Burners, we're usually about fun and games, but today's post is not to be taken lightly. Eating disorders are no joke, and they're far more common, and dangerous, than many realize. It may also come as no surprise that a high percentage of sufferers can be found in the gym. We recruited Jodi Rubin—a licensed clinical social worker, eating disorder expert, and founder of Destructively Fit™, a program designed to educate the fitness industry about these issues—to shed some light on how we can identify and help those with eating disorders. Jodi shares some tips on how fitness instructors can broach the subject with a potentially ill client.
When we heard about Destructively Fit™ we knew that we needed to publish an article on the work Jodi Rubin is doing in the fitness community. This is an issue that hits home for us (RateYourBurn founder Gillian Casten suffered from bulimia for several years - read about her experience here.) We've all worked out alongside people who are suffering - but how do we help them?
Tell us about your program.
The issue of eating disorders within fitness centers is a ubiquitous one that I have noticed ever since I can remember. I’ve seen people spending hours on the treadmill, heard countless patients recounting their obsessiveness with the gym, and others seeming as though their self-esteem became immediately deflated if they couldn’t work out hard enough, fast enough, or long enough. The research I have done has revealed that the presence of eating disorders within fitness centers is sticky and complicated and gets very little attention. Through no fault of anyone in particular, without the education and tools, then how can any trainer feel knowledgeable and confident enough to address this sensitive issue?
I went directly to fitness professionals. As I suspected, it was clear that there is not a lack of interest in this issue. Quite the contrary. Most, if not all, of those with whom I spoke were eager and excited to finally have a forum in which they could learn about eating disorders and how to approach the issue. That’s when I started Destructively Fit™, a 3-hour training with the goal of educating those within the fitness industry about what eating disorders are and what to do if they notice that someone may be struggling. It has since been endorsed for continuing education by both the National Academy of Sports Medicine and The American Council on Exercise and has sparked the interest of a variety of fitness clubs.
Why did you choose this line of work?
Eating disorders have always been my passion. They have been my specialty since I began my LCSW private practice more than a decade ago. Over the years I directed a program for eating disorders, am currently teach a curriculum I created on eating disorders at NYU’s Graduate School of Social Work, and have done a few other things. Yet, I have not found a way to connect my love of healthy fitness and honoring one’s body with my passion for working with those struggling with eating disorders.
How can an instructor identify students who might be suffering from an eating or exercise disorder?
Identifying someone who has an eating disorder can be difficult. Sometimes there are obvious physical signs—like emaciation, excessive workouts, returning to the gym two to three times a day—but usually there are less obvious emotional and behavioral signs and symptoms to be aware of. There's sometimes a particular intensity or unwavering drive that one has towards exercise and their body, and their self-esteem hinges on it all. While there are many examples, a few common ones include having a distorted body image, significant body dissatisfaction, body checking, intense fear of gaining weight, low frustration tolerance, an all-or-nothing mentality, and perfectionism.
How do you recommend that instructors broach the subject with potentially ill clients? This is a painful and sensitive subject for many.
While it is not within an instructor's scope of practice to treat someone, with knowledge about eating disorders it is well within their scope to identify someone who may be struggling. Approaching someone has a lot to do with the relationship. If you already have a relationship, approaching [a client] can simply be expressing concern about symptoms, like a shift in mood, swiftness of weight gain or loss, intensity, etc. If you don't have a relationship with the person, it is also OK to express your concerns directly, or you could consider sharing your concerns with someone who does (perhaps they are also worried!).
It is important to remember that expressing this concern opens the door to future conversations. In group fitness, it becomes a bit more nuanced, but typically, if a member shows up for the same classes each week, a relationship begins to build. It is still possible to address someone in group fitness, it would just be wise to do so privately, either before or after class. Keep in mind, if someone doesn't immediately acknowledge what is going on with them, if addressed sensitively, they will remember that you care, are not afraid to broach the subject, and that they may approach the subject with you in the future.
What do you do when a person is not receptive to help?
Just because we are ready to approach someone doesn't mean that they are ready to hear what we have to say or are willing to get help. As a trainer, it is your job to assess safety. It goes without saying that if it is unsafe for someone to be exercising, then that should be addressed. In extreme cases, I've seen this get channeled to gym managers. Otherwise, it's useful to realize that it may take time for people to recognize what is going on for them.
Trainers are in a unique position and, by nature, their clients are trusting them with their bodies (a big deal for anyone struggling with an eating disorder). Whether the client says so or not, their trainer's voice will resonate deeply and differently than the voices of others (and likely, if there is something going on, the trainer is not the only one who has said something). Remember, raising concern opens the door to future conversations. Be patient and supportive, while always keeping safety in mind.
