- Calorie Counter
- The Reality of Exercising After an Eating Disorder
- Compulsive Exercise
- How does exercise affect those living with an eating disorder?
- Should You Exercise During Recovery From Anorexia? Part 1
- Learning Not to Dread Exercise
- Woman – Center Thyself.
- Easy does it.
- Modifying exercise for the body one has today.
- Patience, Grasshopper.
- Discover the joy in movement.
- Exploring What Feels Right
- Society’s View
- Reality Check
- How ED Interferes
- 4 Ways to Cultivate Healing in Movement
- The Fix
- How To Work Out When Recovering From Anorexia Athletica
- How Is Anorexia Athletica Different From Anorexia Nervosa
- The Problems With Detecting Anorexia Athletica
- The Early Stages Of Recovery
- Is Exercise Healthy For Someone Recovering From Anorexia Athletica?
- Staying Successful In Recovery
- Should gyms step in on anorexic members?
Background: When I started my weight loss journey I was 161 lbs and in about 5 months I got to 110 lbs by eating 500-700 calories a day. I know that was no good for my body but at the time I was losing weight so quickly that I didn’t care. I kept the weight off for 2 years! I slowly started to increase my calories to a more normal amount.. now that it’s been about 2.5 years, I have gained back 10 lbs and I eat about 1500-1600 calories per day.
I obviously lost a lot of muscle mass while not eating for so long so now I’m trying to gain muscle. But I would like to either lose 3-5 lbs OR tone up my muscles so I don’t look so flabby. I am doing 60 minutes of yoga daily and running 1.5 miles at an incline of 3% on the treadmill 5 days a week. I haven’t changed my eating at all, still eating about 1600 calories a day, more if I burn more than about 300 calories. I haven’t noticed any changes in the scale yet, and my stomach sticks out like I’m 5 months pregnant! I’ve been doing this schedule for about 2 months now.
Am I doing something wrong? Or does it take a really long time to notice changes? I just find it weird that I have not lost one ounce since I started exercising. I don’t want to eat less, and I feel like if I eat any more it would be counterproductive.
I’m 5’5″ btw if that helps. Thanks!
The Reality of Exercising After an Eating Disorder
Figure out the food. Exercising means burning more calories, which means you need to eat more to ensure you stay at a healthy weight. But tracking your meals or counting calories, even if it’s just to figure out how much more you need to eat, can be triggering. “It can become too compulsive,” says Fishman. Campbell suggests working with a nutritionist to develop a plan.
Start slow. The type of workout you want to do matters a lot. “Solitary endurance sports like long-distance running can be very triggering to people with eating disorders, because of the extremely high energy needs combined with the false perception that thinness improves performance and the solitary nature of the activity,” warns Ravin. Strength-training may seem safer, but more serious body builders often implement super-strict food plans and seriously emphasize the physical outcome (getting ripped), cautions Campbell. (Even some workout DVDs aren’t safe.)
Fishman says that yoga and other similar grounding, stabilizing forms of exercise are probably best, especially when you’re first getting back into a fitness routine. She says that group workouts are also better than solo sports. But Campbell notes that eventually with the right prep and team of support, it’s possible to do almost anything safely-she counseled a woman in recovery who went on to run the Boston marathon healthily.
Limit yourself. You should never be exercising for more than 45 minutes to an hour at a time, says Campbell. And when you’re just starting out, go for less. (All you really need for fitness is four minutes!)
Watch for these red flags. Feeling guilty if you miss a workout. Becoming overly rigid about your gym plans (like refusing to skip a run if it’s raining or you’re not feeling well). Modifying your diet based on your exercise (“I didn’t work out today, so I can’t eat X”). Comparing your body to other people’s. Exercising for longer and longer periods of time, and rationalizing it away. Frequent injuries like pulled muscles or stress fractures. These are all signs that you need to step back and meet with your therapist-your gym habit is getting out of control.
- By Mirel Ketchiff @mirelbee
Three questions which i see far too often recently and are really beginning to get on my nerve are:
I want to gain muscle but i dont want to gain fat
I dont want to get bulky
If i want to lose weight and have to burn more than i eat, how am i supposed to exercise away 1500 kcal? (example question)
And i get it… most people arent so interested in nutrition or exercise or how the body works. I mean i am pretty sure i have asked some pretty “dumb” questions about cars or make up or songs etc And i am pretty sure anyone who has an interest in a certain area or topic end up getting iritated over the same type of questions being asked all the time.
But what also irritates me is society…. Because for females there is the ideal of the thin body i.e catwalk model body but also now there is the ideal of super lean, big butt and big breasts but basically no fat anywhere else and preferably a toned stomach but not full on abs.
