Exercise and Eating Disorders: An Ethical and Legal Analysis (review)

This is a detailed and insightful book, the complexities of which I will be unable to fully convey in a short review. I hope, however, to address the main conclusions and arguments of the text. In attempting this, I will work backwards from the author's conclusions to the extensive and detailed analysis that underpins them.

Chapter 9 deals primarily with the responsibilities of fitness professionals who have clients with an eating disorder. This chapter draws upon the range of illuminating cases studies presented in Chapter 7, where the author has gathered empirical data regarding the views and actions of fitness professionals in this context. This empirical data directly addresses questions central to the book. Should the fitness professional exclude the eating disorder sufferer for his/her own good? Such an argument would refer to the possible harm that may arise from exercising in an emaciated state. Such exclusion could, however, be framed in an alternative fashion. For a fitness professional to supervise a client with an eating disorder, either in a group fitness session or one-to-one interaction, it could be thought of as an extension beyond the bounds and expertise of the fitness professionals' job. Or should the fitness professional, aware of the harm that might come to the eating disorder sufferer via unsupervised exercise, include the individual and seek to help them deal with their condition in some way? What form might such help take?

Giordano's analysis of the ethical issues arising from the interaction between a fitness professional and a client, or potential client with an eating disorder, is detailed and resists the temptation of offering a generalised response. Giordano proposes contractualism as a framework best placed to understand the relationship between the fitness professional and exerciser, and thus the obligations of the fitness professional towards a client with an eating disorder. A fitness professional can be understood as entering into an "implicit moral contract" (Giordano, 2010: 170) with clients to promote health via safe and well founded fitness advice. Indeed, the role is characterised as providing a customer service. Accepting a client with an eating disorder extends beyond this contract, argues Giordano. That is not to say that a fitness professional assisting an eating disorder sufferer will necessarily lead to harm. Engaging in the sorts of fitness activities on offer might help promote the long-term interests of the client, helping to develop a healthier relationship with the body, for example. Exercise has been used in the treatment of eating disorder sufferers. This sort of help, however, involves a different role to that normally fulfilled by fitness professionals and thus cannot be deemed an ethical obligation. Where serious and imminent harm might befall the client, Giordano insists that the only defensible ethical path is to request that the client suspend activities. Important at this stage to note, however, is that requesting the client to suspend fitness activities should be done in such a manner as to respect the autonomy of the eating disorder sufferer, explaining the reason why, and that they would be welcome back once they are in a sufficient state of health to participate without serious risk. Again, this stance is justified on the grounds of the contract between fitness professional and client — "The instructor is not morally obliged to undertake risks that go beyond his/her competencies, and to comply with attempts to self-harm" (2010: 176).

Thus for Giordano, our actions and ethical responsibilities regarding our relationships — either professional or personal — with those with eating disorders are certainly not underpinned by the common perception of the suffering individual's condition as a mental illness that disables autonomy. Giordano's view is quite the opposite, arguing that eating disorders are not an illness but a state of being, and that there is no reliable evidence to conclude that eating disorders themselves result in a lack of autonomy. Thus, the conclusions above regarding the obligations of fitness...