An Ounce A Day

An athlete in need of weight loss is vulnerable in many ways. A sports nutritionist explains how to develop a sane weight-loss plan with measured goals.

By Leslie Bonci
Leslie Bonci, MPH, RD, is Director of Sports Nutrition at the University of Pittsburgh Medical Center and serves as a consultant to the Pittsburgh Steelers, Pitt athletics, and several area high schools.

Mike was a very successful high school defensive back who was offered a full scholarship to a highly ranked NCAA Division I college football program. Throughout high school, his coach had told him that bigger was better, so he decided to eat more at every meal and spend more time in the weight room. This resulted in an increase in mass, strength, and performance.

The summer before his freshman year at college, he sustained a knee injury in a pick-up basketball game. His activity decreased dramatically, but his eating didn't, and by the time he reported to the first day of training camp at college, he was 25 pounds heavier than his playing weight. He was told to lose the weight fast, doing whatever it took, and to exercise after practice by doing some extra running or stationary biking.

Worried that he wouldn't see playing time if he didn't lose the weight, Mike started skipping breakfast and lunch and eating a large salad and two grilled chicken breasts for dinner. He went to bed hungry, woke up irritable, and was extremely tired and lightheaded during practice. His weight dropped but his performance suffered--and the extra activity aggravated the knee injury. He saw very little playing time.

Obviously, this is an example of what not to do when an athlete needs to lose weight. The timing was wrong, there were no realistic goals, and communication was almost nil.

Weight management is difficult for all involved, and it needs to be treated with care. The individual who is trying to change his or her weight is very sensitive and may feel pressure to do it quickly. The individual who is making the recommendation may be well intentioned, but misinformed--hence, a disconnect develops that results in an uncomfortable and sometimes confrontational situation.

In order to do best by the athlete, you must help him or her put a plan in place, with very specific goals, a timeline, and a strategy for assessing progress. The process also requires communication and an understanding that each athlete and each weight-loss situation is unique.

THE RIGHT QUESTIONS

When an athlete is interested in losing weight, it is a good idea to sit down with him or her and gather some information prior to goal setting. Questions to ask might include:

o Why are you interested in losing weight?

o Has anyone told you that you have to lose weight?

o Do you have particular health concerns?

o Have you lost weight in the past? If so, how?

o What do you expect to notice in your performance as a result of weight loss?

o How much time do you have to commit to working on weight goals?

o What are obstacles that may hinder your efforts to lose weight?

o Do you have a support system in place?

o Do you have a time frame for weight loss?

It is important to ask these questions so that you start a dialogue with the athlete on what may or may not be realistic goals. Athletes should know what they can change in their bodies: fluid balance, muscle mass, and body fat. And they should know what they cannot change: height, frame size, and body shape.

The athlete who diets to have broader shoulders or smaller hips needs to be educated about realistic body goals. With changes in exercise and diet, one can change their size, but not their body type.

The red flag is when someone is overly concerned about the look of their body. These individuals may employ drastic measures to change their bodies, such as dehydration, starvation, and the use of supplements, laxatives, or diuretics. The outcome is not body fat loss, but a change in fluid balance and lean body mass, both of which may adversely affect performance and health. The athlete who seems overly obsessed with his or her body should be referred for counseling.

GOAL SETTING

In the absence of any red flags, the process of weight loss can begin with realistic goal setting. To do this, you'll need to assess the athlete through baseline measurements. I believe the most important baseline measurement to take is the athlete's body fat percentage. Why focus on body fat and not weight? The goal is enhanced performance, and that will not be achieved by a decrease in body weight alone. It is the loss of body fat--without loss of muscle mass--that will lead to a better athlete.

If an athlete loses five pounds a week, it does not indicate fat loss alone, but also fluid and muscle mass loss, which will have a negative effect on performance. In addition, because body weight can fluctuate several pounds in the course of a day due to fluid changes, it can be extremely demoralizing to the athlete who has had a "good" week only to see the scale read higher.

To start out, you'll need a baseline measurement of the athlete's body fat percentage. Underwater weighing and DEXA (Dual Energy Xray Absorptiometry) provide the best measurements, but you can also use skinfold calipers or bioelectrical impedance.

For some athletes, another important baseline measurement is that of frame size. Even if you explain the importance of body fat measurement, some athletes will still obsess about their weight and want their numbers to match those on a standard height/weight chart. For these athletes, it may be helpful to make frame size a part of the equation, since someone with a larger frame size should expect to weigh more than someone of the same height with a small frame. (An assessment of frame size can be computed using elbow breadth as illustrated in Table One, on page XX.)

Once you obtain baseline measurements, how do you set goals for reducing body fat? I usually start with goals of reducing 10 to 15 pounds of body fat over a period of six months. That would equal about 8 percent of body weight if no muscle mass is lost. Long-term goals are important, because in order to avoid losing muscle mass, an athlete needs to lose weight slowly.

