Empowering self-care
in clients with eating and body image issues

Eating and body image issues are the result of deeper, unresolved emotional problems. By encouraging clients with these issues to work on the imbalances in their lives, you can help them learn to love and care for who they are, says Tamika Hilder.

Do you have clients who fail to eat healthily no matter how much encouragement or information you give them? Do you sense that some of your clients lie to you about their eating? Do you struggle to connect with some of your clients and know their issues are hidden well beneath the surface? Are you unsure of how to work with those who have an eating disorder?

After years of working with clients who have eating issues, eating disorders or body image issues, I’ve realised one thing: it has nothing to do with food. Eating Disorders Victoria explains an eating disorder as a dangerous mental illness, not a lifestyle choice, a diet gone wrong or a fad.  An eating disorder is characterised when eating, exercise and body weight/shape become an unhealthy preoccupation of someone’s life.

There are a variety of eating disorders that can affect a person, each with different characteristics and causes. However, in general, eating disorder cases can be linked to low self-esteem and an attempt to deal with underlying psychological issues through practising an unhealthy relationship with food.

More and more men and women are presenting with these problems. If we, as fitness professionals, are to assist our clients in true health and wellness we must learn to recognise these issues, understand our limitations when it comes to help, and know when to refer.

Discovering the problem

Either in your initial consult form or in person, ask questions to see if clients have a history of eating issues, or are deeply dissatisfied with their body image. It should be noted that sexual abuse can be an underlying factor with eating disorders and body image issues. While a client with eating issues may not reveal a history of abuse in an initial consult, it is worth bearing in mind that this confronting topic may be confided further down the track after a level of rapport and trust have been established.

Severely underweight clients with anorexia are obvious to spot, however those with bulimia or binge eating disorder are often a normal weight or just above, and sufferers are very adept at hiding their eating issues, making these problems harder to recognise. Those who are obese are more likely to have a binge eating issue, however individuals may have a combination of bulimia and binge eating, or switch between the two.

‘You need to understand that their eating is the presenting symptom,
not the problem.’

To determine if a client has a problem, you need to find out the truth about their eating and exercise habits, and their mindset/attitude towards food and their body.

Potential questions to ask clients include:

  • Do you have a history of eating issues?
  • What are your motivations to eat? (boredom, emotional, stress, tired, habit, hungry etc)
  • Have you/do you sneak food or lie about what you eat?
  • Have you/do you restrict food and why?
  • How often do you think about food?
  • Do you suffer from guilt associated with eating, and if so to what degree?
  • Are you obsessive about calories/fat/carbs etc? Do you fear getting fat?
  • Do you feel out of control with your eating?
  • Have you ever, or do you currently binge eat? If so, triggered by what, when and how often?
  • Have you ever/do you purge food or use laxatives?
  • What were your parents’ eating habits/relationship to food?
  • Were you labelled as ‘fat’ or ‘chubby’ as a child?
  • What stress in your past and present have you gone through? (Look for when the eating issues began and what was happening three to six months prior)
  • If they do have eating issues, do they want to get better? (if they don’t, there is not much you can do except occasionally encourage them to see a professional)
  • What are your exercise habits? Do you exercise only to lose weight?
  • How happy are you with your body image? (scale 1-10).

Of course, these types of questions need to be asked carefully, in a very supportive, understanding way – and at an appropriate time and place.

Unhealthy relationship with food

Responses to the above questions which are indicative of an unhealthy relationship with food include:

  • Thinking about food all day
  • Feeling guilty about certain foods
  • Stressing about how many calories a particular food has in it
  • Always thinking about how much exercise they have to do in order to burn off X amount of calories
  • Feeling controlled by food
  • Feeling unable to control addictions/cravings
  • Lying about what they eat
  • Starving themselves to lose weight
  • Bingeing regularly.

Unhealthy relationship with body

Responses to the questions that indicate an unhealthy relationship with the body include:

  • Thinking and speaking negatively about your body
  • Worrying that you will gain weight
  • Worrying about what others think of your body
  • Concerned what your body looks like from various angles
  • Afraid to go out in public if you are having a 'fat day'
  • Unable and unwilling to look at your body naked in the mirror
  • Feeling ashamed if someone else sees you naked.

