NOTICE: We are experiencing technical issues with Academy members trying to log into the JAND site using Academy member login credentials. We are working to resolve the issue as soon as possible. Alternatively, if you are an Academy member, you can access the JAND site by registering for an Elsevier account and claiming access using the links at the top of the JAND site. Email us at [email protected] for assistance. Thanks for your patience!

Clinical Observations from Nutrition Services in College Athletics


      College athletes are vulnerable to nutritional risks because of the rigorous demands of their sport, and because of the realities of college lifestyles. Athletes often adopt rigid training diets that predispose them to undernutrition, fatigue, and injury. Disordered eating, a common concern for college-aged women, affects a substantial number of female collegiate athletes, and is a growing concern for their male counterparts. Few resources exist to promote nutritional well-being among college athletes, particularly for individuals who suffer from eating pathology that is subclinical and often perceived as benign. This article presents evidence of the need for nutrition services for college athletes and describes nutritional risks that affect individuals across a variety of athletic teams. A multidisciplinary treatment model is depicted, featuring a nutrition practice at the core of a sports medicine wellness program in Division I college athletics. Observations from this practice document a substantial burden of subclinical eating disorders and elucidate characteristics of high-risk individuals. The Female Athlete Screening Tool is advocated as a useful tool for identifying eating pathology and triggering timely interventions. These insights from clinical practice identify opportunities and behavioral targets for intervention, and promote an effective model for health promotion in college athletics.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Beals K.A.
        • Manore M.M.
        Nutritional status of female athletes with subclinical eating disorders.
        J Am Diet Assoc. 1998; 98: 419-425
        • Skinner P.
        • Kopecky L.
        • Seburg S.
        • Roth T.
        • Eich J.
        • Lewis N.M.
        Development of a medical nutrition therapy protocol for female collegiate athletes.
        J Am Diet Assoc. 2001; 101: 914-917
        • Thrash L.E.
        • Anderson J.J.B.
        The female athlete triad: Nutrition, menstrual disturbances, and low bone mass.
        Nutr Today. 2000; Sept/Oct: 168-174
        • Arriaza C.A.
        • Mann T.
        Ethnic differences in eating disorder symptoms among college students: The confounding role of body mass index.
        J Am Coll Health. 2001; 49: 309-315
        • Schwitzer A.M.
        • Bergholz K.
        • Dore T.
        • Salimi L.
        Eating disorders among college women: Prevention, education, and treatment responses.
        J Am Coll Health. 1998; 46: 199-207
        • Schwitzer A.M.
        • Rodriguez L.E.
        • Thomas C.
        • Salimi L.
        The eating disorders NOS diagnostic profile among college women.
        J Am Coll Health. 2002; 49: 157-166
        • Hoek H.W.
        • van Hoeken D.
        Review of the prevalence and incidence of eating disorders.
        Int J Eat Disord. 2003; 34: 383-396
        • Ross L.T.
        • Gill J.L.
        Eating disorders: Relations with inconsistent discipline, anxiety, and drinking among college women.
        Psychol Rep. 2002; 91: 289-298
        • Prouty A.M.
        • Protinsky H.O.
        • Canady D.
        College women: Eating behaviors and help-seeking preferences.
        Adolescence. 2002; 37: 353-363
        • Kessler L.A.
        • Gilham M.B.
        • Vickers J.
        Peer involvement in the nutrition education of college students.
        J Am Diet Assoc. 1992; 92: 989-991
        • Kurth C.L.
        • Krahn D.D.
        • Nairn K.
        • Drewnowski A.
        The severity of dieting and bingeing behaviors in college women: Interview validation of survey data.
        J Psychiatr Res. 1995; 29: 211-225
        • Malinauskas B.M.
        • Raedeke T.D.
        • Aeby V.G.
        • Smith J.L.
        • Dallas M.B.
        Dieting practices, weight perceptions, and body composition: A comparison of normal weight, overweight and obese college females.
        Nutr J. 2006; 5: 11
        • Beals K.A.
        • Manore M.M.
