Eating Disorders 101: A Guide for Personal Trainers and Group Exercise Instructors

As personal trainers we’re taught to educate, motivate, and inspire our clients. We frame our services as the “ultimate accountability tool”. We attract clients who want to change their body and change their life. We are taught to cheerlead them through every pound and inch lost, and help them stay consistent with their workouts so they can “get results fast”. Our clients brag about how often they work out, how many calories they burned in a session, and how “good” they were on their diet. We high five them, and of course share every before and after picture on Instagram. We get so caught up in the #fitspo (fitness inspiration) of it all, that we don’t realize how much the fitness industry glorifies, or at the very least, normalizes disordered eating and exercise behaviors. The question remains, are we really helping our clients, or are we actually encouraging them to develop an eating disorder?

A recent study found that individuals with eating disorders are twice as likely to contact professionals for weight loss. And, nearly 16% of “overweight” or “obese” individuals actually present with an eating disorder or disordered eating symptoms. Nearly 8 million individuals in the US have a diagnosable eating disorder. Unfortunately, that doesn’t include those with more subtle disordered eating symptoms, or an eating disorder that is not specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Unfortunately, as personal trainers, we don’t receive any training when it comes to eating disorders as a personal trainer. Yet, the likelihood that our clients are suffering are extremely high. Being that we interact with our clients one to three times per week, we are in a unique position to identify an eating disorder in the early stages, use our professional coaching skills to prevent someone from developing a full blown eating disorder, and understand when it’s necessary to refer out to another health professional (hint: it always is).

Below you'll find a summary of the most common eating disorders, and what type of behaviors and language to look out for with all clients (not just clients who appear underweight). Make sure to enter your name and email in the table below to be notified when I publish a follow-up post, on how to manage a client who presents with an eating disorder. 

Note that these tables show many common physical, behavioral, and mental and emotional signs, but these are not exhaustive lists.  

Anorexia Nervosa (AN)

Clients with anorexia typically present with an intense fear of gaining weight causing severe restriction of energy intake which leads to significant weight loss at the expense of physical health. It’s important to note that anorexia is not determined by someone’s size. A person can be both in a larger body, and have anorexia at the same time.

Physical Signs

- Inadequate energy intake
- Dramatic weight loss, regardless of size
- Extreme Fatigue

- Physical pain
- Thinning and loss of hair

Behavioral Signs

- Obsession with weight, food, calories and dieting
- Fear of gaining weight
- Denial of hunger
- Repeated weighing or measuring of themselves
- Covering up in layers of clothing to conceal their body

Emotional Signs

- Depressed mood
- Sudden lack of emotion
- High anxiety about gaining weight
- Social withdrawal

- Perfectionistic or competitive tendencies

Language

Clients exhibiting signs of anorexia will likely use language that indicates a fixation with losing weight and restricting caloric intake. They are also likely to talk about their body or specific body parts that they perceive as being "fat".

Examples:

“I’m willing to do anything to lose weight.”

“I don’t feel like I am doing enough.”

“I wish my legs looked like yours.”

Bulimia Nervosa (BN)

Bulimia nervosa is marked by recurring episodes of binging, followed a compensatory behavior designed minimize the impact of the binge.

Purge type: Binge followed by episodes of vomiting, laxative use or diuretic use.

Non-purge type: Binge followed by episodes of excessive exercise or fasting.

Physical Signs

- Dental issues
- Swelling of cheeks, mouth, or jaw
- Mouth sores
- Dehydration
- Fatigue

Behavioral Signs

- Eating excessive amounts of food
- Self-induced vomiting
- Abuse of laxatives and diuretics
- Excessive exercising
- Extreme fluid intake
- Attitude indicating that weight loss, dieting and control of food are primary concerns.

Emotional Signs

- Depression, anxiety
- Extreme fear of gaining weight
- Low self-esteem
- Dissatisfaction with appearance
- Withdrawal
- Perfectionistic or competitive tendencies

Language

Clients with bulimia will use language that indicates a lack of self control around foods. They will also likely speak about feeling guilty about binging. They may ask you to work them excessively hard to compensate for their binge or talk about the extra time they put in at the gym to offset their excessive calorie intake.

Examples

“I slipped and ate so much ____. You have to kick my butt now.”

“I had to come to the gym an hour and a half early to run before our training session because I went over board at a barbeque this weekend.”

“I am out of control around food”

Binge Eating Disorder (BED)

The most common eating disorder among Americans. Binge eating disorder presents with recurring episodes of excessive food consumption, over a short period of time, often to the point of discomfort. Usually accompanied by a loss of control, and feelings of shame and guilt.

Note: BED is often overlooked when looking for signs of eating disorders. If you are simply looking for caloric restriction or purges, you can easily miss the signs of BED.

Physical Signs

- Weight cycling
- Eating to fullness that reaches pain and discomfort

Behavioral Signs

Eating alone or in secret
- Eating rapidly
- Frequent dieting
- Hiding food

Emotional Signs

- Feeling out of control during eating
- Strong body dissatisfaction
- Self-loathing about body
- Anxiety and/or depression
- Intense stress
- Shame around eating

Language

Clients with Binge Eating Disorder will also talk about feeling guilty about their binging and may even talk about how physically uncomfortable their binging makes them. Unlike bulimia nervosa through, they will likely not talk about or seek compensator energy expenditure or extra workouts. They are also like to talk about being too busy and stressed to eat at work and have excessively large meals later in the day.

Examples

“I just can’t help myself around ______ food.”

“I had such a long day at work that I just ordered pizza and wings on Friday and eat it all in one sitting.”

“I was so full I felt sick for an hour.”

Orthorexia

Orthorexia is the most normalized eating disorder. It is presented as an extreme fixation over the quality and purity of food. Individuals with orthorexia only consume food they perceive to be as healthy, pure, clean, or good. These rigid food ideals can often lead to an unbalanced diet, malnutrition, weight loss and severe emotional distress. An individual with orthorexia when given the choice between eating something they’ve identified as unhealthy and going without food, would choose the latter.

Physical Signs

- Possible weight loss or weight fluctuations
- Malnutrition
- Digestive issues

 

Behavioral Signs

- Fixation on food quality
- Obsession with "clean" eating
- Highly inflexible food choices
- Frequent participation in elimination diets or "cleanses"
- Black and white thinking when it comes to food (good or bad; healthy or unhealthy; should or shouldn't")

Emotional Signs

- Low self-esteem
- Negative body image
- Depression
- High anxiety
- Withdrawal
- Frequent feelings of guilt or shame around food and body

Language

Clients presenting with Orthorexia will use language that indicates a black and white way of thinking about food. If they consider a food to be bad, they likely won’t eat it, even in moderation. They may also talk about clean or healthy eating regularly. They are likely to be highly concerned with the health properties of the food they purchase and possibly the way they cook and prepare their food to maintain the best nutritional value.

Examples

“I went to birthday party over the weekend all all they had was processed food and soda. I couldn’t eat anything.”

“I only shop at the farmer’s market because it’s the other place to get real, good food. That’s all we should eat.”

It's important to note that eating disorders are a behavioral, mental, and emotional illness. A client might not present with any of the physical symptoms (like weight loss) listed above, but the intention behind their actions might be extremely disordered. It is absolutely OK (and recommended) to a refer a patient to a therapist or registered dietitian (who specializes in eating disorders) even if they are not presenting with the physical manifestations of an eating disorder. 

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