Measure body fat at six-week intervals, looking for body fat reductions of three to four pounds. Also ask athletes to assess success in non-scale related ways such as energy levels, better sleep patterns, and improved performance. This is the best way I've found to keep the athlete motivated and the goals performance-based.

If your athlete needs some short-term goals to keep motivated, be sure to add them in. A good goal to start with is 1/2 to 3/4 pound of body fat lost per week, which might equal two pounds per week on the traditional scale. Again, ask about energy levels and mood.

It is also important to start any weight-loss program at the end of the season with the final goal to be achieved by the following preseason. Too often, the athlete may wait until the start of the season, or until the season is already under way, to work on weight goals. It is extremely difficult to focus one's undivided attention on the rigors of training, conditioning, competition, and academic demands, while simultaneously addressing body goals. Timing is a key component of weight loss and trying to lose weight in-season more often than not leads to ineffective performance.

CHOICES & BEHAVIORS

It would be impossible to adequately address weight management without talking about diet. However, do realize that one's diet is composed of two areas: what and how much actually goes into one's mouth; and the when, where, and how of eating.

Let's start with the "what" of the diet, the food. A meal plan should not translate to a decrease in strength, speed, stamina, or mental clarity. Therefore, athletes should not adopt an eating pattern that eliminates or severely restricts an entire macronutrient, such as carbohydrate- or fat-containing foods. Nor should they skip meals. It is important to remind athletes that carbohydrate and fat are the primary fuel substrates for the exercising muscles. Protein is essential for tissue growth and repair and supporting a healthy immune system, but it is an inefficient fuel substrate for exercise. One may drop some pounds by using a high-protein diet, but will pay the price by being too tired to make it through a practice or conditioning session.

What about the actual food choices? Is there one sports diet? Besides eating the proper balance of carbohydrates, proteins, and fat (60/15/25 for the endurance athlete, 50/20/30 for the power athlete), the answer is no.

Overall, you want to reduce caloric intake, but there is not one meal plan or calorie level that will be appropriate for every athlete. The idea is for the reduced calorie level to result in the desired changes in the body while still providing enough energy for the demands of exercise.

To determine appropriate calorie reduction, first figure out the athlete's Resting Metabolic Rate (RMR), which is body weight multiplied by 10, plus 70 percent of that number (to account for an athlete's activity). That gives you the number of calories for weight maintenance. Then, subtract 20 percent from the equation for weight loss. So, for a 150-pound athlete, the equation would be:

150 x 10 + .7(1500) = 2550;

2550 - .2(2550) = 2040.

The athlete should consume 2040 calories for weight loss to occur without negative energy levels. (If an athlete is not exercising, the 70 percent of RMR should go down to 20 to 40 percent.)

There is absolutely no advantage in cutting calories to a minimum. In this example, if our 150-pound athlete had a goal of 130 pounds and decided to eat only 1200 calories a day for weight loss, he or she would end up very hungry, tired, and irritable, and would most definitely notice a decline in performance. Too low is not better when it comes to calories for weight loss. Although most athletes don't know the calorie cost of foods consumed, there are some on-line tools such as the Interactive Healthy Eating Index (www.usda.gov/cnpp), where one can log food intake and get a printout of calories consumed daily.

The next step is to take into account the psychological side of food consumption. Eating is supposed to be a pleasurable experience, thus the athlete's meal choices need to be based on his or her food preferences as well as when and where he or she likes to eat. A simple concept, but one that people forget to take into account!

To help athletes figure out how to change their diets, I give them a chart that lists many popular food items. I ask them to circle the foods they eat frequently, then list how often they eat them. I also ask them to indicate "trigger foods," things that they pig out on or eat for stress reduction, as well as foods they never consume. (See Table Two on page XX.) From looking at the chart, I can see if they are consuming too much or too little of one thing, and whether there may be some psychological factors behind their food choices. For example, if an athlete eats primarily carbs or protein, I would have him or her look at the food choices in the other categories and develop a plan that would include a mix of nutrients at each meal and snack.

I also ask them to describe their eating patterns: Do they eat a lot at any one meal? Do they use snacks as a way to reduce stress, get through a long night of studying, or when hanging out with friends? This helps to determine troublesome times of the day and hungry times, and allows us to concentrate on problem areas rather than the entire day. I want to understand how to take away the calories that have little meaning, while leaving in the calories that do have meaning.

A final tip on setting weight-loss goals: make sure the athlete has input. The athlete must be ready and willing to change, which can more readily happen if he or she has had a thoughtful dialogue about the dieting process. The most superb meal plan will only be effective if the athlete perceives the value of it. Ultimately, it is the athlete, not the coach, health professional, or athletic trainer, who decides what, when, and how much he or she is going to eat and drink.

SUPPORT TEAM

Along with having goals and an overall plan in place, some thought must be put into who will monitor the athlete. If there is not a nutritionist on staff, the athletic trainer is an ideal person to meet regularly with the athlete.

