What should I do if I think a client has an eating disorder?

Individuals with an eating disorder may wish to work with a Personal Trainer for a number of reasons. They may be in recovery and want support, or they may be looking for collusion and help losing weight. If there is an underlying eating disorder present, there are larger issues that need to be addressed over an individual’s need for exercise.


In the UK, 1.25 million people are currently living with an eating disorder and although it is more common in those under the age of 25, people in middle age are increasingly being diagnosed. Figures suggest that up to a quarter of sufferers are male, but due to the stigma around men with eating disorders, many people go undiagnosed or feel unable to ask for help.

It is important to note that a client could be of any age or gender identity to be presenting with an eating disorder and that they do not have to be underweight to be struggling with issues around food. For anyone not trained in this area it can be difficult to recognise without appropriate screening, so including questions clarifying any issues around food would be helpful as a part of your initial assessment with a client.

It is key that you are aware of the co-morbidities, both physical and psychological. These include depression, anxiety, panic disorders, diabetes, amenorrhea (cessation of their menstrual cycle), low blood pressure, muscle loss and weakness and anaemia.

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Is it realistic to expect patients to be completely inactive when moderate exercise is generally accepted as necessary for a healthy lifestyle? This is a sensible question and exercising when in recovery from an eating disorder is possible, but should look very different from their past regimes.

Whilst it is possible for some with an eating disorder to find a healthy relationship with exercise, it is not possible for all. Exercise is a compensatory behaviour for people living with an eating disorder and so it is key as part of recovery for them to change their perspective so that they can see it as part of a healthy lifestyle, rather than a necessity.


Exercise goals need to include the client’s beliefs and feelings towards exercise, which some clients may avoid or be resistant to. For this reason, working within a team approach would be most beneficial. This would include psychological support (Counselling), nutritional support (Dietitian or GP) and medical support (GP).

The guidelines that are suggested by Dr Brian Cook, for the use of exercise in eating disorders treatment, are:

1. Adopt a team approach

2. Monitor medical status

3. Screen for exercise-related psychopathology

4. Create a written contract of how therapeutic exercise will be used

5. Include a psychoeducational component

6. Focus on positive reinforcement

7. Create a graded exercise programme

8. Begin with mild-intensity exercise

9. Tailor the mode of exercise to the needs of the individual

10. Include a nutritional expert

11. Debrief after sessions

Whilst it is not the job of a Personal Trainer to treat an individual with an eating disorder, it is important that they are able to recognise them and know what process to follow if they do. Should a client with an eating disorder come to them for support, it is important that the trainer seeks advice, works as part of a team and does not assist with obsessive behaviour, even if their fitness doesn’t improve as quickly as it could do.

About the author: Jane Hancock, Counsellor

Jane is a Psychotherapeutic Counsellor and Senior Accredited Member of the British Association of Counselling and Psychotherapy. She is the owner of the East Devon Counselling Service and works with individuals and couples, both face-to-face and online. Alongside her therapeutic work, she has also trained new counsellors as a lecturer, delivers CPD courses and runs her own therapy blog, The Coastal Counsellor.