If one of your clients had an eating disorder, would you recognize it? If so, what would you do?
In a recent survey, 32% of fitness professionals correctly indicated that a fictitious client, described in a case scenario, had anorexia nervosa. Another 21% suspected an eating disorder, but felt that either it would be outside their scope of practice to come to a conclusion or they didn’t have enough information to do so. More than half (53%) of the fitness instructors identified the case subject as an “overexerciser,” and nearly all fitness professionals recognized that there were “some” (60%) or “serious” (37%) ethical and liability concerns with such a client. Among a control group of pediatricians, 88% correctly assessed the client’s condition as anorexia nervosa, but only 10% concluded that the subject was an overexerciser. The survey results were published in the March 2008 issue of Eating Disorders: The Journal of Treatment and Prevention.
Information presented about the case subject, a 17-year-old female, included her body mass index and body fat measurements, along with her daily exercise routine and other observations that a fitness professional would notice. Sixty-two registered fitness professionals in British Columbia completed the written survey. The mean age of respondents was 41, and the mean years of experience was 11.5. Fifty-six pediatricians served as the control group; their mean age and years of experience were 53 and 23.5, respectively. While noting that the study’s small size was a limitation, the researchers concluded that fitness professionals would benefit from further education regarding eating disorders and overexercise. Furthermore, 100% of fitness respondents agreed, expressing interest in clear guidelines for handling someone with an eating disorder in their facility or classes.
Fitness professionals may be concerned about stepping outside their scope of practice in this situation, but the study’s authors contend that it is within a fitness instructor’s capacity to “recognize warning signals and observable symptoms of such a chronic health condition.” A doctor may see a patient a couple times a year, but a fitness professional has the opportunity to interact with members much more regularly. In addition, failure to identify a member with an eating disorder who overexercises in your facility could have ethical and legal consequences.
Psychologist Dr. Ronald Manley, lead author of the study, “Fitness Instructors’ Recognition of Eating Disorders and Attendant Ethical/Liability Issues,” offers this clarification to IDEA members: “Remember that we are not asking fitness leaders to make a ‘diagnosis’ but only to know the warning signs and to have a set of guidelines in place for how best to proceed further if it is felt likely that a member is struggling with an eating disorder.”
“A compassionate approach necessitates that we are aware of the circumstances in which we need to intervene to help the person modify their exercise routine and to seek medical and psychological advice,” explains Dr. Manley, a psychologist at the Provincial Specialized Eating Disorders Program at BC Children’s Hospital in Vancouver, and also a personal trainer and yoga instructor. “If the fitness leader can do this in such a way as to ensure an ongoing relationship with their client, then they may maximize the chances that the individual will get the medical and psychological help they need.”
For more on recognizing and assisting clients with eating disorders, see the CEC article “Eating Disorders Among Athletes” by Divya Kakaiya, PhD, in the March issue of IDEA Fitness Journal IDEA Article Archive.