To think that staff should stop this girl using the gym?

[MrBloomsMarrow]

I really don't know if I'm BU or not which is why I'm posting. I joined a gym a few months and go around 2 or 3 times a week. I usually stay for around an hour. There's a girl who's always there whenever I go - she's there when I get there and still there when I leave. She's really young - definitely no older than 20.
She's always on the same treadmill and has the setting to maximum resistance ie it's like going up a really steep hill.
The thing is, she's obviously severely anorexic. I'm a mental health nurse and worked in an eating disorder clinic for 2 years so I do know a bit about it.
A normal BMI is 20-25. 17.5 and below is anorexic, 15 and below is considered dangerously underweight and below 13 is critical - this is the point where sectioning someone would be considered. I'd say that she's definitely in the dangerous category, if not the critical. When I worked in the clinic, there were definitely patients who weren't as underweight as she is. She wears vest tops and you can literally see all her bones jutting out.
I absolutely don't mean that they should stop her going as some sort of "punishment", I have nothing but sympathy as she's desperately ill but I feel that, by allowing her to attend all the time and exercise in the way she does, it's kind of colluding with her thinking that she doesn't have a problem. I know she can go and exercise anywhere but I don't think she could do it in quite such an obsessional way outside of a gym. It's a bit like a landlord refusing to serve someone who's really drunk - of course they can go and get pissed somewhere else but it's still the right thing to do.
Also, I think it's actually dangerous to exercise that much when your body is so fragile and I' always worried that she's just going to collapse.
I've been thinking about having a quiet word to one of the staff or should I just keep my nose out?

There was a woman like this at they gym I used to be a member of. She used to proper get a kick out of walking up and down the changing room, strutting past the mirrors looking at herself. Her face was actually just like a skeleton, sunken cheeks with not one layer of flesh, just skin over bone.

I used to wonder, like you op, if anyone had ever had a quiet word with her, but assumed it was her body, her choice.

That's why anorexia is such a tough illness Vegan. Because the sufferers are functioning in everyday life, people don't realise that they are in a state of absolute delusion regarding their bodies and as such are not competent to make choice when in fact they are no safer to make decisions than any other mentally ill person who lacks insight.

Crankbadger
We have lots of medics at our gym. One of the girls is a surgeon who deals with obesity. And she is keeping her nose out of it because until an individual decides to deal with the issue by seeking help, there is nothing ethical we can do.
Did you watch the program about Bedlam the other night? - those people have sought and will accept help.
Until people do, force feeding etc is just pointless.
Its the same with the morbidly obese - until they decide to help themselves we just have to wait.

I don't think you can say forced treatment is pointless TBh. there are many incidences that forced treatment as part of a bigger rehabilitation plan is successful in providing life saving treatment.

It would be entirely normal for the gym to ask customer about whom it had health concerns to visit the doctor and provide a certificate.

What's she keeping her nose out of, Talk? Obesity, do you mean? Well, if obese people are at the gym, I'd call that a positive, wouldn't you?
No, didn't see the Bedlam programme.

Force feeding...the idea is to keep someone alive until their delusional thinking can be addressed, not to cure them. Much the same as an alcoholic will be sedated to get them through withdrawal so that their addiction can be addressed.

Anorexics are very frustrating.
To be honest, I think I couldn't bear to see it. I would have to stop going myself.
There's an off-on anorexic lady at our pool. She's a healthy weight currently, thank goodness.

I think you should raise your concerns. The staff will know whether they have a duty of care (well, the manager should, at least). There was someone like this at my old gym. When she got changed she had no flesh on her bottom at all, you could see things from the back that you usually coukdnt see even from the front, IYSWIM. She's dead now.

An I the only one who is surprised that despite being a HCP, you are deciding this woman is 'definitely' anorexic based on the fact you see her at the gym 2-3 times a week and what you think her BMI is? (Presumably you've never weighed and measured her?) How on earth can anorexia be diagnosed on weight only anyway? (you say under 17.5 BMI is anorexic)

My BMI was always 15-16 before I had children. I ate like a horse and was certainly never anorexic, I never gave my body a second thought, althought it seemed plenty of others had an opinion on it...

We don't know who she is or what she looks like, but Id say yabu.

BMI in general is just a guide and in many circumstances it is considered to be bullshit, usually in cases where people have a lot of muscle, as in this case it seems.

She is obviously an adept runner, so I would just keep out. Express your concerns if you wish, but if I was her Id be a bit annoyed,

A bmi of 17.5 is NOT anorexic its underweight. Big big difference.

Thanks for your replies, have been at cinema and now on bus with DD so can't do long post but will be back later as there are quite a few things I want to reply to.

