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?

I would probably have a quiet word with the gym, although they are most likely already aware of what is going on already. I'm curious whether or not they have any policy in place really.

Anorexia is a terrible illness and I honestly don't think anyone has a clue how to deal with it.

Even if you are correct in your assumption of this woman's BMI, you still think you can say she is 'definitely' anorexic based on that and the fact you see her 2-3 times a week in the gym. I disagree, even if you are a HCP.

Well yes, Midori, she could be recovering from cancer, she could have some gastrointestinal illness but the point is she looks very unwell and the op is wondering whether to flag it with the gym. But bearing in mind it's the ops job to assess people's body weight it's not unreasonable to assume she's correct.

I think if you have worked with anorexics or have been anorexic you tend to 'just know' that someone is anorexic (rather than very thin for other reasons)

You should definitely ask your gym if they have the essential equipment on site in the case of a collapse.

When I read a tabloid news site article about Duncan Bannatyne someone in the comments was raging that he cut costs in his gyms by not having medical equipment like defibrillators.

www.thenorthernecho.co.uk/news/10028088.Calling_for_more_gym__life_savers_/

Ok, just to clarify, of course anorexia isn't only diagnosed by weight but one of the diagnostic criteria is a BMI below 17.5. The other symptoms used to make a diagnosis are about the way the person thinks and behaves so nobody gets diagnosed with anorexia purely on their weight. And I do think that my experience has made me pretty good at distinguishing between someone who's naturally skinny and someone with an eating disorder. Also, the poster who said that this girl has lots of muscle - she doesn't, she just looks all skin and bone but you're right about BMI being very inaccurate with elite sportspeople because of how much muscle they have.

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

I'm actually surprised that it took three pages before this was pointed out.

You're right of course, a BMI of 17.5 or under does not mean anorexic. It is however classed as underweight and whilst many people (incorrectly) use 'underweight' and 'anorexic' interchangeably I am surprised that a health care professional would make the same mistake.

Ok, just to clarify, of course anorexia isn't only diagnosed by weight but one of the diagnostic criteria is a BMI below 17.5.

Then why did you say in your OP that a BMI of 17.5 or below is anorexic? Why not just say it's underweight? Saying it's classed as anorexic was a very odd thing to say.

Also a healthy BMI actually ranges from 18.5 to 24.9.

There was a person like this at my gym. I found it quite uncomfortable to work out by her, to be honest, as she was so obviously ill. She was self-harming so publicly, and we were all being very English and ignoring her. And she was there every single time I attended, without fail, just like at your gym OP, with a running machine set to maximum incline. I eventually mentioned it to my personal trainer, who knew exactly who I was talking about (the idea that the gym will not have noticed this person themselves is pretty unlikely to be honest). He said that she would exercise anyway, so was safest in a gym where they could "keep an eye on her". I am not sure about this duty of care business but I am pretty certain you will get a similar reply at your gym OP. I think I was pretty naive if I thought that they would spring into action and say "gosh, we had not noticed, thank you, let's stage an intervention"...

It is very tricky, very difficult. I left the gym in the end. I still see her in the street by the gym and she is still obviously very ill.

but you're right about BMI being very inaccurate with elite sportspeople because of how much muscle they have

That would depend entirely on what their discipline is and what sort of muscle and body type predominates. A 100m sprinter is highly unlikely to resemble a 10k or marathon runner.

I would say no intervention for the simple reason that a) it won't have any impact on her if she's so ill and b) it might drive her away and then there would be no one on hand to help her if something awful happens.
I'm sure there are already people in her life trying to help...

If I thought it was straightforward to intervene just because you care (no bad thing at all) I'd wish with all my heart that you could, but I suspect it would backfire.

No, I don't think the staff stop her using the gym or speak to her beyond asking her to visit the GP.

Just thinking of the gym I attend..... the young boys who all work there are a lovely bunch of kids, but intervening in a life threatening eating disorder would be so completely out of their depth. It could well make it worse.

And that's even if her appearance IS down to an eating disorder, and not an extreme exercise routine.

I started reading this earlier but didn't have time to post - I was going to pull the OP up on her sweeping statement about BMI, but am glad to see someone has already done it.

I am 5'6" and my weight has varied between 7.5 stone and 8.5 stone since I was a teenager (which means I have a BMI between 16.9 and 18.1). I am naturally skinny and must have a very fast metabolism as I eat perfectly healthily and in correct portion amounts. I also eat my fair share of crap, but don't ever seem to put on weight.

The heaviest I have ever been was close to 9 stone just before I got pregnant with my first DD - however 16 weeks of severe morning sickness meant that I lost a stone and a half before putting any 'baby weight' on. I have been eight stone or less ever since (other than towards the end of my pregnancies).

Despite this I am not and have never been anorexic - one of my best friends at school so I have close experience of it - including the tears, tantrums and hospital visits.

I know people judge me for being skinny and wonder if I am anorexic and I find sweeping statements about BMI like that in the OP really quite disgraceful - especially for someone who is using their professional credentials to make a judgement on someone else.

