Table 1 Fitness professionals’ responses to online survey questions regarding clients with possible anorexia nervosa

Have you ever encountered clients that you felt might have had anorexia nervosa?

143

 ● Yes

89

62.2 %

 If yes, how confident were you that the client had anorexia nervosa?

  ● Extremely confident

33

39.8 %

  ● Moderately confident

36

43.4 %

  ● Mildly confident

14

16.9 %

Did you take action (with the client that you felt had anorexia nervosa)?

83

 ■ Yes

49

59.0 %

 ■ No

34

41.0 %

  If no, why did you not take action?

   ■ Unsure the client had anorexia nervosa

21

61.8 %

   ■ Not your place to intervene

18

52.9 %

   ■ To respect the client’s autonomy

15

44.1 %

   ■ To avoid embarrassing the client

11

32.3 %

   ■ Didn’t know what to do

8

23.5 %

   ■ The client must assume responsibility for her or his own behavior

3

8.8 %

   ■ Clients were made aware of their personal responsibilities regarding safety prior to participating/attending

2

5.9 %

  If yes, what course of action did you take?

49

   ■ Spoke to the client about your concern

43

87.8 %

   ■ Talked to someone else about your concern

26

53.1 %

   ■ Gave the client information on seeking help

23

46.9 %

   ■ Spoke to the client’s family/friends about your concerns

16

32.7 %

   ■ Did not allow the client to continue to exercise in class/gym

8

16.3 %

  Why did you take action?

49

   ● Concerned about the client’s safety and well-being

49

100 %

   ● Fitness professionals have a duty to protect their clients

40

81.6 %

   ● Concerned about legal liability

8

16.3 %

   ● Worried what other clients would think

6

12.2 %

   ● Other

5

10.2 %

  Do you believe your course of action was adequate/effective?

49

   ■ Yes

21

42.9 %

Do you believe that fitness professionals are ethically obligated to take action when they encounter a client who they feel might have anorexia nervosa?

133

 ■ Yes

102

76.7 %

 ■ No

18

13.5 %

 ■ Only when client is <18 years

13

9.8 %

 ● Speak to the client about your concerns

96

97.0 %

 ● Give the client information on how to seek help

76

76.8 %

 ● Talk to someone else (e.g., boss, colleague) about their concerns

40

40.4 %

 ● Speak with the client’s family/ friends about their concerns

18

18.2 %

 ● Not allow the client to participate in their exercise class/gym

11

11.1 %

 ● Other

15

15.2 %

Did you receive any instructions on how to handle a client you felt had anorexia nervosa during your training or personal and professional development as a fitness professional?

128

  ■ Yes

33

25.7 %

Do you feel that how to handle a client you were concerned had anorexia nervosa was adequately addressed in the applicable code of ethics for fitness professionals?

72

  ■ Yes

21

29.2 %

Do you feel that you were adequately prepared to handle a client you were concerned had anorexia nervosa?

17

  ■ Yes

40

34.2 %

What information or training might help you feel better prepared to deal with a client you suspect has anorexia nervosa in the future? (n = 120 participants chose ≥ 1 response)

120

  ■ The most appropriate course of action

108

90.0 %

  ■ Treatment options and community resources available for clients with anorexia nervosa

106

88.3 %

  ■ Information on liability issues related to such situations

82

68.3 %

  ■ Information about the risks of exercise for clients with anorexia nervosa

77

64.2 %

  ■ How to identify clients with anorexia nervosa

73

60.8 %

  ■ Other

8

6.7 %