Very tricky, not much you can do to stop an anorexic from exercising.

YABU. I don't think anorexics should be banned from gyms. The gym might be helping in giving her some stablility and is better than hiding away out of public sight.

I'm also uncomfortable because anorexia is partly a mental health illness, and where would you draw the line in banning people with mental health issues from gyms?

tbh I think you should mind your own business.

I have a family member with anorexia, she is allowed to continue using the local gym for exactly the reasons people have said - that if anything happens to her, someone will see immediately. If they stopped her using the gym she would exercise just as much,.but who knows where. And potentially no one would be around if anything happens.

And also I find this quite sexist. There are plenty of predominately male gym users who quite likely abuse steroids to bulk up. And there is a very clear link between steroid abuse and early death from circulatory problems. So do you also complain about male bulked up gym users just in case they might be abusing steroids? Or is it only the possibly anorexic female who gets this attention?

Also be careful - she might be a perfectly healthy elite runner. I can think of a couple who do actually look anorexic to the untrained eye.

Now I'm confused my dd must be anorexic according to you but she happily tucked into McDonald's for lunc not what you'd expect for an anorexic. Being underweight and being anorexic are not the same thing and a mh worker should know that. Yabu for diagnosing a mh issue on looks alone.

I think banning her from the gym would be a terrible idea because it won't stop her exercising, it just means she'll do it elsewhere, most likely where there aren't people around to help if she does collapse.

By all means voice your worries to the staff. I would be tempted to try and befriend her, get to know her but I am known for getting too involved in other people's problems and trying to fix everyone.

I haven't read all the messages but this happened To me too. Spoke to staff but they said they had a letter from her GP so it was fine ....

Who said ban her?

At least if (touch wood it never happens) something happens to her in the gym, the staff are there to respond quickly. IF she's out running it could be a while before anyone finds her.

The gym may be the best place for her should the worst happen.

No one is suggesting banning her. If the gym asked to see a letter from the GP then they could be reassured that she was fit to exercize there. That is no different from someone who has a serious medical condition being asked for a GP letter.

And by the way, there is a HUGE difference between the appearance severe anorexics and elite long distance runners. Anorexics are not just a bit skinny looking.

with anorexia the fundamental problem is one of not eating rather than overexercising, although the effects of the latter will be exacerbating the latter.

I think it can just be very upsetting to see someone who is severely emaciated and clearly very anorexic.
Knowing there's not much you can do to help them, and also knowing that a person who continues to starve him or herself will die.

I dont think it is sexist, I'd be just as shocked to see an emaciated man.

starvation is a much greater health risk than using steroids to gain weight, the risks of steroids as used by body builders are greatly exaggerated by the media and misunderstood by those outside of the bodybuilding community

Thanks for your replies, I'm actually quite surprised that so many people think I should intervene, I was expecting a resounding vote telling me to MMOB. Just a few things - midori , Actually, if you've worked in healthcare for a long time, you can usually give a reasonable estimate of people's BMI by looking at them. I work in the community now and still have to calculate my patients' BMI. I always have a rough guess and I'm not usually too far wrong. I know a few distance runners and, yes, a lot of them are very scrawny but they don't have shoulder blades and hip bones sticking out and legs that look like you could snap them. Also, they look generally healthy which this girl definitely doesn't.
upyour I'm sorry your sister had such a bad experience and I know that ED treatment provision is patchy to say the least but, where I live and work, there's a fantastic inpatient unit as well as a day patient facility and the consultant there is practically the world no 1 in eating disorders so this girl would hopefully get good treatment if she wanted it.
lessmiss I'm sorry but your points are ludicrous. Yes anorexia is a mental illness but it manifests itself physically and affects people's physical health. Nobody is suggesting that people with mental illness are banned from gyms. The question I'm posing are about the risks to her physically.
And the point about sexism is equally weird. Anorexia is unique in mental health as, for complex reasons, over 90% of those who get treated for it are female. That's just a fact. I think that sexism in society may actually be part of the reason that anorexia mainly affects women but that's a different argument.
I'm sure that there are male gym users who abuse steroids but are you going to demand that everyone who goes to a gym does a urine test everytime? One of the principles underlying the assessment of mental capacity is that people have the right to make unwise decisions. Obviously, pumping yourself full of steroids is an unwise choice but it's their choice to make. As you. say, anorexia is a mental illness and one of the symptoms is an obsessional desire to be thin so some anorexics exercise obsessively to lose weight so theis behaviour is actually part of a mental illness - taking steroids isn't. Thanks for your (mostly) reasoned responses, there are some very wise people out there.