A Strengths-Based Approach to Increasing Nutrition Knowledge in Student-Athletes: The ‘Eat 2 Win’ Pilot Program

Adequate and appropriate nutrition and hydration are key to athlete health and performance. For the student-athlete, sufficient intake from a variety of foods is particularly crucial to support both the increased training and competition demands, and the increased requirements for macro- and micronutrients for growth and development [1,2]. Specifically, early adolescent nutrition plays a role in the timing of puberty, future adult height and bone mineral density, and body composition [3,4,5]. Inadequate energy intake in student-athletes has the potential to compromise body functions, with the associated nutrient-related deficiencies negatively impacting athletic performance [6], and with subsequent injury risk, as well as increasing the risk of chronic disease later in life [7,8]. Due to high levels of energy expenditure typical in student-athletes (well in excess of non-athletes), a common issue is inadequate energy intake [1]. The condition known as Relative Energy Deficiency in Sport (RED-S) results from Low Energy Availability (LEA) [6,8,9,10]. Energy availability is defined as the amount of energy left for the body’s physiological functions after the energy expended during exercise is subtracted from the energy intake [11]. Ironically, LEA often results in a decreased resting metabolic rate, and therefore a greater risk of higher body fat percentage, which is the opposite of what the individual restricting intake was aiming to achieve [10]. Longer term effects of RED-S include decreased cardiorespiratory fitness, neurodevelopment, and immune function [6,8].

Nutrition inadequacies are of significant concern during adolescence due to the increased energy requirements for growth and development, and the importance of maximising bone density during this life stage [11]. Female student-athletes are particularly at risk of LEA, which can result in delayed puberty, menstrual irregularities, poor bone health, disordered eating behaviours, and an increased injury risk [9]. Male student-athletes are also at risk of LEA, most commonly road cyclists and long-distance runners. Risks include the exercise-hypogonadal male condition, which results in lowered testosterone and libido [9]. Athletes in aesthetic sports and athletic events that emphasise body shape or leanness such as ballet, gymnastics, athletics, and sports with weight categories, are at higher risk of disordered eating behaviours, and thus at higher risk of LEA and RED-S [10,12]. Inadequate energy intake is often associated with disordered eating behaviours such as deliberately skipping meals, eliminating food groups, or attempting ‘fad’ diets. Nutritional risks associated with disordered eating, in addition to LEA, include macronutrient and micronutrient deficiencies, dehydration, electrolyte imbalances, and the risk of progression to a diagnosed eating disorder [10]. Collectively, these deficiencies are also associated with a decrease in athletic performance, including strength, power, endurance, and issues with managing fatigue, thermoregulation, and decision-making. Mountjoy and colleagues [6] term this the ‘REDs Athlete Performance Conceptual Model’ (Figure 1).

Inadequate energy intake often leads to student-athletes under-consuming foods high in key micronutrients. Micronutrients of particular concern are calcium, iron, and vitamin D [1]. Calcium, in conjunction with vitamin D, in adolescence is crucial for maximizing bone mineral density [13] and reducing the risk of stress fractures [14]. In some parts of Australia and globally, vitamin D may appear to be of less concern due to the predominately sunny climate [15]. However, due to the ‘SunSmart’ awareness campaign related to excessive sun exposure and skin cancer risk, vitamin D intake may be inadequate for certain individuals, particularly for those primarily training or competing indoors [16,17]. Iron deficiency is also a global concern [18], and student-athletes, particularly females, are at an increased risk due to iron losses in sweat and blood [19,20]. The consequences of inadequate iron intake on sporting performance include reduced endurance, increased muscle fatigue, increased lactate concentration, and the depletion of muscle glycogen [20].

A lack of nutrition knowledge has been consistently identified as a primary factor influencing the suboptimal dietary choices of student-athletes [21,22], which can negatively affect their overall health, well-being, and athletic performance. Therefore, the aims of the current study were to assess the nutrition knowledge of high school student-athletes; to describe the conceptualization, design, and implementation of the ‘Eat to Win’ pilot program—an innovative nutrition education initiative tailored for student-athletes within an Australian high school sports context; and to evaluate the program’s feasibility and acceptability. The ‘Eat 2 Win’ program was designed to address critical gaps in nutrition knowledge by identifying and incorporating essential components that support the growth and development of student-athletes, and thereby provide a strong foundation for informed and sustainable dietary behaviours.

