Recreational Sports Journal, 2011, 35, 55-60 © 2011 Nirsa Foundation

Assessing Over-Exercise, Anorexia, and Bulimia in Campus Recreation Adrian A. Shepard, Sarah A. Barnes, Sally Click, and Scott Peden The primary aim of this study was to assess the need for and interest in guidelines for addressing instances of over-exercise and eating disorders such as anorexia and bulimia in campus recreation. A secondary objective was to assess the barriers institutions face when posed with scenarios related to these behaviors. Ninetysix percent of respondents agreed or strongly agreed that campus recreation guidelines for addressing instances of over-exercise would help their department better handle such situations. The response to questions regarding the desire for anorexia and/or bulimia guidelines was identical. Future research, implications, and recommendations are discussed. Keywords: over-exercise, eating disorders, anorexia, bulimia

Campus recreation professionals are interested in over-exercise and eating disorders such as anorexia and bulimia. Questions on these topics routinely appear on professional association e-mail listservs. Those who inquire seek to identify institutions actively addressing these sensitive issues; others specifically request ideas, guidelines, and best practices. In an effort to delve further into this topic, the survey, Assessing Over-exercise, Anorexia, and Bulimia in Campus Recreation, was created and distributed to college recreation professionals in December of 2009. The purpose of this targeted study was to collect data related to unhealthy behaviors such as over-exercise and eating disorders in campus recreation facilities. The results help determine the necessity for the development and establishment of guidelines and best practices for addressing such behaviors in the campus recreation environment.

Prior Relevant Research Findings From 2003 to 2006 the Center for Disease Control (CDC) National Center for Health Statistics (NCHS) reported an annual average of 390,400 ambulatory care visits among those 25 years of age and under. Of those, 58% resulted in an Shepard is with the Dept. of Integrated Wellness, Winona State University, Winona, MN. Peden is with the Dept. of Recreation, Butler University, Indianapolis, IN. Barnes is with the Dept. of Health Education and Outreach, Butler University, Indianapolis, IN. Click is with the Div. of Student Affairs, Butler University, Indianapolis, IN.     55

56   Shepard et al.

eating order diagnosis. Despite this high incidence of diagnosis, the recreation literature is not flush with prior study on these topics. A 2008 study did suggest that individuals displaying traits commonly associated with eating disorders may over-exercise, a component of anorexia nervosa and bulimia nervosa, in fitness facilities and group fitness classes (Manley, O’Brien, & Samuels, 2008). Individuals with an eating disorder may attempt to mask the disorder from others by consistently taking part in activities such as group fitness classes or individual cardiovascular and strength workouts. A 2002 study conducted by Duke University, the University of North Carolina at Chapel Hill, and North Carolina State University assessed risk factors associated with over-exercise and eating disorders among college students (Desai, Miller, Staples, & Bravender, 2008). The results indicated 33.3% of overweight respondents and 23.7% of normalweight respondents had a preoccupation with food while 42.2% of overweight respondents and 31.3% of normal-weight respondents had a desire to be thinner. In addition, 11.4% of overweight individuals and less than 8% of normal-weight individuals from the same study feared engaging in bingeing episodes without stopping. Clearly in this study, body image and eating habits were of concern for our primary population. Blocking access to a campus recreation facility and its programs might be one way to address these student concerns but this response poses complex ethical, legal, and clinical issues. Instead, campus recreation professionals can play an important role in identifying and assisting individuals who are struggling with over-exercise and potential eating disorders. One might ask the question: Are campus fitness personnel prepared and comfortable in this role? A study conducted by Manley et al. (2008) highlighted the important role fitness professionals could play in addressing instances of over-exercise and potential eating disorders. The study involved both fitness instructors and physicians (specifically pediatricians). Of the 62 fitness instructors that took the electronic survey, there was unanimous agreement that guidelines for handling instances of eating disorders would be helpful.

Methods This study received approval of the institutional review board (IRB) and the National Intramural-Recreational Sports Association (NIRSA) research clearinghouse. The Assessing Over-exercise, Anorexia, and Bulimia in Campus Recreation survey was developed based on literature related to over-exercise and eating disorders as well as first-hand knowledge of the researchers based on their professional experience. The web-based survey was distributed by the NIRSA National Center (NNC) to the NIRSA members via a NNC e-mail account. The instrument was comprised of five sections: introduction, over-exercise, anorexia and bulimia, institutional guidelines, and campus recreation guidelines. The survey sample consisted of one professional from each of the 264 NIRSA member institutions throughout North America with a fitness and/or wellness employment position identified by the NNC. From this initial sample, six e-mails sent from the NNC were returned as undeliverable, therefore reducing the sample size to 258. Within the two weeks that the survey was open two e-mail invitations went out to study participants.

Assessing Over-Exercise, Anorexia, and Bulimia    57

Results The fitness and wellness professionals returned 128 of the total 258 surveys, a return rate of 50%. Surveys were returned from six regions throughout the country with the highest percentage return rate coming from Region I (23.4%) and Region II (21.1%). The remaining surveys came from Region III (17.2%), Region IV (8.6%), Region V (13.3%), and Region VI (16.4%). The highest percentage survey return rate based on enrollment came from institutions with an enrollment of 10,000–19,999 (31.3%) with the next highest group of respondents representing institutions sizes of 20,000–29,999 (15.6%). See Table 1 for all survey response rates.

Over-Exercise One major purpose of this study was to determine if there are incidences of over-exercise cases in campus recreation. Of the 128 respondents, 78% stated that they have been made aware of or personally observed facility users presenting symptoms and/or behaviors associated with over-exercising. Fifty-nine percent knew of someone on campus trained to handle matters of over-exercising. Furthermore, respondents were asked to identify the person(s) on campus trained to handle these matters. By a large margin, counselors were identified as a key resource by half of the respondents. See Table 2 for responses. Table 1  Enrollment Breakdown Enrollment

n

%

0–999

2

1.6

1,000–2,999

15

11.7

3,000–4,999

15

11.7

5,000–9,999

22

17.2

10,000–19,999

40

31.3

20,000–29,999

20

15.6

30,000–39,999

7

5.5

40,000+

7

5.5

Table 2  Staff Member Trained to Handle Instances of Over-Exercise Staff member

n

%

Assistant director or coordinator-fitness/wellness/health

16

21.6

Athletic trainer

1

1.4

Counselor

37

50.0

Health educator/coordinator

10

13.5

Personal trainer

3

4.1

Physician

4

5.4

Recreation department director

3

4.1

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Respondents were not asked to which areas these perceived “experts” reported but we can surmise that the majority of them are not necessarily in the reporting structure of campus recreation. Of 125 respondents, 65% stated that their department and/or facility had no guidelines in place for addressing matters pertaining to over-exercise. Forty-seven percent of these respondents attributed their lack of guidelines to barriers such as a lack of knowledge pertaining to the subject matter while 34% cited a lack of on-campus resources. Ninety-three percent agreed or strongly agreed that it would be helpful to have departmental guidelines in place. Of the 44 respondents indicating their department and/or facility had overexercise guidelines in place, 98% agreed or strongly agreed that it was helpful to have the guidelines. Of 119 total respondents, 96% agreed or strongly agreed that campus recreation guidelines for addressing instances of over-exercise would help their department better handle such situations.

Anorexia and Bulimia Eating disorders and over-exercise are often related and therefore a secondary purpose for this survey was to determine if there is an issue with user behavior in terms of anorexia and/or bulimia. Of 119 respondents, 63% stated that they have been made aware of or personally observed facility users presenting symptoms and/or behaviors associated with eating disorders such as anorexia and/or bulimia. Furthermore, 79% of respondents knew of someone on campus trained to handle matters related to anorexia and/or bulimia. Respondents were asked to identify the person(s) on campus trained to handle these matters. It is no surprise that counselors were overwhelmingly identified as the campus resource of choice for eating disorder concerns. See Table 3 for responses. Of 24 respondents, 96% stated that their department and/or facility had no guidelines in place for addressing matters pertaining to eating disorders such as anorexia and/or bulimia. Sixty-two percent of these respondents attributed their lack of guidelines to barriers such as a lack of knowledge pertaining to the subject matter while an additional 33% cited a lack of on-campus resources. Ninety-two percent agreed or strongly agreed that it would be helpful to have departmental guidelines in place.