        The prevalence and consequences of subclinical eating disorders in female athletes.
        Int J Sports Nutr. 1994; 4: 175-179
        • Johnson M.D.
        Disordered eating in active women.
        Clin Sports Med. 1994; 13: 355-369
        • Wiggins D.L.
        • Wiggins M.E.
        The female athlete.
        Clin Sports Med. 1997; 16: 593-612
        • Sundgot-Borgen J.
        • Torstveit M.K.
        Prevalence of eating disorders in elite athletes is higher than in the general population.
        Clin J Sport Med. 2004; 14: 25-32
        • Beals K.A.
        Disordered Eating Among Athletes: A Comprehensive Guide for Health Professionals.
        Human Kinetics, Champaign, IL2004
        • Hausenblas H.A.
        • Carron A.V.
        Eating disorder indices and athletes: An integration.
        JSEP. 1999; 21: 230-258
        • Sundgot-Bergen J.
        Prevalence of eating disorders in elite female athletes.
        Int J Sport Nutr. 1993; 3: 29-40
        • Johnson C.
        • Crosby R.
        • Engel S.
        • Mitchell J.
        • Powers P.
        • Wittrock D.
        • Wonderlich S.
        Gender, ethnicity, self-esteem and disordered eating among college athletes.
        Eat Behav. 2004; 5: 147-156
        • Reinking M.F.
        • Alexander L.E.
        Prevalence of disordered-eating behaviors in undergraduate female collegiate athletes and nonathletes.
        J Athl Train. 2005; 40: 47-51
        • Beals K.
        • Manore M.
        Disorders of the female athlete triad among collegiate athletes.
        Int J Sports Nutr Exerc Metab. 2002; 12: 281-293
        • Johnson C.
        • Powers P.S.
        • Dick R.
        Athletes and eating disorders: The National Collegiate Athletic Association study.
        Int J Eat Disord. 1999; 26: 179-188
        • Sanford-Martens T.C.
        • Davidson M.M.
        • Yakushko O.F.
        • Martens M.P.
        • Hinton P.
        • Beck N.
        Clinical and subclinical eating disorders: An examination of collegiate athletics.
        J Applied Sport Psych. 2005; 17: 79-86
        • Wiita B.G.
        • Strombaugh I.A.
        Nutrition knowledge, eating practices, and health of adolescent female runners: 13-year longitudinal study.
        Int J Sports Nutr. 1995; 6: 414-425
        • Grandjean A.C.
        Diets of elite athletes: Has the discipline of sports nutrition made an impact?.
        J Nutr. 1997; 127: 874S-877S
        • Elliot D.L.
        • Goldberg L.
        • Moe E.L.
        • DeFrancesco C.A.
        • Durham M.B.
        • Hix-Small H.
        Preventing substance use and disordered eating.
        Arch Pediatr Adolesc Med. 2004; 158: 1043-1049
        • Steen S.N.
        Timely statement of the American Dietetic Association: Nutrition guidance for adolescent athletes in organized sports.
        J Am Diet Assoc. 1996; 96: 611-612
        • American Psychiatric Association
        Diagnosis and Statistical Manual of Mental Disorders.
        4th ed. American Psychiatric Association, Washington, DC2000 (Text revision)
        • McNulty K.Y.
        • Adams C.H.
        • Anderson J.M.
        • Affenito S.G.
        Development and validation of a screening tool to identify eating disorders in female athletes.
        J Am Diet Assoc. 2001; 101: 886-892
        • Manore M.M.
        • Barr S.I.
        • Butterfield G.E.
        Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance.
        J Am Diet Assoc. 2000; 100: 1543-1556
      1. Diagnostic and Statistical Manual of Mental Disorders.
        in: 4th ed. American Psychological Association, Washington, DC2000: 589-594
        • Dams-O’Connor K.
        • Martens M.P.
        • Anderson D.A.
        Alcohol-related consequences among women who want to lose weight.
        Eat Behav. 2006; 7: 188-195
        • Krahn D.D.
        • Kurth C.L.
        • Gomberg E.
        • Drewnowski A.
