How to Support Your Clients to Move From Disordered Eating Toward Lasting Health

By Sarah Herstich, LCSW

As a personal trainer you attract clients of all sizes who are looking to make behavioral and physical changes in the pursuit of health and wellness. And, you’re committed to helping people achieve exactly that, which is why it’s so important to be aware of the warning signs of disordered eating and eating disorders.

Relying on behaviors that occur on the spectrum of disordered eating to control body shape and size not only pulls people out of their lives, but most often stops them from achieving the results they ultimately desire — living a full, healthy and engaging life.

There are a number of ways that you can support both your clients who are struggling with disordered eating, and clients you are getting to know and beginning your work with.

You have a unique opportunity to begin to change the tide in how people see personal training — shifting from a weight- and body-focused approach that often encourages and supports eating disorder behaviors, to a weight-neutral approach that addresses and supports people to achieve a supportive relationship with food and their body, and lasting health.

If your client is struggling with an eating disorder, encourage them to seek support from a team of eating disorder specialists.

Staying within your scope of practice and referring your client out for evidence-based treatment is imperative.

Collaborate With and Trust the Team That Your Client Receives Treatment From

Connecting with, learning from, and collaborating with local eating disorder professionals bridges the gap between disciplines and provides a consistent and cohesive message of support to clients who are struggling with disordered eating.

It is important for you to know that effective treatment of eating disorders is a collaborative approach, often times pulling in strong and healthy support systems. As their trusted coach, you may be a primary support to your client who is beginning treatment. And at times, the most supportive thing that you can do for your client is to trust the recommendations of the treatment team to suspend or shift the focus of your coaching relationship to support goals of recovery.

Understand That Fat Is Not Synonymous With Unhealthy

Our society has a longstanding and deep-seated fear of fat, which drives people to try attempt to lose weight and change their body composition. Most times, this results in weight cycling — fluxing between periods of restriction and overeating. The fear of getting fat, or shame of being fat, fuels eating disorder behaviors in people of all sizes.

What most people don’t know is that engaging in disordered eating and exercise patterns, behaviors that are not sustainable in the long term, actually increases bodily inflammation, hypertension, insulin resistance and dyslipidemia.

Weight cycling is also associated with poorer cardiovascular capacity and increased mortality risk [1]. These are the conditions that nine times out of 10, the health and wellness industry blame on fat, when in fact, the fear of being or becoming fat are the driving forces.

Studies suggest that being five pounds underweight is actually more dangerous to someone’s health than being 75 pounds overweight [2]. And, that people of all sizes who engage in health-supportive eating and movement behaviors have lower mortality rates than people engaging in disordered eating patterns and sedentary lifestyles [3].

In other words, you can in fact be fat and healthy.

Working toward health and sustainable behavior change, instead of weight loss, plays the greatest role in health improvement, regardless of body size. Understanding that the behaviors that coincide with disordered eating — restricting, binging, and inconsistency in movement — are what actually impacts health markers, can help you and your clients shift away from weight-focused goals and fear of fat, to goals that truly support their long-term health.

Shift Your Focus Away From Weight and Body Size to True and Holistic Health

Taking a weight-neutral and holistic approach to helping people live healthier lifestyles has been shown to help people feel better and actually achieve improved health markers.

Shifting the focus from the scale to caring about and for one’s body in the here and now through enjoyable and sustainable movement reduces feelings of shame surrounding body size, reduces pressure to achieve a certain body type, and increases the likelihood of being able to normalize eating and movement patterns.

Clients who are struggling with their relationship to their bodies and food should be encouraged to measure the gains they’re experiencing outside of the gym, such as:

  • Engaging in hobbies and relationships that give them joy.
  • Moving toward self-acceptance.
  • Being kind to their bodies through movement that they truly enjoy and that enhances their life.
  • Addressing emotional vulnerabilities like depression, anxiety and previous traumas that may be contributing to their drive to change their body size.

Get Introspective About Your Own Behaviors

It’s important that you also process how you have engaged, or still are engaging in disordered eating behaviors yourself.

The old saying, “you can only take people as far as you’ve taken yourself,” can’t be more true when it comes to supporting your clients in moving away from disordered eating thoughts and behaviors.

Take some time to reflect on your personal belief system about being or becoming fat, about how you see, or try to control, your own body size, and how that informs the way you care for your body and how you relate to food.

If you have a preoccupation with the foods you are consuming, how often you engage in movement and how you see your body, seeking support from an eating disorder specialist can help you begin to dismantle the belief systems and narratives that are holding you back from living a full and engaged life — regardless of how your body shows up to the world.

Acknowledging how weight bias and efforts of body control inform the way you interact with yourself and your clients is an important step in being able to open yourself up to new ways of working with clients that encourage self-acceptance and support them to achieve lasting health.

Note: A quick and easy way to find local eating disorder professionals (in the U.S.) is to search the National Eating Disorder Association’s website. You can also search your area on Psychology Today to connect with clinicians who specialize in treating eating disorders.

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About the author:  Sarah Herstich, LCSW

Sarah Herstich is a licensed clinical social worker in private practice in Horsham, PA. Sarah treats women struggling with body image and eating disorders and specializes in treating binge eating disorder. Sarah is a Health at Every Size practitioner and is passionate about supporting women along their journeys in rediscovering that their worth stretches far beyond the way their bodies appear. You can find and follow Sarah on her website, as well as on Facebook and Instagram.


  1. Bacon L, Aphramor L. Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal. 2011;10:9. doi:10.1186/1475-2891-10-9.
  2. Flegal, KM, Graubard, BI, Williamson, DF, Gail, MF (2007). Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA, 298(17), 2028-3037.
  3. Robison J. Health at Every Size: Toward a New Paradigm of Weight and Health. Medscape General Medicine. 2005;7(3):13.

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