic
shoes,
breakfast
cereals,
soft
drinks,
and
a
multitude
of
other
products.
Ath-
letic
trainers
can
use
marketing
strategies
in
similar
ways.
For
example,
a
bulletin
board
in
the
training
room
that
displays
motivating
nutritional
messages,
along
with
pictures
of
well-known
athletes,
can
provide
an
excellent
educational
format.
The
athletic
trainer
can
provide
a
"nutri-
tion
message
of
the
week,"
which
athletes
will
see
on
the
bulletin
board,
along
with
pictures
of
star
athletes,
when
they
come
to
the
training
room.
A
factor
analysis
of
messages
that
stu-
dents
found
motivating
toward
changes
in
nutritional
behaviors
has
been
conducted
(24).
The
fmdings
may
be
useful
when
designing
bulletin
boards.
The
most
pow-
erful
messages
for
students
were:
1.
Watermelon,
peaches,
pineapple,
apples....
You
can
add
lots
of
variety
towhatyoueatbychoosingREFRESH-
NG
FRUIT.
264 Volume
27
m
Number
3
.
1992
m
Joumal
of
Athletic
Training

2.
Fruitmakessuchadelicious
dessert.
It
does
not
leave
you
with
that
heavy,
stuffed
feeling.
3.
Fruit
makes
a
refreshing
dessert.
A
bowl
of
plain
sliced
peaches
and
ba-
nanas
has
only
about
75
calories
and
is
so
enjoyable.
4.
You
can
eat
a
LOT
of
fruit
before
the
calories
amount
to
much,
because
fruit
is
so
low
in
calories.
5.
Choose
an
apple,
an
orange,
or
a
ba-
nana
for
your
sack
lunch
dessert.
Fruit
provides
50-150
calories,
comparedto
350
calories
in
two
oatmeal
cookies.
6.
Do
you
get
in
arut
when
you
eat?
Add
interest
by
choosing
a
crisp,
refreshing
VEGETABLE
SALAD
often.
7.
Drink
water
with
yourmeals
instead
of
punch,
unless
you
need
extra
calories.
8.
What
to
drink?
Water
is
an
excellent
as
a
no-calorie
beverage.
9.
Compare
a
banana
(about
130
calo-
ries)
to
a
piece of
cake
(about
300
calories).
Choose
the
dessert
that
fits
YOUR
calorie
budget.
10.
Fruit
juice
-
such
a
refreshing
AND
nutritious
drink!
11.
Fruits
andvegetables
are
important
eat
four
or
more
each
day.
Goal
Setting
Setting
goals
is
one
of
the
most
effec-
tive
methods
that
athletic
trainers
can
em-
ploy
to
help
young
athletes
eat
well.
The
most
important
element
of
goal
setting
is
the
focus
on
desired
behaviors
rather
than
onthe
problem.
A
simplefive-step
method
of
setting
goals
includes
these
elements:
1.
Establish
apositive,
quantifiable
goal.
2.
Identify
behaviors
to
achieve
the
goal.
3.
Identify
support
person(s).
4.
Establish
an
initial
action
plan.
5.
Identify
reward.
Behavioral
goals
generally
are
rec-
ommended
over
outcome
goals,
because
a
personhas
control
overhis
or
her
behavior.
For
example,
an
athlete
generally
has
con-
trol
over
eating
a
daily
low-fat
diet
consist-
ing
of
six
to
ten
servings
of
carbohydrates,
four
servings
of
vegetables,
four
servings
of
fruits,
two
servings
of
lean
protein,
two
to
three
servings
of
calcium-rich
foods,
and
eight
glasses
of
water.
In
contrast,
the
athlete
may
not
have
control
over
whether
his
or
her
body
loses
ten
pounds
of
fat
or
gains
ten
pounds
of
muscle,
since
the
amount
and
rate
of
gain
in
lean
body
mass
is
subject
to
genetic
and
developmental
limits,
regardless
of
diet.
