Anorexia is a serious eating disorder that can lead to a variety of health problems and even death. Some health club members suffer from this disorder. Once you suspect a member of having this disorder, a number of questions often arise:
1. What is the legal responsibility of a fitness facility or fitness professional if a club member or user suffers an untoward event or dies during or immediately after club use under circumstances where the event is proximately related to anorexia and activity?
2. Is a facility legally required to intervene somehow if a member or user is identified as a sufferer of an eating disorder such as anorexia?
3. May a facility refuse to accept an individual suffering from anorexia as a facility member or user?
These questions often are troubling to fitness facility management and fitness professionals. The answers are complex and not just dependent upon legal solutions since social and ethical issues also are involved. However, the potential legal analysis of these issues deserves a thoughtful response.
The International Health, Racquet and Sportsclub Association (IHRSA) published a briefing paper entitled "Eating Disorders" that was last reviewed in August 2010. The briefing paper addressed the foregoing questions and suggested that anorexia be addressed as the medical condition of any member or user would be addressed: through a member or user screening process. Once a problem is so identified, the paper suggests referral for clearance to a health care provider and the utilization of assumption of risk type procedures.
A club requirement for all members or users to sign agreements that contain prospectively executed waivers or releases of liability should be part of any such process. Where particular states prohibit the use of these contract documents, assumption of risk type documents should be used instead.
Provided the foregoing procedures are used to deal uniformly with all member and user medical conditions, the legal risks associated with untoward events to such members and users should be minimized. Even without these procedures, questions about a member's untoward event due to anorexia and potential facility responsibility for that event would seem to be somewhat misplaced based upon the apparent lack of probable cause between any such event and any duty or omission by the facility toward the client. Arguments related to the duty issue of fitness facilities and professionals would seem to be tenuous at best since any untoward event due to an undocumented health condition would seem to be within the knowledge of the member or user and not that of a facility or fitness professional.
Even where such a condition is obvious, screening and the provision of information to the member or user should shift responsibility to that member or user. Releases or waivers of liability or assumption of risk documents would also shift the risk to the member or user, and anorexia—along with other potential risks related to activity and member or user conditions—can be included in a facility's forms for that purpose. Such documents also should include a statement that members and users assume all risks, including those related to any medical or health condition that they may have.
There appears to be no readily available case law on the question of a facility's obligation to intervene if a member or user is identified as suffering from anorexia or some other similar condition. However, if such a condition is identified, then it may be incumbent upon a professional to deal with issues related to member or user performance of fitness activity as it would be with any similar situation with other members or users. IHRSA's briefing paper suggests a discreet communication by a professional with the member or user in question to provide input about weight loss and/or extreme exercise. Accurate documentation in facility files, including date(s) and content of conversations as to such interactions, is important and necessary.
Although there has yet to be any legal case that has determined that anorexia is a protected disability under the Americans with Disabilities Act (ADA) requiring a health club, as a place of public accommodation, to accept persons with anorexia as members or users, it appears likely to be the case. In fact, IHRSA, in its briefing paper on rating disorders, has reported that the United States Department of Justice has determined that individuals suffering from anorexia are protected under the ADA from discrimination. As a consequence, it would appear that clubs would be well advised to refrain from discriminating against such individuals and to secure specific advice from facility legal counsel as to how to best deal with these situations.
This article is written and published to provide accurate and authoritative information relevant to the subject matter presented. It is published with the understanding that the author and publisher are not engaged in rendering legal, medical or other professional services by reason of the authorship or publication of this work. If legal, medical or other expert assistance is required, the services of such competent professional persons should be sought. Moreover, in the field of personal fitness training, the services of such competent professionals must be obtained.
Adapted from a Declaration of Principles of the American Bar Association and Committee of Publishers and Associations.
- S Giordano, "Risk and supervised exercise: the example of anorexia to illustrate a new ethical issue in the traditional debates of medical ethics," J Med Ethics 2005 31: 15-20 doi: 10.1136/jme.2003.004812.
- Marwan El Ghoch, Fabio Soave, Simona Calugi and Riccardo Dalle Grave, "Eating Disorders, Physical Fitness and Sport Performance: A Systematic Review," Nutrients 2013, 5, 5140-5160; doi:10.3390/nu5125140.
- Shana McGough, "Exercise Addiction and Eating Disorders" McLean in the News, July, 2004, http://www.mclean.harvard.edu/pdf/news/fitnessmanage0704.pdf.
- "Get out of My Club," http://theinsuranceguy.com/get-out-of-my-club//.
- The International Health, Racquet & Sportsclub Association (IHRSA ), "Eating Disorders: An IHRSA Briefing Paper", http://download.ihrsa.org/publicpolicy/papers/eatingdisorder.pdf.
- Chad E. Kurtz, "Adding Weight to the ADA: Why Anorexia Should Constitute a Disability and Thus Be Protected Under the Americans with Disabilities Act", Temple Law Review, Vol. 81, No. 1, Spring, 2008, http://sites.temple.edu/lawreview/files/2011/07/kurtz.pdf.
- The International Health, Racquet & Sportsclub Association (IHRSA), "Injury Liability: How to Protect Your Club – Briefing Paper", last updated: 10/17/1997.
- The International Health, Racquet & Sportsclub Association (IHRSA), "The Americans with Disabilities Act – An IHRSA Briefing Paper", updated November 2012, http://download.ihrsa.org/publicpolicy/papers/ada.pdf.
David L. Herbert is an attorney at law with David L. Herbert & Associates LLC in Canton, OH. He also is editor of The Exercise, Sports and Sports Medicine Standards & Malpractice Reporter and author of "The Personal Trainer, A Tale of Pain, Gain, Greed & Lust."