Individuals with eating disorders may pursue overexercising in fitness facilities and exercise classes. The primary aim of this study was to assess registered fitness instructors' capability to recognize an individual with anorexia nervosa and determine what they would do professionally in that situation. A secondary objective was to assess fitness instructors' understanding of potential professional, ethical and legal issues inherent in this situation. Fitness instructors and pediatricians were administered a survey consisting of a descriptive case scenario of an individual with probable anorexia nervosa. Fitness instructors were also surveyed on various related issues. Thirty-two percent of fitness instructors indicated the case scenario subject presented with anorexia nervosa compared with 88% of pediatricians, a statistically significant difference. Sixty percent of fitness instructors recognized that there were some ethical and liability issues inherent in the scenario, and 37% identified these as serious. All fitness instructors suggested guidelines in this area would be helpful. Implications for training and continued education opportunities for both fitness instructors and pediatricians are discussed.

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Ethically problematic situations frequently arise in the care of children and adolescents with eating disorders. The younger person with anorexia nervosa can often deteriorate quickly, therefore the child who is in denial with respect to the seriousness of her condition and/or markedly ambivalent regarding renourishment is at grave risk. Involuntary treatment is likely to be a consideration during such a medical crisis. In this paper we outline an ethical decision-making framework that can assist the clinician in engaging the young patient and her family well in advance of a crisis, so that decisions can be made at a time when recourse to establishing incompetency or enforcing involuntary treatment are unnecessary. We have adopted a narrative approach in our application of the decision-making framework, and safety is emphasized as the central concept underlying the application of this model. Finally, a number of recommendations are made regarding application of the ethical decision-making framework with younger persons.

Objective: Positive and negative themes about their illness have been identified in an adult population with anorexia nervosa. It was our goal to explore the thematic content of the letters written by an adolescent population in order to better our understanding of how this different population relates to the illness. Method: Twenty-seven adolescents with anorexia nervosa were asked to write two letters to their eating disorder, one addressing it as a friend and the other, as an enemy. The coding scheme initially developed by Serpell and Treasure, with minor adjustments, was used to code the letters by two trained raters, with high inter-rater reliability. Results: Many similarities and a few notable differences between the adolescent population and an adult population were noted. Compared to an adult population, adolescents valued to a greater degree the sense of feeling looked after by the disorder and the increased attention that they felt the disorder provided. In contrast, they did not view loss of periods as a benefit. Regarding perceived costs of anorexia nervosa, adolescents described a greater degree of psychological distress in relation to the disorder, and a greater sense of having been tricked by the disorder. They did not describe as much frustration with preoccupation with thoughts about food or of being controlled by food. All other themes were not considered appreciably different in terms of percentage of statements or of subjects. Discussion: An understanding of how adolescents relate to their illness in terms of themes can help to provide the therapist with a sense of where a patient is in terms of motivation and readiness for recovery. This in turn can aid in the determination of an appropriate treatment approach that is most likely to foster an optimal therapeutic alliance and to enhance motivation to recover.