        Pathological dieting and alcohol use in college women—A continuum of behaviors.
        Eat Behav. 2005; 6: 43-52
        • Bulik C.M.
        • Klump K.L.
        • Thornton L.
        • Kaplan A.S.
        • Devlin B.
        • Gichter M.M.
        • Halmi K.A.
        • Strober M.
        • Woodside D.B.
        • Crow S.
        • Mitchell J.E.
        • Rotondo A.
        • Mauri M.
        • Cassano G.B.
        • Keel P.K.
        • Berrettini W.H.
        • Kaye W.H.
        Alcohol use disorder comorbidity in eating disorders: A multicenter study.
        J Clin Psychiatry. 2004; 65: 1000-1006
        • McLean J.A.
        • Barr S.I.
        Cognitive dietary restraint is associated with eating behaviors, lifestyle practices, personality characteristics and menstrual irregularity in college women.
        Appetite. 2003; 40: 185-192
        • Klopp S.A.
        • Heiss C.J.
        • Smith H.A.
        Self-reported vegetarianism may be a marker for college women at risk for disordered eating.
        J Am Diet Assoc. 2003; 103: 745-747
        • Committee on Sports Medicine and Fitness
        Medical concerns in the female athlete.
        Pediatrics. 2000; 106: 610-613
        • Clark N.
        Sports Nutrition Guidebook.
        3rd ed. Human Kinetics, Champaign, IL2003
        • Manore M.M.
        Dietary recommendations and athletic menstrual dysfunction.
        Sports Med. 2002; 32: 887-901
        • Rosen L.W.
        • McKeag D.B.
        • Hough D.O.
        • Curley V.
        Pathogenic weight control behaviors in female athletes.
        Physician Sportsmed. 1986; 14: 79-86
        • Byrne S.
        • McLean N.
        Elite athletes: Effects of the pressure to be thin.
        J Sci Med Sport. 2002; 5: 80-94
        • Smolak L.
        • Murnen S.K.
        • Ruble A.E.
        Female athletes and eating problems: A meta-analysis.
        Int J Eat Disord. 2000; 27: 371-380
        • Ashley C.D.
        • Smith J.F.
        • Robinson J.S.
        • Richardson M.T.
        Disordered eating in female collegiate athletes and collegiate females in an advanced program of study: A preliminary investigation.
        Int J Sport Nutr. 1996; 6: 391-401
        • Rhea D.J.
        Eating disorder behaviors of ethnically diverse urban female adolescent athletes and non-athletes.
        J Adolesc. 1999; 22: 379-388
        • Rumball J.S.
        • Lebrun C.M.
        Use of the preparticipation physical examination form to screen for the female athlete triad in Canadian interuniversity sport universities.
        Clin J Sport Med. 2005; 15: 320-325
        • Bass M.
        • Turner L.
        • Hunt S.
        Counseling female athletes: Application of the stages of change model to avoid disordered eating, amenorrhea, and osteoporosis.
        Psych Rep. 2001; 88: 1153-1160
        • Golden N.H.
        A review of the female athlete triad (amenorrhea, osteoporosis and disordered eating).
        Int J Adolesc Med Health. 2002; 14: 9-17
        • Vinci D.M.
        Effective nutrition support programs for college athletes.
        Int J Sport Nutr. 1998; 8: 308-320
        • Jacobson B.H.
        • Sobonya C.
        • Ransone J.
        Nutrition practices and knowledge of college varsity athletes: A follow-up.
        J Strength Cond Res. 2001; 15: 63-68
        • Brandon T.A.
        • Lamboni P.
        Care of collegiate athletes.
        Md Med J. 1996; 45: 669-675
        • Clark K.L.
        Working with college athletes, coaches, and trainers at a major university.
        Int J Sport Nutr. 1994; 4: 135-141
        • McAdams M.A.
        • Van Dam R.M.
        • Hu F.B.
        Comparison of self-reported and measured BMI as correlates of disease markers in US adults.
        Obesity. 2007; 15: 188-196


      P. A. Quatromoni is an assistant professor, Department of Health Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA.