Do gyms have responsibilities towards people with eating disorders?

That's the question raised by researcher Rony Duncan. In his "News and Views" piece for the British Medical Journal, published this past September, Duncan argues that gyms do have some responsibility, and lays out three main areas in which this could be beneficial.

1) It provides a possibility for intervention.
2) It can help promote a healthy body image.
3) It can help break through the delusional thinking that accompanies EDs.

The possibility for intervention is well-intentioned and will probably fall on deaf ears. It would have for me. This isn't to say that people shouldn't speak up, just that speaking up will not necessarily produce a newly-converted couch potato. Frankly, if someone had spoken up to me, I would have just switched to a new gym. In fact, I was so paranoid about someone noticing that I took all sorts of steps to make sure I never exercise excessively in any one place at any one time. I spread my exercise sessions throughout the day and in several different locations: outside, my apartment, the gym at work, the gym at home. No one knew, of course, that I worked out several times each day.

The second point is almost laughable. First of all, Duncan is making the assumption that anyone who exercises excessively is visibly underweight. I rarely was. And many others aren't, either. Do we not have a problem until you can count our vertebrae? Secondly, preventing the visibly anorexic from exercising will probably not have a large impact on most people's body image, nor is that something that other people can control. Kicking someone out of a gym because they're very thin and giving other people a complex sounds more like playground logic.

There's also the problem that many men have exercise addictions, and also that someone can have a lower BMI (known as being constitutionally thin) and be perfectly healthy.

The third point is, perhaps, the most valuable. Writes Duncan:

...when gyms fail to intervene over members who are below a healthy body weight, they risk becoming complicit in the delusions held by these individuals, strengthening the perception that more exercise and weight loss are needed.

My long experience with anorexia has left me peeved at any number of things, including the paucity of good treatments (and treatment providers!). One of my other peeves is that, other than my mom, no one really spoke up and told me I was exercising too much or losing too much weight. Would the truth have made a bit of difference? Probably not then. But it's very hard to convince yourself you have a problem when everyone else seems to be living in the same delusional world as you are. If I were sick, I thought, surely somebody would say something.

And because they didn't, it only reinforced the idea that I was fine.

I don't necessarily think that speaking up to an exercise addict about his/her gym habits will magically take off the blinders. I don't know that it will decrease his/her overall exercise. I don't know that it will improve others' body image. I don't even know that it will break through the wall of delusion and anosognosia that comes along with eating disorders.

But there is value in speaking the truth, in saying what needs to be said whether the listener wants to hear it or is ready to hear it. I am incredibly angry that so few people said anything to me during my illness, when I ran to the bathroom after meals, when I basically moved into the gym, when I was using binder clips to keep my pants up. I was secretive, yes, but you would have had to be blind to miss some of this stuff.

Speaking up says one incredibly priceless thing to a sufferer: I care about you. And that is a message that sufferers need to hear, over and over and over again.

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Telstaar said...

I agree :)

I also think that gym's are well positioned to assist with HEALTHY exercise, because to not exercise at all is bad (and it can be a great mood stabiliser which is my most common use of exercise rather than weight loss)... but when a gym see's someone excessively exercising (noting that not all people will exercise in the one place as your story demonstrates), but when they do, to say, "Hey! I think you're overdoing it, and that's not healthy or okay." Again, its not necessarily going to change anything then, but it shows the person that its not good!

Also on the whole visible weight loss thing, I'm soo with you, my T regularly will reinforce to me my weight, what needs to happen and the process of that (in a very gentle way) and she has checked with me that such attention is not harmful. I have told her that it CAN be tricky at times (because sometimes there is a satisfaction that comes with it) BUT, if she says nothing then I assume I'm fine or I'm my worst nightmare so on balance better to say something.

I also agree that it comes with, "Hey, i care about you and I'm concerned enough to SAY something."


Cathy (UK) said...

As you probably saw, Carrie, I left two comments ('rapid responses') on Rony Duncan's article. I have very strong feelings about this issue and also made a youtube video on the topic a number of months back to gauge people's views on this (

I largely agree with you and Telstaar. However, the unfortunate reality of the situation is that despite their 'health-promoting' approach, gyms are a business designed to make money. It would be difficult for them to argue that they have an ethical responsibility beyond their legal responsibility.