Those ideals are just wrong, because for the majority of people they arent healthy or attainable. And being able to have big breasts and a big butt while also having very little body fat percent, not so easy and not to mention not so healthy physically or mentally.
I am going to start off with the first question which i see about 5 times a day on different pages or sites, and the fact is… to gain muscle you need to gain fat as well. Gaining muscle means being in a surplus of calories, and not all those calories go to your muscles, they also get stored as fat. But in time, as you gain more muscle your body will also burn more each day as muscle is active and therefore needs energy all the time to keep it that way. So generally speaking the more muscle you have the easier it is to lose fat over time. Because when you are in a deficit of calories, i.e eating less than your body needs (below your TDEE) then your body will be in a catabol state and need to take energy from its own stores, but it will also break down muscle for energy as well as part of the protein you eat going to energy to sustain the body and glucose levels instead of going to the protein synthes…. that is why its easier to gain muscle while on a calorie surplus because the protein will go to the protein synthes and building up of your muscles (if you strength train anyway, otherwise protein will be converted to glucose and stored anyway) . But you cant forget that the muscles also need glucose to be able to work to their potential and to then build stronger.
Anyway, there were just the facts. But people seem to be so incredibly scared of gaining fat, and they just want to gain muscle… and many who are in “recovery” i have noticed just want to gain muscle so that the number on the scale goes up but they dont go up in fat and can therefor trick the people around them that they are a healthy weight when in all honesty their body fat is below a healthy level and most likely their thoughts about themselves, food and exercise arent healthy.
Your body needs fat, thats a simple fact. You both need to eat fat for the essential fatty acids, but your body also needs fat to function. I mean people are incredibly scared of cholesterol but we already have cholesterol in our body which is synthesized on its own and is part of the cell membran as well as other important functions in the body, and not to mention the important functions fat has in our body both keeping us warm and acting as a shock absorber for our organs as well as being part of the cell membran. Women especially need a certain procent of body fat to keep their body healthy and for their menstrual cycle to function. If you workout too much, eat too little, dont get enough fat or iron in your diet or you are very stressed or have too low body fat, all of those things can affect you getting your menstrual cycle, which can be good to be aware of.
Wanting to build muscle should be 1) To be stronger and feel stronger, 2) You want to progress with your exercise i.e if you are a runner, swimming, lifter, dancer etc it is beneficial to have muscle mass 3) Because you think it looks good (I mean you cant deny that many people who strength train do it for appearance reasons, but i ALSO think there should be other reasons behind why you workout or strength train, because having just appearance based goals will never make you satisfied and you will just keep comparing yourself to others). It is ok to have fat on your body, in fact it is essential. YES, you most likely will gain fat when you gain muscle… no that shouldnt prohibit you from strength training, and really, it isnt that much fat. Also when you strength train you get different body proportions and ratios. I mean i weigh roughly 4-5kg more than when i began to strength train but i look very different (picture below to show the difference).
Also know that for girls it takes alot to look “bulky” from strength training… Its not like you drink one scoop of protein powder, do some deadlifts and bicep curls and suddenly you look like someone who has trained for 20 years. But that is what some people seem to think…. Of course some have it easier to gain muscle, i mean some girls who have worked out for 9 months or a year have gained the same muscle mass that i have in 3 years, so body types are different. I dont easily gain weight or muscle so for me it is more of a struggle to build muscle and then maintain the muscle mass i have, but i am more focused on trying to keep up my strength and improve my strength and progress in my workouts, rather than building muscle. Strength train for YOU and because you want to, and the chance of you getting bulky is very unlikely.
And last but not least, “you need to burn more than you eat” – this question isnt so appropriate for this blog, but it might be a good reminder anyway. Your body is always burning calories so your BMR is what your body burns just keeping you alive for example if you were in a coma you would get fed by a tube the amount your BMR is (usually around 1300-1600 kcal depending on height, weight, body ratio etc). But then your TDEE is what your body burns including activity, which can be anywhere from 2200-3200 or more. So for me when i have calculated i have a BMR of around 1450, but a TDEE of around 2800-3000, and that is roughly the amount i eat each day more or less. Bbut when people talk about burning more than you eat, it doesnt mean you eat 1200 and run 2 hours to burn 1200, it means you eat less than your TDEE ex. i would eat roughly 2300-2500 if i wanted to lose weight. Not appropriate on here, but i hope that makes sense… to make you realise that if you are eating 800kcal a day…. it is not enough, even eating 2000kcal and trying to gain weight on that isnt really enough. Because weight gain should mean eating your maintenance (i.e most people around 2000kcal without any extra exercise + 500kcal to gain weight. And then if you exercise as well you need to eat those burned calories)
So… a long post and i am pretty sure nobody read all of it, thats ok. I just felt like i needed to rant and share some information and “facts”. Dont be scared of fat, there are far worse things in life than having fat on your body and if you are so scared of having fat on your body but you want to exercise 12 hours a week, then ask yourself how healthy is your relationship with your body, exercise and food?
