Sports & Fitness Professionals
Coaches, trainers and other fitness professionals are at the frontline when it comes to noticing changes in their athletes and clients, including when it comes to detecting early signs and symptoms of eating issues and disorders.
Fitness professionals therefore play a vital role in enabling early intervention, which means helping to prevent any eating issues from developing further, with better long term outcomes for treatment.
Sports and Fitness Professionals at the frontline
Eating disorders and disordered eating may occur in people who are seen by others as extremely fit and healthy. Both males and females engaged in competitive physical activities, including sports, fitness and dance, have increased rates of body dissatisfaction, disordered eating and eating disorders.
This is especially the case among people who are involved in a sport with weight classes (such as boxing or horseracing) or in sports with an artistic element where a smaller body is thought to improve visual lines (such as dancing or gymnastics).
Physical activity and sporting environments play an important role in influencing how people perceive their own bodies. Even if you are training people in a non-competitive environment, they may still be struggling with body image and eating. The ways that you talk about bodies during a training session and the ways that you frame fitness goals with a client can make a big difference.
For more information, see the NEDC booklet: Eating Disorders in Sport and Fitness: Prevention, Early Intervention and Response
How eating disorders can affect sports and fitness professionals
Eating disorders and disordered eating can affect every aspect of an athlete’s life, including:
• Concentration
• Athletic performance, when malnutrition and dehydration lead to low energy and weakness
• Psychological health, especially causing negative moods
• Physiological health (e.g. weight loss or gain, muscle loss, osteoporosis, gut problems headaches, muscle cramps, dizziness or fainting, fatigue and poor sleep quality)
• Social life, leading to withdrawing from others
Recognise the warning signs
People with eating disorders may display a combination of symptoms or they might show only one symptom. In some cases, they may not show any signs or symptoms at all.
They may make significant efforts to conceal their behaviour or they may not even recognise that there is anything wrong or that their eating habits have become ‘disordered.’ This is especially true for people who are surrounded by others who follow strict diet, meal plan or training regimes, which are common among athletes and other people focused on fitness.
Warning signs that can signal the onset or the presence of an eating disorder include:
Physical warning signs
• Rapid weight loss or frequent changes in weight
• Fainting or dizziness
• Lethargy and low energy
• Swelling around the cheeks or jaw, calluses on knuckles, damage to teeth and bad breath which can be signs of vomiting
• Feeling cold most of the time, even in warm weather
Behavioural warning signs
Behavioural symptoms are commonly present in those with eating disorders. While you may recognise some of these symptoms in someone you care about, these signs can still be concealed and may be difficult to detect.
• Dieting behaviour (e.g. fasting, counting calories, avoiding food groups such as fats and carbohydrates)
• Compulsive or excessive exercising (e.g. exercising in bad weather, continuing to exercise when sick or injured, and experiencing distress if exercise is not possible)
• Eating in private and avoiding meals with other people
• Evidence of binge eating (e.g. disappearance or hoarding of food)
• Frequent trips to the bathroom during or shortly after meals
• Vomiting or using laxatives, enemas or diuretics
• Changes in clothing style (e.g. wearing baggy clothes)
• Making lists of good or bad foods
• Suddenly disliking food they have always enjoyed in the past
• Obsessive rituals around food preparation and eating (e.g. eating very slowly, cutting food into very small pieces, insisting that meals are served at exactly the same time everyday)
• Extreme sensitivity to comments about body shape, weight, eating and exercise habits
• Secretive behaviour around food (e.g. saying they have eaten when they haven’t, hiding uneaten food in their rooms)
Psychological warning signs
Psychological warning signs can be difficult to detect in anyone suffering from an eating disorder. They usually only come to light through changes in behaviour or through discussion and conversation.
