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Eating disorders: do you have a moral obligation to say something?

You’ve probably witnessed it yourself. What about the deathly thin woman who speed walks through your neighborhood every morning? Or the dangerously defined gym rat who sweats obsessively in the sauna between punishing sessions in the weight room?

Eating disorders are a serious mental health concern that can cut across gender, age and ethnicity. How to respond when you come in contact with a person exhibiting such behavior presents an ethical struggle. If the person appears to be hurting him or herself, is it your moral obligation to step in?

Recently a reader raised this very issue with me, and so, looking for perspective from an expert, I called Jillian Croll Lampert, PhD, chief strategy officer for The Emily Program, a national eating disorder treatment center based in St. Paul, with branches in Washington, Ohio and Pennsylvania.

Lampert’s response was characteristically quick and clear.

MinnPost: A reader recently told me that every time she visits the gym, she sees an emaciated woman using the elliptical machine for hours at a time. The reader is concerned that this woman is anorexic. She wonders if she should talk to her about her concern or not say anything. What do you think?

Jillian Lampert: I think your reader should say something. If she saw someone with a big, bleeding gash on her leg walking down the street, she’d probably stop her and say, “Excuse me. You look like you’re hurt. You’re bleeding. Do you need help?” If that woman is anorexic, she is hurting herself, and talking to her about your concerns would be appropriate.

MP: Have you ever talked to a stranger like this?

JL: I have. It’s can feel difficult, but I think it is important. Just this fall, for instance, I was on an airplane. I sat next to someone who I was pretty sure had anorexia. I’m a clinician. I know what I’m talking about.

I didn’t get a chance to say anything to her, though. I had an awful cold, and just as I was about to talk to her, I started having a coughing fit. It was a very short commuter flight, and by the time I was finally finished coughing, it was already time to get off the plane, so I missed her.

I’m not afraid to speak out about this kind of thing, and I’ll do it when the opportunity arises. But needing to pause because of my cough forced me to take time to really think about what I was about to say. It drove home for me how hard it must be for other people who don’t do this kind of thing every day.

Jillian Croll Lampert
Jillian Croll Lampert

I had decided that when I talked to this woman, I would make it about me and not about her. I was going to say something like, “I don’t want to offend you, but I’m a compassionate human being and even though I know nothing about you, I want you to be safe. I’m concerned for you.” 

MP: Were you worried about how the woman on the plane might react? How have others reacted when you’ve expressed concern about their health?

JL: I tell myself that the worst thing that’s going to happen is that the person is going to say, “I don’t know what you’re talking about,” or “You must be wrong,” or “Don’t talk to me.” But if you keep your comment coming from a place of honest, open compassion and concern, that is the worst reaction you are going to get.

MP: What if you make a mistake and the person you are expressing concern for actually is emaciated from cancer treatment, or just naturally thin? In that case, wouldn’t your questions seem more rude than compassionate?

JL: People who are at a low weight from cancer aren’t on the elliptical machine for two hours a day. You can tell that this is an eating disorder if the person is always at the gym, always on the elliptical machine. Or maybe he’s always in the weight room: He’s ripped, he has really defined muscles, but he’s also emaciated.

MP: You work with many people with anorexia. Have any of your patients told you that a stranger had this sort of conversation with them?

JL: Not often enough. Many times I’ve had patients tell me, “When I was at my thinnest, my most sickly, nobody said anything to me. I’d walk around the gym looking like I was about to die, and nothing. Nobody told me they were concerned.”

I’ve had a lot of people who’ve struggled with an eating disorder say to me, “I wish someone would’ve said something to me. I walked around obviously sick for so long and nobody said anything. It would’ve been helpful if somebody had said something to me even if I’d gotten mad. It might have knocked some sense into me.”

MP: What if the person you’re talking to responds angrily?

JL: Once you’ve had this conversation, you might have the awkward situation where you’ll have to avoid them at the gym. But is that really so bad? You already feel awkward every time you see what they are doing to themselves.

MP: What if you are not brave enough to talk to the person yourself? Is there an alternative approach that you would recommend?

JL: You could speak with a trainer at the gym. I’ve heard from people who’ve done that and the trainer has said that other members have also expressed concern. Sometimes gyms cancel a person’s membership. They’ll say, “You seem to be a danger to yourself. We don’t want to support this behavior.” But that may not be solving the problem.

Another option would be to hand this woman one of The Emily Program’s drop-off cards. It’s the size of a business card. It lists essential facts about eating disorders and resources for help. It’s a quick little education piece that people can hand to someone they’re concerned about. You could say something like, “Here’s something you can read to learn more about eating disorders.”

No matter how you do it, stepping forward like this is interjecting yourself in someone’s life. It takes bravery.

The Emily Program’s drop-off cards
The Emily Program
The Emily Program’s drop-off cards

MP: And interjecting yourself in another person’s business isn’t typical Minnesota behavior.