Therefore,
goals
thatfocus
on
changes
inbody
composition
Fig
2.-A
sample
goal-sefting
sheet
to
help
encourage
positive
dietary
behavior
change
generally
are
not
recommended.
Athletes
are
outcome-oriented,
so
athletic
trainers
can
link
behavioral
goals
with
outcomes
and
still
encourage
the
focus
on
behaviors.
To
operationalize
the
goal-setting
method,
a
sample
worksheet
is
provided
in
Figure
2.
Goals
are
most
effective
when
set
in
a
positive,
measurable
context.
The
athlete
mustbe
able
to
measure
andrecordtargeted
behaviors.
The
use
of
positive
statements
helps
to
create
a
series
of
internal
images
and
memories,
which
assist
in
achieving
the
goal.
When
presented
with
a
negative
goal-setting
statement,
the
athlete's
mind
may
create
images
inconsistent
with
the
desired
behavior
change.
For
example,
if
a
teenager
is
told
not
to
think
about
eating
chocolate
cake,
his
or
her
mind
recalls
chocolate
cake
and
has
difficulty
moving
past
this
image.
An
altemate
approach
would
have
the
athlete
focus
on
the
energy
benefits
of
eating
at
least
five
servings
of
pasta
each
week
and
setting
that
as
a
goal.
Themindeasilyforms
images
of
mounds
of
spaghetti
noodles
served
with
low-fat
to-
mato
marinara
sauce.
Quantifying
goals
into
behavioral
terms
is
essential
to
provide
structure
and
refime-
ment
toward
the
dietary
changes.
After
appropriately
identifying
a
goal,
the
athlete
is
asked
to
identify
specific
actions
that
will
be
taken
to
achieve
the
goal.
Strategies
might
include
buying
the
necessary
foods,
packing
snacks
for
use
before
and
after
a
workout,
or
writing
the
goal
on
a
card
and
placing
the
card
in
one's
locker,
notebook,
or
on
the
bathroom
mirror.
The
third
step
towards
successful
goal
attainment
is
to
identify
a
support
person-
thus
establishing
a
social
support
network.
In
addition,
the
athlete
must
be
able
to
communicate
clearly
what
specific
actions
he
or
she
would
like
their
support
person
to
take.
A
teammate,
friend,
or
athletic
trainer
may
be
an
ideal
support
person
to
provide
a
listening
ear,
a
supportive
face,
and
words
of
encouragement.
Identifying
an
action
to
be
taken
dur-
ing
the
first
3
days
of
the
goal
period
is
the
next
step.
Breaking
large
behavioral
goals
into
smaller
tasks
maximizes
achievable
outcomes.
Secondly,
the
success
of
a
first
step,
however
small,
establishes
a
positive
mode
and
reinforces
the
athlete
to
continue
toward
the
larger
goal.
The
fifth
step
in
the
goal-setting
pro-
cess
is
to
identify
a
reward.
Rewards
are
important
because
they
reinforce
the
series
of
actions
and
attitudes
that
resulted
in
reaching
the
athlete's
goals.
Rewards
are
most
effective
when
consistent
with
the
behavioral
goal.
For
example,
a
chocolate
sundae
is
not
the
best
reward
for
eating
three
servings
of
vegetables
each
day.
Re-
wards can
include
the
purchase
of
non-food
items
suchas
books,
anewpiece
of
clothing
or
music,
bedroom
accessories,
tickets
to
sports
or
entertainment
events,
or
activities
such
as
outings,
video-
or
movie-watching,
picnics,
social
events,
or
games.
The
sample
goal-setting
sheet
in
Fig-
ure
2
incorporates
a
1-week
time
frame.
Longer
times,
such
as
2,
3,
or
4
weeks
also
can
be used
effectively,
particularly
after
the
athlete
and
athletic
trainer
have
estab-
lished
familiarity
with
the
process.
Goals
spanning
more
than
4
weeks
are
generally
less
effective
than
short-term
goals,
be-
cause
focus
and
motivation
tend
to
wane
as
time
passes.
Goal
attainment
is
enhanced
when
goals
are
both
written
and
verbalized
to
individuals
in
the
athlete's
social
support
network.
