Written summary

1. What is the background to this research?

This study was a part of a broader project aiming to understand the energy demands and therefore energy requirements of elite female soccer players. Previous observational research of elite senior footballers in England identified under-fuelling and insufficient carbohydrate intake in most of the included participants. The reasons for this under fuelling are not yet understood. It could be attributed to a degree of unawareness around dietary guidelines amongst female players (along with coaches, sport science staff, parents) thus fuelling is not actively encouraged. Alternatively, there could be various financial and organisational factors that limit opportunities to engage in sound nutrition practice. It could also be related to underlying belief systems and misconceptions amongst players and stakeholders around fuel, carbohydrate, and body composition in conjunction with an environment where body composition is emphasised.

2. What was the aim of the study and how did you go about conducting the study?

The aim of the study was to explore player and stakeholder perceptions of nutrition practices in support of female soccer players’ development and performance. Semi-structured interviews were conducted with a purposeful sample of players (n = 12), coaches (n = 9), parents (n = 9), sports scientists (n = 7), nutritionists (n = 5), and medical staff (n = 5) who had experiences of elite female football in England. An open-ended format to the interviews was adopted to allow maximum voluntary contribution and detail. The interview was split into three domains: (1) participant background and demographics; (2) perceived impact of nutrition on performance with an emphasis on priorities and challenges; (3) female specific performance nutrition priorities and challenges. The interviews were transcribed and an inductive approach to data analysis was undertaken. Transcripts were coded based on question domains, then themes were subsequently developed and refined. To improve rigour and reduce researcher bias in theme development, a critical friend with experience in qualitative research but detached from nutrition practices in elite sport checked and challenged analysis, theme generation, and the presentation of selected quotes.

3. What were the major findings from the interviews?

Four major themes were established from the inductive analysis.

Theme 1: Fuelling is important but under fuelling is common. Fuelling was consistently identified as a priority by participants, regardless of role (player, coach, sport scientist etc), where a focus was placed on carbohydrate intake for match day performance. There were however contrasting views, and an apparent misunderstanding of what fuelling should look like, for example in regard to requirements the day before a match. Although fuelling well was identified as beneficial to performance, under fuelling was also identified by some players as having a negative impact on performance and long-term development.

Theme 2: Carbohydrate confusion, do carbs make me fat? There was a perception among some participants that players may under fuel due to a reluctancy or fear of carbohydrate. This was particularly linked to a perception that carbohydrate consumption will result in body fat gain. The context of post-gym and game day minus 1 were identified as occasions where players had shown a reluctance to consume sufficient carbohydrates.

Theme 3: Skinfold culture, body image issues and social media pressure. Participants identified the challenge of fuelling while also promoting a desirable body composition as a cause for concern. Six of the nine coaches mentioned body composition as an example of how nutrition relates to performance, appearing to value lower levels of body fat in order to optimise performance. Contrastingly, other staff members were more concerned with players losing too much body fat. Players themselves expressed body image as being more of a consistent challenge, with perceived pressure around body composition assessment and targets being a feature of discussion around body image. Comments from stakeholder groups and social media were also identified as negatively impacting player’s perception of body image.

Theme 4: Nutrition support – the current challenge and future solution. A lack of professionally accredited nutrition staff was highlighted as a limitation in domestic-level teams compared with international teams. This was reported to influence player nutrition knowledge as well as increasing the burden on non-nutrition practitioners to provide dietary guidance to players. A lack of finances likely contributes to limitations around nutrition staff presence. It will also limit the availability and quality of food provided to players at some clubs.

4. How can sports dietitians use these findings in their own practice?

For sports dietitians working in elite female sports, education of not only players but other stakeholders such as parents and other staff members will likely have a significant impact in regard to athlete health and performance. The education itself can be around dietary guidance, such as how much to eat, but also educating other staff around how they educate the players about eating. This would allow staff members to reiterate key nutrition messages provided by the sports dietitian, creating a positive culture around food, fuelling, and performance. It could also build a more positive environment and culture around body composition assessments. Where there is the capacity to do so, collaboration with a psychologist would be extremely helpful in creating that positive environment around eating and fuelling.