Food Choice Decisions of Collegiate Division I Athletes: A Qualitative Exploratory Study

Eligible participants were Division I college athletes at a large university; these athletes participate at the highest, most regulated level of intercollegiate athletics in the United States sanctioned by the National Collegiate Athletic Association [12]. Most Division 1 athletes are actively recruited for a collegiate sports team based on their athletic excellence in secondary education sports programs. They are among the most elite athletes and typically train up to 20 h per week [12]. Athletes were recruited via email announcements sent to coaches and athletic trainers and directly to athletes as well as in person at athlete fueling stations on campus and through referrals by athletes. Recruitment notices invited athletes to help researchers learn more about athletes’ eating behaviors. Students who participated in the study were entered into a drawing to receive 1 of 5 $25 gift cards as compensation for their time.

A semi-structured interview guide was developed based on the results of interviews with dietitians working in the area of sports nutrition. The interviews gathered information on perceived behaviors of athletes and identified knowledge gaps related to athlete’s food/nutrition-related beliefs and behaviors. The interview guide was reviewed by a panel of 5 experts in the areas of sports nutrition, eating behaviors, and qualitative data collection.

A trained moderator conducted brief (~20 min) semi-structured phone interviews with each athlete while a trained note-taker recorded responses. Interviews were completed between September 2018 and August 2019. Interviews addressed 5 main topic areas: commonly consumed foods, avoided foods, food ‘rules’, their definition of healthy eating, and supplement use. Interview questions were developed de novo after a thorough literature review to identify gaps in the literature related to nutrition professionals’ understanding of athletes’ eating behaviors as well as results from a series of interviews with sports dietitians [13]. The semi-structured interview guide was followed closely to ensure consistent and complete data collection during each interview. Table 1 lists the interview questions.

Within 24 h of completing each interview, notes were reviewed by the note-taker and edited for accuracy, clarity, and completeness. The notes were then reviewed by the moderator within 48 h of the interview to ensure accuracy and completeness. Any discrepancies in the notes between the note-taker and moderator were discussed, and a consensus was reached to finalize the notes. Then, a trained researcher qualitatively content analyzed the data. The constant analysis concurrent with subsequent interviews allowed the researcher to determine the point of data saturation (i.e., when no new information emerged from the interviews), which signaled data collection could end [14]. Once data saturation was reached, the data were independently content analyzed by two trained researchers using standard procedures [15,16] to identify themes and patterns within the data. Researchers compared their analyses and discussed differences to reach a consensus. The presentation of qualitative data is based on the verbal expressions of participants and “quotes are the primary form of evidence to support an author’s interpretation of the raw data” [17], thus this study employed the quote replete data reporting method.

Findings from the athlete interviews are summarized in Table 1. In response to the interview question. “What foods or drinks do you consume every day or almost every day?”, nearly all athletes named water as a “staple” in their diet. Other foods frequently reported by athletes as being commonly consumed were chicken, fruits, vegetables, milk, Greek yogurt, and eggs. Athletes reported that fruits (e.g., apples and bananas) and snacks supplied by fueling stations at the gym (i.e., granola/protein bars, trail mix, fruit snacks) were common snacks.

When asked, “Why do you choose to consume these foods and drinks frequently?”, participants responded they drank water “to stay hydrated because we practice twice a day and I lose fluids”. Chicken and other sources of protein were consumed “for energy and muscle recovery”. The motivation for eating fruits and vegetables was “to make sure I have all the vitamins I need so my body is fully functioning”. Athletes chose to consume milk “because I want the calcium and protein source” and yogurt because “it’s great for probiotics and protein”. In general, athletes ate less processed foods because “they’re what makes me feel best as opposed to other more processed options”. Other factors influencing common food choices were “I like foods that are cheap and available” as well as foods that “fill me up”.

