Fitness Instructors, Eating Disorders & Scope of Practice
Updated: Jan 1
I have been increasingly concerned for fitness instructors, eating disorder treatment centers and no one more than the clients they serve based on posts I have seen lately encouraging fitness instructors to engage in practices that are out of scope for them. So why are these practices so concerning, and exactly what am I talking about? Many eating disorders treatment facilities engage in advertising that is more like business advertising, but targeting specific people to do interventions can be problematic. Just as therapists and treatment professionals have ethics codes and a specifically defined scope of practice, so do other professions. Whenever we encourage others to engage in activities professionally, we must consider both their scope of practice and their ethics codes, as well as the environment in which they work. So what can a fitness instructor do who suspects disordered eating?
If A Fitness Instructor or Gym Employee Suspects Disordered Eating or Problematic Exercise
If a fitness professional spots the warning signs of an eating disorder in a gym-goer, one course of action is to start a conversation. Start by checking in and asking how they are. Then mention that you have noticed some behaviors that are concerning to you. From there, list specific examples of what you are seeing that causes you concern. Make sure that you listen if an explanation is offered, and don't jump to conclusions.
During this conversation, it’s important that the fitness professional does not diagnose or suggest a diagnosis, or a particular place to get an assessment. State observable concerns and recommend that the person connect with a general practitioner (rather than to an eating disorder assessment) to discuss these concerns. If the person is a minor, you could speak with their parents and provide them with information about what concerns you have noticed.
During the course of the conversation, your worries may be calmed and no further action is necessary. It is also possible that the individual may reject your concerns while you maintain worry. If this happens, you could explain that you’ve heard them and that you understand what they are saying. You might continue to say that you are concerned and ask them if they would be willing to see a general practitioner to speak about their exercise habits and how they may be affecting their health.
Eating disorder behaviors can be dangerous- the longer they go untreated the more severe, and possibly life-threatening, they may become. So, if you are concerned, it’s okay to ask the person to visit a doctor and obtain medical clearance to participate in the activity again. Even if the person has an eating disorder, they may not need to stop exercising. For many people, engaging in exercise throughout recovery is warranted and safe, and the practice is supported by research in helping achieve better outcomes. Above all, it’s important to make sure people are safe and well, and protect your liability when considering interventions among people you suspect might have disordered eating behaviors.
A Sample Conversation
If you decide to have a conversation with someone as a fitness instructor, first ask yourself if you are sure it is necessary. Has this person mentioned to you before that they are under medical care and have clearance to exercise? Have they mentioned anything else that could be the reason for the behaviors that are making you concerned? First, consult with your supervisor or manager and discuss whether or not they have any similar concerns if they know the person, or if anyone else has come to them with concerns. If you work alone, consider consulting with a colleague (while maintaining the person's privacy of course) or consulting with your licensing authority (ACE, AFAA, NETA, etc), whether by phone call or going over the materials that you have from them. Many of the organizations all ready have very clear policies on what your duties are to people with suspected eating disorders. If you decide to proceed with a conversation, use facts and behavioral data, such as:
"I see you have been at the gym 2x a day for 2 weeks without a rest. I am concerned your exercise habits could be impacting your overall health. Have you thought about talking to your general practitioner about your exercise routine?"
Occasionally, you may become concerned about a client's exercise habits, whether or not you suspect disordered eating. It is well within scope of practice to require medical clearance to engage in physical activity for a fitness instructor, deciding whether or not a person can participate if they have this clearance is not. Remember you are not a doctor, and while your heart lies in the best interest of your clients, it's best to stick with the recommendation from the medical professional. Sometimes what we see may not be completely the whole story, so it is import to remember if you stop someone from doing something they have been medically cleared for, you might also be putting yourself at risk.
Many people like to offer well meaning advice for fitness instructors on how to deal with suspected eating disorders. Be careful of trainings on this topic not offered by your licensing authority. Too often, people outside the field of fitness can offer suggestions that are out of your scope of practice, and can put you in danger of legal consequences or even doing harm to the person you want to help. If their credentials don't match your own, you probably have different rules. Remember to stay in scope while promoting the best health you can for your clients.
Referrals & Advertising
If a treatment center approaches you as a fitness instructor or a gym you work at and asks if they can advertise there, the answer is "no." While well-meaning, this can be considered a referral. Just as you cannot suggest a certain place or specialty care for your clients in a one-on-one conversation, you also cannot do it by partnering with a treatment facility.
If you have any questions on ethics or scope of practice for fitness instructors and suspected eating disorders, please feel free to reach out. I am happy also to provide trainings to fitness instructors and treatment centers on this topic.
For Therapists & Other Mental Health Professionals*
There is no doubt that your heart is in the right place wanting to help fitness instructors and other gym employees help people who might have trouble with eating or exercise concerns. There are ways you can reach out and partner with folks in the fitness industry, and its not as hard as you might think! With knowledge of each other's standards, ethics, and scope of practice, there is no doubt that the fitness industry and the mental health field can come together to help people find health, wellness and happiness.
The author is a graduate student studying and researching ethics, exercise and eating disorders treatment. She is a licensed group fitness instructor through the American Council on Exercise, and her favorite format to teach is Zumba. For more information on the author, check out www.exert-ed.com
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