CSSD Ethical Practices & Evidence-Based Guidelines 4 — Questions and Answers
Question 1: A CSSD learns during counseling that a professional athlete is using a banned substance not related to nutrition. The practitioner's obligation is to:
- Report to the athlete's federation immediately
- Document the disclosure and consult legal and ethical guidance, as mandatory reporting for banned substances is not a standard dietitian obligation (Correct answer)
- Provide nutritional support to minimize the substance's side effects
- End the professional relationship without explanation
Correct answer: Document the disclosure and consult legal and ethical guidance, as mandatory reporting for banned substances is not a standard dietitian obligation
CSSDs are not mandatory reporters for doping violations; they should document carefully, seek guidance, and maintain professional boundaries.
Question 2: An athlete's coach pressures the CSSD to provide a nutrition strategy that contradicts evidence-based harm-reduction principles. The CSSD should:
- Follow the coach's guidance since coaches hold primary authority over athletes
- Implement the plan but document the disagreement
- Communicate evidence-based concerns to the coach and prioritize athlete health, escalating if necessary (Correct answer)
- Immediately terminate the contract with the organization
Correct answer: Communicate evidence-based concerns to the coach and prioritize athlete health, escalating if necessary
The CSSD's primary obligation is to athlete wellbeing; they must advocate for evidence-based care even under institutional pressure.
Question 3: Relative Energy Deficiency in Sport (RED-S) clinical guidelines are classified as evidence-based because they are:
- Adopted by the USOC and therefore legally binding
- Developed using systematic literature review and expert consensus with explicit evidence grading (Correct answer)
- Based on anecdotal reports from elite athlete case studies only
- Produced by supplement manufacturers with research divisions
Correct answer: Developed using systematic literature review and expert consensus with explicit evidence grading
IOC consensus statements on RED-S employ systematic evidence review and graded recommendations, meeting evidence-based practice standards.
Question 4: A CSSD working with a weight-class sport athlete is asked to help the athlete make weight through severe restriction the week before competition. The practitioner should:
- Implement the plan as the athlete has autonomy over their body
- Design the most medically manageable rapid weight-loss protocol possible
- Educate the athlete on health and performance risks and decline to facilitate harmful restriction (Correct answer)
- Report the coaching staff for athlete abuse immediately
Correct answer: Educate the athlete on health and performance risks and decline to facilitate harmful restriction
Beneficence and non-maleficence require the CSSD to refuse facilitating practices with documented health risks while providing athlete education.
Question 5: Which type of study is most susceptible to confounding when assessing a dietary pattern's effect on athletic recovery?
- Double-blind crossover trial
- Observational cohort study (Correct answer)
- Systematic review with meta-analysis
- Placebo-controlled randomized trial
Correct answer: Observational cohort study
Observational cohort studies cannot control for unmeasured confounders that may explain associations between diet and recovery outcomes.
Question 6: A CSSD is asked to provide a testimonial for an athlete client's social media post praising a commercial nutrition product. The ethical concern is primarily:
- The client did not pay for the testimonial service
- The testimonial implies professional endorsement without independent evidence review and requires disclosure of the professional relationship (Correct answer)
- Testimonials are prohibited by CDR regardless of content
- Social media promotion is outside the CSSD scope of practice
Correct answer: The testimonial implies professional endorsement without independent evidence review and requires disclosure of the professional relationship
Professional testimonials can mislead the public and require both an evidence basis and clear disclosure of any professional-client relationship.
Question 7: The concept of 'clinical equipoise' in sports nutrition research ethics means:
- Both arms of a trial use identical caloric intake
- Genuine uncertainty exists in the expert community about which intervention is superior (Correct answer)
- All participants must receive equal portions of the supplement
- Researchers are financially balanced between industry and academic funding
Correct answer: Genuine uncertainty exists in the expert community about which intervention is superior
Clinical equipoise justifies withholding one intervention from a control group only when there is genuine uncertainty about superiority.
CSSD Ethical Practices & Evidence-Based Guidelines 4
A CSSD learns during counseling that a professional athlete is using a banned substance not related to nutrition.
The practitioner's obligation is to: