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SocietyFebruary 23, 2023

Why personal trainers need better awareness of eating disorders

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With minimal education required around nutrition and eating disorders, some personal trainers are giving clients diet advice that could exacerbate a serious illness. 

If you’re a fitness professional, you are likely working with clients who have eating disorders, whether they’ve disclosed this to you or not. It’s estimated that 103,000 New Zealanders struggle with an eating disorder. And with only 6% of these people medically diagnosed as “underweight” it can be tricky to tell the difference between a committed, dedicated client, and someone who is extremely unwell. 

Charlotte* a 31-year-old marketing professional from Tāmaki Makaurau, knows how easy it is to hide an eating disorder. She’s always been quite petite, but when she took up rock-climbing in her twenties, she started to build muscle. And people started to react to her changing body. 

“People noticed I’d put on weight and they started commenting about it. The next five years of my life were defined by excessive exercise, anaemia, and the ability to accurately calculate the amount of calories in most foods.”

Under the guise of “making healthier choices”, Charlotte sought the advice of online fitness influencers – from proponents of the Atkins diet, to YouTube stars. Considered an example of perfect health by others, she was often praised for her dedication and lean physique.

“Conventional PTs (personal trainers) would’ve seen me as a star client, and not how unhappy and unhealthy I was.”

New Zealand Eating Disorders Clinic co-founder and psychotherapist Kellie Lavender​​ says it can be difficult to spot the signs of an eating disorder. “Size and weight are not a criteria for how unwell someone is. You can have anorexia and still be a normal weight.”

New Zealand Eating Disorders Clinic co-founder and psychotherapist Kellie Lavender. (Photo: Supplied)

Most people think of eating disorders in narrow terms, with anorexia and bulimia being the most commonly recognised. But in the past couple of decades, the understanding of disordered eating has broadened hugely – the term OSFED (other specified feeding and eating disorder) was coined, reflecting the fact that many who present as “healthy” suffer from very unhealthy eating behaviours and relationships with their bodies. 

This puts personal trainers in a difficult position, says Lavender. “What can start as a very positive notion of wanting to exercise more and eat well, can actually become something a bit more sinister. And you can’t really predict who might be more vulnerable to eating disorders, just from meeting someone for the first time.”

Beware where you get your diet advice

Demand for personal trainers is on the rise – with the last census in 2018 indicating that more than 4,000 were employed in New Zealand. But the role of trainers isn’t clearly defined. Some meet their clients regularly in their homes or at the gym, while others might run just one or two sessions with a client as part of a gym membership package. And while their role is simply to advise clients about exercise, many people turn to their trainers for detailed nutrition guidance too. But should trainers be dishing that out, especially if they don’t fully understand a clients’ relationship with food and their body? 

The personal trainer industry body REPs (part of the NZ Register of Exercise Professionals) does not support certified trainers prescribing meal plans or recommending specific food and supplements. 

“Our Code of Ethics talks about scope of practice. With food, it’s about making sure that PTs keep to general messaging around healthy eating, and it’s evidence based,” says Richard Beddie, CEO of Exercise NZ – the non-profit body supporting the fitness industry in Aotearoa.

Anyone who is REPs certified, whether by the big facilities like Les Mills, right down to independent trainers, should follow this counsel. Technically. But there’s no easy way to enforce it. 

Haris Butt, a personal trainer and former NZIHF (New Zealand Institute of Health and Fitness) educator, says some of his peers sell cookie-cutter meal plans and restrictive exercise regimes. “One of my students was getting the worst advice from her trainer. He was telling her to basically starve herself. She was doing way too much exercise. And she had this immense emotional connection with the trainer because he helped her lose weight.”

Personal trainer Haris Butt. (Photo: Getty Images)

Amber Cloney runs strength-based classes for women out of her Auckland studio. During her time working in big box gyms, she saw similar scenarios play out. “They give out a generic PDF diet plan. They say ‘following this will help you lose weight’. They’re really low-calorie and really dangerous. They don’t take any consideration into who the client is and what their situation is. If you’re expecting long-term change in a six-week weight loss challenge, you’re setting yourself up for an eating disorder. Guaranteed.”

The quest for visible abs

This is when it all begins to unravel. PTs are often contractors. They pay huge rental fees to gym facilities, and their income can be volatile when they first start out. “A lot of trainers are scared about losing clients so they think they’ve got to give them quick results,” Cloney says. 

PT’s are like any other small business or sole contractor – they need to attract and hold onto clients. The promise of weight loss is one of the most powerful ways to do that.

A lean trainer with visible abs is an extremely powerful marketing tool. But having a “shredded” midsection is a misleading credential. “I think there are too many personal trainers who sell their abs on Instagram. The assumption is if they’ve got abs, they know what they’re talking about. I did Iron Man and I still don’t have abs. But that doesn’t mean I don’t know what I’m talking about,” Cloney says. 

A muscular midriff, often touted as a reward for discipline, is an impossible goal for many humans. (Photo: Getty Images)

While a “six-pack” has become a common image levied at people online, it’s actually an impossible goal for most and not a reliable indicator of physical health. The way we metabolise fat and build muscle is largely down to genetics, which means some people – no matter how hard they work in the gym, or how meticulously they calculate their daily calories – will never have visible abs. Some of the top athletes in the world don’t look like Instagram fitness models, despite their elite levels of physical strength and stamina. 

Of course, not all trainers are shredded snake-oil salesmen. Most fitness professionals are educated, certified, and get into the industry because they’re genuinely passionate about helping people. So can we chalk up bad nutritional advice as a simple case of “people don’t know what they don’t know?” 

The danger of a little knowledge

To be certified, all trainers must get a REPs recognised qualification – ranging from a certificate, through to a diploma or a degree. Personal training qualifications usually have a nutrition component, but you could say the content is “snackable” at best. Butt has both taught these courses, and been a student of them. “We gave a lot of general advice. There wasn’t any room in the construction of a course to go in-depth with anything. I’m like, hey, this is like the bare minimum. Good luck!”

Once qualified, trainers have to complete a certain number of REPs approved courses per year as a part of a points-based system. The REPs online education portal has over 200 courses, with 31 of these covering nutrition. 

“Trainers aren’t limited to the courses on the website though,” Beddie adds. “If there is a course, programme or conference that a trainer thinks is right for them – do that and REPs can review it when they re-register.”

So, a trainer can pick any course they’d like, in order to meet their minimum yearly education requirements. There are no compulsory topics, per se. “Pilates workouts with props” might be more interesting than the less sexy “nutrition advice while staying with scope or practice”. 

Perhaps a trainer does stay within their scope, referring clients to specialists for more detailed nutrition advice, as they’re advised to do in the REPs Code of Ethics. Perhaps they’re comfortable providing evidence-backed advice, like eat fruit as an afternoon snack Linda! Swap that fourth latte of the day for more water, Larry! 

But, are trainers taught to tell the difference between a client who is committed to improving their health, and a client who is committed to punishing or shrinking their body?

Caryn Zinn, an associate professor at AUT’s School of Sport and Recreation says the basics about eating disorders are taught in most fitness trainer qualifications. “We talk to them about disordered eating. We teach our students about signs and symptoms, and what to look out for.”

But of the 200 REPs courses listed online, there’s only one containing eating disorder education. It’s worth .5 of a “point.” When you click the link, it takes you to a course description on “power plates” and “body vibration” training. One can only assume this is a broken link, but perhaps it’s symbolic of something else – that the way we teach trainers about disorders is broken. Or at the very least, the information provided is in dire need of an update. 

Lan Pooley, a qualified nutritionist and trainer, echoes this concern. She says it can take years of specialised experience to recognise the different disorders – from the well known ones, through to more specific issues, such as muscle dysphoria (an obsession with large muscles) or orthorexia (an obsession with “clean” eating). 

“Back when I was lecturing, there was a limited component on eating disorders, but it focused very heavily on bulimia and anorexia. Trainers are much more likely to be dealing with binge eating disorders or just behavioural issues with food. People who have been on fad diets for years and years and now they’re scared of certain food groups. That’s still disordered eating behaviour, but it doesn’t fall clearly into bulimia or anorexia.”

A male obsession with exercise and weight often goes undiagnosed as disordered eating has traditionally been considered a female illness. (Photo: Getty Images)

Complicating this, recent graduates might not be aware of their own weight biases. They’re not well-practised in having hard conversations with at-risk clients. They haven’t built a network of specialists to which they can refer clients. And to be fair, there aren’t many education providers out there teaching this stuff. 

“We can’t really make PTs ask those hard-hitting questions because they’re not actually qualified to deal with what comes out of it. It’s a tricky position for them. We either need to have further education for personal trainers, or they can learn to recognise when they’re out of their depth and refer on,” Pooley says. 

While personal trainers shouldn’t be diagnosing disorders, Lavender would like trainers to be more aware of the language they’re using with clients. 

“I think most people have good intentions to help people, it’s just having the tools to recognise what’s helpful and what isn’t. I don’t think they quite understand what the impact their messaging could have.”

For trainers, this means shifting the narrative around motivation. Getting rid of the “no pain, no gain” edict. Doing away with language that assigns moral weight to food. Focusing on the body in terms of its function, rather than its appearance. 

Pooley sets non-aesthetic goals with her clients. “If someone asks me how to lose ten kilos, I would take a different talk track straightaway. Start talking about what quality of life changes they can make. How can we make you feel better, how can we make you feel more confident, stronger?”

There’s one thing the experts and trainers unequivocally agree on – it’s important to refer an at-risk client to a medical professional for an official diagnosis and treatment plan. From dietitians to doctors, nutritionists to trainers, the industry would benefit from being more collaborative. 

“Some people have quite severe eating disorders, but their gym just lets them go there everyday. It’s not the gym’s job to fix it. But I think it’s a responsibility to question it, and not necessarily ignore it. Have a list of the places that you could refer someone if they wanted some help – public and private,” Lavender suggests.

Some trainers are proactively learning more about eating disorders, so they can better support their clients.

“There’s a personal trainer who I know well. She has educated herself about eating disorders, and refers clients to us in a really supportive way. She understands what’s going to be helpful for them and has actively been involved in the treatment plan. What a difference that makes to the client, because the shame and stigma has been taken away,” Lavender says. 

If you’re someone who struggles with food and exercise, always check a PT’s qualifications before choosing one to train you, let alone direct your diet. If a trainer tells you to drink two protein shakes a day and assigns you an arbitrary calorie target, question their knowledge and integrity. And if they recommend any kind of supplement for 10% off using their discount code, run for the hills. 

“You are allowed to go to a trainer and ask lots of questions before you sign up with them. If you’re getting advice that doesn’t sit well with you, don’t keep going. Find someone else,” Cloney says.

A healthy lifestyle is one that makes you feel good – not just physically, but mentally. While it’s certainly not a trainer’s job to be an eating disorder specialist, it’s important that they aren’t inadvertently contributing to the problem. 

In an ideal world, trainers would know that it’s wrong – dangerous even – to assume we know anything about an individual’s physical and mental health simply by the way they look; that there’s a whole person inside that body – and the way that person eats, sleeps, thinks – all contribute to their hauora ; that people in average-sized bodies can have eating disorders, and that big bodies can be fit and strong. But weight biases do exist, and so the wheel turns. 

Lavender remains hopeful. “My hope is that the focus becomes wellness rather than weight loss. And personal trainers can actually play a role in broadening the perspective on health and inclusivity.”

Keep going!