**TRIGGER WARNING PHOTOS***
Compulsive exercise is not a recognized clinical diagnosis in the DSM-5, but many people struggle with symptoms associated with this term. If you are concerned about your or a loved one’s relationship with exercise, please speak with a treatment professional.
WARNING SIGNS & SYMPTOMS OF COMPULSIVE EXERCISE
- Exercise that significantly interferes with important activities, occurs at inappropriate times or in inappropriate settings, or when the individual continues to exercise despite injury or other medical complications
- Intense anxiety, depression, irritability, feelings of guilt, and/or distress if unable to exercise
- Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury
- Discomfort with rest or inactivity
- Exercise used to manage emotions
- Exercise as a means of purging (needing to “get rid of” or “burn off” calories)
- Exercise as permission to eat
- Exercise that is secretive or hidden
- Feeling as though you are not good enough, fast enough or not pushing hard enough during a period of exercise; overtraining
- Withdrawal from friends and family
HEALTH CONSEQUENCES OF COMPULSIVE EXERCISE
- Bone density loss (osteopenia or osteoporosis)
- Loss of menstrual cycle (in women)
- Female Athlete Triad (in women)
- Relative Energy Deficiency in Sport (RED-S)
- Persistent muscle soreness
- Chronic bone & joint pain
- Increased incidence of injury (overuse injuries, stress fractures, etc.)
- Persistent fatigue and sluggishness
- Altered resting heart rate
- Increased frequency of illness & upper respiratory infections
- Learn more about health consequences >
- Learn more about eating disorders statistics >
How does exercise affect those living with an eating disorder?
- Covert and secretive activity
- Depression & Anxiety
- Risk of progression of disease
- Exercising whilst injured, dehydrated (or sedentary behaviour)
- Powerless feelings of restricting exercise
- Food preoccupation
Let’s get started
It is important to see an Accredited Exercise Physiologist (AEP) before engaging in exercise. The AEP will understand your condition and work with the other allied health professionals (AHPs) in your team to form the most appropriate treatment plan for you as an individual.
Sessions can range from education and information (if you are not ready to mentally or physically engage in movement) to many forms of clinically safe exercises.
Alanah Dobinson is an Accredited Exercise Physiologist and the Mental Health Programs Coordinator at Iridium Health, South Brisbane. Alanah brings immense passion to movement therapy within the mental health sector, where she works with a large number of organisations including Headspace.
We all know that working out is good for us, and a way to manage stress, stay in shape, and end up with a nice post-exercise endorphin rush and glow. But there’s an imaginary line that exists between a healthy gym habit and a dangerous obsession, and sometimes it can be tough to figure out when it’s been crossed.
When specific behaviors are paired with hard core exercising they can signal a problem, says Patricia Pitts, Ph.D., a licensed clinical psychologist who created one of the first outpatient eating disorder clinics in the nation in the mid-1980s. These include extreme guilt if a workout is skipped, hitting the gym through illness or injury, and putting too much focus on how many calories a workout burns off.
If someone also exhibits low self-esteem, poor body image, and obsessive-compulsive traits along with their over-exercise, they might have what’s called an “other specified feeding or eating disorder,” or OSFED. People with a condition characterized by a need to eat only healthy, clean or pure foods, called orthorexia, can fall into this OSFED category, too.
“Because we have so much focus on healthy eating and healthy exercise, people who are trying to do things that good for them end up crossing this line,” Pitts tells SELF. Once they’re in this disordered space, it can be tough for people to identify that what they’re doing can actually put their health at risk. “A lot of these people are in denial,” Pitts says.
With that in mind, here are six things that you need to know about compulsive over-exercising, including how you can get help if you think you have a problem.
1. Compulsive over-exercising goes by many names.
Because compulsive over-exercising isn’t listed in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition—the tool used by the American Psychiatric Association to make clinical diagnoses—it can go by many names.
One term that’s typically used to describe over-exercising is “exercise addiction,” which implies that the exerciser is hooked on the positive feelings they associate with working out. The term “compulsion,” on the other hand, implies that the exerciser doesn’t enjoy the exercise, but feels that they must continue it anyway, even if they’re sick or injured, or have to skip work or cancel social plans to do so.
The term “anorexia athletica” is used to describe what is essentially anorexia plus excessive exercise, while “exercise bulimia” is characterized by binging on food and then using exercise as a compensatory way to purge off the calories.
As a general rule, most experts prefer the term “excessive exercise,” as it’s the most accurate way to describe this type of behavior, but for the purpose of this article, any of these lay terms might be used interchangeably.