OK, can we stop nitpicking about the BMI thing? As I clarified in my last post, having a BMI below 17.5 would mean that you were underweight. Having a BMI below 17.5 because you were excessively restricting your calorie intake and/or exercising obsessively or using laxatives,were trying to lose more weight and had a morbid fear of gaining weight and a distorted body image would qualify for a diagnosis of anorexia.
And if we're going to get pedantic, anorexia simply means loss of appetite. Anorexia nervosa is the correct term but I don't generally jump on people to correct them because I know what they mean.
I know this is AIBU but I posted this because I seriously wanted to know what people think - I just don't see why people feel a need to score points over something like this. Ok, it's just possible that she doesn't have an eating disorder but she is clearly ill because nobody who is healthy looks like a walking skeleton, they just don't. So, if she has another illness that causes severe weight loss eg cancer, it's highly unlikely that she would be spending hours and hours a week vigorously exercising in a gym.
It's been really eyeopening to me to see how many other people have experienced this and thanks for your responses.
I think I will just speak to the staff and if it is a kind of harm minimisation thing ie she's going to do it anyway so may as well do it somewhere safe, I can see the sense in that.
I think I may just try to have a really quiet word with her and give her my number if she ever wants to talk as I do know quite a bit about accessing help. I get the impression she doesn't want help at the moment but it just might be helpful for her to know there's someone to talk to if she ever needs it.
I know that eating disorders are complex and notoriously difficult to treat and I don't have any delusions about being able to cure her but I do know the direction to point her in.
I just find the whole thing heartbreaking and it's reminded me what a bitch of an illness anorexia is. She's so young, I presume she has family out there who are worried sick about her.

It depends what this woman looked like. The one at my gym had so little body fat she looked like a victim of famine. No way was she just naturally underweight.

I'm horrified that a health care professional would state that if someone's BMI is below 17.5 they have a serious mental illness. These sort of inaccuracies are why as natural tall and skinny teenager, I was dogged by anorexia comments. Some of us are natural slim and our NORMAL BMI will be lower. There are also plenty of other reasons why someone could have a low BMI, mental health is not the sole cause.

I am shocked at the majority of posts here. OP, you're a professional yet your comments and judgments are quite sickening. She's definitely anorexic and she definitely has a BMI of below 17.5?

I am a size 6, 5ft 2, legs like French fries (that look like you could snap them, in your opinion) and not a lot of extra weight at all. I have always been this way, I am perfectly healthy. I run long distance and spend a lot of time in the gym. Even when I don't though, I stay the same weight. The face gives away a lot however, my face is quite full, betraying the idea that I might seem anorexic to you if you see me in the gym.

I am so sick of judgements against skinny people. It's a free for all isn't it, because we don't have feelings or anything, like overweight people.

You don't know a single thing about this woman. Unless she looks sick or frail, stay out of it.

OK, can we stop nitpicking about the BMI thing? As I clarified in my last post, having a BMI below 17.5 would mean that you were underweight. Having a BMI below 17.5 because you were excessively restricting your calorie intake and/or exercising obsessively or using laxatives,were trying to lose more weight and had a morbid fear of gaining weight and a distorted body image would qualify for a diagnosis of anorexia.

But you didn't state any of this in your OP. You made a sweeping generalization and said that a BMI of under 17.5 was anorexic. If you said it was underweight that would have been fine and correct but you didn't. That's what people are annoyed about.

Withknobson READ MY LAST POST! And I also said earlier, that I generally am pretty good at telling the difference between someone who's naturally skinny and someone with an eating disorder.My 11 year old DD is like a stick insect and she exercises a LOT - she does a lot of sport because she loves it and eats like a horse. I KNOW that some people have high metabolisms and are naturally skinny. I have not said anywhere that if your BMI is below 17.5, they have a serious mental illness FFS.

SocialClimber, yes she does look sick and frail. She looks exactly like the people you see in famine areas - her eyes are sunken, all her bones protrude. She wears quite a baggy top and when it slips down, you can see every single one of her vertebrae. But I'm sure you're right and she's just naturally skinny.
Yes, my OP wasn't accurate but I've corrected it now due to this being pointed out.
I started this thread because I am genuinely concerned about this girl. Now it's just descended into saying that I'm a disgrace to my profession because I wasn't 100% correct in my OP, which I have since corrected/clarified. Oh, and I also want naturally skinny people sectioned.
Thanks again to all those who've given advice.

MrBloom, I dont think you are anything but genuinely concerned about a young girl who clearly is severely anorexic, it is a horrifying thing to watch, I wish I could think of something useful or helpful to say but I cant:(

I have not said anywhere that if your BMI is below 17.5, they have a serious mental illness FFS.

Actually you did in your first post:

"A normal BMI is 20-25. 17.5 and below is anorexic"

An anorexic would be someone suffering from anorexia nervosa, which is a mental illness, no?

OP
Interestingly the gal at our gym is not anorexic, just in a temporary state of (untrated) depression.
Because we all see each other naked, the first question whenever anybody loses weight is "is your marriage OK"
also
From the cases I've encountered (both over and undereating)
anorexics are not even trying to be thin, they have mentally convinced themselves that they are fat.
When they look in the mirror they see a fat person.
Get them to draw around their own reflection and they will draw a fat outline.
Eating disorders (at both ends of the scale) tend to come down to control

• which is why force feeding is utterly counter productive.

In the case of the girl at your gym, somehow you need to let her see what she really looks like
unexpected reflections are often one of the best
as she'll see what is there rather than the prepared image in a mirror

but its so hard to see when there is little you can do.

It's not clear that she's anorexic, at all. And of course people can be extremely ill and or underweight from other conditions or causes and still work hard at the gym - like my friend with cancer who manages a spin class most days. There are lots of things that look like anorexia but are not, just because you consider them unlikely doesn't mean they are not possible here.

And exercise has its role even within the treatment of anorexia anyway. This is horrible gossipy stuff dressed up as concern.