When and How to Refer to a Nutrition Pro
Last week I was lucky enough to get in front of a bunch of performance professionals: physical therapists, strength coaches, personal trainers, and even a chiropractor! All were en route to developing their own system on the return-to-sport and high-performance spectrum as part of a mentorship program led by my pal (and full disclosure, he is my coach, but I have no financial interest in promoting him), Dr. Mike Reinhardt PT, DPT, OCS. He super knows his stuff but also respects the realm of what I do as a nutrition professional.
This post is geared toward the providers out there who might be asking when and why you might make a referral, how to know, and even how to broach that conversation.
First off, I know this can be a really delicate and difficult topic. It’s also a necessary one, and perhaps one that we need to normalize early and often. I’m not just saying this because I would benefit from more referrals. Early intervention for eating disorders and disordered eating helps prevent complications and keeps athletes from digging themselves deeper into a hole that only gets harder to dig their way out of. And just because it’s a difficult topic doesn’t mean we need to look away or pretend it isn’t happening. We need to put our athletes’ needs ahead of our own fears. Sometimes ego has a part to play, but from my experience, I can say it’s often because we don’t know the limitations of our own knowledge and capabilities with our athletes.
There may also be some stigma or negative associations with referring an athlete to see a dietitian. It subtly implies, “I think you’re doing something wrong,” or may even be heard as a comment about the athlete’s weight. We certainly don’t wish to intentionally offend anyone!
But here’s the truth: athletes get minimal exposure to sports nutrition education. Nutrition knowledge is generally low among athletes, and they’re often taking cues from peers, influencers, other dubious sources[1]. If you're a provider who has strong rapport with your athletes, you’re already in a trusted position and can be an excellent advocate for positive fueling.
How to Support Athlete Nutrition
Note that these are my professional opinions and reflect my current lens, not those of any employer or certifying organization.
1. Get familiar with the nutritional requirements of your sport.
Know the ballpark carbohydrate needs for your athlete population. You don’t need to know the exact grams per kilogram per day, but you should be able to recognize when something is way off. For example, if an endurance athlete is regularly eating fewer than three meals a day or is avoiding entire food groups, that’s a red flag. You don’t have to do a dietary analysis, but you do need a sense for when something doesn’t pass the sniff test.
2. Neutralize how you talk about food and bodies.
Language matters. Generally speaking, categorizing foods is not helpful and may do more harm than good, especially with younger athletes who think about things very concretely. Simply describing a food as what it is does the trick. No need to categorize foods as good or bad (note that there is definitely such a thing as poor timing of certain foods around workouts). I also suggest not making evaluative comments on bodies as a general rule. There is much that is left unsaid when you make comments about someone’s appearance, even if well-intentioned, complimentary, or about someone else.
The internalized belief that leaner equals faster or better performance is a predictor of disordered eating[2]. Challenge some of your own thinking here about what it means to be an athlete- do you have to look a certain way to perform, or is it more broad than that? It’s tempting as humans to want to categorize and have certainty about what would give an athlete an “edge” but in reality, there are multiple factors that impact performance and weight is one among many. Athletes may need support with de-emphasizing weight and shifting towards factors that they may have more control over such as readiness and fueling. We really have so much power to reinforce the belief that actually, fueled athletes are the fastest!
If you think it would be helpful to inquire about behaviors, lead with curiosity, openness, and non-judgment. Statements like this:
What does your recovery look like?
How are you fueling before and after workouts?
What have you noticed about your energy in training lately?
Where did you learn that cutting out x food group would help your performance?
Help open the door to a supportive conversation. Generally, nutrition that emphasizes inclusion of a variety of foods, consistently eating throughout the day, and appropriately managing training loads are truly where the performance professional can shine and have the greatest impact. Reinforce that fueling should match training demands and may require an intentional, planned effort to feel their best.
