8 Unintentional Ways Trainers Promote Disordered Eating (and What to Do Instead)

August 22, 2018

This post was originally published on this site

https://www.girlsgonestrong.com/

Dear fitness professionals, are you inadvertently misdirecting your clients? Are you unconsciously promoting disordered eating?

What we hear, think, and say has a profound influence on how we feel about our health and our bodies. As personal trainers and fitness instructors, we have a powerful platform that can impact our clients in meaningful and lasting ways. We know the positive results — it’s why we love our jobs! There’s nothing better than watching our clients accomplish goals in the gym and in life they never thought they could.

Unfortunately, we can also unintentionally have a negative impact on a client’s health and body image by the messages we inadvertently send through how we speak and what we do in our sessions.

The fitness industry often amplifies rather than interrupts the messaging of today’s diet culture, which is fueled by a 60-billion-dollar diet industry. It’s a culture that is more interested in fads than facts, and in which health has become synonymous with the image of a lean, white individual with rock hard abs.

Weight loss and calories burned have become the primary markers of success. Marketing slogans and fitness challenges like, “Summer Beach Body Challenge,” “Weigh Less for The Dress,” and “Little Black Dress Challenge,” are everywhere. You can’t go far without hearing about the powers of “clean eating,” 30-day challenges, and detox kick starts.

Our current fitness paradigm is keeping clients stuck in cycles of dieting, food perfectionism, and using movement primarily for weight loss. Below are eight pitfalls I challenge us to avoid as trainers, as well as eight alternatives that can promote true health and positive body image.

1. Complimenting Weight Loss

What we say: “Wow you’re looking great! Looks like you’ve lost weight!”

What our clients hear: You didn’t look as good before. Thinner is better. Your trainer is evaluating your body.

What research shows: Although seemingly harmless, research shows that the positive reinforcement of weight-loss-related compliments is a big factor in increasing dieting behaviors and negative preoccupation with body [1,2]. Some clients also feel a sense of personal boundary violation when someone comments on their body. Furthermore, weight loss isn’t necessarily an indicator of health. A client’s weight may have shifted because of disordered eating, a negative life event, depression, stress, or sickness.

The alternative: Do not comment on someone’s body. Praise things like effort, consistency, strength, or actions. For example:

“I can really tell how dedicated you’ve been to your workouts.”
“I really appreciate your attitude and effort each session.”
“Your consistency is really admirable.”
“Your energy seems really great today.”

2. Perpetuating Weight Bias

What clients may say: “Ugh, I feel so fat!”

What we say: “No, you look great!”

What our clients hear: Being fat is bad. The smaller your body the better.

What research shows: These comments perpetuate the weight bias and stigma around body size in our culture. Weight stigma has been shown to have numerous negative impacts on health, including exercise avoidance, psychological stress responses, and disordered eating behaviors [3]. Many individuals in larger bodies avoid joining gyms or fitness classes because of the fear of being shamed.

The alternative: Use this as an opportunity to connect with your client. Fat is not a feeling. Find out more with questions such as: “I can hear you’re not feeling good in your body today. What’s going on?”

3. Using Punitive Language Around Food and Exercise

What we say: “Come on, gotta earn that [cheat meal/holiday/weekend]! Let’s burn those calories!”

What our clients hear: In order to enjoy or “deserve” certain foods, you need to compensate with added exercise. Calories in, calories out.

What research shows: Focusing on calories burned increases feelings of guilt and preoccupation around certain foods, and it decreases enjoyment of movement. In addition, the “calories in, calories out” model, otherwise known as the Energy Balance Equation, does not accurately capture the dynamic and adaptable system that is the human body [4]. When you cut calories or increase exercise, a cascade of changes in the body occurs to self-regulate and stabilize.

The alternative: Avoid talking about exercise as a compensatory tool. Instead focus on the empowering benefits of movement for encouragement. For example:

“Way to go, feel those strong muscles work!”
“Keep that amazing effort through this last rep!”
“Let’s start your weekend with some endorphins!”

4. Choosing Measurements Over Other Progress Markers

What we do: Using BMI or body fat measurements to calculate progress, measure health, and motivate clients.

What our clients internalize: Measurements are accurate and are the most important reflection one’s health and progress. Improvements in health behaviors such as increased sleep, stress reduction, or consistency with movement don’t matter or aren’t “enough” if measurements are staying the same.

What research shows: The BMI was created in the early 19th century by a mathematician, not a physician, and was not intended to be a health indicator. It’s an indirect measure of body fat that doesn’t take into account important details about age, gender, hormones, bone structure, and fat distribution [5,6]. The BMI tends to overestimate fat in very muscular people and underestimate it in elderly individuals.

Studies have repeatedly demonstrated that fitness is more protective of health than a low weight or particular BMI. This means that a larger, metabolically fit person is more likely to have a longer lifespan than a thinner individual who may look healthy but potentially have hidden health risks. In fact, studies involving women show that some extra weight on the hips and thighs is actually beneficial and can lead to a longer life [7].

