Personal trainer Leila Neve asks, are fitness professionals doing everything they can to avoid contributing to the widespread culture of disordered eating?
Like many people, I grew up with disordered eating and battled an eating disorder for a number of years. Now, as a personal trainer, I wonder if we as fitness professionals are doing everything we can to learn about disordered eating and avoid contributing to it?
As fitness professionals, we are uniquely positioned to help create and drive a more positive relationship with food and exercise. So, let’s start with ourselves. Let’s get honest about our own habits and practices, the words we use and the examples we show. Let’s move away from huge calorie deficits, reducing our clients to data on a spreadsheet, over-exercising and ‘earning’ food. Let’s be the change we NEED to see; let’s educate ourselves and our clients about the enjoyment of fuelling our bodies so that we can move with joy and purpose, and let’s lead the way to a kinder, less anxious, less fearful, healthier, happier and more confident future.
The numbers
A huge 1.25 million people in the UK (including those as young as five years old) are estimated to be living with a diagnosed eating disorder1. Disordered eating and eating disorders are widely recognised as a cultural issue, with the desire to be a certain size and/or shape driven and maintained by peer behaviour and vocabulary, social media and magazines, etc. In fact, Hesse-Biber et al said that eating disorders provided a “lucrative market”2 for many industries such as cosmetic surgery and advertising, and, I’m guessing most importantly for you lovely reader, the fitness industry. So, what can we do to help? Well first, although they can be linked, it’s important to understand the difference between disordered eating behaviours and diagnosed eating disorders, so that we can look out for any warning signs in our own behaviour and/or the behaviours of our clients.
Eating disorder or disordered eating – what’s the difference?
The National Institute of Health and Care Excellence defines eating disorders such as anorexia and bulimia as “persistent disturbance of eating or eating-related behaviours which leads to altered intake or absorption of food causing significant impairment to health and psychosocial functioning.”3 Eating disorders can be characterised by obsessively thinking about food, calorie consumption and/or one’s size or shape, as well as engaging in compulsive exercise which aims to earn/negate food consumed regardless of illness or injury. Interestingly, compulsive exercise is the most common form of negative exercise behaviour and is seen in up to 80% of anorexia nervosa patients and 55% of those diagnosed with bulimia, further highlighting the importance for PTs, fitness instructors, facility owners, etc. to recognise these behaviour patterns.4,5
The characteristics of disordered eating can be the same as those of an eating disorder; however, they can present with less regularity and/or severity. Disordered eating can look like emotional eating (due to stress, sadness, boredom, etc.), food avoidance, binge eating/restriction, guilt, referring to foods as ‘good’ or ‘bad’, skipping regular meals, calorie restriction, overeating, excessive exercise and/or laxative/diet pill misuse. Recently, binge eating disorder (BED) (regular binge eating without the purging normally associated with bulimia), night eating syndrome (consuming 50% or more of one’s daily calorie intake after 7pm), impaired sleep and morning anorexia have also been recognised as common patterns of disordered eating. Nobody is immune to the dangers of disordered eating; however, people living with conditions such as depression, anxiety and OCD, and those who have experienced trauma or are going through stressful life changes such as the breakdown of a relationship, moving house, or a new job etc. can be at greater risk of developing disordered eating patterns.4
I want to just pause for a second and ask you to read that last paragraph again. And as you do, I want you to think honestly about your own eating patterns and your reasons for eating the way you do. Ask yourself if you fall into any of those categories. I want you to consider your clients and your group exercise class members – have you noticed if they demonstrate any of the behaviours discussed above? And finally, I want you to consider the language used in/around your facility. Is it positive? Or are we engaging in, and therefore encouraging, disordered behaviours?
How can we do better?
Conversely, the opposite of disordered eating is referred to as ‘normal eating’; enjoying the consumption of varied, balanced and nutritious foods in sufficient quantities to meet the body’s energy needs in a flexible way without labelling foods as ‘good’, ‘bad’, ‘healthy’, ‘unhealthy’ or ‘cheat meals’. Intuitive eating is a relatively modern term, which can also be applied to a more positive approach to food. It describes a non-judgemental way to choose what and when to eat, based on the body’s own rhythms and needs without influence from diet culture. Studies have shown intuitive eating to be associated with positive body image, wellbeing and self-esteem – surely this must be the wider goal for us all?6,7
Pereira and Alvarenga stated that the more we as a society perform the behaviours of disordered eating, the more widely accepted they are.5 Conversely then, perhaps the more we perform the behaviours of normal/intuitive eating, and the more we demonstrate that beauty, strength, resilience – and the myriad other amazing human qualities – come in ALL shapes and sizes, the more widely acceptable they will be?
So how do we do this?
I’m glad you asked!
For starters, we have to get back to the basic fact that food is fuel. Fuel to move, grow and repair. Fuel for brain function, bone health and the prevention of illness. Food is not something to simply reduce body mass or improve health. One analogy I use with my clients is to think of the body like a car. We would never put £5 worth of fuel in our car and expect it to drive for miles and miles and miles without issue, so they can’t expect to put minimal food (fuel) into the body and expect it to move, take care of the family, work, exercise, etc (drive) without issue.