A primary reason why student-athletes make poor nutrition choices, including inadequate food and fluid intake, as well as inappropriate nutritional supplement usage, appears to be a lack of nutrition knowledge [21,22]. Student-athletes are often unaware of the importance of adequate energy intake in general and carbohydrate intake in particular. In addition to inadequate energy intake generally, student-athletes under-consume carbohydrates, while over-consuming protein [1], with excessive protein from common supplements [21,23]. They often underestimate their hydration needs, especially during prolonged or intense exercise, or in hot and humid conditions, being unaware of the link between dehydration and reduced physical and cognitive performance [20]. A recent systematic review of 32 studies found general and sports nutrition knowledge were lacking in adolescent athletes [22]. However, the authors highlighted that many of the studies used inadequately validated questionnaires, with mean nutrition knowledge scores varying from 33% to 91% [22]. Fourteen studies assessed hydration knowledge, and the number of correct scores in this domain varied between 33% and 88% [22]. Despite this variation in the results across studies, a common theme was poor knowledge around nutrition supplements, with most study participants answering ‘incorrect’ or ‘don’t know’ to those questions. For example, Bird and Rushton [21] surveyed 101 youth academy athletes aged 13–18 years, with 42% answering ‘unsure’ to questions related to the supplement subcategory. Notably, 31% reported using protein supplements (Figure 2); however, there was much uncertainty when asked why they were taking protein supplements, as 45% reported ‘unsure’. Overall, the mean ‘correct’ score for nutrition knowledge was 44%. In agreement with previous research, the authors concluded that elite youth athletes lack fundamental nutritional knowledge [21].

Jovanov and colleagues [23] examined 348 athletes aged 15–18 years and reported very high supplement use, particularly protein supplements, with the main motivation being the enhancement of athletic performance, but 72% of the participants were unaware of the health risks associated with supplements in general. Similar results regarding protein supplement knowledge and use were reported in an Australian study of 87 student-athletes aged 13–18 years [24]. Sixty percent of the participants used protein supplements; the main reason for consumption was to aid muscle recovery, with general performance enhancement also a motivator [24]. Despite the heterogeneity of nutrition knowledge tools and methodological issues highlighted in the systematic review by Hulland et al. [22], it is evident that there are common misconceptions surrounding protein supplementation, and misunderstandings about hydration and energy requirements. Additionally, there also appears to be a mistaken belief by student-athletes that consuming excessive amounts of protein will significantly enhance muscle growth and recovery. While protein is essential, balance with other macronutrients is also crucial, and excessive protein intake can lead to the neglect of other important nutrients.

Furthermore, many adolescent athletes also underestimate their hydration needs, especially during prolonged or intense exercise [25], and fail to adjust their food intake to meet the demands of training [26]. Such issues surrounding nutrition misinformation are exacerbated in student-athletes due to their susceptibility to messaging from coaches and social media influencers with limited nutrition knowledge [21]. Added to this are targeted student-athlete marketing campaigns from sports food, beverage, and supplement companies with nutrition messages that may undermine appropriate nutrition choices [1]. Nutrition messages that focusses on dietary and supplement strategies aimed at manipulating weight and body composition are particularly insidious [1,10], especially when devoid of an underlying ‘food first’ philosophy [27]. Close et al. [28] suggest that ‘where practically possible, nutrient provision should come from whole foods and drinks rather than from isolated food components, dietary supplements or sports foods’ (p. 371). This is a significant consideration, as attitudes toward food choices, nutritional supplements, and eating behaviours established during childhood and adolescence often persist into adulthood [29].

There is evidence that nutrition education programs can support student-athletes to make informed food choices [30,31,32] by increasing nutrition knowledge in general and addressing specific knowledge gaps [33]. A systematic review by Tam et al. [34] examined thirty-two nutrition education interventions delivered to athletes (mean age 17.4 years, 66.1% female; 56.3% university-level athletes; 75% based in the US) and found a significant increase in knowledge overall. However, due to the wide range of tools used to measure nutrition knowledge, it is difficult to compare outcomes between studies, and determine which delivery mode may be most effective. Additionally, a systematic review of nutrition education programs in athletes by Boidin et al. [35] compared dietary intake outcomes from interventions with a variety of education modalities that included face-to-face group lectures or workshops, or individual counselling. While more than half of the studies (12/22) reported a significant change in at least one nutrition parameter, it was again not possible to determine the overall impact of nutrition education on either knowledge or nutrition behaviours due to methodological differences in the way the nutrition education was delivered. Collectively, the authors noted limited research on the effectiveness of nutrition education interventions for athlete populations. This is an interesting observation given the substantial resources dedicated to collegiate nutrition programs [36], so there is a pressing need for well-designed, rigorous studies to guide and enhance future best practices [35].

