I actually would borrow what I always say to people I think are domestic violence victims -- as I would talk to her. I'd say something like: "You know, I've seen you here many times and I'm getting terribly worried about you. You have gone beyond being thin and have gotten so terribly bony that I'm afraid for your life. Are you okay? Are you able to let yourself eat?"

The thing that is hard to live with is that is about all you can do without infringing on personal autonomy. You can't force a DV victim to leave an abusive situation -- you can only hold out your lifeline and hope they take it. Likewise, you can only flag, I think, the distorted thinking of someone with an eating disorder.

I must admit I might also talk to the gym staff and ask if they've mentioned to her how dangerous it can be to exercise vigorously while denying oneself food.

I would say something too. For one reason: The feeling I have inside saying "talk to her," is, IMO, how our Best Self/Higher Self/Whatever you call it communicates with us.

One of the commentors on the example page suggested talking to someone at the student health clinic. GREAT idea. That's a great way to developing a "best strategy" for eventually speaking up. In this case, pointing the issue out to the RA, if there is one, and the counseling center would also be helpful for the woman in question.

I would go to the gym manager. That's a potential lawsuit.

I totally understand and sympathize with the desire to intervene, but since the writer knows literally nothing about this woman other than her physical appearance, I can't think of anything to say about this person's body* that wouldn't be sheer presumption.

Yes, the appearance and behavior described is consistent with the spectrum of self-abuse [eating disorder/body dismorphia/exercise bulimia]. But it's also consistent with plenty of other organic conditions that might contribute to or cause her thinness, and that is NOT A STRANGER'S BUSINESS.

And, even though they see each other pretty frequently, if (as the entry seems to indicate) they don't talk already, they are indeed strangers. If the writer had described any previous contact or conversation or even any other reason why she'd choose to converse with this woman, that might be a different matter.

Ideally? Well, ideally one would establish a solid acquaintanceship with someone before judging their right to their own bodily autonomy.

Also: ideally, one might bring her to the attention of someone better qualified to judge: a mutual friend, a trainer at the gym described in the link, or a health-care worker who might have some authority or oversight in that situation. (On preview: MonkeyButter's idea of contacting a student health and/or counseling center is a great one.)

* Here's a handy rule I use: if the discussion of the person's appearance is the ONLY conversation we will ever have had up to that point, then I am absolutely not qualified to judge. Goodness knows I wish other people would use the same metric when giving me advice about my health or appearance.

I totally understand and sympathize with the desire to intervene, but since the writer knows literally nothing about this woman other than her physical appearance, I can't think of anything to say about this person's body* that wouldn't be sheer presumption.

Agreed. I would do nothing.

There's just no way to know what's wrong with the woman. Even more so, if she has some sort of body dysmorphic disorder, wouldn't the attention of a total stranger which is entirely based in her physical appearance exacerbate the problem?

Really, if she has an eating/exercise disorder, it's a terrible thing and she needs help, but it's not the sort of intervention a stranger make. Unlike domestic violence, where a stranger can make a positive intervention, treatment of eating disorders--in my understanding--can be undermined by the interference of strangers or non-intimates who aren't briefed on the appropriate things to say, strategies to take, or correct ways to comment on things like food, exercise, or appearance.

Just as a personal anecdote, I have recently lost quite a bit of weight (not anywhere near the description of the woman in the blog post, but I was not overweight at all before and I have lost a fair amount of weight). I have lost this weight as a result of a side effect of some medication I am taking, despite eating extremely calorie dense food at every meal. Here's my perspective.

Unless I have invited you to talk to me about my weight loss by explicitly bringing up the subject, please don't comment on it. I'm getting extremely tired of well-meaning coworkers and near-strangers cornering me and initiating conversations meant for my own good about how I need to eat more and why am I losing so much weight and I was so pretty just how I was before. I don't have an eating disorder, and I don't need anyone to rescue me. I already feel awkward enough about the weight loss, without getting actual confirmation that people are noticing me and judging me for it.

You just don't know why people look the way they do. You may think you do, but you really just don't know unless you have had an actual conversation where they actually tell you. Honestly, this whole thing reminds me of the time some well meaning person asked me how soon my baby was due and I had to tell her I had a frigging tumor. You just don't know and getting it wrong is going to make the person feel so indescribably awful, and if you're a total stranger, even getting it right is unlikely to make the difference you think it will.

That's my two cents.

Nthing going to the gym staff.

When I was travelling in Alabama, I had breakfast at a place and noticed one of the waitstaff had a black eye. When I got home I looked up the nearest domestic violence center, called the restaurant and gave her manager the contact info.

I had the feeling if I'd said anything directly to this woman, the response would have been something to the effect of "mind your own fucking business, Yankee bitch".

Our university gym had a *lot* of flyers up for the campus eating disorders clinic. If those were not in place at the gym in question, I'd talk to the gym staff and/or the counseling dept. about doing some general outreach there (flyers, tabling, brochures, etc.). I wouldn't speak to the woman directly, for all the reasons Elsa and Twiggy brought up.

It would depend on how she was handling it. If she looked otherwise upset or worried I might ask her if she was okay. If she seemed just sort of normal I would think it was not any of my concern.

Or if I wasn't giving a shit at the moment, I'd ask her if, while she's at it, could she lose some of my weight too?

I wouldn't speak to her for the reasons others have brought up.

I would have hit on her in her Sorority Girl Thin phase, had a brief affair, and would think that her disorder was all because of me.

My sister was anorexic. I wish someone had said something to her before her life was endangered. I realize it may not be polite and that there may be other reasons for being emaciated ( while fiercely exercising??) but better to ask than ignore a condition that puts her in imminent risk.

This does not mean it is OK to comment on physical appearance of strangers nom ally. Only when life may be imperiled.

Normally not nom ally. (BAD IPad!)

I realize it may not be polite and that there may be other reasons for being emaciated ( while fiercely exercising??) but better to ask than ignore a condition that puts her in imminent risk.

For me, though, the major consideration would be the efficacy of a stranger telling someone with body issues that she looks bad, not just the etiquette of it. I'm really dubious that intervening in that way would help and may in fact just exacerbate the problem.

Some comments from people recovering from disordered eating about this sort of thing.

A good deal of this is approach. -- supportive versus critical. To quotecsomeone from the link who identified herself asvrepeatedly anorexic:

I think maybe the way in sometimes is simply saying, "I'm worried about you" and backing it up with actual compassion, empathy and acknowledging that you probably really don't get it goes a very long way. It might not be the road to recovery or helping someone through recovery but it's a start.

I totally agree. I'm just not sure a stranger is the right person, 99% of the time, to do that, because it's hard to show real empathy to someone you don't know (and I say that as a therapist whose job description is building rapport with strangers in need). I very much do believe that friends, family, acquaintances, and medical professionals have an obligation to speak up, though -- I'm not against intervening, but I do think it matters who does it.

Once I was in a bike crash (I ran into a gutter after making a turn while going down a hill). This lady came rushing up to me in a bit of a panic, and I had to quickly hurry to standing and reassure her, so I didn't get the chance to assess myself and my injuries and the position of my bike, etc., before getting up.

Last year, I was in another bike crash (went over some invisible bump in the road and went over the handlebars). The lady who came up to me this time was much more calm. Rather than a demanding capacity, she was there in a supportive capacity, and I really appreciated her presence.