When asked, “What foods or drinks do you consume frequently because you feel they enhance your performance?”, most participants focused on the importance of hydration and noted that they are sure to drink plenty of water or Gatorade^® because “the more hydrated you are, the easier it is for your muscles to recover after your workout and you also just want to be hydrated throughout the day”. Athletes also reported that staying hydrated is key because “If I don’t have enough [fluids], it can affect my energy levels and staying hydrated helps athletes last longer through practice”. Protein was a key nutrient named by the athletes, many of whom reported choosing high protein foods because “we were told by our nutritionist that after practice we should consume protein”. Athletes believed that they “need protein to put on good muscle size”, that “protein shakes allow me to give the same intensity [to my workout] day after day”. Snacks like beef jerky, protein shakes, and chocolate milk were provided to the athletes after workouts which they perceived as supporting the importance of protein for recovery. Although the athletes identified protein-rich foods as performance-enhancing, they did not always know the specific benefits provided but relied on the advice of their sports nutritionist. Commenting about the benefits of chocolate milk one athlete said, “I forget why chocolate milk [is beneficial], but I’ve had nutritionists and trainers say it’s good for you”.

Eating during practice or competition was another theme that emerged. Athletes reported choosing fruit snacks or sports chews “if I get tired during practice” and want to “get some sugar in me” “to give me a little boost”. While some of the athletes reported they “don’t know what [these sports food products] have in them”, others stated that they had learned from the dietitian that these foods contain the “types of carbs that digest really quickly”.

Athletes felt specific nutrients that could be beneficial for performance. One athlete drank “milk for calcium because I’ve had injuries and I need strong bones”. Another reported being anemic and thus was “trying to eat spinach, take iron supplements, and eat high iron foods”. A distance runner shared that she “read somewhere that there are certain chemicals in beets that are good for distance running” and thus ate beets frequently.

Athletes also were asked, “What foods or drinks do you consume frequently because you feel they have a beneficial effect on your weight?”. Many reported that they were not concerned about their weight, but that fruits and vegetables are a good option for feeling full without overeating. A few athletes were trying to gain weight and reported that protein shakes and whole milk were some of the foods they ate often.

When asked, “What foods do you avoid?” and “Why do you avoid them?”, athletes readily named fast food, fried foods, and other foods that are “too processed, oily, or greasy”. Specific foods that met these criteria included french fries and pizza. Athletes avoided these because “I can feel it at practice the next day. I feel sluggish like it is sitting in my stomach”. Soda and other sugary drinks also were commonly named as being avoided. Some also reported avoiding sweets like candy and desserts.

When asked “What foods do you avoid while you are in season, but will eat out of season? Why are those foods reserved for the off-season?”, most athletes reported that there “isn’t too much of a difference” in their diet between the in and off-season. Some athletes were a bit more liberal during the off-season and had the occasional fast food meal or ate dessert more regularly. Alcohol was mentioned by two athletes as something that they avoid during the season, but do consume during the summer months when they are not practicing with the team. Some athletes reported that they “eat less healthy while in-season because, when we are traveling, sometimes we have to eat fast foods. Whereas, when I’m in the off-season, I’m always making my own food, my normal healthy stuff.”

In response to “What foods or drinks do you avoid because you feel they have a negative impact on your performance?”, athletes commonly named sugary drinks and fried foods. Athletes reported avoiding sugary drinks like soda and coffee drinks because they displaced water intake, which could negatively affect performance. They also avoided “heavy” or “fatty foods” like mac and cheese or pizza, particularly late at night because they can result in “feeling slow and sluggish” the next day.

When asked, “What foods or drinks do you avoid because you feel they would have a negative effect on your weight?”, sugary drinks and fatty food were again named. One athlete reported that it was important to limit sugary drink consumption because “over time, if the body doesn’t use up the sugars it consumes in a day, it stores it as fat.” Another athlete indicated it was important to select nutrient-dense foods over sugary treats noting, “calorie-wise, if I’m trying to get something out of it, I’d rather have some type of protein that builds muscle rather than something sugary like a Pop-Tart^®”.