Table 3  Staff Member Trained to Handle Instances of Anorexia and/or Bulimia Staff member

n

%

Assistant director or coordinator-fitness/wellness/health

6

6.4

Athletic trainer

1

1.1

Counselor

65

69.1

Health educator/coordinator

15

16.0

Personal trainer

0

0.0

Physician

5

5.3

Recreation department director

2

2.1

Assessing Over-Exercise, Anorexia, and Bulimia    59

Of 113 total respondents 96% agreed or strongly agreed that campus recreation guidelines for addressing instances of anorexia and/or bulimia would help their department better address such situations.

Implications and Recommendations The results of this targeted study show that the NIRSA fitness and wellness professionals work in settings where they personally observe or are made aware of facility users presenting symptoms and/or behaviors associated with over-exercise, anorexia, and bulimia. Since most facilities have campus recreation staff on the front lines interacting with and observing the vast majority of facility users, these results could prove to be challenging in that most front-line staff members, let alone the professional staff, are not adequately equipped with the proper training to identify or respond to these unhealthy behaviors. Some may argue that recreational professionals are not now or will never be qualified to diagnose these conditions. That may be true but our unique setting within an educational institution provides us access to qualified personnel. Given the overarching educational mission of our institutions, campus recreation professionals have a responsibility and an opportunity distinct from those who work in the private sector. At the very least, campus recreation professionals are part of the identification and support network. As partners in a behavioral response team, recreation staff can lend their expertise and observations to campus prevention and response efforts. It is clear that counseling professionals are perceived as experts with issues of eating disorders. A 20% discrepancy existed between those able to recognize eating disorder experts on campus versus those who might be over-exercise experts. This suggests that campuses have knowledgeable and trained professionals to access when eating disorders are identified. It suggests a lack of perceived expertise regarding overexercise on our campuses. With guidelines and training, this is a void that recreation professionals could fill given our access to and observations of our facility users. Of 128 respondents, 78% indicated their recreation office or department reported to student affairs signifying the potential for collaboration with helpful resources within their division, the likely organizational home of counselors and health care professionals. Whether recreation falls within or without of the student affairs umbrella, it is likely that our key allies on these issues do. Given limitations in training and credentials, recreation staff must partner with available health care providers on campus or in the community. While the NIRSA fitness and wellness professionals recognize the necessity for collaborating with qualified professionals at their institutions to address such matters they desire campus recreation guidelines to equip their department to better address the instances of over-exercise and eating disorders they encounter. Based on the results of this study it is recommended that the NIRSA consider collaborating with the American College of Sports Medicine (ACSM) on the exploration of basic guideline development for addressing instances of over-exercise and eating disorders in campus recreation. Other potential collaborative partners include the Association for University and College Counseling Center Directors (AUCCCD), National Eating Disorders Association (NEDA), Academy for Eating Disorders (AED), American College Health Association (ACHA), and the American Council on Exercise (ACE).

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Future Research Results show respondents desire the development of campus recreation guidelines to better address instances of over-exercise, bulimia, and anorexia. Coincidentally one area that needs further assessment is the knowledge of the NIRSA fitness and wellness professionals regarding definitions, signs, and symptoms of these behaviors. Other areas for potential exploration include assessing the role campus recreation professionals should play in the prevention of over-exercise and eating disorders as well as defining over-exercise and eating disorders in the campus recreation environment and determining the prevalence and effectiveness of intervention teams.

References Center for Disease Control National Center for Health Statistics. NCHS data on eating behaviors [Data file]. Retrieved from http://www.cdc.gov/nchs/ data/infosheets/ infosheet_eatingbehaviors.pdf Desai, M., Miller, W., Staples, B., Bravender, T. (2008). Risk factors associated with overweight and obesity in college students. Journal of American College Health, 57(1), 109–114. Manley, R., O’Brien, K., Samuels, S. (2008). Fitness instructors’ recognition of eating disorders and attendant ethical/liability issues. Eating Disorders, 16(2), 103–116.