A Note on Food Journals and Calorie Counting
It can be tempting to ask athletes to track their food intake to “see what’s going on,” but in many cases, food journaling or calorie counting can do more harm than good, especially if the athlete is already exhibiting signs of disordered eating or rigidity around food. These tools often heighten preoccupation with food, reinforce perfectionistic tendencies, and send the message that food needs to be micromanaged to be effective. Unless you are working closely with a registered dietitian trained in eating disorder care, I would strongly advise against encouraging food tracking apps or calorie goals as a diagnostic or motivational tool. There are safer, more effective ways to get insight into an athlete’s fueling habits. Further, the information is not likely to be accurate and can be skewed by the coach-athlete relationship. This is another reason having a separate person on the athlete’s team can be helpful- it protects the relationship and rapport that you already have.
Even among athletes with good nutrition knowledge, I very rarely use calories or macros as a tool. They’re often overwhelming and require an unnecessary amount of effort to see and make changes.
3. Notice the behavioral cues.
Many times we make assumptions about how someone struggling with their fueling (intentionally or not) may look. Try to look for the behaviors that would indicate that something isn’t right, regardless of the athlete's weight or shape.
Fatigue, poor recovery, repeated injuries, or fading out through the course of a week
Weight changes (loss or gain- this may not always be the case, though)
Obsession with clean eating, macros, or “needing to follow” certain rules or guidelines
Exercise despite illness or injury, especially when accompanied by stress about food or body image
Cutting back on food or unwillingness to increase nutrition as training volumes change
Avoiding team meals or only being able to eat limited foods
Comments that hint at food guilt, restriction, or fear
These aren't reasons to diagnose, but they are signs that more support may be needed. The IOC REDs consensus statement can also provide a more detailed picture of the signs and symptoms of REDs, when underfueling has persisted for longer.
Approaching the Referral Conversation
These conversations can feel really difficult, but it’s important to remember that you are showing to the athlete that you care about their whole self and longevity in sport. Earlier is better than later when it comes to bringing in additional help and there’s very little downside to having an athlete meet with a nutrition provider. It’s good to know at what point is working with a nutrition and/or medical provider is a “must” vs. a “would be nice”. The REDs Clinical Assessment tool is an additional resource when looking at having some specific screening questions and in making that decision.
Here’s a simple framework to structure a confidential conversation with an athlete.
Name what you’re seeing: “I’ve noticed you’ve been low energy during training lately.”
Connect to behavior and concern: “I wonder if it might be related to those nutrition changes you made recently. I’m concerned that there’s something we are missing that’s impacting your energy”
Normalize the support: “Lots of athletes work with sports dietitians to make sure they’re meeting their needs.”
Offer options: If possible, give a list of trusted providers, or offer to make the introduction. Those first steps require immense courage and vulnerability and some support here could make a difference.
Let them know that dietitians also work with people for a wide variety of reasons including planning and prevention of deficiencies. Recently diagnosed with celiac disease or became vegan? It might be a good idea to check in with a dietitian to fill in the gaps. Athletes might feel defensive or even relieved; both are possible and totally okay. Remember that you are showing to the athlete that you care about their whole self and longevity in sport.
Having referrals and connections locally here is key so you’re not scrambling for resources- I suggest finding providers (at minimum an RD, therapist or psychologist, and MD/sports medicine) with experience and/or advanced training/certifications in both sports nutrition and eating disorders.
Stigma and shame are two common barriers for athletes to seek help. We challenge this stigma and shame every time we bring these conversations into the open with care, consideration, and safety.
Final Thought
Working as part of an interdisciplinary team means knowing your lane and also understanding what you have the capacity, training, and knowledge to respond to and what may be out of your zone of expertise. None of us can do this work alone or to completion. When we each do our part and collaborate, athletes benefit.
Let’s normalize working together, normalize positive fueling culture, and normalize having hard conversations that reflect your integrity as an athlete provider.
Questions or looking to connect? Shoot me an email at em@brickbybricksn.com
[1] Hopper, C., Mooney, E., & Mc Cloat, A. (2025). Nutritional Intake and Dietary Knowledge of Athletes: A Scoping Review. Nutrients, 17(2), 207. https://doi.org/10.3390/nu17020207
[2] Fatt, S. J., George, E., Hay, P., Jeacocke, N., Day, S., & Mitchison, D. (2024). A systematic review and meta-synthesis of qualitative research investigating disordered eating and help-seeking in elite athletes. The International journal of eating disorders, 57(8), 1621–1641. https://doi.org/10.1002/eat.24205
