CSSD Eating Disorders in Athletes 3 — Questions and Answers
Question 1: A collegiate swimmer's coach restricts caloric intake to improve performance. According to ethical guidelines, what is the sports dietitian's primary obligation?
- Follow the coach's plan to maintain the team relationship
- Prioritize athlete health and advocate for adequate energy intake (Correct answer)
- Report the coach immediately to athletic administration without talking to the athlete
- Defer to the team physician's judgment only
Correct answer: Prioritize athlete health and advocate for adequate energy intake
Sports dietitians are ethically bound to prioritize athlete health and must advocate for adequate energy availability regardless of coaching pressure.
Question 2: Which biomarker measured via blood work provides the best indicator of chronic energy restriction and nutritional status in an athlete suspected of disordered eating?
- Serum albumin
- Insulin-like growth factor 1 (IGF-1) (Correct answer)
- C-reactive protein
- Serum creatinine
Correct answer: Insulin-like growth factor 1 (IGF-1)
IGF-1 is sensitive to energy and protein availability and declines with chronic restriction, making it a useful biomarker for assessing nutritional status in athletes.
Question 3: An athlete purges via excessive exercise rather than vomiting. This is best classified as which type of compensatory behavior?
- Purging type bulimia nervosa
- Non-purging type bulimia nervosa (Correct answer)
- Anorexia nervosa binge-purge subtype
- Other Specified Feeding or Eating Disorder (OSFED)
Correct answer: Non-purging type bulimia nervosa
Non-purging type bulimia nervosa involves compensatory behaviors like excessive exercise or fasting rather than self-induced vomiting or laxative use.
Question 4: Which cardiac finding on ECG is most concerning in an athlete with severe anorexia nervosa and should prompt immediate medical referral?
- Sinus bradycardia at 52 bpm
- Prolonged QTc interval (Correct answer)
- First-degree AV block
- Increased R-wave amplitude
Correct answer: Prolonged QTc interval
A prolonged QTc interval in anorexia nervosa indicates risk of fatal arrhythmia (torsades de pointes) and warrants immediate cardiac evaluation.
Question 5: When using the Brief Eating Disorder in Athletes Questionnaire (BEDA-Q), a positive screen should trigger which next step?
- Immediate suspension from sport participation
- Referral to a mental health professional with eating disorder expertise (Correct answer)
- Initiation of a high-calorie meal plan by the dietitian alone
- Repeat screening in 4 weeks
Correct answer: Referral to a mental health professional with eating disorder expertise
A positive screen on any eating disorder tool should prompt referral to a qualified mental health professional, as diagnosis and psychological treatment require clinical expertise.
Question 6: What effect does chronic low energy availability have on resting metabolic rate (RMR) in athletes?
- RMR increases to compensate for energy deficit
- RMR remains unchanged due to athletic adaptation
- RMR decreases as the body adapts to conserve energy (Correct answer)
- RMR is unaffected in athletes compared to sedentary individuals
Correct answer: RMR decreases as the body adapts to conserve energy
Chronic low energy availability triggers metabolic adaptation including a reduction in RMR as the body down-regulates energy expenditure to preserve function.
Question 7: In the context of sports nutrition counseling, motivational interviewing is preferred over direct advice-giving for athletes with disordered eating because it:
- Is faster and more efficient for behavior change
- Elicits the athlete's own motivation and reduces resistance to change (Correct answer)
- Avoids the need for follow-up appointments
- Provides specific meal plans the athlete can immediately follow
Correct answer: Elicits the athlete's own motivation and reduces resistance to change
Motivational interviewing is client-centered and evokes intrinsic motivation, which is especially important when athletes are ambivalent about changing eating behaviors.
CSSD Eating Disorders in Athletes 3
A collegiate swimmer's coach restricts caloric intake to improve performance.
According to ethical guidelines, what is the sports dietitian's primary obligation?