As an industry, health clubs often sell “the perfect body” in their advertising and promotions. Lose weight, tone, sculpt, build muscle and be beautiful. And while the message that exercise is good for your body is a beneficial one, peddling the “perfect” body may serve to perpetuate negative body obsessions that a small percentage of the population takes to heart.
The health club industry is certainly not alone in glorifying a thin, fat-free body, but we do, unfortunately, come into close contact with the results of this negative obsession. While the majority of health club members are healthy individuals with a positive outlook on themselves, a rare few use club facilities as a means of perpetuating their own deadly perfectionism. The desire to be thin drives them towards dangerous eating disorders coupled with compulsive, obsessive exercise patterns.
Sadly, because our industry sells exercise as a healthy lifestyle choice, we may not realize when members pay more than they can afford.
“Back when I managed clubs for Bally Total Fitness, we had a member who eventually died of organ failure due to a combination of an eating disorder [and] a compulsive exercise disorder,” says Bret FitzGerald, vice president of corporate communications for Las Vegas Athletic Club. “She was at the club for three to four hours a day on the Stairmaster the entire time. She killed herself, sadly, by assuming she was never thin enough…
“The toughest part about the woman at Bally,” he continues, “is that she never bothered another member or employee. She just came in, exercised and left. Then, one day, we heard she was in the hospital. Then, we heard she had passed away. I think it's a form of slow suicide, inflicted on one's self because of [one's] obsession with thinness.”
If you think your club is immune, think again. Approximately five to 10 million teenage girls and women, and one million teenage boys and men, struggle with eating disorders and borderline conditions, according to Eating Disorders Awareness and Prevention Inc. (EDAP). In fact, the number of people with an eating disorder or borderline condition triples the number of people living with AIDS, states EDAP. Sadly, an estimated 1,000 women die each year from anorexia nervosa, states the National Eating Disorders Screening Program. Exercise addiction itself accounts for about 1 to 3 percent of the population, according to the American Council on Exercise (ACE).
And it's not just women who are affected by this condition. In the case of many men with the disorder, they use excessive exercise to bulk themselves up (see sidebar, page 43). “They have the feeling that they're terribly underweight, but yet when you look at them, they look like the Incredible Hulk,” says Caroline Davis, a professor of psychology at Toronto's York University, who has published several studies on eating disorders and compulsive physical activity.
Although there is no recognized disorder called “Obsessive Exercise Disorder,” it is a condition that “almost doesn't exist out of the contest of an eating disorder,” reports Davis. While not every person with an eating disorder has an obligatory exercise disorder, many use exercise as a means of purging themselves of unwanted calories. Eighty percent of those with an eating disorder are addicted to exercise, according to Davis. And while not all 80 percent may belong to a health club, chances are a good portion do. Chances are there is at least one member at your club with this condition and you may not even know it.
“I've talked to thousands [of club operators] in my 10 years here,” says Helen Durkin, IHRSA's director of public policy. “Every club thinks their situation is unique.
“I can't imagine that there hasn't been a club that hasn't dealt with this,” either with a member or with someone on their staff, she says.
But how easy to spot is compulsory exercise? After all, how can you tell the difference between an athlete training excessively in order to gear up for a competition and a person who obsessively trains in order to purge calories and fat? “You can ask them [if] they [are] training for something, and if they are, it's probably of short duration,” advises Davis. Very often, she says, elite athletes do not exercise to exhaustion for a long period of time, or else they would burn out. (However, research does indicate that a significant number of athletes also suffer from eating/exercise disorders as well. According to a study published in 1987 by Nancy Clark, MS, RD, compulsive exercisers are often athletes. Studies show that 10 percent of athletes are bulimic as compared to 1.5 percent of non-athletes, Clark reports).
Secondly, there are some other warning signs to consider. Obsessive exercisers will participate in physical activity even under unsafe conditions (i.e. injured) and have very regimented routines, according to Cedric Bryant, senior vice president for Stairmaster Health and Fitness Products, sports medicine advisory boardmember for Bally Total Fitness, and member of the scientific advisory board for ACE as well as an ACSM-certified exercise specialist. In other words, exercise isn't fun for these members; they are controlled by the need to exercise and their exercise schedule, even to the point of harming themselves.
