Vol. 31 / No. 4 — Eating Disorders Review
Most employees had experience with clients with EDs or use of excess exercise.
A fitness center can be almost like a second home to many, but also can be problematic to some persons with undetected eating disorders. Some may over-exercise to compensate for binge-eating or to lose weight. Mixed in with these individuals are other fitness center clients who exercise excessively, but not to lose weight or change body image. Swiss sports and health experts wanted to know how commonly fitness center employees detected clients with suspicious exercise patterns and how they handled the situation.
In one of few studies of fitness center awareness of suspected eating disorders, Dr. Flora Colledge and her colleagues at the University of Basel, Switzerland, used an online questionnaire to contact 140 fitness centers in the German-speaking regions of Switzerland. The authors asked if any fitness center employees had noticed any suspicious behaviors that seemed related to eating disorders or excess exercise and, if so, what actions had been taken (J Eat Disord. 2020; 8:8).
Ninety-nine employees (60 men and 39 women) responded to the questionnaire. All reported having encountered at least one client who had an eating disorder or who was exercising excessively. Those who avoided confronting the customer explained that they did not know what to say, and a few felt it was not their responsibility. Most of the respondents reported they were able to differentiate between an eating disorder and excessive exercise. Age played a role, too, because older long-time employees were significantly more likely to act upon their suspicions. However, fewer than half had been given any guidelines on how to act when they suspected disordered exercise patterns, and most wanted more information about what to do with their suspicions and how to address eating disorders symptoms versus excessive exercise.
A unique chance to observe possible EDs
Employees of fitness centers are in a unique position to observe the signs of an eating disorder. The employees’ reasons for suspecting an eating disorder or excessive exercise differed. For EDs, the clues included body shape and physical signs, while for excessive exercise, telltale signs were frequency and duration of training. According to the authors, this is particularly true for gym clients with AN, who may have physical signs, such as a layer of lanugo, or fine dark body hair, in addition to signs of semi-starvation. Similarly, those with BN may have Russell’s sign of the hand, calluses on the knuckles or back of the hand, from induced vomiting. Other types of eating disorders, such as BED or orthorexia, offer few such clues and no clear-cut physical signs. Excessive exercise may be seen as healthy and even laudable, or might seem like a stage in the preparation of a high-level athlete.
Ways to approach gym clients
In a prior study of 143 Canadian fitness center employees, 62% reported having seen a client they thought suffered from AN; however only 25% had been trained on how to deal with this situation (J Eat Disord. 2015; 3:40). In the Swiss study, fitness employees all agreed they would like to have more detailed information about how to manage customers at risk, along with a detailed description of symptoms, management techniques, and a list of resources. They unanimously agreed that such information should be available in all Swiss fitness centers.
When a fitness employee suspected an individual had an eating disorder or was using excessive exercise, the first response was to show concern for the customer’s health and to suggest they stop their session and consider taking a few days off from their fitness programs.
Whether it concerned a client suspected of excessive exercise or of a suspected eating disorder, the fitness professionals almost unanimously reported needing more information about bringing up the subject. There are a number of organizations and fitness centers that have collaborated on just such information. For example, Fitness Australia has collaborated with the Centre for Eating Disorders to issue guidelines on how to approach gym members with suspected disordered eating/or exercise (Marks and Harding, 2004), and the National Eating Disorders Association, or NEDA, has released a toolkit for those who work with school sports programs and fitness centers. The toolkit gives examples of steps to take and offers examples of conversations about EDs and excessive exercise (https://www.nationaleatingdisorders.org/learn/help/coaches-trainers). The authors also suggest that once an ED is suspected, guidelines and sample conversations can be practiced in advance before approaching clients.