2. Side effects can be serious.
Excessive exercise can cause a number of physical issues, including everything from dehydration and fatigue to chronic pain in the knee or back, injuries like shin splints, strains and sprains, tendinitis of the shoulder, knee, elbow or hip, and stress fractures. More long-term health problems that might be the result of excessive exercise include osteoporosis, degenerative arthritis, loss of one’s period, reproductive problems, or heart issues, experts say.
Colin O’Banion, a doctor of physical therapy and the owner of Integrate NYC Physical Therapy, says that he sees patients every day who are injured because of their excessive exercise habit. Recently he saw a CrossFitter, who typically lifts weights four or five times per week, with persistent neck tightness, and a runner with a stabbing pain in her knee every time she went over four miles. Neither of them was willing to dial back or stop their workout routine to allow their bodies to heal. “A lot of these people are worried that if they’re not killing themselves during their workouts that they’ll gain weight,” O’Banion says, so they’ll push their bodies to the breaking point. “Even when they can barely walk or have consistent knee or joint pain, many of them would rather work through the pain than give their body the rest it needs to heal.”
3. It can be difficult to determine when someone has a problem
Because exercise promotes wellness and is generally considered a good thing, it’s tough for people to tell when exercise becomes problematic. Compulsive over-exercising isn’t necessarily about the amount of exercise. Rather, it’s about pinpointing when it becomes out of balance, or when the drive to exercise is coming from a disordered place, says Ilene Fishman, a licensed social worker who’s treated people with eating disorders for three decades in New York City.
Should You Exercise During Recovery From Anorexia? Part 1
In this first post we start with the physiology and then move on to the psychology. And then in the sequel we offer some practical suggestions for how to exercise, or not, in your own recovery. Our focus will be on anorexia and other restrictive eating disorders, but many points will apply more broadly across the eating-disorder spectrum.
Starvation, hormones and exercise
A common argument for wanting to continue to exercise in recovery is thatexercise is a healthy pursuit, with the associated concern that refraining from physical activity during weight restoration would equate to becoming ‘unhealthy’ or ‘unfit’. This harks back to societal concerns about the ‘obesity epidemic’ and the assertion that doctors are always telling people they need to take more exercise (and eat less sugar/fat etc.) to reduce their risk of heart disease, type 2 diabetes and all manner of other modern-world afflictions. The evidence on which these recommendations are based is shaky at best, but the message is pervasive nonetheless.
Diet and exercise recommendations made by medical professionals to the general population as a whole DO NOT apply to people in recovery from anorexia. (They also don’t apply to many other ill people who, likewise, either have to remind themselves of this fact and resist the widespread pressure, or risk exacerbating their illness.) Attempting to use the health argument to justify a behaviour that is contributing to energy deficit during starvation and thus helping perpetuate a life-threatening illness is classic eating-disorder logic. It is highly unlikely that your motivation for going out for a run at 5 am in the cold, dark, wind, and rain is to benefit your health. If you are suffering from anorexia, you are not going to develop heart disease or type 2 diabetes by resting as you weight-restore. And there will be plenty of time for fitness once you are fully recovered, if you want there to be.
So, let’s have a look at the evidence – is exercise healthy for those in recovery from anorexia?
One basic problem with exercise during starvation is that it puts even more physical stress on an already weakened body, exacerbating endocrine adaptations to malnutrition and energy deficit. A vicious cycle develops, centred on dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, which is responsible for production of reproductive hormones in both women and men.During starvation, hypothalamic production of gonadotropin-releasing hormone (GnRH) decreases to pre-pubertal levels. This leads to reduced production of luteinising hormone (LH) and follicle-stimulating hormone (FSH), which in turn leads to decreased synthesis of oestrogen and testosterone. In women, this often (but not always) results in cessation of menstruation (amenorrhoea), an indication of extreme physiological stress. Although this clear physiological marker is obviously not applicable to men or post-menopausal women, the underlying hormonal dysfunction and resultant adverse consequences are the same.
Additional hormonal adaptations take place in response to chronic energy deficit, which have serious adverse effects on bone health and body composition. Low levels of growth hormone (GH) and insulin-like growth factor (IGF-1), and high levels of the stress hormone cortisol, cause rapid reduction in bone density and changes to the microarchitectural skeletal structure. This leads to an increase in fracture risk that may be irreversible (Fuqua et al., 2013). Additional consequences include increased catecholamines and ghrelin, and decreased leptin and thyroid hormone (Allaway et al., 2016).