There is also the issue of athletes. Some athletes (e.g. marathon runners and triathletes) exercise for over 20 hrs per week. Should gym staff or other members inform them that they're exercising dangerously?

The Artful Dodger said...

This has been on my mind recently because there are currently at least 3 girls in our local gym who are seriously near the point of collapse. I do not know how they are still standing. I'm not talking about thin, but emaciated to the worst extent I have ever seen (and I've seen a lot). A friend of mine uses this gym and made a number of complaints to the gym because these girls were clearly at physical risk (no one is naturally this thin, and if it was due to another kind of illness - which I do not believe - no one would allow them to exercise for hours at a time). However, the gym called her sizist and said they looked after their members just fine.

I realise the girls would probably find another gym to go to, yet, there are only a finite number of gyms. I'm not saying this would stop the excessive exercise and obviously says nothing of those who are not visibly at death's door, but that doesn't mean it should just be left. I wonder if it is any different in the US where litigation is a much greater threat?

PTC said...

Interesting post. I think (gym) people are in their own little world. I teach aerobics, and have been teaching for 12 years. I spent hours at my hometown gym. People never (I don't think) thought I was obsessed. I think they justed looked at me and thought I was really into fitness and referred to me as "the cardio queen." I had one person, a close friend who is like a big sister to me, tell me that I was working out too much. It didn't really mean anything to me though, especially since she is also an instructor and was teaching 1-3 classes a day.

It took my parents 15 years before they said anything to me.

mmaaggnnaa said...

Hi, Carrie -

My gym has a basic fitness evaluation (BMI, strength, cardio, flexibility, blood pressure, lung capacity, etc.) that is done in private . . and it is low fee.

Would something like that be helpful?

- Marie (Coming Out of the Trees)

tia said...

I don't think I would like my gym to approach me. I go to there to be invisible, to do my thing. I already feel watched enough by people in my life, it would drive me nuts if i also felt watched there.

Cammy said...
This comment has been removed by the author.
Cammy said...

When I was in high school, my gym actually called the police to come to my house and check on me when I did not show up for 3 days in a row, because they knew I was absolutely obsessive and only some major event could have kept me away (such as dropping dead because I was emaciated). Kind of ironic that the staff had apparently discussed how unhealthy my body and behaviors were, but didn't speak up until I was suddenly out of their realm of observation.

I had actually just purchased my own treadmill, which was the reason for the absence. But anyway, in that case I think they overstepped their bounds, my mom was incredibly pissed at the time (small town, word gets around about things like the police being called to do a welfare check on your children).

Anyway, that's my slightly relevant anecdote. As someone with major exercise issues, I agree with your pragmatism about these points, Carrie. In theory, there is a possibility for intervention and help, but if someone is already mired in an ED I don't see it as doing anything but driving them away to find someplace else to continue their behaviors.

Carrie Arnold said...

I would love for a gym to be able to insist upon a doctor's clearance for people- preferably everyone, but especially for those whose habits seem worrying.

You all bring up such wonderful points. Personally, I would have been humiliated if anyone approached me about my exercise habits. But the goal of them approaching me isn't to make me feel better, it's to express their concern and worry. As much as I wanted to metaphorically "disappear" during my ED, I also wanted people to notice that I was gone. And as I get healthier, it angers me how much self-destruction people were willing to tolerate because outside of the gym, I had it pretty well together.

Gyms are a business, and Duncan raised some good points about whether a bar should serve alcoholics or (though I disagree with this next one) McDonald's should serve an obese person. If a bar served someone who, day after day, drank themselves into an oblivion, or someone at McDs noticed someone binge eating, then the human thing to do is say something. There's always another gym, another bar, and another fast food joint. But we don't need to tolerate self-harming behaviors, either.

Suzy Q said...

I agree. I may not have been ready to change at different points but I still needed to hear it so that when I was ready to change I had another reason. I too felt like since nobody said anything I must not have been sick. I don't know why people didn't say anything .. maybe I was just good at hiding. I hope so, or else it feels like they just didn't care. And that's much worse.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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