What Can Gyms Do if They Think Someone Has an Eating Disorder?

As a kid, Josh Cox figured out how to keep his bulimia a secret: He threw up silently into grocery bags in the corner of his room, then tossed them out in the mornings before going to school. That way, he could avoid suspiciously long trips to the bathroom. “They’d think I was either vomiting up my food or masturbating excessively, neither of which is appealing to a teenager,” he says.

His eating disorder followed him to the gym, where he’d push himself to the point of true exhaustion, he says. But he was able to hide that as well. He had multiple gym memberships so he could hop from one gym to the next on any given day—“not just for convenience, but to spread out my visible workload so people wouldn’t think I was doing too much,” says Cox, now 31. “I figured no one knew what I was going through in my life so I’d rather avoid the conversation than run the risk of having it.”

Now, Cox whips battle ropes and bangs out burpees as a certified trainer at Anytime Fitness in Santa Rosa, California, where he’s worked since 2008. Eating disorders, depression, self-harm, obesity—he’s lived through all of that, so he can understand what his clients are going through if they open up to him about their bumpy relationships with food or fitness.

“I’ve found the best approach is to put yourself out there, heart on your sleeve, and be real about what you’ve been through,” he says. “At the heart of these eating and exercise disorders is one simple common denominator: a lack of feeling in control and a need to regain it.”

Because Cox has worked at the same Anytime Fitness location for ten years and has shared his past from day one, people often know about his backstory before he tells them himself. Still, if a new client shows some vulnerability during their first meeting, he often says something along the lines of, “I have a history with depression, bulimia, and self-harm”—that way, the client knows whatever they tell him won’t fall on deaf ears, he says.

Gym employees are in the perfect position to spot red flags like members working their bodies too hard while nourishing them too little. But they have no clear guidelines on how to respond to suspected eating disorders and over-exercising, so it can be difficult to help members in a way that’s morally, socially, and legally sound.

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Depending on the severity, people with eating disorders are protected from discrimination under the Americans with Disabilities Act and the ADA Amendments Act of 2008. The law doesn’t list the disabilities it covers. Instead, people are protected if they have a physical or mental impairment that limits a “major life activity” like standing, concentrating, eating, or sleeping; or a “major bodily function” like those of the digestive, reproductive, or respiratory systems.

Presumably, this law makes it illegal for gyms and health clubs to refuse someone a membership, limit their access to a gym, or terminate their membership based on their eating disorder alone. “That can put clubs in a place where the safe legal action may not feel like the right moral action,” says Helen Durkin, the executive vice president of global public policy for the International Health, Racquet, & Sports Association (IHRSA), the trade association serving the gym industry. Meaning gyms are weighing the health of their members against the risk of getting sued for discrimination.

Eating disorders often go hand in hand with exercise disorders, and it’s common for people to try to hide their behaviors like Cox did. Gym owners and managers have told Durkin about members who try to disguise themselves with wigs so they can come back to the gym and exercise more without being noticed. One owner even told Durkin of a woman who thought the gym had locked the door to keep her out; in reality, she was just too weak to open it.

Bartenders are supposed to cut customers off when they’re too intoxicated, but helping a member with a suspected eating disorder is murky territory, Durkin says. Many large gym chains don’t have an official policy at all.

At Crunch Fitness, their “no judgments” tagline is their policy, with the purpose of promoting self-esteem and body positivity, says Jessica Pollack, the company’s public relations director. “We don’t have medical professionals at our gym, we have fitness professionals,” she says. “[Eating disorders are] not something we handle at the gym.”

At Life Time Fitness, they determine what to do on a case-by-case basis. “We strive to help each individual develop and implement the exercise and nutrition program that allows them to achieve optimal health,” public relations specialist Riley McLaughlin told Tonic in an email. “Such plans and discussions are highly personalized and, therefore, confidential.”

Anytime Fitness is one of the largest gym franchises worldwide with nearly 4,000 locations—each individually owned and operated. If employees are concerned about a member’s health, the company recommends that they first report it to the franchise owner or manager, says Mark Daly, the club’s national media director. Before taking any action, that person should “consult with [the franchisee’s] attorney regarding state and local regulations, and also with qualified medical professionals regarding best practices,” he adds.

That all sounds clinical, but Cox says the actual process is much more organic. “During the sign-up process for a new member, we have questions and paperwork that allow someone to disclose any health-related issues they may have,” he says. “There isn’t a blanket policy at Anytime Fitness on how to approach members with suspected eating and exercise-related disorders, but that stems not from a lack of awareness or compassion, but rather from how difficult it can be to assess each situation.” Still, they’re relying on their members to be forthcoming.

If a trainer and member feel comfortable, it may be appropriate to talk about it openly. Catrina Kitonyi, a certified trainer based in Albany, New York, says most of her clients with eating disorders are upfront about it from the moment they sit down to talk about their fitness goals. Even if they stay mum, she never calls them out. “I always let a client come out and tell me even in instances where I knew or assumed,” she says.

If she's worried about a client who hasn't opened up yet, she voices her concern by encouraging rest and moderation in both food and fitness. "I always try to drop these hints and stay very positive," she says. Kitonyi used to binge and purge in private and, like Cox, she’s always honest with her clients about her past—she brings it up "when the moment feels right,” though many of her clients know from the get-go that she’s had eating disorders because she posts about it on social media.

She’s right not to act on assumptions. Just like there might be a completely unrelated explanation for someone’s thinness or weight fluctuations, someone living with an eating disorder may show zero physical signs. “There were times that I looked the clichéd part of somebody going through some shit, but a lot of times I came off as fine with no outward cause for concern,” says Cox, who used to dig dull pens into his inner thighs until he bled, rather than cutting visible parts of his body like his wrists.

“You can’t always recognize whether someone is struggling from an eating disorder based on how they look,” says Lauren Smolar, the director of programs at the National Eating Disorders Association (NEDA). “Trainers have insight to other signs that can be really important”—like a member who always complains of cramps, dizziness, or muscle weakness; who insists on a strict exercise routine even if they’re exhausted; or who seems obsessed with burning calories from food.

The IHRSA says that people with eating disorders often hide it from their friends and family, and that those closest to them may be in denial despite the red flags. Because of that, trainers can be critical to helping people get treatment if they need it, the organization says.

If trainers do broach the topic, they should talk to the person in private; only discuss behaviors that a trainer would normally give guidance on anyway (i.e. “I noticed you’re getting injured often—are you making sure to rest and eat enough so you can perform your best?”), and avoid commenting on the client's weight or size since that can do more harm than good, Smolar says. “But a lot of it can come down to modeling good behavior, encouraging clients to nourish themselves properly and to not push themselves too far, and supporting a lifestyle that is healthy and in moderation,” she says. (See page 30 in NEDA’s toolkit for more ideas.)

Gyms can avoid intervening altogether—and help members who don’t work with trainers—by creating a supportive culture that shows people they won’t face backlash if they open up about their eating disorder. They can include information on eating disorders in their waivers and signup forms, encourage a healthy balance of exercise and rest, and have info about treatment options on hand in case someone wants or needs the resources, Smolar says. They can also take part in NEDA’s Awareness Week at the end of February.

“We all have circumstances in our lives where a nasty notion has taken hold of our brains and we cause ourselves a lot of hurt as we try to figure it out,” Cox says. “It’s about making someone feel like you’re a safe person to confide in whenever they’re ready, rather than forcing the issue on them before they get there.”

Correction 2/8/18: The representative quoted from the International Health, Racquet, & Sports Association was Helen Durkin, not Shannon Vogler. We regret the error.

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