All these hormonal changes collectively result in high levels of blood glucose and cholesterol, causing problems for the cardiovascular system. Adverse affects on body composition also ensue, with excess cortisol contributing to wastage of lean muscle tissue and fat accumulation with preferential deposition around the midsection. So ironically, the long-term physical consequences of continuing to exercise while malnourished are precisely the opposite of what your exercise may be intended to achieve: an increased ratio of fat:lean tissue and a reduction in bone mineral density (Mountjoy et al., 2014).
Excessive exercise may also have a negative impact on your metabolism: the chemical processes by which your body uses food for energy and growth. The basal metabolic rate in response to the energy deficit (Loucks et al., 2003). Essentially, the metabolic rate slows down to conserve vital energy in the context of chronic over-expenditure.
Most research in this area has been done with athletes. Energy deficit has been found to correlate with decreased basal metabolic rate in female endurance athletes (Melin et al., 2015), whilst increasing training over 4 weeks in rowers of both sexes led to a significant reduction in basal metabolic rate (Woods et al., 2017). Women with an energy deficit brought about through diet and exercise have been shown to lose less weight than predicted over a 3-month period, again with a significant reduction in basal metabolic rate (Koehler et al., 2017). In this context, adequate rest and energy intake through good nutrition is essential to redress the balance and allow the metabolism and the rest of the body to heal.
When the body is nutritionally stressed and hormonally depleted, exercise exacerbates the physiological consequences of anorexia. Once nutritional rehabilitation has taken place and energy intake is consistently sufficient, however, the effects of physical activity are more positive. This means that good nutrition, weight restoration, and normal hormonal physiology are crucial to deciding whether, in purely physiological terms, exercise is safe and advisable. And the presence or absence of menstruation is a good first clue as to whether ‘normal or abnormal hormonal physiology’ is what you’re dealing with.
This point can be demonstrated by considering the effect of exercise on bone health. Osteopenia (mildly lowered bone mineral density) and osteoporosis (more severely lowered density) are common effects of restrictive eating disorders, and once osteoporosis is present, the risk of bone fractures is significantly increased. Once fractures have occurred, pain often remains even after healing, becoming more pervasive as the bones incur more damage.
The role of exercise is critical here. In the presence of adequate estrogen or testosterone, exercise increases bone density (Ackerman et al., 2012). In the presence of HPA dysfunction, however, exercise exacerbates bone loss. Studies of athletes with HPA dysfunction consistently show impaired bone density compared to athletes with normal menstrual cycles and healthy controls (e.g. Christo et al., 2008; Nazem and Ackerman, 2012).
For eating disorders specifically, an observational study comparing women with anorexia and amenorrhoea with a weight-restored recovered group whose menstrual cycle had returned to normal found that those who were still ill who exercised even moderately, including restlessly walking around, developed worse bone density than ill patients who didn’t exercise. After recovery, however, all exercise (including high bone-loading exercise) was associated with better bone density compared with not exercising at all (Waugh et al., 2011). So although these findings were only correlational not causal, excessive moderate bone-loading exercise (like walking, elliptical etc.) while ill may put people with anorexia at higher risk of low bone mass, whereas high bone-loading activities (like running) may enhance bone restoration after recovery. And overall the associations between inadequate nutrition, excessive exercise, hormonal dysfunction, and bone damage are incontrovertible.
Adding force to these observational studies, an experimental intervention involving weight-bearing and impact-loading exercise for post-menopausal women with osteoporosis recently demonstrated, for the first time, that severe bone density loss can be reversed (not just halted or slowed) through exercise (Watson et al., 2017). The participants were all otherwise healthy, including in bodyweight terms (the average BMI was around 24). So once everything else is back to normal, exercise can contribute to repairing the damage done by illness. Before that, it cannot.
We need to be very clear here that having a regular period should be viewed as no more than a bare minimum indicator of some form of hormonal balance. The point is that amenorrhoea is a red flag signifying extreme dysfunction – NOT that having a period means all is well. As discussed in this post, the presence or absence of a menstrual cycle in any individual at a given time is the result of a long evolutionary process wherein different survival constraints were in play, and so menstruation is only a crude indicator of the many contributors to health that we have the luxury of caring about now.
Resumption, or lack of cessation, of menstruation should not be taken as a green light to engage in intense exercise before full recovery: getting a period does not mean you can lace up your running shoes and sign up for a marathon to raise money for Beat. There are other very important and relevant physical and psychological factors to consider.
Anorexia has numerous serious physical effects in addition to those already discussed. Some of these, like bone density loss, are silent – and can be present at any weight. People with anorexia often feel well despite the existence of significant and dangerous medical problems, which may come to light only when the body is subjected to additional physical stress. The heart muscle can become wasted and weakened through starvation and unable to withstand the additional demands of increased activity. Exercise in the context of electrolyte abnormalities (which are particularly common in purging subtypes) can be lethal. Disturbances in potassium levels can induce dangerous heart arrhythmias and result in cardiac arrest and sudden death.