Accountability is a huge part of goal setting, so be sure to check body fat percentages or go over eating plans when you say you will. Most athletes need to know that someone is monitoring them for their efforts to be successful. It is also important to build in incentives so that the athlete perceives the value in going through the effort. Ideas for incentives might include positive comments, talking about effects on performance, an effort award, and even letting a successful weight-loser be a peer counselor for athletes just starting out on a weight-loss plan.

Some additional tips for those on the support team:

_ Always focus on what works for the individual. Even if you have personally found a meal plan and lifestyle pattern that works for you, you should not assume it will work for someone else.

_ Take a positive approach. Losing weight can be much more difficult for some athletes than lifting a heavier weight or learning a new play. Do not belittle or criticize, or else your efforts may backfire. The environment and support system need to be positive.

_ Remind athletes that weight loss is a series of steps, not a slide, so there are going to be weeks when their weight doesn't change. Explain that this is the body's adaptation to the process of weight loss, and it is not necessary to eat less or exercise more.

_ Suggest that the athlete take pride in what he or she has accomplished so far and what they notice in terms of performance. Tell them there is no such thing as perfection. When an athlete hits a plateau, it is a good idea to encourage him or her to monitor intake for a few days to see if perhaps calories are on the high side, or perhaps they just need to have patience.

Weight loss does not occur overnight, and so far, no magic pill is available. It takes time, effort, and commitment on everyone's part. The underlying goal is performance enhancement and positive body changes. If weight loss is approached in a healthy way, the athlete will be proud of his or her accomplishment and see the results in his or her performance.



Table One:

Elbow Breadth

The measurements listed below correspond to a medium frame for the given height. If elbow breadth is less than the numbers listed here, the athlete has a small frame. If elbow breadth is greater than the numbers listed here, the athlete has a large frame.

To measure elbow breadth the athlete should be standing, with dominant arm extended forward and palm down. Bend elbow to a 90 degree angle so that the back of the hand faces the athlete. Measure the distance around the narrowest part of the elbow joint.

For a male

Height Elbow Breadth (inches)

5-2 to 5-3 2-1/2 to 2-7/8

5-4 to 5-7 2-5/8 to 2-7/8

5-8 to 5-11 2-3/4 to 3

6-0 to 6-3 2-3/4 to 3-1/8

6-4 to 6-7 2-7/8 to 3-1/4

For a female

Height Elbow Breadth (inches)

4-10 to 4-11 2-1/4 to 2-1/2

5-0 to 5-3 2-1/4 to 2-1/2

5-4 to 5-7 2-3/8 to 2-5/8

5-8 to 5-11 2-3/8 to 2-5/8

6-0 to 6-4 2-1/2 to 2-3/4

Source: "Elbow breadth as a measure of frame size for US males and females," by Frisancho AR, Flegel PN. AJCN Vol. 37, 311-314, 1983.



sidebar: Quick Tips

The following tips can help with weight loss:

Cutting Calories:

o Use a smaller plate, bowl, or glass to control portion sizes.

o Look at the serving sizes on packages of foods to keep the portions in check.

o Do not reduce carbohydrates, but decrease the serving size.

o Understand that fat-free and sugar-free foods are not necessarily calorie-free.

o Be aware of calories in condiments.

o Use a smaller amount of real salad dressing, peanut butter, or mayonnaise instead of large amounts of fat-free versions.

o When eating out, order half-size portions or have an appetizer and salad, or soup and half a sandwich.

Eating Habits:

o Try to eat more early in the day to prevent overeating in the evening.

_ Always eat breakfast.

o Eat something every three to four hours.

o Be consistent with the number of meals a day, seven days a week.

o Sit down when eating.

o Put all foods, even snack foods, on a plate.

o Try to eat when hungry, and on a fullness scale of 1-10, stop at about a 5.

o Try not to eat when at the computer or watching television.

o Put tempting foods out of sight, or better yet, out of the house, apartment, or dorm room.



Table Two:

What Do You Eat?

When starting a weight-loss plan, ask athletes to write down next to each food item how many times they eat that food per week. Also ask them to put a TF next to any "trigger foods" they eat to reduce stress, when hanging out, or as a quick meal solution.

Carbohydrate-containing foods

Bread

Bagels

Cereal

Pasta

Rice

Fruit

Vegetables

Juice

Sports drink

Soda

Candy

Cookies

Cake/Pies

Pastries

Crackers

Pretzels

Chips

Potatoes
Yogurt

Ice cream/frozen desserts

Protein-containing foods

Beef

Veal

Lamb

Pork

Fish

Shellfish

Chicken

Turkey

Eggs

Cheese

Nuts

Nut butter

Dried beans (kidney, lentil, etc)

Soy products (tofu, soy milk, veggie burgers)

Milk

Yogurt

Fat-containing foods

Margarine

Butter

Salad dressing

Mayonnaise

Oil

Bacon

Cream cheese

High-calorie drinks

Alcohol

Beer

Wine

Mixed drinks