She has been on the treadmill for 110 minutes and counting. I can tell, not because I’ve been at the gym for over an hour, but because I could not help but glance at the time on her machine’s screen.
And others have been talking. They are whispering about her today and they’ve spoken to me about her before.
The very underweight woman on the treadmill is at my gym every morning. She follows a frightening routine that includes a long stretch of aerobic exercise and an additional hour or more using the weight machines. She wears a fleece over her baggy exercise clothes, even in the middle of a hot summer.
As a physician who has specialized in the treatment of individuals with eating disorders, I have the unusual experience of speaking with patients about the dangers of exercise. I believe in the health benefits of exercise, of course, and, like most physicians, am aware that most people on the planet could benefit from a doctor’s nudge in the direction of increased physical activity. Yet, this is not the case for many of the underweight patients with whom I work.
Individuals with eating disorders commonly develop exercise patterns that are excessive and potentially harmful. These individuals may spend extensive time exercising — several hours at the gym, many days each week. If they exercise less than planned, they are likely to feel terribly guilty or fat. They may walk rather than taking other forms of transportation, sometimes stacking up many times the “targeted” 10,000 steps daily. Initially, these behaviors may have seemed appropriate and health enhancing. But as the illness takes hold, the exercise becomes obsessive, driven, almost required for the affected individual. Skipping a day feels out of the question, even if one has sustained an injury or has caught a cold. Exercise time or intensity is likely to increase in relation to eating behavior. The purpose of the physical activity is no longer to relieve stress, improve mood, or help with sleep, but rather primarily to burn calories, control weight and body shape. Exercise begins to get in the way of work, social life and sleep. Class schedules get adjusted. Weekend brunch plans with friends are forgone. Patients speak of the “voice” of their illness telling them that they must not stop moving.
Is there a way to offer these individuals another “voice” to counter that of the eating disorder? Many members at my gym have asked me what to say to the woman on the treadmill. Friends and colleagues who work out elsewhere have asked me the same question. Everyone seems to know someone, friend or stranger, who struggles with an eating disorder in this way.
Surely, there’s no perfect thing to say. There’s no message, no comment that will make the excessive exerciser hop off the treadmill and thank you for the good advice. But choosing to say something at least offers a chance that the individual might hear your concern and become more concerned themselves—simply put, it never hurts to say that you’ve noticed, and that you’re worried.
I decided to ask the woman in my gym if she has been feeling ok. I told her that she didn’t look well to me. She thanked me for my concern and told me she was trying. I told her that I was pleased that she wanted me to know that.
I know that my comment to that woman at the gym probably didn’t change her illness course. At least, it didn’t change anything immediately. But my first comment helped me to make a second comment, and then later to discuss a health spot that she saw me watch on one of the gym’s TV monitors. I have recently told her that I am a psychiatrist who specializes in eating disorders. I have tried to show her that my door is always open.