Excessive water consumption during endurance activity can cause fluid shifts leading to critically low sodium levels (hyponatraemia) and a severe form of brain damage called central pontine myelinolysis (CPM). Blood glucose levels can be very unstable during anorexia, with extreme highs (hyperglycaemia) and lows (hypoglycaemia) both observed. Hypoglycaemia can be exacerbated through exercise as blood sugar is rapidly consumed to provide the muscles with fuel, resulting in irreversible brain damage or death. If you know you have any of these medical problems, you should make sure they’re resolved before even considering reintroducing structured physical activity into your life. The catch is, you may not necessarily know.
The bigger picture: Careful exercise really can make you feel better
The upshot from the physiological evidence, then, is: if you’re underweight and amenorrheic, don’t exercise until you are weight restored and your period returns. But does this mean that you should lie in bed until this happens, and plunge straight back into a full high-intensity exercise schedule once it has? No, it doesn’t. Here we return to some of our sliding-scale questions: the question of what we actually mean when we say exercise, and the question of what benefits and risks we decide matter more to us.
In her recent book Sick Enough: A Guide to the Medical Complications of Eating Disorders (2018), medic and eating disorder clinic founder Jennifer Gaudiani argues that although ‘serious exercise is a privilege of full recovery , movement during weight restoration makes recovery sustainable’. Gaudiani believes that physical movement should be part of the recovery process for all but the most physically depleted patients. She has observed that
very weak patients would brighten and glow as they saw rest, nutrition and expert physical and occupational therapy result in stronger, more independent bodies. They accepted nutrition and rest more readily because they saw improvements in their functional status.
In her clinic, Gaudiani recommends a slow increase in movement incorporating a variety of activities such as yoga, walking, and free weights, with rest days in between, and with additional nutrition if needed. She acknowledges this may contribute to some bone density loss in patients with HPA dysfunction, but feels that a sustainable plan involving movement can lead to earlier achievement of full eating-disorder recovery, which will have a better long-term overall effect on bone health.
In Gaudiani’s view, forbidding people in recovery from undertaking any form of physical activity unintentionally reinforces the disordered perception that the sole purpose of movement is to burn calories and prevent weight gain. In this way, a policy of strict rest may inadvertently exaggerate the tightness of the links between exercise, weight, and calorie intake, giving credence to the complex and rigid calorie input-output calculations and calibrations that often characterize anorexia.
So the toss-up here is whether or not we prioritize longer-term potential benefits over short-term dangers: the possibly increased likelihood of full and swift recovery over the probably increased likelihood of some temporary bone damage. It’s a hard call to make, and making the right call depends on giving careful consideration to both the precise physical nature of the exercise being contemplated, and the care with which its possible benefits and risks are managed for you as an individual. This is an even harder line to tread if you’re recovering without intensive professional support, so – as we’ll go on to suggest in Part II – there’s a strong argument for keeping things simpler for yourself by abstaining from anything structured until you’re well on the way to fully recovered.
The even bigger picture: The psychology of compulsion and the dangers of setting conditions for weight gain
Like everything else about eating disorders, the costs and benefits of exercise are a combination of physical and psychological: we ignore either at our peril. When it comes to continuing exercise during recovery, the biggest psychological dangers are probably 1) leaving obsessive-compulsive aspects of the disorder unchallenged, and 2) setting conditions for weight restoration. And the two are intimately intertwined.
Anorexia always involves obsessive-compulsive rituals of some kind. Most often the central ones are food-related: immovable requirements (far beyond preferences) for time and place and other contexts of eating, for the type and amount of food itself, for the speed of eating, and so on. Often these requirements extend beyond the eating to encompass things that make it acceptable to eat – and exercise is the obvious candidate here: eating is not acceptable unless I’ve completed my daily workout, say.
For Emily, exercise was never a huge part of her anorexia.The rules were very food-centric, and although a bike ride did happen every day, it never got longer or more intense over the years, and although she fretted about exercise levels if she was away from home (and usually replaced cycling with something else, like walking), the desire not to spend too much time away from work prevented the exercise demands from spiraling as the food once had – one arguably positive example of one obsession trumping another, perhaps.
Source: Karen Photiou
For Karen, the same was true in her first episode of teenage illness, in which her anorexia was characterized solely by starvation, perfectionism, and obsessive academic work. Following weight restoration, she had a desire to move away from her former life as an over-achieving stick insect clinging to a radiator and took up running – with the intention of developing strength and fitness and learning to appreciate her body for its functionality rather than aesthetics. The aim was not weight loss, but anorexia can be a cunning shape-shifter. Over the years her running became increasingly frequent and intense, with rigid rules forming around timings and distances – all of which were disguised by the socially acceptable rationales of training for races, self-discipline, and remaining ‘fit and healthy’. Until her weight fell to a point below which she could no longer pretend (to herself or anyone else) that she was healthy or motivated by the attempt to be so, and she realised that missing a daily run or eating more felt impossible.