Behavioral
Self-Monitoring
A
dietary
checksheet
is
auseful
tool
to
promote
healthy
food
choices
in
a
positive,
intentional
context.
A
written
or
graphic
Volume
27
.
Number
3
1992
m
Journal
of
Athletic
Training
1.
My
one
week
nutritional
goal
is:
2.
Five
or
more
ways
I
wil
achieve
my
goal
are:
3.
Whom
will
I
ask
to
help
me?
What
will
I
ask
of
this
person?
4.
My
first
step,
in
the
next
two
days,
will
be
to:
5.
At
the
end
of
the
week,
I
will
reward
myself
by:
265

I
(V
Heilti
wImornon
Asocmites
Inc.,
198_
Fig
3.-Sample
"Nutririon
Bingo"
behavioral
goal
record
sheet
(above)
and
weekly
checklist
(facing
page)
list
of
food
categories
can
be
presented
for
Readiness
and
mental
condition
possible.
By
adding
each
day,
with
a
targeted
number
of
serv-
Adolescent
athletes
must
be
ready
be-
dietarybehaviorchangetothemanytherapy
ings
from
each
category
being
the
athlete's
fore
they
can
take
the
necessary
steps
to
treatments
used,
athletic
trainers
will
be
goal.
For
example,
a
"Nutrition
Bingo"
change
their
dietarypractices.
Readiness
is
helping
athletes
to
reach
their
personal
and
system,
shown
in
Figure
3,
has
been
suc-
"the
possession
of
behaviors,
attitudes,
athletic
goals.
cessfully
employed
to
help
direct
people
toward
dietary
goals
(17).
The
weekly
sheet
displays
graphic
images
of
foods
rep-
resenting
categories
such
as
whole
grains,
fruits,
vegetables,
water,
dairy
products,
and
lean
meats/dried
beans
with
a
sug-
gested
number
of
daily
servings.
An
ath-
letic
trainercoulddevise
asimilarchecksheet
and
distribute
copies
directly
to
athletes,
or
provide
the
sheets
to
coaches
for
use
with
a
team.
When
the
checksheet
is
carried
with
the
athlete,
it
serves as
a
reminder
and
motivatorregardingfoodstobeeaten.
When
posted
on
the
refrigerator,
the
sheet
can
also
serve
as
a
focal
point
for
family
discussion,
social
support,
and
meal
planning
for
the
athlete.
skills,
andconcomitantresourcesthatmake
it
possible
for
individuals
to
incorporate
a
new
health
behavior
into
a
permanent
lifestyle
(15)."
A
readiness
model shows
a
progression
from
knowledge
gathering
and
understanding
to
complete
adoption
of
the
new
behavior
as
part
of
a
lifestyle.
Athletic
trainers
can
apply
nutrition
education
principles
and
research
to
influ-
ence
adolescent
athletes
to
make
healthy
dietary
choices.
Athletic
trainers
can
edu-
cate
athletes
about
nutritional
training
meth-
ods
that
promote
a
positive
self-concept
as
well
as
enhance
performance,
aid
in
recov-
ery
from
injuries,
and
contribute
to
overall
health.
A
primary
goal
of
athletes
is
to
participate
in
their
sport
in
the
best
physical
References
1.
Ajizen
I,
Fishbein
M.
Understanding
Attitudes
and
Predicting
SocialBehaviors.
Englewood
Cliffs,
NJ:
Prentice-Hall;
1980:
79-107.
2.
AuldGW,Smiciklas-WnghtH,ShannonBM.
School
health
interventions
for
adolescents
at
nutritional
risk:
a
survey
ofhealth
teachers,
nurses,
and
coaches.
JNutrEduc.
1988;
20:319-325.
3.
Bandura
A.
Cultivating
competence,
self-efficacy,
and
intrinsic
interest
through
pmximal
self-motiva-
tion.
JPerson
Soc
Psych.
1981;
41:586-598.
4.
Bandura
A.
