How Fitness Center Environments Influence Eating Disorder Recovery: Learning From Women With Lived Experience

Eating disorders (ED) are serious illnesses that compromise the physical and psychological health of those who suffer from them. With maladaptive exercise being a common ED symptom, individuals with EDs may gravitate to fitness centres where pro-weight loss, anti-fat messages are the norm. Previous research has examined how aspects of the fitness center environment can impact EDs and subclinical ED presentations, with a small number of studies focusing on fitness professionals' knowledge and awareness of EDs. To date, however, the inclusion of those with lived experience of EDs remains a notable gap in the literature. We sought to address this by focusing on understanding how fitness center environments impact recovery from the perspective of women with EDs.

Using purposive sampling, we recruited 10 adult women who regularly attended fitness centres and who self-identified as being in ED recovery. Using the enhanced critical incident technique (ECIT), we asked them to describe fitness center-related factors that helped and/or hindered their recovery. We also invited them to share "wish list" items. Interviews were transcribed, coded, and analyzed according to themes.

Participants identified 28 helping factors, 54 hindering factors, and 33 wish list items; these were organized thematically into categories with the following seven categories being directly relevant to fitness settings: ED literacy, hindering ambient gym culture, hindering interpersonal gym culture, numbers-based assessments, helpful ambient gym culture, helpful interpersonal gym culture, and staff intervention. Overall, participants found it helpful when exercise was framed around movement, having fun, building confidence, and honoring limits. Conversely, participants found it hindering when exercise was framed around appearance, weight loss, calorie burning, pushing through pain and fatigue, and ignoring one's bodily signals.

This study identifies important helping and hindering factors present in fitness center environments and shows how fitness professionals, business owners, and professional associations can better support the health and wellbeing of people who use these spaces. The results of this study also offer important insights to ED care providers who might benefit from understanding how fitness center environments can impact their clients' EDs and recovery.