For both of us, having some time without any of these previously non-negotiable kinds of exercise was crucial in kicking the habit. Emily did it in an ad hoc way, as life started to expand and she was able to go on trips and spend time with people and let go, one by one, of all the aspects of her previously highly rigid solitary daily routines. Karen needed a period of complete abstinence from exercise to break the rigid rules and conditions and allow movement to become a choice, rather than a compulsion.
Some eating-disorder therapists and recovery coaches recommend a prolonged period of complete rest from both structured exercise and low-level movement for everyone in recovery, regardless of weight or exercise history. We broadly agree that a period of total rest is important for everyone. But there is no empirical evidence base on this topic, and there exist no specific, categorical recommendations for how long those in recovery should refrain from exercise. This is highly individual – the goal on the psychological side is to break any links between exercise and eating and allow enough time for any obsessive and compulsive elements to dissipate.
Source: Karen Photiou
So in summary, keeping exercising during recovery from anorexia is not a way to stay healthy. Healthy for you means resting while your body repairs itself, and not putting yourself at risk of any of the ways exercise can exacerbate the physical damage done by anorexia. Healthy for you means allowing your body’s fat reserves to be replenished, so they can return to playing the crucial regulatory role they’re meant to in a fully functioning endocrine system. Healthy for you means remembering that muscle mass can’t be effectively built up in conditions of nutritional deprivation. Healthy for you means knowing that the research on bodyweight overshoot (letting your bodyweight increase during recovery to a level beyond where it will ultimately stabilize) is nowhere near well advanced enough to predict how different activity levels may affect your overall weight gain, but that accepting you can’t know exactly where your weight will stabilize is necessary for full recovery.
What does all this mean in practice? In the sequel to this post, we go on to suggest some practical strategies for weaning yourself off whatever kind of exercise addiction may be part of your eating disorder. Read Part II here.
By Erin Risius, MA, LPC, Program Director at Green Mountain at Fox Run
For those struggling with binge eating disorder, their exercise patterns tend to mirror their eating patterns – falling prey to an all-or-nothing tendency. With food, this involves a restriction/binge cycle and for exercise, this all-or-nothing tendency usually shows up as a cycle of no pain/no gain exercise and then being sedentary.
The no pain/no gain approach inevitably creates a psychological resistance to movement primarily due to the approach – not the lack of willpower on behalf of the person (think: New Year’s Resolutions).
Add to this, potential childhood scars around exercise (think: gym class) and/or orthopedic conditions and mobility challenges that make movement painful, and exercise can easily be seen as the “enemy” – something that must be endured and certainly not enjoyed.
Learning Not to Dread Exercise
Regardless of whether this view of exercise stems from early experiences, recent experiences or both, the result is that exercise is avoided – not embraced. However, in order to heal one’s relationship with the body – and in the end, with Self – finding a way to move healthfully in the body one has today will be important for the BED recovery process.
At Green Mountain, women come to us dreading the exercise part of our program, fearing it will be another boot camp, but instead they are met with an approach that makes them feel exercise is not only doable – but enjoyable.
This shift in perspective is what enables them to leave feeling empowered and encouraged to continue movement on their own. With that in mind, here are four key strategies that help those struggling with BED to climb out of the all-or-nothing pattern with exercise and into a consistent practice of healthy movement.
Woman – Center Thyself.
The practice of mindfulness forms the foundation of our approach to helping women reconnect their minds to their bodies. Those struggling with BED often feel cut off from their bodies and our goal is to help them to get off auto-pilot and begin to tune into their thoughts, emotions, and bodies.
This process requires the practice of centering – of taking a moment to connect to the here-and-now experience and to their physical core – before starting an exercise. This involves a conscious physical alignment of their spine so that whether a woman is walking, strength training, or stretching she starts by actively tuning IN to the body before movement.
Easy does it.
Since many women who come into our program are used to the all-or-nothing approach our goal is to help them to experience ‘middle ground’ with movement around exercise intensity, frequency, and duration. Therefore, we teach them how to use the Rating of Perceived Exertion scale (RPE) with cardiovascular, strength and flexibility training while aiming for moderate intensity with all exercises.
Working at moderate intensity (5 – 7 on a scale of 1 – 10) creates the feeling that exercise is doable, which instills a sense of confidence to enhance the fitness level without gasping for air or pushing through the burn. This approach sets up a psychological reinforcement toward exercise adherence.
Modifying exercise for the body one has today.