Given that eating disorders are a serious mental health problem, it is important to know the signs and signals, be familiar with responses that might indicate a problem, and to gently and carefully speak with your client about what you are noticing or concerned about. It is not your role as an exercise professional to counsel or work through these problems, but to be a part of a support network for the clients. Clients with suspected eating disorders should be referred to a psychologist, counsellor or doctor. To ensure that you are fully aware of the signs and symptoms of eating disorders, and for more helpful information, check out the following free websites:

Adopting a compassionate approach

As you learn to recognise the signs and begin to understand your client’s history, thoughts and feelings, you will begin to realise why they relate to food and their body the way they do. By displaying compassion and empathy to clients who have unhealthy food and body image relationships, you will help them feel safe enough to truly open up to you. Often, a problem shared is a problem halved. Feeling ‘safe’ with you means they feel that you:

  • Understand their situation and can empathise
  • Will not judge them for anything they say related to past events or current feelings
  • Can love/accept them despite their ‘issues’ – this is very important to their healing.

Healing past emotions – a courageous step

Let your client know how courageous they are to face their feelings and deal with their issues. Help them to see that their past attempts at dealing with their problem by using food have not worked, and encourage them to find an approach that will work – by addressing the root cause. Just hold the space for them to open up to you. In most instances, clients will not have even shared their feelings with their own self, so doing so with you is a major step for them – and also the start of their healing.

Black and white thinking vs. rainbow thinking

You should avoid telling clients with bulimia or binge eating disorder what to eat, when to eat and how much to eat. Most of them will already know this. It is usually not for lack of information that they struggle with their eating. You need to understand that their eating is the presenting symptom, not the problem.

If the client ‘stuffs up’ with their eating, let that be OK. They live with feelings of guilt and harsh, critical self-judgement every day – which is a major part or even cause of their eating issue – so you don’t want to exacerbate this. If you judge them for not eating according to your standards, they will feel like a failure and as though healthy eating is too hard for them. Most clients with eating and body issues struggle with these feelings on a daily basis, so you should be careful not to push them away or they are likely to stop training with you. Your aim is to keep them feeling safe so they will continue to be honest with you about what they are eating and feeling. Remember: love not judgement!

Understand that a large part of their problem is their idea that some foods are ‘good’ and others are ‘bad’. This limited, black and white view of food causes them to label their days and even weeks and months as the same; either ‘bad’ or ‘good’. If they are good, they are eating healthily and exercising but if they eat something they consider bad, that turns their day or week into a bad one until they start the following day or week afresh. This extreme way of thinking needs to be relaxed so that if they do eat a so-called ‘bad’ food, it’s not such a big deal; that they are able to enjoy it, and then get back on track to eating foods that nourish their body. This will reduce their obsessive attitude toward food.

Food as nourishment for mind, body and soul

Remind your client that food is about nourishing their mind, body and soul. Food is a way to nurture and nourish every cell in their body. Rather than seeing food in terms of grams of fat, carbs, protein or calories, assist them in seeing the nutritional value for their cells. Encourage them to eat whole foods but don’t make it a ‘diet’. They will never have to count calories again if they focus on eating real foods. This is really simple and cuts out the confusion and stress for them. It brings the joy back into food, and allows them the choice of what to eat, bringing the power back into their hands.

Self-love and self-care practice

The common thread in clients with these issues is a lack of self-love. The abusive way they treat their bodies reflects the abusive thoughts they have about themselves. They usually believe that once they lose weight they will feel happy about who they are. They are looking for something external, such as body image, to give them an internal feeling of happiness. Focus not on a number on the scale, but on wellness. Encourage them to love themselves first so they’re naturally inclined to treat their bodies with the love, kindness and gentleness it deserves. Self-love must come first. Cheryl Richardson’s The Art of Extreme Self-Care is a great book to guide clients through a 12-month program of self-care.

Eating and body image issues are the result of deeper, unresolved emotional issues. Encourage your client to look at healing whatever is unbalanced in their life and to learn to love and care for who they are. By addressing the true imbalance, they will cease using food as a way to numb their feelings. A happy mind and heart will result in a healthy body. By taking a holistic, supportive and compassionate approach with these clients, you position yourself as someone who cares and is willing to support them on their journey to find healing and balance.

Tamika Hilder
Tamika is the creator of the Think Your Body Slim healthy eating method and an expert in the mind-body connection related to weight loss, eating issues and body image. A speaker at the FILEX fitness industry convention and contributor to fitness publications, her passion lies in educating personal trainers about the psychological and emotional causes of weight and eating issues. Contact Tamika at tamika@holisticwellnesscoaching.com.au or via www.holisticwellnesscoaching.com.au.