Coaches, Trainers and Fitness Instructors

Athletes and Eating Disorders

Athletes are at a higher risk of developing an eating disorder than non-athletes. Studies show that approximately 20% of female athletes have eating disorders (compared to 5% of non-athletes). Rates are higher in aesthetic sports (gymnastics, figure skating), weight classes (rowing), and sports where a low body mass is seen as an advantage (cross-country or cycling). These are not the only sports and activities where participants may be affected by eating disorders/disordered eating.

It’s critical that coaches, instructors, and trainers:

  • be adequately trained to recognize the warning signs of eating disorders
  • understand the physiological and psychological risks involved
  • use pre-screening tools and validated protocols to ensure the athlete is healthy enough to train
  • engage in conversations with their athletes when they have concerns
  • work cooperatively with treatment professionals and parents to support recovery
  • examine coaching language and materials to ensure the promotion of health and proper nutrition to support peak performance
  • feel comfortable integrating other professionals, such as Health At Every Size(HAES)-aligned, weight inclusive dietitians, psychologists, and others when supporting athletes both during regular practice, recovery, and ongoing recovery maintenance

This page will help you learn more about creating and supporting a safer active environment for clients and yourself.

A note about the resources on this page

The resources on this page are offered in addition to -not a substitute for- work or training with a qualified professional

If you are concerned about yourself, a client, or a loved one, feel free to send us an email: info@edsna.ca 

You can also find a list of psychologists, dietitians, and other healthcare professionals on our Private Care Treatment page.

For more information about publicly-funded healthcare, please view our Public Health Services page.

Where to Start

Eating Disorders: Awareness and risk mitigation in the fitness industry workshop

  • EDSNA and healthcare professional partners offer periodic workshops addressing challenges, offering information, and providing practical tips about working with eating disorders/disordered eating in the fitness industry. Check out EDSNA’s program page to see when this workshop will be offered next!

Printable Gym Posters

Posters are available to print for communities across Alberta. We intended to have these placed above scales in gyms, so people who may be struggling with an eating disorder or disordered eating know resources are available to them. Please let us know if you want us to print one of these posters by emailing our Public Awareness Coordinator angie@edsna.ca.

The HAES Files: An Open Letter to Fitness Professionals

  • Information about weight-based discrimination and internalized weight bias.
  • Includes both fictional and real-world accounts of people experiencing weight-based discrimination.

For Athletes and Coaches – Eating Disorders Center for Treatment and Research

  • Eating disorder signs and symptoms specific to an athletic setting.
  • Medical consequences of disordered eating in athletes.

NEDA Coach and Athletic Trainer Toolkit

  • The National Eating Disorder Association (NEDA) provides a downloadable toolkit for staff who work in gyms, school settings, outside athletic groups, dance studios, etc. who would like to know how to support athletes who may be affected by eating disorders.

What Gyms Can Do if They Think Someone Has an Eating Disorder? (USA)

  • *Trigger warning* Contains more graphic imagery from a personal account of someone struggling with an eating disorder while also attending the gym.
  • Tips for trainers on how to spot and talk about disordered eating/eating disorders with their clients.

2016 Update on eating disorders in athletes: A comprehensive narrative review with a focus on clinical assessment and management.

  • Understanding the epidemiology and pathophysiology of eating disorders allows the sports medicine clinician to optimize his or her role in screening at-risk athletes and providing treatment. Using evidence-based guidelines for clearance and return to play encourages transparency and accountability between the sports medicine care team and the athlete. Efforts to prevent eating disorders should be aimed at athletes, coaches, parents and athletic administrators, and focused on expanding knowledge of healthy nutrition in support of sport performance and health.

Mindful Movement and Recovery for Compulsive Over-Exercise

  • Information about compulsive over-exercising and the importance of mindful movement.

InsideOut: Fitness Australia Recommendations for Eating Disorders

  • Five recommendations for the identification and support of people with eating disorders in the fitness industry

SEES Guidelines

  • Safe Exercise at Every Stage guidelines for managing exercise and return to sport in athletes with eating disorders

Webinar: Fostering Positive Body Image and Preventing Disordered Eating in Girls Engaged in Youth Sport

  • Webinar by NEDIC, featuring two local researchers. Theory and practical tips are provided, as well as a link to the website they are creating

Pre-participation Physical Examination (PPE)

  • Developed by several US sports organizations has questions aimed at disordered eating behaviours and also looks at the consequences of eating disorders, including stress fractures, mood disturbance, and substance abuse.

Female Athlete Triad: Cumulative Risk Assessment, Consensus Statement on Treatment and Return to Play of the Female Athlete Triad

  • A guide to help coaches and physicians determine if an athlete is well enough to return to training after an eating disorder diagnosis. Please note: “Athletes diagnosed with anorexia nervosa who have a BMI < 16  or athletes with moderate-to-severe bulimia nervosa (purging >4 times a week) should be categorically restricted from training and competition.”

Common Co-Occurring Factors

Orthorexia & Fitness


What is Orthorexia: Symptoms, Complications and Causes

  • An article by Eating Disorder Hope on Orthorexia

NEDA: Orthorexia

  • Warning signs and symptoms
  • Health consequences
  • Treatment

Eating Disorders, Body Dysmorphia, Muscle Dysmorphia & Fitness


When reading these articles please remember: body- and muscle dysmorphia can affect any and all genders.