Furthermore, measurement tools used such as BMI handheld machines have high degrees of variance and don’t give consistent readings. Even methods touted as the gold standard such as underwater weighing and DXA scans disagree by an average of 7 percent [8]. Inaccuracies from measurement to measurement can be very upsetting to clients who are unaware of the limitations of these tools.

The alternative: Focus on meaningful markers of well-being that still resonate with your client’s goals such as increasing metabolic fitness, reducing stress levels, improving quality of sleep, and supporting positive body image.

If a client asks to be weighed or measured, use it as an opportunity for dialogue. Our clients look to us as the experts and often just assume measurements are important because of the messaging the fitness industry sends. Ask questions like:

“How is the information going to be helpful to you?”
“How do you typically feel after getting measurements done?”
“Do you find that getting measurements taken influences your eating habits the rest of the day?”

Some fitness locations require trainers to do measurements. If this is the case, there should be an ethical responsibility to provide a disclaimer on the variance that comes with measurements, their impact on body image, as well as the poor correlation between measurements and markers of health or effort.

5. Marketing With Before-and-After Images

What we do: Display before-and-after images and marketing materials that celebrate weight loss and smaller bodies.

What our clients internalize: You can’t be healthy in a larger body. Exercising will result in weight loss if you’re working out correctly.

What research shows: Multiple meta-analyses research studies show that adding in physical exercise actually has very minimal impact on weight in and of itself [9]. Also, using body size as a reflection of health is highly problematic. Our health is determined by many factors beyond weight, including:

Genetics
Access to quality healthcare
Stress
Social and economic inequality
Sleep
Social connection
Nutrition
Movement
Smoking
Alcohol
Mental health

More importantly, when people exercise for enjoyment and well-being rather that weight loss, they are more likely to make movement a consistent part of their lives. So while weight loss marketing might get clients through the door, letting go of weight loss and body size as the primary image of health or success is crucial to long term client retention and in supporting a client’s emotional well-being.

The alternative: In marketing materials, include images of diverse body types engaging in movement. Use testimonials and language that focuses on the ways movement can improve one’s life holistically (for example, being able to play with one’s grandkids). This imagery and wording will resonate and feel more welcoming than a stock photo of a thin fitness model that clients will inevitably compare themselves against.

6. Asking About a Client’s Diet Without Permission

What we say: “Tell me about your diet?” or “So, what did you have to eat this weekend?”

What our clients hear: There is a “right” answer. Foods are either bad or good, and I will be judged on my response.

What research shows: Your clients respect you as their trainer and often want your approval [10]. Because the word “diet” isn’t neutral in our culture, asking questions about what a client eats can feel very personal and cause anxiety and shame, especially if they have a history of chronic dieting or an eating disorder.

The alternative: In an initial conversation when first meeting your client, explore their history through an open-ended question such as, “If you feel comfortable sharing, I would be interested in knowing a bit more about your relationship with food and how, or if, you hope I can be a support in that area of your health.”

During the rest of your time with a client, let your client take the lead on initiating conversations around nutrition. If you have a question you want to ask, start by asking permission. For example, “Nutrition is sometimes an area where clients find support helpful. Would it be OK if we checked in on that? If not, that’s OK! I’m always here as a resource.”

7. Assigning Moral Value to Food

What we say: Using terminology like “clean eating,” speaking of food strictly as “fuel,” categorizing food as either “good” or “bad,” or challenging your clients to only eat “real, whole, foods.”

What our clients hear: Nutrition is something that can be done perfectly. You always can and should be eating better than you are. Refined foods just damage your health and should be avoided.

What research shows: Being concerned with the nutritional quality of the food you eat isn’t problematic in and of itself. It’s when people become so fixated on so-called “healthy eating” that it impacts their physical and psychological well-being.

For example, orthorexia is a disorder that centers on obsession with proper or “healthful” eating. According to the National Eating Disorder Association, symptoms can include [11]:

Compulsive checking of ingredient lists and nutritional labels.
An increase in concern about the health of ingredients.
Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products).
An inability to eat anything but a narrow group of foods that are deemed “healthy” or “pure.”
Unusual interest in the health of what others are eating.
Spending hours per day thinking about what food might be served at upcoming events.
Showing high levels of distress when “safe” or “healthy” foods aren’t available.
Obsessive following of food and “healthy lifestyle” blogs on social media.

It is common for personal trainers and even doctors to essentially promote or prescribe disordered eating behaviors, increasing stress and preoccupation around food and body.

The alternative: You can still talk about nutrition or support a client in incorporating more nutritionally dense foods into their life. But it is important that you understand your client’s mindset around food. Dieting and diet behaviors are so common place that it is easy to overlook destructive patterns. 45 percent of American women and 25 percent of American men are on a diet on any given day. 35 percent of dieters progress to pathological dieting. Of those, 20 to 25 percent progress to partial or full-syndrome eating disorders [12].

We can use conversations around nutrition to help clients shift away from a “morality” approach to food. As Ellyn Satter, dietician and internationally recognized leader in eating competency, says, “When the joy goes out of eating, nutrition suffers” [13].