When asked, “How would you define healthy eating?”, the athletes repeatedly stated “balanced meals”, which they defined as “getting the food groups in each meal” or “having a balance of carbohydrates, protein, and vegetables”. Some athletes specified consuming 3 meals and at least a couple of snacks and “not skipping meals” was important. Variety (“a rainbow”) and portion size (not just what you eat, but how much) were also common responses. Some athletes specifically mentioned that it was important for athletes to focus on “eating enough” and noted that “cutting calories” or avoiding specific foods was not ideal for athletes.

In response to the question, “When you are deciding if a food is healthy or not, what types of things you think about?”, some athletes noted that they consider how the food will make them feel. Others reported talking to friends or their nutritionists about what constitutes healthy food. Most of the athletes felt unprocessed and home-cooked foods were healthier than processed foods and fast food because, “if I make it, it’ll be healthier because I know what’s going into it. I know what it is.” Many athletes said that “a lot of foods I consider healthy, I just know are healthy because they are what they are”, naming fruits, vegetables, lean meat, and whole grains as foods they considered to be healthy. A few athletes reported using the Nutrition Facts panel on processed foods to determine if was healthy. When reviewing the Nutrition Facts panel, these athletes reported noting the “fat content, specifically saturated fat” and “looking at the sugar content and the first few ingredients”.

Athletes were asked, “Do you think that healthy eating for an athlete is different than healthy eating for a non-athlete? How so?”. In general, the athletes felt that healthy eating for athletes and non-athletes were similar in some ways, but differed in others. The main difference noted by athletes was that they are eating to fuel performance, which can dictate their intake. As one athlete said, “the base [diet] is the same, but depending on what kind of athlete you are, you might have to increase the amounts of each particular [macronutrient] you need. It’s relatively similar, but higher calorically and content-wise for athletes.” For example, “for athletes, you need more protein at different points in the day” and “there are days before matches or any competition where athletes do need to carb load. Whereas, if a non-athlete carb-loaded, it wouldn’t be such a good idea.” The athletes noted that they consumed the “same types of food [as non-athletes], but larger portions.” Stating that, “You have to eat a lot more than the average person which makes it difficult because you feel like you are overeating, but that’s what you have to do.”

Participants were asked, “What supplements, such as dietary or nutritional supplements, ergogenic aids, herbal supplements, vitamins, and minerals, if any, do you use? What is your reason for using the supplement?” The most common supplements were multivitamins, vitamin C, calcium, iron, and protein shakes. Other supplements included fish oil, glucosamine, echinacea, salt, and magnesium. The athletes who reported using a multivitamin said they did so as a “good way to get the vitamins I need”, reporting that it was convenient (“it takes two seconds and it’s easy to take”). Multivitamins were seen as a way to fill in dietary gaps as one athlete stated, “I know I still have to work on my diet. [I] want to make sure I’m getting some of the nutrients I might be missing from a multivitamin.” Vitamin C was thought to improve immune function and athletes reported “Vitamin C keeps us well, sickness affects our training. I don’t want to get sick and miss training or have it mess up our performance.” Athletes who reported taking calcium supplements did so to strengthen bones and prevent stress fractures that can take them out of competition. Most athletes who reported taking iron reported that they had “been tested for low iron and if I’m feeling particularly tired, or sluggish, I’ll get my blood drawn before I take iron.” However, one athlete noted that “a bunch of kids on our team have an iron issue, more in the women obviously but some of the men, but I take iron pills because I don’t want to be one of the kids with an iron deficiency.” Post-workout protein shakes (or high protein milk drinks) were the most common supplement used by athletes who wanted to “start rebuilding muscle right after practice” in order to “feel like I’m getting the maximum out of the workout”. Although some athletes reported that they “can’t remember the science behind it, but I know it does help with recovery, someway somehow.” They felt these shakes were beneficial because “it’s what [the nutrition staff] provide us in our fridge [in the weight room].” All athletes reported consuming at least one supplement. However, an athlete who only consumed protein shakes and Emergen-C^® stated, “I don’t take too many supplements because I forget or I don’t necessarily know if I’m lacking in anything and need them.”