The participants (all females) involved in this study were full-time workers and had between two and fifteen years of experience in sports nutrition practice. Each of the participants had worked with athletes engaged in different types of sports (racquet sport, power and strength sport, skill sport, team sport and combat sport).
In general, the participants were approached by coaches who had concerns about their athletes’ nutrition. They would then proceed with an action plan that consisted of meal planning. Weight management was a major issue of concern to many coaches, as shown below:
“…then we will look at the coach’s concern on their athlete’s weight, so if necessary, we will do weight management plan.” [SN 2]
“When I meet the coach, they will give me a list of athletes and their weight categories. Coach gives athletes current weight and targeted weight based on their weight categories. Then I will determine who can go for weight management either weight reduction or weight increment.” [SN 5]
Subsequently, the following themes emerged as a result of the problems received by SNs from the coaches
- Collecting pertinent data;
- Analyzing the collected data;
- Determining nutrition prescription;
- Formulating goals and determining actions;
- Recommending and implementing actions; and
These themes constituted the general processes used by the SNs to develop meal plans for athletes. The sub-themes were the specific processes important enough to be included in each process of meal planning. The result of this analysis is summarized in Table 1. The following section expands on the six general processes with different specific processes that had been identified.
Summary of themes and subthemes
Sub-themes (specific process)
Collecting pertinent data
Ø Conducting body composition assessment
Ø Identify training periodization plan
Ø Identify training time
Ø Identify food and nutrition-related history
Analyzing the collected data
Ø Analyzing body composition
Ø Analyzing dietary intake
Determining nutrition prescription
Ø Calculating energy requirement
Ø Determining macronutrient distribution based on g/kg body weight
Ø Using food exchange distribution table to distribute macronutrients across the mealtimes
Ø Determining the use of supplements
Formulating goals and determining actions
Ø Emphasizing in gradual dietary changes strategy
Ø Setting achievable goals
Ø Conducting one to one meeting between SNs and athletes to discuss the meal plan
Recommending and implementing action
Ø Dietary education
Ø Adjusting and improvising current dietary intake
Ø Determining mealtimes (main meal, pre & post-exercise meal) to match with training time
Ø Monitoring dietary intake
Ø Monitoring body composition
Process 1: Collecting pertinent data
To understand the current condition of their athletes, SNs collected data such as: the athlete’s body composition, periodization plan, training time, and food and nutrition-related history.
“I will do body composition assessment first, maybe the skinfold assessment or bioimpedance analysis just to get the baseline measure…” [SN 3]
“…. check athletes in which competition phase, different athletes different phases; elite athletes maybe in the phase where they don’t have time to do weight loss, they have to perform in their competition…” [SN 1].
“Athletes training at different times, some at night, some have one session. So, we have to see their training time to adjust mealtime” [SN 5]
Food and nutrition-related history consisted of several important components, which included dietary assessment, food preferences and food availability:
“I will do dietary records, if I have time, I will try to do 3 days dietary recall which I will follow the athletes for 3 days. I will ask them to take a picture of their food and beverage intake. But if I have limited time, I just interview and take their 1-day common diet” [SN 2].
Process 2: Analyzing the collected data
Two main specific processes highlighted by most SNs were the analysis of body composition and dietary intake.
The athlete’s body composition was analyzed to identify suitable actions to be implemented.
“next we will analyze the data [to figure out] how far she/he is from the target. From body composition, we will be able to determine how much weight she/he needs to lose” [SN 1]
The analysis of dietary intake enabled the SNs to figure out the unsuitable foods consumed by the athletes and whether the athletes were getting enough energy.
“When we conduct diet recall, one to one, with athletes, we were able to see ... oh he eats rice, fish and suddenly eats chocolate for that particular lunch, so from that we were able to identify the problem.”[SN 4]
Process 3: Determining nutrition prescription
The specific components that were included in the process of determining nutrition prescription were estimation of energy requirement and advice on suitable macronutrient distribution (gram/day). The decision was made based on information that were received during processes one and two. Next, the nutrition prescription values were used to develop a meal plan. The values of macronutrients (in gram/day) were converted into a food exchange list using an exchange system. The food exchange list represents the portion size of each food containing a given amount of nutrient. SNs distributed and rearranged the food exchange list into mealtimes to meet the desired requirement. In addition, the SNs also determined the types of supplements suitable to be included in meal planning. At this point of the process, SNs would come out with a set of meal plan that consisted of the desired nutrition needs in the form of food group exchange list, together with the portion sizes for each mealtime.
