Source:Giordano S. Risk and supervised exercise: the example of anorexia to illustrate a new ethical issue in the traditional debates of medical ethics.
J Med Ethics.
2005
;
31
:
15
–20.

Exercise class instructors and fitness professionals may face ethical issues similar to those confronted by health care professionals. This article uses the case of anorexia nervosa and examines the ethical issues that arise when individuals with anorexia are allowed to participate in exercise classes. Although exercise may be harmful to someone with anorexia nervosa, there are reasons to allow supervised exercise. The principle of respect for autonomy could support allowing an anorexic individual to participate in supervised exercise once the participant has displayed an understanding of the risks. It can also be argued that by allowing an individual to participate in a supervised exercise program, an instructor can more effectively monitor and minimize harm from exercise than if an anorexic individual pursues unsupervised exercise because she is denied access to a supervised program. The author argues that it may then be appropriate to accept an anorexic student but that the instructor is being asked to accept responsibilities that go beyond his or her training. As a result, while the instructor may choose to supervise an exercise program for an anorexic student, there is no ethical obligation to accept a student who may suffer harm from the activity being taught.

Dr. Forman has disclosed no financial relationships relevant to this commentary.

This article argues that although there are “strong ethical reasons” to allow anorexics to participate in exercise programs, there is no moral imperative to do so. One might also argue that there is a moral obligation to deny participation of some anorexic individuals. A person with anorexia has disordered thinking and could be considered incompetent regarding judgments about her own nutrition (“I exercise because I am fat”). An instructor ought to be paternalistic towards such an individual, not allowing participation in an exercise program unless the participant agrees to medical consultation and exercise supervision.

This article offers a nice analysis of the ethical issues faced by exercise instructors who have anorexic individuals in their classes. The author makes a compelling argument that while exercise is one of the central features in anorexia, these individuals might be better off in supervised situations than if they simply exercise without supervision. Turning them away from classes will not keep them from exercising. Far better, it seems, to make participation in exercise class contingent upon medical evaluation or enrollment in a treatment program. This article raised another question for us: how can exercise instructors accurately identify individuals with anorexia? We suspect that most will not offer their diagnosis upon joining the class and will most likely deny it if asked.

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