Body Dysmorphic Disorder (BDD)

  • General information from Johns Hopkins Medicine about BDD including symptoms, diagnostic treatment, and an overview of treatment modalities

Body Dysmorphia: Symptoms, Causes, and Treatment

  • General information from Eating Disorder Hope about BDD, and how it intersects with eating disorders

Recognition and Treatment of Muscle Dysmorphia and Related Body Image Disorders

  • Research discussing psycho-behavioral characteristics of muscle dysmorphia, recognition of the disorder, and describing treatment and referral options

Articles & Podcasts

Weight Bias: A Primer for the Fitness Industry

  • Looking to increase awareness among fitness professionals about weight bias and its consequences, and to outline strategies for increasing sensitivity and preventing bias with overweight and obese populations

Fitness Australia Guidelines: Identifying and Managing Members with Eating Disorders and/or Problems with Excessive Exercise

  • This policy has been designed to assist managers, personal trainers and instructors to work effectively with gym members who are at risk of developing (or who have developed) an eating disorder or exercise disorder, in order to sensitively and appropriately address issues of health and safety

In Obesity Research, Fatphobia Is Always the X Factor

  • An opinion piece on fatphobia in obesity research

Podcast: WNW Series: Reframing Stress & Enjoying Movement with Dr. Kelly McGonigal

  • Kelly McGonigal joins Dana Fulwiler and Elizabeth Tingle to share her research and insights on stress mindset and joyful movement.

Hopeful, Hungry and Chasing a Lie. ​

  • Brutally honest article about long-distance runners and the risks they take by restricting in order to shave seconds off their time. Written by a professional runner.

Psychology Today article: Lessons from a Marathon Runner in Recovery

  • An article by Gia Marson, Ed. D on eating disorders in athletes.

Podcast: Maintenance Phase

Academic Literature (Studies)

Alberta-led Exercise & Disordered Eating Research by Maxine Myre

  • University of Calgary researcher Maxine Myre has an extensive catalogue of articles they have authored and co-authored. Support disordered eating and fitness-related research in Alberta

Perspectives of Canadian fitness professionals on exercise and possible anorexia nervosa.

  • Study of fitness instructors’ knowledge about eating disorders. Done in Alberta.

Disordered eating behavior among group fitness instructors: a health-threatening secret?

  • Study from Norway on disordered eating among fitness instructors.

Defining compulsive exercise in eating disorders: acknowledging the exercise paradox and exercise obsessions

  • A scholarly article in the Journal of Eating Disorders defining compulsive exercise

Responses of fitness center employees to cases of suspected eating disorders or excessive exercise

  • A scholarly article in the Journal of Eating Disorders looking to determine whether gym employees report incidences of eating disorders and exercise issues

My fitness pal usage in men: Associations with eating disorder symptoms and psychosocial impairment

  • Some have raised concerns of calorie-counting apps potential to precipitate, intensify, or maintain eating disorder symptoms, this study looks at that

Objectifying fitness: a content and thematic analysis of #fitspiration images on social media

  • The study examines the nature of images and text contained within #fitspiration posts on social media

Digital pruning: agency and social media use as a personal political project among female weightlifters in recovery from eating disorders

  • This article traces the ways in which women who are in recovery from eating disorders and engaged in weightlifting strategically navigate their social media ‘worlds’

Protect me from my selfie: Examining the association between photo-based social media behaviors and self-reported eating disorders in adolescence

  • This study examined whether social media behaviours were associated with higher odds of meeting criteria for an eating disorder and whether gender moderated these relationships.

Perspectives of Canadian fitness professionals on exercise and possible anorexia nervosa

  • The purpose of the study was to examine Alberta fitness professionals’ experiences with clients suspected of having anorexia nervosa, and their views on related ethical issues

Instagram use is linked to increased symptoms of orthorexia nervosa

  • The study investigate links between social media use, in particularly Instagram and orthorexia nervosa symptoms

Exercising for weight and shape reasons vs. health control reasons: The impact on eating disturbance and psychological functioning

  • The aim of this study was to determine the prevalence and correlates of exercise motivated by health and weight/shape reasons

Female athletes and eating problems: a meta-analysis

  • The relationship between athletic participation and eating problems is examined using meta-analysis

Absence of menstruation in female athletes: why they do not seek help

  • This study looks to gain more insight into the reasons why female athletes do not seek help when experiencing amenorrhea and how care for these women could be improved

Potential Adverse Cardiovascular Effects from Excessive Exercise Endurance

  • A routine of regular exercise is highly effective for prevention and treatment of many common chronic diseases and improves cardiovascular (CV) health and longevity. Notwithstanding, the hypothesis that long-term excessive endurance exercise may induce adverse CV remodeling warrants further investigation to identify at-risk individuals and formulate physical fitness regimens for conferring optimal CV health and longevity.

Defining Compulsive Exercise in Eating Disorders: acknowledging the exercise paradox and exercise obsessions

  • Recently Dittmer et al. (JED 6:1–9, 2018). suggested a transdiagnostic definition and a clinical assessment for
    compulsive exercise in adolescents and adults with eating disorders.. [W]e suggest adding “exercise obsession” as a fourth subtype of compulsive exercise.

Additional Supportive Fitness Organizations

Mental Health Resources – Canadian Centre for Mental Health and Sport

  • A list of mental health resources and organizations
  • USports Guidelines
  • NCAA Guidelines

Canadian Sport Psychology Association

  • The Canadian Sport Psychology Association (CSPA) is an organization devoted to applied sport psychology. Has a list of consultants.

Athletes Embodied

  • A partnership between NEDIC, Western University and the University of Toronto, Athletes Embodied, integrates scientific research and perspectives from athletes, leaders, and decision makers in Canadian youth sport, with the goal of improving the experiences and retention of adolescent girls in sport. We do this by providing actionable, evidence-based guidelines and resources that address body image challenges in sport, with a specific focus on girls ages 11-16.

Fitness Australia

  • Create guidelines and learn more from the in-depth resources from Fitness Australia

SAMHI

  • Student Athlete Mental Health Initiative resources