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Back on February 4, I blogged about a dilemma one might face at the gym: What do you do when you think someone might be overexercising, at the risk of their health? And we got some very different responses. So I thought I’d just respond to them here and keep the conversation going. I hope you will chime in too!

Commenter #2, S:

The question I wanted to raise is: What if someone is in trouble and no one does anything? It wasn’t to look judge someone’s size. I can see how it could have been interpreted that way since I did mention the size of the woman. I apologize; exercise obsession can and does occur in people of all sizes. I am coming from this gym dilemma as a person who has recovered from anorexia nervosa. So believe me, I do understand.

I appreciate what RW said about exercise and body image. Unfortunately, most of us do exercise to achieve thinness. Studies show a physiological connection between eating disorders and excessive exercise and dieting. Many of us begin by dieting and exercising, but it can lead to a possible eating disorder, especially if what is driving these behaviors is unhappiness with ourselves and our physical appearance.

To see what their take is, I recently spoke to therapists who work with individuals with eating disorders and I received the following sage comments and advice: Patients with eating disorders say that no one else seems concerned about their problem, which helped them continue their denial. Denial is the hallmark feature of eating disorders. While it is true that people have the right to be as athletic as they want and have the right to make poor food/health choices, it is also true that some folks are acting out of illness.

Having our compassion, not judgment, is helpful. Eating disorders are the most lethal of all psychiatric disorders, and to ignore possible trouble due to misguided “political correctness,” or even just politeness, is tragic. Is it so terrible to merely ask, “Are you OK?”? If I see someone at the gym or McDonald’s who looks like they are going to pass out, regardless of size, I would want to approach them and ask if they are alright.

— M.R.