Nutrition is a critical component of supporting the growth, development, and athletic performance of student-athletes. Despite this, adolescent athletes often prioritize physical training over nutritional practices, which are frequently neglected. This neglect is closely tied to consistently low levels of nutrition knowledge reported across studies. The findings from the ‘Eat 2 Win’ pilot program align with previous research, demonstrating that baseline nutrition knowledge among youth athletes is generally limited. For instance, the baseline score of 42.2% observed in this study is comparable to the 47% reported by Trakman et al. [37], and slightly lower than the 49.6% and 52.5% reported by Scanlon and Norton [41] and Bird and Rushton [21], respectively, among youth academy and development athletes. The post-program score of 51.9% in the current study is similar to our previous findings [21] and reflects a 9.7% improvement. This is consistent with other intervention-based studies, which reported a 10% increase in overall nutrition knowledge following targeted education in female college athletes [42]. A particularly notable outcome of the current study was the significant gain in hydration knowledge (+34.4%), a finding that contrasts with prior research, where improvements in hydration understanding were less pronounced [21]. This suggests that the ‘Eat 2 Win’ program effectively emphasized hydration as a priority topic. However, the minimal improvement observed in vitamin knowledge (+3.1%) highlights the persistent challenge of addressing complex topics like micronutrients in student-athlete populations.

The ‘Eat 2 Win’ pilot program was designed as an initial step toward addressing these gaps by providing a structured framework for nutrition education tailored to the unique needs of student-athletes. While the results highlight measurable improvements, particularly in hydration knowledge, the findings also underscore the need for further refinement to achieve the desired “good” threshold of nutrition knowledge across all categories, as defined by Trakman et al. [37]. These limitations are consistent with the nature of a pilot study and reflect the program’s early stage of development. To expand on the significance of this work, it is essential to situate these findings within the broader context of nutrition education interventions for youth athletes. For example, studies by Zinn et al. [43] and Walsh et al. [44] similarly reported modest improvements in nutrition knowledge following educational interventions, suggesting that incremental gains are a realistic outcome in this population. The emphasis on practical, actionable knowledge (such as hydration and macronutrients) may serve as a strength of the ‘Eat 2 Win’ program, given that these areas are more immediately relevant and applicable to student-athletes’ daily routines. Looking forward, further development of the ‘Eat 2 Win’ program must address knowledge gaps in complex areas like vitamins and supplementation, potentially through greater emphasis on innovative teaching strategies for enhancing complex creativity, such as combined interactive workshops and gamified learning strategies. This is an important consideration, with recent work by Lee [45] highlighting that ‘students considered that gamification could stimulate their motivation, attitudes, and interest in learning’ (p. 11). Additionally, longer-term interventions with follow-up assessments are required to evaluate the retention of knowledge and its translation into sustainable dietary behaviours.

Student-athletes face unique nutritional demands, placing them at an increased risk of inadequate dietary intake [27]. Achieving optimal health and performance requires a comprehensive approach to nutrition, including informed choices about meals, snacks, and beverages throughout the day and around training or competition [1]. Addressing nutrition knowledge and suboptimal dietary practices commonly observed in adolescents [33] through targeted education programs, such as ‘Eat 2 Win,’ has the potential to enhance nutritional knowledge and positively influence long-term dietary behaviours. By equipping student-athletes with both nutrition knowledge and cooking skills, such programs foster independence, empower informed decision-making, and lay the foundation for a positive relationship with food. The ‘Eat 2 Win’ pilot demonstrated measurable improvements in nutrition knowledge among high school student-athletes, particularly in macronutrients and hydration knowledge. While the findings reveal areas for further refinement, they underscore the potential of targeted education initiatives to address critical knowledge gaps and support the unique nutritional needs of student-athletes. The ‘Eat 2 Win’ program establishes a valuable foundation for future nutrition education research to optimise health and performance outcomes in student-athletes.

The authors thank the staff and student-athletes of Bremer State High School, in particular Michael Seiler and Ami-Lee Tully. We also thank Sarah Hervert and Naomi Ferstera for delivering the nutrition education workshops.

Conceptualisation, S.P.B.; writing—original draft preparation, A.F.; writing—review and editing, S.P.B. and A.F. All authors have read and agreed to the published version of the manuscript.

The study was conducted in accordance with the Declaration of Helsinki and approved by the University of Southern Queensland Human Research Ethics Committee (ETH2024-0527: Approval date 3 September 2024).

Informed consent was obtained from all subjects involved in the study.

The raw data supporting the conclusions of this article will be made available by the authors on request.

The authors declare no conflicts of interest.

This research was funded by a University of Southern Queensland Collaboration Grant.