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FitPros: A Guide to Working with Clients with Eating Disorders

As fitness professionals, we play a vital role in our clients health, especially for those with eating disorders.  I myself am a Registered Dietitian and Trainer, working with athletes and active women who struggle with disordered eating and eating disorders.  From my experience, I have found it is extremely important for fitness professionals to understand the signs and symptoms as well as some basic guidelines for working with this population.  

Eating disorders can often present as overexercising, undereating, and other behaviors intended to change body shape or size and/or to elicit certain emotions.  Eating disorders are a clinical mental illness and diagnosable in the DSM-V, yet many suffer unrecognized and undiagnosed.  Additionally, due to diagnostic criteria, many individuals fly under the radar of a classic eating disorder though exhibit many symptoms which are problematic.  This is also masked greatly by our societies obsession with weight loss, thinness and extreme dieting behaviors which are often normalized.

With this considered, it is important for fitness professionals to understand the signs, symptoms, and health risks of eating disorder clients.  Eating disorders can occur at any body weight, body shape, age, ability and gender.  It is important not to assume that someone who appears to be fat and overweight should be ruled out from an eating disorder.  Behaviors and mindsets listed below can be experienced by individuals of all sizes.

  1. An obsessive fear of weight gain or obsession with losing weight which consumes a large amount of their time and energy.
  2. Constant weight fluctuations which may be labeled as “yo-yo” dieting.
  3. Constantly talks about calories, carbs or fat in foods; refuses to eat foods they deem unhealthy due to the content of these nutrients and calories.
  4. Engaging in ritualistic eating patterns, such as cutting food into tiny pieces, eating alone, or hiding food.  Refuses to go out to eat or eat in front of others. 
  5. Fixation with food, cooking, baking, buying food.  They may cook or bake but not partake in eating it.  They may force others to eat it.
  6. Avoidance of social functions, family, and friends. May become isolated and withdrawn.
  7. Switching between periods of overeating and fasting.
  8. Discusses eating and feeling out of control.
  9. Fatigue, lethargy, loss of period, gastrointestinal issues. 
  10. Extreme guilt, anxiety or anger around missing a workout; excessive exercise beyond workout prescription, both cardio and strength.  

If you believe your client may exhibit some of these signs and symptoms, it is absolutely imperative you refer out and require your client to seek medical attention, counseling and work with a professional like a dietitian.  Continuing to work with such a client, without a clinical team, can pose a risk for the client who may be training with low energy availability.  This can cause health issues as seen in Relative Energy Deficiency in Sport (RED-S), which impacts bone health, reproductive health, cardiovascular health, musculoskeletal health and more.  Please educate yourself on RED-S to be a well rounded, informed trainer.  The International Olympics Committee (IOC) consensus statement will provide you with an in depth overview of RED-S and its impacts.

If a client is in recovery, there is a key role you can play in ensuring they have positive outcomes while engaging in exercise.  It is important that all persons engage in physical activity, but for this population who once used exercise to fuel their disorder, it can be challenging to adopt a healthy routine.  Follow these tips to ensure your client is safe and to promote a healthy relationship to exercise.

  1. NIX the Activity Tracker Calorie Count!  Depending on one’s state of recovery, seeing calories expended can be triggering to clients.  Unfortunately, there is no way to remove calorie goals from popular devices, so it may be best to avoid them until the client decides with their treatment time if it is appropriate.  Focus on other ways to track progress like monitoring rate of perceived exertion, pounds lifted, time under tension, mobility, speed and power.
  2. Question Your Client on their Meals of the Day.  Make it a part of the contract of working together that the client must come fueled to their training session.  This means adequate carbohydrates to perform at the level of intensity prescribed for the day.  No fueling? No training.  Regardless of the client’s weight.
  3. Set Up Boundaries on Movement.  Help your client create a comprehensive workout plan for outside sessions with you.  Create this as part of the contract of working together and methods to check in and adhere to this.  Limit cardio sessions to an appropriate time and encourage adequate intake to match with 
  4. Set the Focus AWAY From Aesthetic Goals.  They may tell you their goal is to have visible abs, but it is your job to ensure their health is at the forefront of each session.  This includes their mental health and relationship with their body.  Depending on the clients progress in recovery, they may still be battling recovery ideals versus body image ideals.  It is important to set non-aesthetic based goals that are performance and behavior driven.
  5. Shy away from weight talk, weighing in, or inquiring for weight goals.  While this may be a given, your client may talk about weight.  Other clients may be able to do well with weight based goals, but it’s best to stick to non-weight, non-aesthetic based goals regardless of what the client states her overall goal is.  Stick to behaviors and actions that are behavior based from a healthy approach.

Not everyone feels comfortable working with clients with eating disorders or histories of eating disorders.  There are individuals though who are open and willing to cultivate healthy relationships with exercise and food for their clients.  If you are ready to learn more about how to work 1:1 with a client or want mentorships with a specific client, please feel free to reach out to me at nutritionbygabby@gmail.com.  Together we can help you and your client achieve a new mindset and attitude towards their training goals and make you a vital part of the treatment team.

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