Self-efficacy:
toward
a
unifying
theory
of
behavior
change.
Psychol
Rev.
1977;
84:191-
215.
5.
Bandura
A.
Social
Learning
Theory.
Englewood
Cliffs,
NJ:
Prentice-Hall;
1977:1-247.
6.
Brunswick
AF.
Health
needs
of
adolescents:
how
the
adolescent
sees
thenL
Am
J
Health.
1969;
59:1730-1747.
266
Volume
27
*
Number
3
*
1992
*
Joumal
of
Athletic
Training

One
cup
lowfat
milk
or
yogurt,
1 1
/2
oz.
cheese,
or
one
300
mg
calclum
supplement.
Four
servings
a
dav
recommended.
TO
DO
LIST
For
mV
goal
this
week,
will:
VITAMIN
C-
one
piece
or
1/2
cup
Juice
of
RICH
FOODS.
grapefruit
or
tangerine;
1/2
cup
melon,
strawberries
or
other
berries;
or
1
whole
green
pepper
or
tomato.
one
serving
a
day
recommended.
One
cup
raw
or
1
/2
cup
cooked
or
kale,
chard,
spinach,
broccoli,
or
brussels
sprouts;
or
one
cup
romaine,
or
red
or
green
leaf
lettuce.
One
serving
a
day
recommended
DARK
MEATS
Three
oz.
of
lean
beef,
pork,
or
dark
&
DRIED
meat
from
chicken
or
turkey;
or
BEANS:
1
cup
cooked
beans
like
pinto
beans,
black-eyed
peas,
split
peas,
or
lentils.
Two
servings
a
day
recommended.
One
cup
water
or
herb
tea.
Six
servlngs
a
day
recommended.
FRUITS
&
One
cup
raw
or
1/2
cup
cooked
Of
VEGETABLES:
anV
additlonal
fruits
or
vegetables.
Two
servings
a
daV
recommended.
can
answer
yes
to
all
of
these
questions
aoout
r-.;
goal:
LII
1.
Does
it
say
exactly
what
will
do?
D1
2.
Do
I
have
direct
control
over
it?
0
3.
Could
a
friend
see
me
doing
it?
D
4.
Can
I
tell
when
I've
accomplished
it?
LI
S.
Does
It
say
what
I
will
do
rather
than
what
wCfl
t
do?
LII
6.
Is
it
easy
to
do?
The
steps
I
will
take
to
reach
mv
goal
are:
One
slice
whole-grain
bread;
1/2
cup
oatmeal,
brown
rice
or
other
cooked
grains;
or
3/4
cup
ready-to-eat
whole-grain
cereal.
Four
servings
a
day
recommended.
;.
"eanm
Prxnoton
Assocules
nc
IN98S
7.
CarruthBR,SkinnerJD.
Whatdoweknowandwhat
should
we
do
about
nutrition
education
for
adoles-
cents?
JNutrEduc.
1988;
20:
271-272.
8.
Contento
IR,
Michael
L,
Goldberg
CJ.
Food
choice
among
adolescents:
population
segmentation
by
motivations.
JNutrEduc.
1988;
20:
289-297.
9.
Contento
IR,
Murphy
BM.
Psycho-social
factors
differentiating
people
who
reported
making
desir-
able
changes
in
their
diets
from
those
who
did
not.
JNutrEduc.
1990;
22:
6-13.
10.
Davis
C,
Cowles
M
A
comparison
of
weight
and
diet
concems
and
personality
factors
among
female
athletes
and
non-athletes.
J
Psychosom
Res.
1989;
33:
527-536.
11.
Deuster
PA,
Dolev
E,
Kyle
S,
Anderson
RA,
Schoomaker
EB.
Magnesium
homeostasis
during
high-intensity
anaerobic
exercise
in
men.
J
AppI
Physiol.
1897;
62:
545-550.
12.
Douglas
PD,
Douglas
1F.
Nutrition
knowledge
and
food
practices
of
high
school
athletes.
J
Am
Diet
Assoc.
1984;
84:1198-1202.
13.