• Preoccupation with eating, food, body shape and weight
• Feeling anxious around meal times
• Feeling ‘out of control’ around food
• Having a distorted body image
• Feeling obsessed with body shape, weight and appearance
• ‘Black and white’ thinking (e.g. rigid thoughts about food being ‘good’ or ‘bad’)
• Changes in emotional and psychological state (e.g. depression, stress, anxiety, irritability, low self-esteem)
• Using food for comfort (e.g. eating as a way to deal with boredom, stress or depression)
• Using food as self-punishment (e.g. not eating for emotional reasons like depression/ stress)
Understand who is most at risk
Eating disorders can occur in people of all ages and genders, across all socioeconomic groups, and from any cultural background. There are many risk factors that increase the likelihood that a person will experience an eating disorder at some point in their life. Knowing who is most at risk of developing an eating disorder can help fitness professionals know who will benefit most from preventative interventions.
High risk groups that you may be in contact with as a fitness professional
• Athletes
• Adolescents
• People who engage in weight loss dieting
• People exposed to unhelpful messages around health and weight
• People with features of mental illness (such as depression or anxiety)
• People involved in performing arts
• People who have experienced weight-related teasing, bullying or sex-based harassment
• People with difficult peer relationships.
• People who are in periods of high stress, such as transition from primary to high school, exam times, moving from education to the workforce, ending relationships, pregnancy and childbirth, or menopause
• People with perfectionist qualities
Specific risks in sport and fitness
Three key periods have been identified as representing increased risk for people involved in competitive physical activity:
- the development stage
- non-competition periods
- retirement or cessation of intense physical activity.
In addition, sub-elite athletes and dancers maybe at risk if they aspire to the body shape of elite performers but do not have access to the medical and nutritional support services to help them achieve this in a safe and healthy way.
Sport and dance codes often require or prefer specific body shapes or weights. People who do not naturally have those body shapes but who strive to attain them are at greater risk of developing an eating disorder. Helping a person match physical activity to body type may reduce some of the risks.
Peer pressure is an issue for anyone in group training where body comparison becomes a part of the group culture. In this context, advice given to one person about exercise or weight loss may be transferred to all members of the group, leading to people engaging in inappropriate activities for their health needs. For example, when one person receives advice to lose weight this may lead to all members of a group trying to lose weight regardless of their need to do so.
Eating disorders in males
While eating disorders are often portrayed as illnesses that only affect females, large population studies suggest that up to a quarter of people suffering with anorexia nervosa or bulimia nervosa are male, and almost an equal number of males and females suffer with binge eating disorder. We also know that underdiagnosis and cultural stigma mean that the actual proportion of males with eating disorders could be much higher.
One unique difference between males and females with eating disorders is that men often engage in compulsive exercise as a compensatory behaviour, typically with the aim of achieving a more muscular, and not just slender, body type. Compulsive exercise describes a rigid, driven urge to exercise and is a serious health concern.
To find out more, see the NEDC fact sheet Eating Disorders in Males.
Screening
Screening questions may help people to identify and talk about their body dissatisfaction or disordered eating with a health professional leading to earlier access to treatment.
Screening for Eating Disorders
- Eating disorders are complex illnesses with serious consequences for health and quality of life
- Early detection and intervention can reduce the severity and impact of the illness
- High risk groups can be identified
- Screening tests are available
For more information, please contact the NEDC.
KEY STEPS: What to do if you suspect someone has an eating disorder
Be familiar with Mental Health First Aid
The Mental Health First Aid guidelines for eating disorders provide evidence based recommendations about how to help a person developing or experiencing an eating disorder.
Be prepared
While there is no 'right' or 'wrong' way to talk to someone with an eating disorder, there are some important steps you can take to be prepared.
For more information, see the NEDC resource: Eating Disorders in Sport and Fitness: Prevention, Early Intervention and Response
Express your care and concern
The first steps toward treatment and recovery from an eating disorder are often very hard to take. However, if you suspect that someone has an eating disorder it is important that they seek help immediately.
The sooner a person starts treatment for an eating disorder, the shorter the recovery process will be. Seeking help at the first warning sign is much more effective than waiting until the illness is in full swing.
Some helpful tips could include:
• Help them to feel it is safe to talk to you
• Give them time to talk about their feelings
Some things to avoid:
• Avoid putting the focus on food - try talking about how the person is feeling instead
• Avoid taking on the role of a therapist - you do not need to have all the answers, rather it is most important to listen and create a space for them to talk
For a more extensive list of tips and important things to avoid, see the NEDC resource: Eating Disorders in Sport and Fitness: Prevention, Early Intervention and Response
Seek help early
The importance of seeking help early cannot be overstated. The earlier an intervention occurs, the shorter the duration of the eating disorder, and the greater the likelihood of full recovery, especially in children and younger adolescents.
