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Exercise red flags for eating disorders. Presented by Dr Warren Ward

Non-weight related markers of clinical stability and exercise exclusion 

Understanding the contraindications to exercise is one first step in decision-making when a client you are working with discloses, is suspected of, or is undergoing assessment for, an eating disorder. Dr Warren Ward shares red flags for exercise participation and offers insights to developing an “ED aware” approach to your practice.  

Recognising an eating disorder should not rely on stereotypes. Eating disorders occur in people of all age, weight, size, shape, gender identity, sexuality, cultural background and socioeconomic group. They are under-diagnosed and common. 

We learn that clinical stability and markers of nutritional status occur independently of BMI. This affirms the importance of using non-weight related, objective measures for assessment. The RANZCP clinical practice guidelines for the treatment of eating disorders offers ‘red flag’ assessment criteria that indicates both the need for hospital admission, and, inappropriateness for exercise participation. 

Compulsive and excessive exercise behaviours can contribute to eating disorder development and perpetuates the impact of starvation on the brain. They can be difficult to recognise because they are embedded, reflected and reinforced by fitness culture norms. 

A primary big picture goal in eating disorders is keeping patients alive. High mortality (10-20%) in anorexia nervosa reinforces the importance of all movement professionals understanding clinical markers of instability and actively supporting access to appropriate and timely treatment.  

Beyond this, your involvement in working with clients with a diagnosed eating disorder depends on your scope of practice and relies on ongoing further training in this area.  

Dr Warren Ward is an Associate Professor at The University of Queensland and was Director of the Queensland Eating Disorders Service from 2005 to 2023. He was also Chair of the Queensland Health Eating Disorder Advisory Group for more than ten years and co-author of the Royal Australian and New Zealand College of Psychiatry (RANZCP) Clinical Practice Guidelines for Eating Disorders. Dr Ward also recently served as the inaugural Medical Director of Wandi Nerida, Australia’s first residential program for eating disorders, and is currently Director of the Eating Disorder Program at Ramsay Health’s New Farm Clinic.

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