Eating Disorders and Over-Exercise in Collegiate Recreation (Part II)

October 18, 2015

A Reflection on the Last 15 Years

Adrian A. Shepard, MS, RCRSP
Recreation Management Program Faculty, Madison College

Editor’s Note: this is part 2 in the series

It’s essential for recreation professionals to know and understand their scope of practice. Unless qualified to do so, recreation professionals can’t diagnose eating disorders. However, they can look for observable signs that may signify eating disorders. The following table provides behaviors and symptoms associated with eating disorders as provided by the National Eating Disorders Association (NEDA) and the Academy for Eating Disorders (AED).

Anorexia Nervosa
• Inadequate food intake
• Intense fear of weight gain
• Dramatic weight loss
• Preoccupation with weight, food, calories, fat grams and dieting

Bulimia Nervosa
• Frequent episodes of consuming very large amounts of food followed by behaviors to prevent weight gain such as self-induced vomiting, excessive exercising and/or use of laxatives
• A feeling of being out of control during the binge eating episode

Binge Eating Disorder
• Frequent episodes of consuming very large amounts of food but without behaviors to prevent weight gain
• Feelings of strong shame or guilt regarding the binge eating
• Indicators that the binge eating is out of control

Other Specified Feeding or Eating Disorders
• Atypical anorexia nervosa
• Bulimia nervosa (with less frequent behaviors)
• Binge-eating disorder (with less frequent occurrences)
• Purging disorder
• Night eating syndrome

The following table provides behaviors and symptoms associated with over-exercise as provided by the American Council on Exercise (ACE).

• An individual no longer chooses to exercise, but instead, feels compelled to do so and struggles with guilt and anxiety if their workout is not completed
• Exercise continued even with ill or injured
• Withdrawal symptoms if exercise is reduced or stopped
• Depression, irritability, apathy, low self-esteem
• Increased muscle fatigue, disturbed sleep patterns, gastro-intestinal disturbances
• Increase in resting heart rate and blood pressure
• Decrease in performance

Over-exercise and eating disorders are oftentimes linked. Over-exercise shows itself in Anorexia Nervosa as an excessive, rigid exercise regimen with the compulsive need to “burn off” calories taken in. In Bulimia Nervosa, over-exercise is demonstrated by way of excessive exercise used as a purging method after a binge eating episode.

Given educational backgrounds and scope of practice, many recreation professionals, specifically those in the fitness/wellness arena, have the capability to address situations where students present behaviors associated with over-exercise in the campus recreation setting. It’s important to remember that most are not qualified to directly address and treat eating disorders. However, while recreation professionals can’t directly address eating disorders they can serve as part of the initial identification process and collaboration with qualified campus personnel. The following table is a synthesis of various models used by campus recreation departments. It provides an example of recreation facility personnel and the role they might play in the over-exercise and eating disorder identification and help process.

Student Employees
• Serve as the front-line or eyes and ears of the facility
• Relay concerns brought forward from patrons to designated professional staff
• Report observable behaviors that they have personally witnessed to professional staff

Program Coordinators
• Increase knowledge base through continuing education on the subject matter in coordination with the facility manager
• Educate student employees about the subject matter through trainings and in-services
• Follow-up on persons of concern
• Befriend person of concern if possible
• Work with facility manager to verify facility usage reports, if applicable
• Assess threat level and act accordingly to policies and procedures
-Is the person at risk for harming him/herself?
-If so, what stage are they at and what steps should you take?
• Keep administrator(s) in the communication loop

Facility Managers
• Increase knowledge base through continuing education on the subject matter in conjunction with the program coordinator
• Support and/or assist with training of student employees
• Relay concerns brought forward from patrons to program coordinator
• Report observable behaviors that have been personally witnessed to program coordinator
• Assist program coordinator in usage verification process, if applicable
• Enforce access ability in accordance to policies and procedures, if applicable

• Perform a comprehensive nutrition assessment and determine nutrition diagnosis
• Plan and implement a nutrition intervention focused around:
-Normalizing eating
-Changing “food rules”
-Improving body image
-Developing eating pattern for optimal health
-Diminishing excessive exercise

• Provide support and direction to staff as needed
• Report concerns to campus response team or other designated personnel per policies

The following suggested best practices were developed to help recreation professionals better address situations pertaining to eating disorders and over-exercise (Shepard, 2011).
• Understand your limitations (scope of practice) and know your role as most campus recreation staff aren’t qualified healthcare professionals
• Focus on the observable by becoming familiar with signs and symptoms
• Develop a departmental definition encompassing the high-risk behaviors you’re monitoring for
• Identify potential campus and community partners who can support your efforts
• Integrate your efforts with your student behavioral response team, if applicable
• Collaborate via a committee or task force including, but not limited to, legal council, health services, counseling services, insurance carrier, dietician or nutritionist, dean of students and athletics
• Educate and train professional and student employees about these behaviors and how to report them if they suspect something’s wrong; invite healthcare professionals to assist with and/or lead these efforts
• Establish a streamlined and confidential reporting process
• Designate your department’s point person and implement a clear, consistent, and time-efficient chain of communication with your collaborative partners
• Learn about and adhere to confidential record keeping practices
• Evaluate your protocol on a regular basis and modify as necessary
• Create and make available educational handouts about over-exercise and eating disorders
• Keep in mind that you and your co-workers are role models – what you say and how you dress can have a direct impact on those you come in contact with
• Ensure you abide by university legal, risk management and/or insurance protocols

In conclusion, Collegiate Recreation professionals have the ability to serve as key allies in their campus communities as part of the identification and support network for students demonstrating high-risk behaviors such as eating disorders and over-exercise. Continued education, research, open dialogue, collaboration, information sharing and development of best practices are key elements to success in this area. Providing assistance and education, within scope of practice, to those demonstrating these high-risk behaviors will further cement campus recreation professionals as key assets at their institution and as agents in fostering atmospheres that promote healthy lifestyles.

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The Renfrew Center Foundation for Eating Disorders (2003). Eating disorders 101 guide: A summary of issues, statistics and resources.

Shepard, A. (2011). Campus recreation in the 21st century: addressing over-exercise and eating disorders. Risk Management for Sport and Recreation, 6(2), 5-8.

Shepard, A., Barnes, A., Click, S., Peden, S. (2011). Assessing over-exercise, anorexia, and bulimia in campus recreation. Recreational Sports Journal, 35(1), 55-60.

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