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 think giving her the eating disorders unit contact number might be the way forward, as opposed to talking to the gym. She may not take it well but at least you've done something constructive.

that would be a horrible thing to do, you don't know anything about her

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.

Very true.

We have no way of knowing whether this girl actually is anorexic or has some other illness that has caused her to be so skinny and frail.

I wish the BMI handwringers would RTFT and get a grip. The OP has explained what she meant, let it go.

Mitchy - there's a difference between a spin class and hours on the treadmill at the maximum incline.

I was anorexic when my life was very horrible and difficult. The gym was where I went to escape. I find it weird that no one stopped me but at the same time if they had removed that 'safe place' from my life at that point I suspect I would have gone downhill very rapidly. Difficult one.

Look, OP, if you are that worried why don't you ask one of your colleagues who has been to medical school and gone on to pass some psychiatry exams and actually has some diagnostic experience what they think you should do. If anything.

five look, I can understand that it must be really annoying for people to constantly think you have an eating disorder when you don't but you're getting ridiculous now. I'm on the internet, not in the fucking witness box. Honestly, it's like "And I put it to you MrBloom that at 17:06, you stated that ..." Why don't you pull out your notebook to read from?
My OP was inaccurate, I've admitted that and corrected it, please move on from banging on "and then you said this and then you said that". I KNOW what I said and I have since clarified.
Mitchy "horrible gossipy stuff dressed up as concern" That's just a vile thing to say. You're flaming me for supposing things about this girl based on little info but you are telling someone you've never met that their concern is not genuine but just horrible gossipy stuff. Hypoctitical much?
I know this is AIBU but there's no need to be deliberately fucking nasty.
Oh I totally forget that I also want mentally ill people banned from gyms, can't remember who posted that.
I give up now, will stick to chat in future.

MrBlooms
you raised a really valid point
but rashly did not send a week editing your OP
I suspecdt you are very right in your diagnosis, but very tied by what might potentially work!

Mitchy - so OP should know her place as she's not a doctor? You think RMN's are just hired help?

MrBlooms - I am so sorry people have made such nit-picky and arsey comments. FWIW, I think you're right to be concerned and people underestimate what terrible and life-limiting illness anorexia nervosa can be.

I can't believe some of the things I've read here, not all your own work OP, some people are really not thinking about how it might feel to be the subject of this kind of speculation whether the concerns are justified or not.

I think some people are diagnosticians and others are not, but that's not an entirely subjective view is it?

Mitchy OK, in order to diagnose someone with an eating disorder, one of my "psychiatry colleagues" would have to sit down with someone for around 1.5 hours and ask them lots of questions and if they were willing, ask their family lots of questions too so they would be no help in diagnosing as they rightly wouldn't come to a gym and ask a random stranger loads of questions, even if she was willing to answer them. And. if I asked them what I should do, they would likely say that they don't have a clue - actually. our previous consultant may well have advised that I post on MN as she rated it very highly.
And what is it with the psychiatry exams and "actually having some diagnostic experience"? Nurses don't actually have to pass any exams you know and obviously 20 years experience in mental health counts for nothing as I'm not actually a doctor.
I really appreciate those of you who have had eating disorders posting and I can absolutely see how intervening could possibly make things worse in some cases.

They'd possibly be in a position to offer more useful advice to you than you can expect to find here, it was just an idea.

Thanks Gosh

bloom you sound genuinely concerned for this young woman. I think in your position I would speak to the staff. No harm can come in this. You are showing compassion. In the event it's misplaced then you can stand corrected but at least know you spoke up.

five look, I can understand that it must be really annoying for people to constantly think you have an eating disorder when you don't but you're getting ridiculous now

Tbh I've never had people assume I have an eating disorder so I don't really know how annoying it is. I could imagine it is quite annoying though.

You still haven't answered how you know for sure she's anorexic. As mentioned above there are several illnesses that can cause extreme weight loss and leave people very underweight and frail looking. I mean you can probably tell whether someone's naturally skinny or unnaturally so but you can't tell just by looking at them what the illness that's making them unnaturally skinny is. How do you know she doesn't have cancer, for instance?

Examples

Though there is undoubtedly more.

She may very well be anorexic, I don't know. It is a little unfair however to just assume she is when there's numerous other ailments she could have that's causing her to be this way.

They probably wouldn't actually Mitchy They'd know something about how you treat eating disorders but that's not what I'm asking. Our current (locum) consultant has the interpersonal skills of a slug. Part of the reason for that is that he is very old school and of the view that doctors are Gods. All decent psychiatrists that I've known freely admit that they rely heavily on nursing colleauges in making diagnoses and clinical decisions because they recognise that nurses spend far more time with patients that they do. On most wards, a consultant will see a patient for half an hour whereras nurses are there all the time. I work in the community now and see most of my patients every 1-2 weeks, doctors see them every 3 or 4 months. In psychiatry, diagnosis is made by what the patient tells you and what you can observe - there are no real diagnostic tests like X rays or biopsies. And often, patients need to trust you to disclose certain things so you need to be able to build a relationship in order to assess them properly. Going back to our current psychiatrist - he's got exams and diagnostic experience coming out of his ears but lots of patients refuse to talk to him because he's so arrogant and patronising to them. anyway, I know it's drifting away from the topic but I think the way that you rubbished my professsion because I'm not a doctor is really insulting actually.

MrBloom if anyone was ever kind enough to offer their number, point me in a direction of excellent NHS help and show care if I ever needed it I would be touched. Your post has restored hope in mental health nurses caring for me.

Hoop Thank you. I do genuinely care about my work and I know that my colleagues do as well. I've had serious mental health problems myself and was hospitalised with severe depression a few years back and it made me see that good nurses can be so powerful in supporting peoples' recovery because they spend so much more time with them. There was a nurse on the ward who spent almost a whole night shift with me, literally holding my hand, as I was convinced that my children were going to die. I'll never forget her. There were also some nurses who were appalling so I'm not banging the "all nurses are saints" drum.
I have genuinely found some of the recent comments quite hurtful so I appreciate you being nice to me

I have genuinely found some of the recent comments quite hurtful so I appreciate you being nice to me

I'm sure many people have found some of your comments quite hurtful, including myself.

this isn't your work, this is someone you don't know who may well find your unsolicited concern genuinely hurtful - talk to whoever is in charge of the gym if you must but please think about what it might feel like to be the subject of this

Cancer has been mentioned a few times. Just saying, as a current cancer patient, you are more likely to be overweight/bloated due to steroids/cancer drugs, rather than anorexic thin... And also wouldn't have the energy to obsessively exercise, especially if you lost so much weight that you looked anorexic. Which I think would apply to severe weight loss due to any illness.

Op, I think you should say something to gym management. It will get them thinking, and make them more aware, even if they decide not to take any action.

I think your heart is in the right place. FWIW, I was that anorexic in the gym. I'm glad someone noticed, it gave me a kick up the backside. I spent an awful lot of time solely in the company of anorexics in my earlier years of life and actually, I can recognise a person with an eating disorder quite easily.

Cancer can still cause weight loss though. A friend of mine was a cancer patient and she did lose a hell of a lot of weight during treatment, to the point where some people did assume she was anorexic.

I would let it be. People are't obliged to follow medical help and if she wants to use the gym then she is free to do so.