According to information posted on the Web site of Anorexia Nervosa and Related Eating Disorders Inc. (ANRED, www.anred.com), recognizing the obligatory exerciser is relatively easy. “These people talk of nothing but their sport, their training schedules and their injuries. When injured, they will not take time off to heal unless immobilized. Obligatory runners with stress fractures, torn ligaments and joint injuries have been known to work out in their walking casts.”
Sadly, many clubs know all too well the effects of this terrible affliction. Durkin recalls an incident at a club where a member complained that the club was barring the doors to keep her from using the facility. In actuality, the doors were unlocked. The woman was simply so weak from over-exercising/unhealthy eating habits that she lacked the strength to open the door.
The urge to over-exercise also affects the person psychologically, as well. “There is a significant difference in mood before and after exercise,” Bryant explains. “It's almost like they need to get their exercise ‘fix’ to be themselves, if you will.” They can also become depressed by what they deem a poor workout.
This drive to exercise takes over their lives as both work and social time suffer as a result. Physically, they become exhausted and have a history of reoccurring overuse injuries. “How much [exercise] is too much? It really depends on the person,” Bryant says. “It doesn't depend so much on the amount of exercise but the quality of the exercise and more importantly, the attitude of the person.”
ANRED offers the following profile of the obligatory exerciser's emotional state: “Exercise addicts misuse their athletic achievements. Instead of enjoying their abilities as one part of a multidimensional life, they make exercising their whole life. They try to boost self-esteem, meet deep needs and solve complex problems through performance excellence. Or they hide from emotional pain in workout schedules. It doesn't work, but instead of trying more effective behaviors, they raise their goals and standards, hoping that the increased effort will get the job done. It doesn't.”
The question posed to health clubs, then, is this: If you know or suspect that a member of your health club suffers from an eating disorder/exercise compulsion what do you do? What is your responsibility to that member? “If you are a club operator and you see someone with all the warning signs of a heart attack, do you continue to let them work out at your club?” asks Durkin, hypothetically.
With eating disorders, however, there is a catch 22 involved, she says. According to the Justice Department's interpretation of the Americans With Disabilities Act, eating disorders qualify as a disability, meaning if you tell a member she can't work out at your club, you could be sued. “So on the one hand, the ADA is saying to clubs you can't do anything,” Durkin says, “and the other legal side is like a duty of care and your legal liability.
“There is a risk in acting and there is a risk in not acting,” she says. For legal concerns, Durkin advises clubs to inform their insurance carriers about members with eating disorders. “I've worked with clubs on both sides. Some said, ‘I'm not going to let this person kill themselves.” Some clubs opted to suspend memberships, others chose to limit the number of hours the person could work out. Still others assumed the member would find another way to work out if they shut their doors to them, and so chose to keep them as a member in order to provide as safe an environment for them as possible.
FitzGerald remembers his own uncertainties about how to approach the compulsive exerciser at Bally: “I spoke with her very little, because I never knew what to say. If you say, ‘Man, you are too skinny,’ they think that their routine is working and they do more. These people need help from their family members. The average health club employee is not properly trained to deal with a disorder of this magnitude. It would be like saying to Jeffrey Dahmer, ‘Hey Jeff, what about easing up on those serial murders?” In his case, professional help would potentially have been more likely to help.”
While it's true that health club staff are most likely not qualified to treat a person with these disorders, that doesn't mean they can't seek help. “They should play the role of being a ‘suspectician,’” advises Bryant. “If there's been enough of a rapport that's been established, they could recommend them seeing a mental health professional.”
Davis recommends talking to members with suspected eating disorders and obligatory exercise patterns in a friendly way. Preferably, have a staff member of the same sex as the member talk to him or her. “I would think it would be more appropriate for a woman to approach a woman about this. It might make them feel more comfortable,” she says.
