Should gyms step in on anorexic members?
There's a girl in my gym class who looks like she's about to faint.
She has large, 'deer in the headlight' eyes, her hands are shaking and she looks like she may burst into tears at any moment.
And we haven't even started training.
She's so frail she literally teeters and has to do little half squats instead of our regular exercises. A breeze would knock her over.
The personal trainer ignores her.
I don't know if they have a prior arrangement, if she's known to the gym or perhaps just the trainer but I do know she's not the first I've seen.
If you're like me and find yourself at the gym most days, chances are you'll see someone like I described above. Maybe a few.
They stick in your mind, out of concern at first, but then your thoughts trail to something a little deeper.
Do they see her?
Should someone who clearly doesn't have medical clearance be exercising here?
Fitness Australia has guidelines for these clients that seeks to define, identify and provide step-by-step recommendations for the "sensitive management of clients who fall under the categories of anorexia or disordered exercise".
The guide, detailed and 47 pages long, was created in 2004 in collaboration with the Fitness First chain and the Centre for Eating and Dieting Disorders. While this certainly sounds good and proper, the '2004' date gives me pause; it predates Instagram (with all its #fitspo glory) and the document itself uses the cheesy WordArt headings of your primary school reports.
Anachronistic headings aside, a couple crucial questions remain: is it being implemented? And should it be updated for a world that now includes social media's booming #fitspiration?
To test this query, I asked a number of gyms across NSW a simple question: "Do you have a policy regarding clients with anorexia?"
The most common response was: "Not that I know of". One club, open 24-hours said, "This is something that would be club specific - we don't have an overall rule," but conceded that, "There could be a restriction on a membership if requested by a parent or guardian for the person to only have access to a club in the staffed hours so their activity can be monitored what exercise they do."
Only one club said they had mandatory health checks when members (all members) signed up.
Another franchisee sticks out in memory as being nothing short of abysmal, undeniably the worst out of all those I contacted (a serious concern considering the chain's prominence).
One of the club's CBD locations told me, "Not that I remember" and then, "Actually no," and "I'm not sure. You better call head office" Another said, "I don't think there's any policy. Nothing that I know of. I mean, technically it's discrimination".
It's interesting that discrimination is brought up, as it's a common thought for many.
And as The Butterfly Foundation CEO Christine Morgan points out: "Eating disorders and body image concerns do not discriminate, and can affect all ages, gender identities, socio-economic status, abilities and cultures," she explains.
This is entirely true and but perhaps in a health setting where an organisation, and its people, should have duty of care, a cry of 'don't interfere, it's discrimination' by staff is misplaced?
I also spoke to several trainers about the issue and without exception every single one jumped at the chance to speak out. They were deeply troubled about what is commonly regarded as the 'open secret' in the fitness community.
One trainer, working at a popular franchise for ten years said they had never had training on what to do if they saw somebody dangerously underweight or exhibiting behaviours consistent with anorexia. They were very concerned about this and had, from afar, encountered the worst imaginable:
"There was a girl who trained at [location] who was severely anorexic and she used to come to classes and just kill herself pushing too hard," the trainer said.
"It was horrible to watch. They ended up telling her she could only train if she was with a PT and not on her own."
Another former gym employee spoke of a dangerously thin woman who used to come in every day and run at high speeds on an inclined treadmill.
"Often she would stop and run to the bathrooms and run straight back to the treadmill. Many times she would not make it to the bathroom and would either get diarrhoea on the treadmill or leave a trail of it to the bathrooms.
"She would leave for staff to clean then get back on the treadmill - such is the nature of the disease, making you so focused on the exercise.
"The manager tried to speak with her and get her to see a doctor or bring in a doctor's letter but the woman would just go to other gyms and do the same, gym-hopping."
Another told me she'd had a few girls faint on her after not eating and running on the treadmill:
"Low [blood] sugar collapses happen all the time! It's so common and awful," she said.
"The gym I was at, we'd call the ambulance and their guardian and pass the responsibility."
So should gyms take responsibility for these clients?
After all, gyms certainly appear to be fully servicing other clientele. Those who are overweight, obese, have emotionally disordered eating or are trying to be 'the best the can be' consistently have the full backing and enthusiastic support of the gyms they visit. It's reflected in every scrap of communication from every gym. One step inside and you know, they're here for you and your health.
So would the gyms' answers of "I don't know" and "that's discrimination" be the same if the client were overweight or obese? Or would they jump at the opportunity to demonstrate their care and ability to achieve results?
The rise of social media is no small issue according to experts.
"We now have constant access to images of people, their food, their lives and quite frequently their bodies," Morgan explains.
"This can lead to unhelpful comparisons, pressure to achieve a certain body type and may contribute to body dissatisfaction."
"Sharing your diet and exercise regimen on social media and #fitspo can potentially inspire copycat behaviour without seeking professional advice and guidance to ensure health for the individual. "
At the end of the day, the question is simple:
Should gyms have a greater responsibility/duty of care for the health of anorexic clients?
And Morgan's response is simple:
"As a society, at the very minimum, we should all have an awareness of eating disorders. Ideally, personal trainers and fitness coaches should receive training to help recognise and refer clients who they think might be at risk.
"In addition to this, gym staff should be supported in their role through education and resources to be able to support their client's needs both physically and mentally."
If only this were being done.
If you, or anyone you know is experiencing an eating disorder or body image concerns, you can call the Butterfly Foundation National Helpline on 1800 33 4673 (ED HOPE) or email firstname.lastname@example.org.