You can help by remaining supportive, positive and encouraging.
Carers also have access to specialised services for support and advice. You can access these here.
In a school/ dance academy/ sports institute context: Involve the family whenever possible
Decisions about when to pass confidential information about a student’s health and wellbeing on to the student’s parents can be complicated as not all schools are covered by the same legislation or guidelines. Teachers should refer to their own school’s privacy policy and codes of practice to inform their decisions about communicating with parents.
From a recovery perspective there are many potential benefits of involving the family of a student with an eating disorder. Family and friends play a crucial role in the care, support and recovery of people with eating disorders. Clinical guidelines for best practice in managing eating disorders encourage the inclusion of families at each stage of treatment for adolescents with eating disorders, from the initial assessment to providing recovery support.
For more specific suggestions on correct procedures for contacting parents with regards to student welfare issues, see the NEDC resource: Eating Disorders in Schools: Prevention, Early Identification and Response.
In a school / dance academy/ sports institute context: Establish a support network
A student places a huge amount of trust in a teacher by disclosing a mental health issue and so it is important to respect that trust and respond appropriately to any such disclosure. One element of an appropriate response is the need to respect the confidentiality of the student.
Always be upfront and honest about your duty of care and any responsibility you may have to report issues to other members of staff, the student’s family or any external authorities. Ideally you should obtain the student's permission to pass their information on, but if this is not possible be clear about who you are going to tell and why. Try to minimise the number of people who are told to show the student you are trustworthy and are respecting their privacy.
For more specific information on following school policy and confidentiality, see the NEDC resource: Eating Disorders in Schools: Prevention, Early Identification and Response.
For Friends and Family
Friends and siblings of a person with an eating disorder may need support in adjusting to the situation and their role in supporting their friend or sibling. Friends of a person with an eating disorder can become confused about their own body image and ideas about diet and exercise.
For specific ideas and tools of how to care for your friend or sibling with an eating disorder, see:
8 Tips for Dealing with an Eating Disorder and Eating Disorders 101
Your workplace
Within your work context, some opportunities for intervention and support include:
Interventions at work
• Introduction of specific policies regarding eating disorders, their risk factors and prevention in sport, fitness and dance organisations and programs
• Screening for compulsive exercise or excessive exercise as a means of weight control and nutritional imbalance
• Training programs that take age and body shape into consideration
• Support for open dialogue about unrealistic appearance expectations
• Focus in sport on functional achievement rather than appearance
• Regular health checks for children and adolescents engaged in competitive sport including screening for eating disorders
Your communication
More and more, fitness professionals need to use communications about health and fitness as a way to attract and retain clients and build a public profile. It is important however that the messages do not accidentally reinforce or promote eating disorders or body image concerns. This means taking the focus off “fat burning” and turning it towards ideas such as building strength, increasing skills or feeling good.
Communication styles or topics to avoid
• Measurements, weight or BMIs
• Moralisation of eating (e.g. labelling foods as ‘good’, ‘bad’, ‘right’ or ‘wrong’)
• Weight bias and stigmatisation – even using subtle language that suggests that fat is bad or that people in larger bodies need to lose weight can be harmful to people at risk of an eating disorder
• Nutritional advice that may encourage food fears and unhealthy dieting
• Messages that may increase body dissatisfaction, dieting, and use of unhealthy weight control practices
Positive strategies
• Focus on health, not weight
• Use a holistic perspective with equal focus on social, emotional and physical health
• Focus only on modifiable behaviours, such as physical activity, sedentary time, recovery
• Show that people of all sizes deserve a nurturing environment and will benefit from a healthy lifestyle and positive self-image
• Honour the role of parents and carers, where relevant, and support them to model healthy behaviours at home without overemphasising weight
• Be sensitive to diverse norms, cultural traditions and practices
• Ask qualified health care providers or researchers who know the risk factors for eating disorders to evaluate any programs that you deliver