August 10, 2012 by Deanna James, LPC, CEDS in Clinical Articles Many colleges have started requiring a health/fitness class for all students admitted to the college. This initiative I have no doubt is in the wake of a million anti-obesity campaigns and concerns about the health of our youth. In theory this sounds like a wonderful idea: Promote balanced nutrition, healthy exercise and overall health. What I have learned from my clients is that this is FAR from what happens in these courses.
These courses appear to be a veritable how to guide for Eating Disorder behaviors or at the very least they can easily trigger those with an Eating Disorder. The first problem is how progress is measured in the courses. Professors use metrics such as weight loss, BMI, body measurements, and increase in exercise rather than data that may reflect actual health such as blood pressure, labs, or self report measures. Suggesting that BMI or weight is the best measure of health is false and completely perpetuated by the medical community, however, it would be best to use many measures of health in a class rather than ones protected health information.
For fitness, students are encouraged to wear pedometers and increase their steps (which can be a healthy choice for many, but perhaps should not be the only option explored). Students are encouraged to weigh at the beginning of exercise sessions at the gym and after sessions at the gym. In some of the classes students do group weigh-ins! For those whom weight loss is a goal, and it should not be for all students, weight loss should be measured in much more realistic measurements either weekly or daily. Suggesting that you should lose weight while at the gym is shameful. Students are also encouraged to increase their exercise output without first checking how much they are exercising in the first place. This means that if a student is exercising 1/2 hour-1 hour a day- a very healthy amount they are encouraged to increase this- even though it might not be in their best interest.
In terms of nutrition- students are taught good and bad foods rather than all foods in moderation- thus perpetuating the shame associated with various foods or food groups. They are not taught portion control, mindful eating techniques, or anything that might teach actual health- just good and bad foods. They are expected to keep food journals not to explore balance and food groups but rather to count calories and reduce calories throughout the semester. And in most of the classes their is no mention of mental health, healthy body image, challenging body image stere0types, balanced living, time management or any other helpful life skills.
I will not say that the classes are all bad as some of the assignments and options offered DO promote health for those without body image issues or eating disorders. However, my largest problem with the courses is that I have now heard from three former clients that they were forced to take the course even after going to the office of disability and providing documentation of their eating disorder. The teachers in the courses were supposed to offer accommodations to the students so that they did not have to participate in anything which was detrimental to them. The problem with this is obvious to anyone who has an eating disorder or works with eating disorders. Many students with an eating disorder will not ask for an accommodation- rather they will be the person with the best scores, highest amount of weight loss, highest increase in exercise or the one feeling shameful that they haven't lost weight, binging or purging after class due to the shame. Or for the client in recovery who asks for accommodations- which ones should they ask for ? Not to participate in weigh ins, measurements, increasing exercise projects, varying exercise projects, counting calories for nutrition, etc. Well that is the entire class! How do you get a good grade in a class you cannot participate in without triggering eating disorder thoughts or behavior.
Castlewood has provided documentation to the teachers and suggested alternative projects for the students but none of my clients escaped unscathed. The class was triggering and could have reduced progress in their recovery had they not been in outpatient therapy to process. Forcing clients with eating disorders to take these courses is like asking an alcoholic to take a course in a bar- that would never be tolerated!
So I encourage any of you out there encountering this to contact the administration at your school- not just the office of disability. And if that does not work, contact the media, National Eating Disorders Association, whatever it takes! The promotion of unhealthy food and exercise behaviors in the name of health or fitness should not be tolerated on our college campuses. Help spread Eating Disorder Awareness.