As we discussed earlier, terms such as ‘healthy’, ‘unhealthy’, ‘good’, ‘bad’, etc. can really start a negative internal dialogue around food which, in turn, can lead to a whole host of negative food behaviours, such as restrictive eating. There is absolutely no such thing as ‘good’ or ‘bad’ food. There are no church halls where the ‘good food club’ meets once a week to think of how to make your life as lovely as possible. Nor are there underground lairs where the ‘bad’ foods meet to plan how to really ruin your week!
I think what we really mean by ‘good’ and ‘bad’ food is more nutrient dense and less nutrient dense. Maybe in this case, we could encourage our clients to choose nutrient-dense foods such as fruits, vegetables, whole grains, lean meats, etc. There are also no single ‘healthy’ or ‘unhealthy’ foods. This also comes down to the nutrient densities of each food and in what quantities they are/aren’t being consumed. It is again down to us to encourage clients to be as consistent as possible with their choices. With that said, it is worth noting that not all people can afford to eat fresh, organic, nutrient-dense, whole foods, so it is vital that we allow, and encourage, flexibility.
‘Cheat meal’ is a term which has become popular in recent years and is another red flag in terms of disordered eating. What exactly are we cheating? By focusing on the popular reduced calories through the week followed by a ‘cheat’ (larger calorie consumption) at the weekend we are actually following a restrict/binge pattern which, as we discussed earlier, is a form of disordered eating. Instead, we could refer to those more calorie-dense meals as ‘treat’ meals. This is something I do with my clients and it brings really positive results.
We should all be able to calculate our clients’ calorie needs without packaging it as ‘eat less, move more’ and instead, calculate their energy needs, encouraging them to make the best nutrition choices they can make (financially/time/resources permitting), while allowing and supporting flexibility.
Perhaps there is also room for some new language within our group exercise sessions too? Instead of going all out for the ‘calorie burn’, we could talk about ‘raising the heart rate’ and all the associated benefits of this (promoting heart health, increased stamina, boosting mood, etc.) and let’s talk about the other great reasons to move, especially with other people (motivation, social time, improved mental health, a good sing-along, and err hello … FUN?)
I hope this has given you some food for thought (pun absolutely intended) and that you find it useful in your own practice. If you or anyone else you know need to speak to someone, or find out some more information, please head to the following organisations:
https://www.beateatingdisorders.org.uk
https://www.eatingdisorderhope.com
References
- BEAT (2022), How Many People Have an Eating Disorder in the UK? [online] Beat. Available at: https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/how-many-people-eating-disorder-uk/, accessed 15 October 2024.
- Hesse-Biber S, Leavy P, Quinn CE and Zoino J (2006), The mass marketing of disordered eating and eating disorders: The social psychology of women, thinness and culture, Women’s Studies International Forum, [online] 29(2): 208-24. doi: https://doi.org/10.1016/j.wsif.2006.03.007, accessed 15 October 2024.
- NICE (2019), Eating disorders: What is it? [online] National Institute for Health and Care Excellence. Available at: https://cks.nice.org.uk/topics/eating-disorders/background-information/definition/, accessed 15 October 2024.
- Fuller K (2022), Difference Between Disordered Eating and Eating Disorders. [online] Verywell Mind. Available at: https://www.verywellmind.com/difference-between-disordered-eating-and-eating-disorders-5184548, accessed 15 October 2024.
- Holland LA, Brown TA and Keel PK (2014), Defining features of unhealthy exercise associated with disordered eating and eating disorder diagnoses, Psychology of Sport and Exercise, [online] 15(1): 116-23. doi: https://doi.org/10.1016/j.psychsport.2013.10.005, accessed 15 October 2024.
- Pereira RF and Alvarenga M (2007), Disordered eating: Identifying, treating, preventing, and differentiating it from eating disorders, Diabetes Spectrum, [online] 20(3): 141-48. doi: https://doi.org/10.2337/diaspect.20.3.141, accessed 15 October 2024.
- Turner R (2021), What Is Intuitive Eating? A Nutritionist Explains. [online] Cedars-Sinai. Available at: https://www.cedars-sinai.org/blog/what-is-intuitive-eating.html, accessed 15 October 2024.
Further reading
Linardon J, Tylka TL, Fuller‐Tyszkiewicz M (2021), Intuitive eating and its psychological correlates: A meta‐analysis, International Journal of Eating Disorders, 54(7). doi: https://doi.org/10.1002/eat.23509, accessed 15 October 2024.
Leila Neve
Leila Neve is an award-winning personal trainer and group exercise instructor with a BSc in Sport Science, specialising in physical rehab and motivational coaching. She is incredibly passionate about making health and movement accessible to all, her black Labrador, Leonard, and pretty much anything covered in cheese.
