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.
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.
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.