“We use a quick method to calculate the energy requirement. We also use various formulas to calculate energy requirement, we even use local studies. So, we will calculate based on weight and gender” [SN 2].
“…protein requirement we will see either if it is for a man or a women, training phase … we are not using the percentage to distribute the macronutrient but we use g/kg body of carbohydrate and protein….after all set, we will cross-check with total energy requirement that we prescribe to match with the exchange distribution later on …” [SN 1]
“I used the total of g/day and convert into exchange … the Atlas of Food Exchange and Portion Size book is my main reference.” [SN 2]
“...we will decide to give them a dietary supplementation or not, for example in some athletes we allowed them to drink sports drink, but some may not. Calorie from supplement must be included in total energy requirement” [SN 1]
Process 4: Formulating goals and determining actions
Negotiating with the athletes was an important specific process to make them aware of all the changes they needed to make in their dietary intakes. Specific processes highlighted by the SNs included: gradual changes in dietary intake, setting achievable goals and meeting with SNs to discuss dietary plans.
“For athletes, we cannot change them instantly into 100% perfect. Some athletes, their dietary intakes [are] not so good and they also know about it. So, we cannot ask them to change immediately. Change it gradually and step by step. We target one change at a time and they will not feel that burden.” [SN 1]
Process 5: Recommending and implementing actions
Recommending and implementing actions were based on the required nutrition prescription that had been determined previously in process three and athlete’s negotiation in process four. Athletes were provided with a meal plan that had been developed in process three. Most SNs will not directly explain the details of foods to be consumed but highlight on a few strategies such as dietary education, adjusting and improvising on the current dietary intake and determining mealtimes based on training time. These strategies can guide SNs in designing individualized meal plans.
Based on the meal plan, SNs emphasized on dietary education that included portion size, healthy food choices and suitable foods based on mealtimes.
“I design the meal planning based on exchanges and I don’t really insist on a type of food, but I do give examples. So, for them to understand the exchanges, I will conduct an education session and teach them about exchanges. So, it’s like giving them self-efficacy. They know how much they should eat, and they can choose what kind of food they can eat” [SN 2]
When discussing mealtimes with the athletes, the SNs highlighted the pre-, during and post-exercise meals. The example below is how a SN suggested a suitable food based on mealtime:
“...but, for example, if athletes finish school quite late, maybe around 2.30-3.00 pm which is 1-2 hours before their training schedule, I would still advise them to take a complete meal but a light one which is easy to digest ... perhaps a sandwich or pizza with vegetables and proteins but less in fat or bread with tuna...” [SN 4]
There were situations where SNs adjusted the current dietary intake by changing the types of foods and portion sizes to parallel with the recommended meal plan in process three.
“yes, the food suggestion will be planned based on athlete’s diet history or diet record. Then from that, we will make adjustments…” [SN 5]
In addition, timings for breakfast, lunch, dinner and snacks were suggested according to the athletes’ training schedules.
“Usually the issue of mealtime occurred when there is an early morning or afternoon training because need to include their pre-training meal. If training early as 7.30 am, I will recommend snack such as fruits as pre-exercise meal. And after they finish their training maybe at 10am, then can consume complete meal and we consider as breakfast.” [SN 2]
Process 6: Monitoring
Monitoring is a process that occurred after the meal plan has been provided to the respective athletes. The SNs monitored their athletes’ dietary intake and body composition over time. The methods used to conduct the dietary monitoring process included: meeting the athletes during lunchtime to determine what they were consuming, texting athletes and asking whether there were any problems related to the new menus or asking the athletes to take a picture of foods and beverages that they were consuming.
“...a lot of time, we will try to meet them, to see what they eat.” [SN 1]
“...after a few days I will contact and ask “How’s the menu?” I do the follow-up usually through WhatsApp.” [SN 2]
“After 1 month I will request the athletes to meet with me and I would assess their body composition to see either the goals have been met or not.” [SN 3]