JL: I know. But I believe we all share this world. If you walked by a woman crying on the street corner on your way to work every day, you’d probably eventually wonder if she was okay. If you were a good person, eventually you’d stop and say, “Do you need something? Can I help you?” We have a problem in our society where if we see something that troubles us, we hope somebody else will take care of it.

This illness is one of secrecy, of saying, “I’m fine,” and, “I’m going to manage this myself.” If enough people build up the courage to say, “It seems like you are not fine. Do you need help?” it might actually be a relief for those who are struggling.

We are so concerned about being polite and staying in our own personal space. Sometimes we need to be reminded that we all live in this world together, that we can help others and be helped by others, too.

MP: When I mentioned this interview to a friend, she asked, “What if a person is morbidly obese? Is it okay for me to express concern about their health?” What’s your opinion?

JL: It is always important to focus on a person’s health rather than their looks in conversations about weight. So if you were to talk to somebody based on overweight, it should be couched in, “I’m concerned about your health,” and not “I think you look too fat.” 

But even the health argument can feel shaky in this situation. There are a lot of healthy people who are higher weighted.

Odds are that most higher-weighted people in the United States are already well aware that their weight exceeds our physical ideal. I think there is pretty clear literature on the discrimination that higher-weighted people face in this country. They earn lower pay. They get treated differently in one-on-one interactions. They get more rude comments and more eyebrows raised at what they order and eat and buy.

Eating disorders are a mental health issue. Obesity is not automatically an eating disorder or a mental health issue. So that situation just feels different to me. 

Comments (5)

  1. Submitted by Connie Sullivan on 05/01/2015 - 12:06 pm.

    There’s a woman at my gym to whom I’d love to speak about how desperately thin she is; she works out strenuously and at length every day. I’d love to speak with her about her unhealthy look, but I’m inhibited by my awareness of how I would feel if a stranger interrupted my life and routine to comment on how awful they thought my health was.

    This therapist may be used to speaking to strangers about their health and food problems (I will never forget the skeletal young woman I saw at the U of MN one day, buying tea with lemon for her lunch meeting with a friend who had a sandwich and soup cup). But it is no different from telling someone they’re dangerously overweight, or criticizing a smoker. Intrusive and unwelcome.

    These women have families and friends. Those family members and friends should be the ones to speak up. Or this therapist, who (like me with the two I have seen) let that anorexic woman get off the plane and disappear without her even handing her an Emily card.

  2. Submitted by Bill Schletzer on 05/01/2015 - 01:37 pm.

    my old Y had such a woman

    She worked out at least a couple hours a day. I’m sure she knew her situation so to intrude with my condescending comments would have seemed wrong to me. I see more overweight people, many with diabetic sores on their legs. If I speak to one I should speak to another or maybe I should assume that they have their full faculties about them but they are making their own choices. Should I stand in the cereal aisle at Cub directing people away from Sugar Pops?

    I have my own issues and if someone who knows me shares that issue I will be delighted to help in any way possible but until then I can only worsen the situation by intruding into their struggle. It’s called attraction rather than promotion.

    Notice the doctor didn’t follow her own advice, which probably saved her from being told to mind her own business.

  3. Submitted by Richard O on 05/01/2015 - 03:12 pm.

    Walking up to a stranger and saying something about their personal hygiene or weight or whatever is being a busybody. Do you really think they are oblivious? Back off. All of us have a right to our privacy.

  4. Submitted by David LaPorte on 05/03/2015 - 09:48 am.

    Alert a trainer at the gym

    I’d suggest that, if you observe someone who’s emaciated and appears to be exercising obsessively, don’t talk to them yourself. They could easily be offended and it really isn’t your business.

    Instead, bring it to the attention of the trainers at the gym. They own the equipment that this person appears to be abusing and (s)he is a member of their club. They have a right (actually an obligation) to make sure that their members are using their gym for healthy purposes.

    Trainers are used to talking to their members about how to use their equipment. If someone is lifting weights with poor form, they’ll give them tips on how to avoid getting hurt. Overuse of an elliptical machine is no different. A smart trainer can then steer the conversation into other health issues, such as eating patterns, particularly if you’ve raised this concern with them privately.

  5. Submitted by Amy Gage on 05/04/2015 - 05:30 pm.

    Morbid obesity and anorexia

    As the friend of Andy’s who suggested the final question in this story, I want to point out that my goal was not to shame people who are overweight. “Morbid obesity” is different from the extra 10-20 pounds that many Americans these days carry.

    My point was simply this: If we’re positing that it’s OK to tell an apparently anorexic woman that she’s over-exercising, would we take the same stand with a morbidly obese person in a fast-food line? And if not: Why not?

    Both are life-limiting if not outright dangerous activities.

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