“Many patients say they hate what they're doing but they just can't stop,” Davis says.
There are a myriad of organizations out there that can help people with eating disorders. They may be able to offer advice or send you information, which you could pass on to the member. You may even want to offer a program at your club. Some organizations to contact include:
- Eating Disorders Awareness and Prevention Inc. (edap.org)
- Screening for Mental Health Inc. (nmisp.org/eat.htm)
- Anorexia Nervosa and Related Eating Disorders Inc. (anred.com; (800) 931-2237)
- American Anorexia Bulimia Association Inc. (aabainc.org)
- Something Fishy: The Web site on Eating Disorders (something-fishy.org).
- Or call your local hospital or medical professional for their opinions and advice.
TYPES OF EATING DISORDERS
Anorexia Nervosa: Anorexia Nervosa is a disorder in which preoccupation with dieting and thinness leads to excessive weight loss. Anorexics have an intense fear of fat, and their preoccupation with food and weight often masks other underlying psychological problems. The individual may not acknowledge that his or her weight loss or restrictive eating is a problem. One percent of teenage girls in the U.S. develop anorexia nervosa and up to 10 percent of those may die as a result.
Bulimia Nervosa: Bulimia Nervosa is described as a disorder in which frequent episodes of binge eating (rapid consumption of food in one sitting) are almost always followed by purging (ridding the body of food). Purging can involve vomiting, abusing laxatives and/or diuretics, exercising compulsively and/or fasting. Binging and purging is often followed by intense feelings of guilt and shame. The bulimic may not be visibly underweight and may even be slightly overweight. Like the anorexic, the bulimic uses self-destructive eating behaviors to deal with psychological problems that may go much deeper than her/his obsession with food and weight. Usually, the individual feels out of control and recognizes that the behavior is not normal. Up to 5 percent of college women in the U.S. are bulimic.
Binge Eating Disorder: Binge Eating Disorder or compulsive overeating, involves uncontrolled eating usually kept secret. People with this condition engage in frequent binges, but unlike bulimics, they do not purge afterward. Binges are usually followed by intense feelings of guilt and shame. Again, food is used as a dysfunctional means of coping with psychological problems. The individual often experiences depression and other psychological problems. Up to 40 percent of people who are obese may be binge eaters.
Information courtesy American Anorexia Bulimia Association Inc. (see www.aabainc.org).
MEN AND EATING DISORDERS
- Five to 10 percent of eating disorders occur among men.
- Men more frequently use excessive and obsessive exercise and bodybuilding prior to and during their eating disorders.
- Issues relating to sexuality and gender identity are sometimes associated with male eating disorders and there appears to be a higher rate of eating disorders among gay males.
- Men may be less likely to seek treatment for an eating disorder because of the social stigma of having a problem that has generally been perceived as a “woman's problem.”
- The signs, symptoms and treatment needs of eating disorders in males are similar to those of women.
Information courtesy Screening for Mental Health, Inc., formerly the National Mental Illness Screening Project (see nmisp.org).
- The average American woman is 5 feet 4 inches tall and weighs 140 pounds.
- The average American model is 5 feet 11 inches tall and weighs 117 pounds.
- Most fashion models are thinner than 98 percent of American women
- More than 50 percent of high school girls want smaller hips, thighs and/or waists.
- Nine-year-old children rate silhouettes of fat figures as having fewer friends, being less liked by their parents, doing less well in school, being less content with their appearance, and wanting to be thinner.
Information courtesy Screening for Mental Health, Inc., formerly the National Mental Illness Screening Project (see http://www.nmisp.org/eat.htm) and Eating Disorders Awareness and Prevention Inc. (Edap.org).
How has your club dealt with members who have eating disorders and/or obesssive exerise disorder? Drop us a line at: Letters to the Editor, Club Industry, One Plymouth Meeting, Suite 501, Plymouth Meeting, PA 19462. E-mail: [email protected]. Fax: (610) 238-0992.