If You See Something, Do You Say Something?

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.

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Evelyn Attia, MD

I am a psychiatrist at Columbia and Weill Cornell Medical Centers and have spent the last 30+ years working to improve our understanding of eating disorders and develop effective treatments.


  1. It happened to me. I was EXTREMELY underweight, I could die at any point. And I was going to the gym every single day. Only once the trainer asked if I’m sure that I can participate. ONCE! I could die! I think it should be illegal to allow very sick people to the gym.

  2. So the very first thought that popped into my head was, “Was this girl running or walking?” I guess that’s a problem, since all of these different numbers and comparisons ran through my head.

    I see people like that at my gyms too. (Yes, gyms plural, but they are in two dif. states, so it’s not some crazy ED situation). I look at them and feel sad for them. Then, of course, I can’t help but think how I need to stay on the machine as long as they do, or that I have to work out harder. Then I think, “What do people think when they see me working out? How do they think I look? Well, I don’t look like that so they probably don’t think anything, unless they’re thinking I’m fat.” Crazy thoughts, I guess, since most people are too concerned about their own appearance to care what others look like.

    I tend to think that I don’t have an exercise problem because I “work out so much less than I use to.” However, there are times when I can that it might be, like when I ran while I was waiting for my MRI results to see if I had a broken foot because if it was broken and I was going to be in a cast for weeks, I needed to run while I could. Or when I’m sick and I drag myself to the gym…or, like now, when I have a concussion, still going to the gym to work out everyday and wondering if that’s why it’s taking my brain so much longer to recover. I tell myself that I’m not doing anything high impact or bouncy (elliptical and bike) so it’s okay, but would a “normal” person keep working out? I don’t know.

    I thought this was a great post, and I’ll probably re-read it several times.

  3. I think the young woman was lucky you decided to take an active interest in her well-being by saying something, especially since you are in a position to offer sound judgment and could actually help her. I’ve always wondered what professionals would do in that kind of situation … Is it a personal choice to say something? Does it feel like a personal or professional ethical dilemma, or would it be moreso to say nothing when your training knows she is at risk?

    Run-of-the-mill gym-goers might not have as much to offer as you do. And, in some cases, confrontation with concern may prompt avoidance/switching gyms/moving it outside/off-hours/away-from-notice, fear of intervention … which could be more dangerous. I really wish there was a common guideline by which gyms/trainers could post and implement … so people working out know what the boundaries are for safety; what the gym’s action-of-concern might be; and a referral tree. Is this something any of the professional eating disorder professional or advocacy groups could publish?

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