8. Pushing Diets for Weight Loss

What we do: Encouraging your clients to track their calories or try a certain diet program for weight loss.

Note: Be wary of diets in disguise. In the past decade, the word and concept of “dieting” has been replaced with phrases such as “healthy lifestyle” or “clean eating.”

What our client hears: Dieting will result in sustained weight loss. The trainer knows what foods are best for you.

What research shows: Research shows that 95 percent of all dieters will regain the lost weight in one to five years [11].The majority of those people will even gain back more. Weight loss and weight gain from yo-yo dieting is more harmful on the body than a stable weight at a higher BMI [7]. Dieting also increases preoccupation with food and negatively impacts body image.

The alternative: If you engage in conversation with your client around nutrition, focus on helping them determine what foods and eating patterns feel best. Remove morality in food by avoiding “good” vs. “bad” terminology. Help them explore the barriers that are getting in the way of them finding consistency. Reflect what you are noticing from what they are sharing instead of trying to “fix.”

This approach, also called intuitive eating, is an evidenced-based health intervention that helps people reconnect with internal hunger fullness signals, allowing them to become the experts of their own bodies.

Dieticians and originators of the approach, Evelyn Tribole and Elyse Resch, define an intuitive eater as someone who “makes food choices without experiencing guilt or an ethical dilemma, honors hunger, respects fullness and enjoys the pleasure of eating” [14]. Studies have demonstrated that intuitive eating leads to decrease in thin idealization and triglycerides, as well as an increase in well-being, good cholesterol, and self-esteem.

So Where Do We Go From Here?

As professionals in the fitness industry, we want to support our clients’ physical and mental health. Helping them connect with movement in a positive and empowering way is far more effective than simply blasting them with the most intense workout or latest nutrition fad.

Let’s focus on helping our clients become the experts of their own bodies. Let’s encourage them as multidimensional people, not just a set of measurements, and let’s expand the definition of health to encompass the whole person and a wide range of health behaviors. Let’s dispel the harmful myth that wellness is indicated by the size of one’s body.

Let’s have conversations around nutrition carefully, with permission, and without inserting judgment and morality into food. There is no one “right” way to eat. Pleasure and satisfaction are key elements of nutrition and rules or restrictions are often more harmful than helpful. The nutrition scope of practice for a personal trainer is limited and most certifications have minimal to no education around nutrition psychology. When in doubt, refer to a weight-inclusive nutrition professional.

Lastly, we need to remember that health itself is not a moral imperative or requirement. Everyone gets to decide if and how they want to take care of their bodies. Our role is to be a coach and support on their journey, not to judge or determine their choices. That’s the trust our clients have placed in us.

References

Budd G, Disordered Eating: Young Women’s Search for Control and Connection, Journal of Child and Adolescent Psychiatric Nursing, 26 June 2007. https://doi.org/10.1111/j.1073-6077.2007.00091.x
Engeln R, Beauty Sick: How the Cultural Obsession with Appearance Hurts Girls and Women, Harper, April 2017.
Puhl R, Suh Y, Health Consequences of Weight Stigma: Implications for Obesity Prevention and Treatment, Current Obesity Reports, June 2015. https://www.ncbi.nlm.nih.gov/pubmed/26627213
Thomas DM, Gonzalez MC, Pereira AZ, Redman LM, Heymsfield SB. Time to Correctly Predict the Amount of Weight Loss with Dieting. Journal of the Academy of Nutrition and Dietetics, 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4035446/
Rothman KJ, BMI-related errors in the measurement of obesity, International Journal of Obesity, August 2008. https://www.nature.com/articles/ijo200887
NPR, Top 10 Reasons Why The BMI Is Bogus, Weekend Edition Saturday, July 4 2009. https://www.npr.org/templates/story/story.php?storyId=106268439
Lavie CJ, Loberg K, The Obesity Paradox: When Thinner Means Sicker and Heavier Means Healthier, 2014.
Fogelholm M, van Marken Lichtenbelt W, Comparison of body composition methods: a literature analysis, European Journal of Clinical Nutrition, August 1997. https://www.ncbi.nlm.nih.gov/pubmed/11248873
Ross J, Janssen I, Physical activity, total and regional obesity: dose-response considerations, Medicine and Science in Sports and Exercise, June 2001. https://www.ncbi.nlm.nih.gov/pubmed/11427779
Melton D, Dail TK, Katula JA, Mustian KM. Women’s Perspectives of Personal Trainers: A Qualitative Study, The sport journal, 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439248/
National Eating Disorder Association, What Are Eating Disorders, Orthorexia, https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia
Eating Disorder Hope, Eating Disorder Statistics & Research, https://www.eatingdisorderhope.com/information/statistics-studies
Ellyn Satter Institute, How to Eat, Adult Eating and Weight, https://www.ellynsatterinstitute.org/how-to-eat/adult-eating-and-weight/
Tribole E, Resch E, Intuitive Eating: A Revolutionary Program That Works, St. Martin’s Griffin, September 2003.