A fitness club’s legal authority when it comes to dealing with people with an eating disorder, such as anorexia or bulimia, is a pretty gray area. (iStockphoto)

During a recent Zumba class at the Washington Sports Club in Dupont Circle, an emaciated woman came in a few minutes late and began to follow the class’s movements. One class participant was alarmed enough to tell the front desk.

“I was very concerned she would break a bone or sustain a heart attack,” said the woman, who did not wish to be identified. “I don’t know what the legal situation is, but ethically it seems to me that for a sports club to let somebody like her exercise is similar to a bar serving drinks to a very drunk customer.”

It turns out a fitness club’s legal authority when it comes to dealing with people with an eating disorder, such as anorexia or bulimia, is a pretty gray area.

People with eating disorders are protected under the Americans With Disabilities Act, so fitness clubs are prohibited from discriminating against them. In a 2011 briefing paper, the International Health, Racquet & Sportsclub Association (IHRSA), the trade association serving the global health club and fitness industry, stressed the importance of fitness clubs educating themselves to recognize the signs of eating disorders. But the paper also said clubs “do not have a specific obligation” to inform members about anorexia and bulimia but should do so to protect the club and its employees from liability, and to protect a member’s health.

IHRSA added that clubs should treat eating disorders like any other medical condition and include eating disorders in disclaimers and medical clearance forms. IHRSA worked with the National Eating Disorders Association (NEDA) on its briefing paper.

Claire Mysko, chief executive of NEDA, said fitness centers, athletic trainers and coaches are really on the front lines in helping people with eating disorders.

“They are in a position to recognize behaviors and certainly if they are witnessing dramatic weight loss in a person, they can intervene to try and help,” Mysko said. “But that’s a difficult line because fitness instructors and coaches sometimes don’t have the information they need to help someone with an eating disorder.”

Mysko added that you cannot tell if someone has an eating disorder just by looking at them.

“Anorexia is the most visible disorder when a person is severely underweight, but people with eating disorders can be of normal weight or overweight,” she said. “Thirty million Americans — 20 million women and 10 million men — struggle with an eating disorder at some point in their lives.”

NEDA offers tool kits on its website for athletic trainers and coaches, as well as for parents and educators. The tool kits offer materials on the types of eating disorders, myths about them and tips on how to help someone. And for people who want to see if they have an eating disorder, NEDA offers a free online screening tool.

The issue of how the fitness industry deals with members with eating disorders is Jodi Rubin’s mission. Rubin, a psychotherapist specializing in eating disorders, would go to her gym and see people spending hours working out.

“Overexercising is often a sign someone has an eating disorder, and I would see fitness club employees not know how to handle such a situation,” Rubin said. “But many clubs want their employees to be trained to understand what eating disorders are and how they can help. This is not about asking someone who visibly has an eating disorder to leave the gym. It’s about being able to understand the dangers and destructiveness of what the disorder is doing and to offer your help.”

Rubin decided to become certified as a fitness trainer so she could provide online training courses to coaches and instructors through her Destructively Fit website. Her courses also highlight how to spot the signs of overexercising.

“If you never take a day off from exercising, feel depressed or anxious if you miss a day at the gym, or give up social engagements to exercise, those are signs of overexercising,” Rubin said. “If you use exercise as a way of purging — running on the treadmill to burn off a 500-calorie meal, for example — that’s also a sign.”

Rubin said the woman at Washington Sports Club who voiced concern about the emaciated member in her Zumba class did the right thing by speaking up. Rubin cautioned that it is best to approach someone in a private setting, and even better if you have a relationship with them.

Lauryn Lax said if several members of the YMCA in Nashville had not approached her in 2014, she might be dead today. Lax, who had struggled since she was 10 with an eating disorder, weighed 79 pounds in 2014 and was working out up to eight hours a day, going to one of several gyms where she had memberships.

“I call them my YMCA angels,” Lax said in a telephone interview. “They said they were worried about me and they wanted to take me to the hospital.”

Lax went to the hospital and started her long road to recovery. She now is a doctor of occupational therapy and a nutritional therapy practitioner in Texas.

Lax said the only time she was approached out of concern for her health while at a gym was at the YMCA by other members.

“Fitness instructors would talk to me in a way that did not address my problem outright,” she said. “They would see me at the gym all the time and some would say ‘Oh, back again?’ in a backhanded way. That’s why I had several gym memberships.”

“That only accelerated my eating disorder even more because I wanted to cling to the exercise even more,” Lax said. “Education is the key for trainers so they know how to handle clients with eating disorders and recognize the signs. I would have rather have been shown some love and concern than ignored.”