I had the honour of presenting a 90min lecture at Filex 2017 on “Identifying and Managing Clients with Eating Disorders in the Fitness Industry”. One of the participants at the end of the session asked why every trainer was not in the session. Her daughter had signed up for a 12-week body transformation challenge, and was told that dairy and carbs were ‘evil’. She was instructed to do an extra hour of cardio on the treadmill because she had eaten these. Her daughter was not long after placed in a clinic suffering Anorexia Nervosa.
There are so many risk factors that contribute to the development of an eating disorder. Fitness professionals are in a position to identify a person who may be displaying signs of these serious mental health issues. A duty of care exists for physical injuries and so a duty of care with these issues needs to be considered.
The World Health Organisation’s definition of health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” All these components are not independent of one another. Just as we hope that we are treated as a whole person by others, management of clients should consider all these factors if we are to be effective in improving HEALTH and not just influencing body shape.
Team Approach
Just as clients are referred to allied health professionals for physical injuries and chronic diseases, we can work alongside allied health professionals to be part of the solution, not only for our clients but for our colleagues and ourselves. Fitness professionals are not expected to offer psychological help but can work as part of this team to offer a holistic approach. In an industry that seems to have become so ‘body shape’ orientated, we may have lost sight of total health. Eating disorders, disordered eating and excessive exercise certainly result in serious negative consequences for physical, mental and social health.
Screening
We screen for physical injuries, chronic physical health conditions, medications and recent surgery. We also need to know how to screen for mental health issues, especially eating disorders, which are associated with unhealthy diet and exercise behaviours. Determining the appropriate questions to include and having some understanding of the possible responses is required to determine if there is a risk of a problem developing.
Communication
To start a conversation with someone who you may be concerned about can be difficult.
Many fitness professionals may avoid these conversations for the following reasons:
- They think they may upset the client
- They do not know how to address this
- They may not be able to recognise that there is a problem.
Research shows that dieting is the single biggest predictor of an eating disorder developing. Women 18-25, who diet severely are 18 times for likely to develop an eating disorder within 6 months. Interestingly enough, this demographic has the highest participation rate of gym/fitness activities. This alone shows that having this initial conversation sooner rather than later is crucial. A person may deny that there is a problem at first, but showing that you care, with constant appropriate support can mean a turning point for them. There are two key factors for this initial conversation.
- Express concern about the person’s health and not their body weight or shape.
- Be non-judgmental and be empathetic, considering the impact of the language that is used on the client.
Contraindications
If we are only focused on shape and have unhealthy means of attaining this, we may not be aware of the damage done to our bodies. There are contraindications for certain forms of exercise because of the health risks associated with certain eating disorders. Some of these include osteoporosis, cardiac complications, electrolyte imbalances and hormonal deficiencies as a result of dangerous compensatory behaviours.
Exercise Prescription
The value of physical activity on mental health is well documented. Eating disorders are serious mental health issues. Depending on the medical complications, and physical health consequences, the type, frequency and intensity of exercise programmed needs to consider achieving a balance for optimal health. Rigid regimes are not helpful if they result in an obsessive, compulsive need to exercise in which anxiety is increased.
Diet Recommendation
Certificate III and IV trained personal trainers are not qualified to write meal plans unless they have appropriate nutritional qualifications. Advice given should be based on the Australian Dietary Guidelines.
This applies to advice given to any client let alone those at risk of an eating disorder. A registered nutritionist and dietitian are qualified to do this. Providing rigid meal plans may not be helpful for a person suffering from eating disorders or disordered eating as they already base their sense of worth around adhering to their own, often unhealthy, strict rules. There are dietitians and nutritionists who can specifically assist with the nutritional needs of these clients.
Progress Measures
There are so many other improvements for measures of health other than the number on the scale and body composition. To focus on these for a person at risk of an eating disorder may not be helpful as these things are often their only focus already. It may be more helpful to use measures such as:
- Improvement in strength and flexibility
- Enjoyment of movement rather than a compulsion to exercise
- Eating meals with others
- Eating meals that they have not prepared
- Decrease in binge episodes
- Decreased anxiety around diet and exercise behaviours
- Increased rest
- Improved mood
Gain a better understanding of all the above-mentioned points to help to identify and assist people that may be struggling with these issues. Contact Eleni at info@brazengrowth.com.au if you would like to organise the delivery of CEC approved workshop “Identifying and Managing Clients with Eating Disorders in the Fitness Industry” for your fitness professionals.
