Recognizing Eating Disorders in Clients

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.