Gates
G,
Kennedy
S.
Peer
educators
reach
college
students
with
nutrition
information.
Coll
Health.
1989;
38:
95-96.
14.
Gill
DL.
Psychological
Dynamics
of
Sport.
Champaign,
Ill:
Human
Kinetics;
1986:
38-51.
15.
Girdano
DA,
Dusek
DE.
Changing
Health
Behav-
ior.
Scottsdale,
Ariz:
Gorsuch-Scarisbrick;
1988:
29-37.
16.
Hackman
RM,
Keen
CL.
Changes
in
senum
zinc
and
copperlevels
afterzinc
supplementation
in
mnning
and
nonnmning
men.
In:
Katch
FI,
ed.
Sport,
Health,andNutrition,1984OlympicScientificCon-
gress
Proceedings.
Champaign,
Ill:
HumanKinet-
ics;
1986:89-100.
17.
Hackman
RM,
Wagner,
E.
Nutrition
bingo
in
the
senior
gardening
and
nutrition
project.
JNutrEduc.
1987;
19:224A.
18.
Hedin
D,
Resnick
MK
Blum
R
Minnesota
Youth
Poll:
Youth'sViewsonHealth,lilnessandMedical
Care.
St.
Paul,
Minn:
Center
for
Youth
Develop-
ment
Research,
Agricultural
Experiment
Station,
University
of
Minnesota;
1980:1-26.
19.
Hochbaum
GM.
Strategies
and
their
rationale
for
changingpeople'seatinghabits.
INutrEduc.
1981;
13:
S59-S65.
20.
Hutchinson
M:
Transforming
Body
Image.
Trumansburg,
NY:
The
Crossing
Press;
1985:1-
170
21.
Kanfer
FH,
Grimm
LG.
Freedom
of
choice
and
behavioral
change.
Consult
Clin
Psychol.
1978;
46:
873-878.
22.
Lewis
CJ,
Sims
LS,
Shannon
B.
Examination
of
specific
nutrition/health
behaviors
using
a
social
cognitive
model.
J
Am
Diet
Assoc.
1989;
89:194-
202.
23.
Lewis
M,
Bmn
J,
Talmage
H,
Rasher
S.
Teenagers
and
food
choices:
the
impact
of
nutrition
education.
INutrEduc.
1988;
20:
336-339.
24.
Neilson
JL,
Larson-Brown
LB.
College
students'
perception
of
nutrition
messages:
How
motivating
are
they?
INutrEduc.
1990;
22:
30-34.
25.
Parr
RB,PorterMA,HodgsonSC.
Nutritionknowl-
edge
and
practice
of
coaches,
trainers
and
athletes.
Phys
Sportsmed.
March
1984;
12:127-138.
26.
Radius
SM,
Dillman
TE,
Becker
MEL
Adolescent
perspectives
on
health
and
illness.
Adolescence
1980;
15:
375-383.
27.
Smith
NJ,
Worthington-Robeits
B.
Foodfor
Sport.
Palo
Alto,
Calif:
Bull;
1989:101-110.
28.
Stensrud
RH,
Stensrud
K.
Counseling
for
health
empowenrent.
Personnel
Guidance
J.
1982;
60:
377-381.
29.
Storm
J.
Nutrition
advice
to
think
twice
about.
Women's
Sports
and
Fitness.
November,
1989;
11:20.
30.
Story
M,
Resnick
NE
Adolescents'
views
on
food
and
nutrition.
JNutrEduc.
1886;
18:188-192.
31.
WallstonB,WallstonK.
Socialpsychologicalmod-
els
of
health
behavior:
an
examination
and
integra-
tion.
In:
Baum
A,
Taylor
S,
Singer
JE,
eds.
Hand-
book
of
Psychology
and
Health,
IV.
Hillside,
NJ:
Erlbaum;
1984:23-53.
Volume
27
d
Number
3
*
1992
*
Journal
of
Athletic
Training
267
NUTRITION
BINGO
riAIRY:-
LEAFY
GREENS
WATER
WHOLE
GRAINS