An instructor's job is to inspire, and we often hear instructors saying things like, "Do you want to fit into those jeans?!" Often these phrases are related to body size, since, well, many people are in the gym to lose weight. Are there any terms or phrases that instructors should completely avoid using?
Without giving a long (and inherently incomplete) list of what to say and what not to say, I offer you this to consider: Get to know your clients first. For some, focusing on numbers can be fun and not emotionally charged. But for anyone with an eating disorder, numbers can lead to a road of obsessiveness and destructiveness. Focusing on health for each individual body (and every body is different) is a way to veer away from numbers and more towards overall health, strength, flexibility, endurance, and FUN!
Many instructors are afraid to say anything to clients because they don't want to offend them. Do you have advice for them?
It's not offensive to care for your clients. If you think that your client will be offended by what you want to say, perhaps you can think about another way to phrase your concern. It's true that your client may feel caught but, if done sensitively, they will also feel that you care. And having already established a trusting reciprocal relationship with your client, your relationship will be able to tolerate and survive this discussion.
Do you need to know a client well before approaching them about the topic?
Safety first. If someone is clearly in danger, be active and address it, or inform your manager of your concern. Otherwise, I recommend asking someone about whether they have had or currently struggle with an eating disorder when you first meet them. Generally, there is an initial assessment that personal trainers complete, so that's a great time to raise the issue.
If the instructor is not an expert on the topic, who can they refer the client to for help?
There are many resources for anyone struggling with an eating disorder. There are a few websites that have directories of eating disorder specialists around the country. The National Eating Disorders Association and the Eating Disorder Referral and Information Center are two that i recommend. And, of course, you can contact me and if I can't be of help, I can help you find someone who can.
What about instructors who suspect that colleagues are suffering? Any tips for this?
I would offer the same advice!
Tell us about exercise disorders. Is it similar to bulimia, where the working out is to purge? (I'm trying to grasp this, since I would not be able to run, walk, or swim after a binge).
Yep! One of the diagnostic criteria of Bulimia Nervosa is binge eating followed by purging. Excessive exercise is a way to purge. So if someone binge eats and then purges via excessive exercise, I would diagnose them with Bulimia Nervosa.
Why are eating disorders such a big deal? Give us a fact run-down.
- Americans spend over $40 billion on dieting and diet-related products each year.
- The average woman is 5'4" and weighs 140 pounds. The average model is 5'11" and weighs 117 pounds.
- Most fashion models are thinner than 98 percent of American women.
- If mannequins were women, they would be too thin to bear children.
- 67 percent of women ages 15 to 64 withdraw from life-engaging activities, like giving an opinion and going to the doctor, because they feel badly about their looks.
- Of all psychiatric disorders, eating disorders hold the highest mortality rate due to natural and unnatural causes.
- 25 percent of all reported cases are male.
- The No. 1 wish of girls 11 to 17 is to lose weight.
- Nearly 1/3 of teenage boys engage in unhealthy and dangerous behaviors to control the weight and size of their body, such as skipping meals, refusing to eat, smoking cigarettes, vomiting, and taking laxatives.
- 90 to 95 percent of men and women diagnosed with eating disorders are members of fitness centers. (source: McLean Hospital)
Remember, this is a delicate and nuanced subject matter that CAN be addressed successfully. What I've offered above are things to consider. In no way is this a complete how-to or step-by-step instruction guide to addressing someone who may be struggling. Endorsed by NASM and ACE, Destructively Fit™ was designed to offer the education and forum to discuss and explore eating disorders within the world of fitness and to give fitness professionals the confidence and knowledge necessary to approach this issue.
About Jodi: Jodi graduated with a B.A. in Psychology from SUNY at New Paltz and earned her Master’s degree in Social Work from New York University. In addition to over a decade of work as an LCSW with individuals, families, and groups in her private practice, Jodi is a former director of Day Treatment at The Renfrew Center for Eating Disorders and a founding member of Metropolitan Psychotherapy and Family Counseling Practice. She is the creator of a curriculum on eating disorders for the Graduate School of Social Work at New York University and has been teaching this course, as well as guest lecturing in the NYU Post-Master’s Program, for the past several years. Jodi is a contributor to We Are The Real Deal and actively lectures and teaches students, families, and professionals throughout the metropolitan area about the etiology, prevention, treatment, assessment, and work with eating disorders. Jodi is passionate about her work with eating disorders and, through Destructively Fit™, she has had the opportunity to merge her love of her work and her love of fitness into something that can affect change. You can contact Jodi for trainings and read more in Jodi's blog.
For more on Jodi Rubin and Destructively Fit™, visit destructivelyfit.com. You can also find Jodi on Facebook and follow her on Twitter.