All of our exercise classes have special modifications that take into account different intensity levels, orthopedic injuries/conditions and mobility levels. We adapt the exercise to our participants’ bodies, not vice versa. For example, participants at Green Mountain learn how to honor their shoulder, knee, or low back conditions, and to work with not against their body’s capabilities.
Learning how to honor the body’s cues in the moment is crucial for cultivating body awareness, reducing discomfort and enhancing the enjoyment of movement, which has a positive impact on exercise consistency and duration.
Typically the default button around movement is set to ‘sedentary’ before entering our program, so easing into rather than diving into an exercise program requires caution and patience to build upon one’s successes. Keeping one’s expectations in check and then re-evaluating them regularly is important for preventing the relapse into an all-or-nothing pattern with movement.
Focusing on the measurements of success outside of weight loss (i.e., increased endurance, strength, and flexibility) helps one to focus on the practice of self-care instead of measuring success through the tunnel vision of weight loss.
Discover the joy in movement.
When it comes to exercise, it’s important to explore a variety of exercises to find out which ones are personally enjoyable – or at the very least – tolerable.
- Exercising alone or in a group
- Exercising on machines versus exercising outside
Green Mountain provides a lot of fitness options so our participants can discover their own fitness style.
Exploring What Feels Right
Instead of trying to fit into someone else’s fitness approach, we encourage participants to explore what feels right for them by providing a safe environment in which to explore. Collaborating on creating an exercise program enables them to take into account their preferences and body conditions.
This helps ensure that exercise becomes a way of life – instead of just a means to an end. This shift in perspective around movement enables one to deepen their connection to the body, which is a crucial part of the BED recovery process.
Exercise is seen as this really healthy thing within society. We praise each other for fitness goals: steps taken, higher weights lifted, more complex yoga poses mastered, and further distances achieved in our runs. Exercise is not something we simply do for our bodies, but has now become the latest investment for our minds and mental health as well.
On the surface, this is an incredibly positive message for those who’ve never had a strained relationship with exercise. Moving your body to support your mood is something I definitely support, but the motivation behind it must come from the right place.
The truth is moving your body can be a truly amazing and pleasurable experience, or it can feel like punishment if you’re in a bad head-space with food, self-image and self-worth.
I personally experienced the latter for several years when I was struggling with anorexia/orthorexia and can hand over heart admit I was addicted to movement for the wrong reasons.
Do you feel like exercise is controlling your life? Join us in the School of Recovery to learn to balance your mind and body with movement.
How ED Interferes
Having an eating disorder changes the way you think. Your mind becomes a check-list of must-do’s and you’re almost convinced that these actions are your true values. On the surface I convinced myself and others that the workouts I was doing were purely for my mood and enjoyment, but the truth is I was still uncomfortable in my changing body and fearful of the physical restoration I so desperately needed.
So what changed?
Did I magically wake up one day and experience radical self-love and acceptance?
Far from it!
Instead it was a gentle letting go of the movement that no longer served me, and a thinking process that was flawed and perpetuated by diet culture messages. Instead I focused on my ‘why’, which was rebuilding a life where my head-space could be free from thoughts of food, exercise and my body. All of this took years, and was a process of trial and error, but I’ve recounted the main things that helped me below in the hopes that it might support your own healing journey.
4 Ways to Cultivate Healing in Movement
1. I stopped running like a tiger was chasing me
Previously when I went to the gym, for a run, or even to a yoga class, I only had one speed – all out. I knew long term this was unsustainable so I had to ask myself: how do I make exercise (an activity I really enjoy) one that’s more sensible, respectful to my body and mind, and supportive of my recovery needs? The answer was to slow down.
2. Make movement more mindful
I started to engage my senses when I was exercising. If I went for a walk, I took notice of what was around me, what the air smelled like, how my hair felt in the breeze, and change in footing under my feet. I would stop to take a picture of something pretty, or to pat a dog that was cute. In essence I became engaged in what I was doing, never rushed and had no expectation of smashing or setting a “personal best”.
3. I stopped when I was tired
This seems pretty common-sense but can be difficult for those who’ve previously pushed themselves to the extreme. I thought tiredness meant weakness, but I was SO wrong. I started to recognise that my body was talking to me and for years I was ignoring the signs that I needed to SLOW DOWN and rest. Subsequently I had days where I had more energy than I’d ever experienced before to think, be productive in other areas of my life, and still enjoy a bit of exercise.
4. I decided to quit the gym
Something I never thought I’d do, but it was a place that never ‘sparked joy’ as Marie Kondo puts it. It always reminded me of the days I pushed too hard and I needed a new environment and clean state to start exercising in a more balanced way again. So, I started practicing Pilates, Yoga, and going for walks instead. Then when I was ready I joined up to a studio that ran group exercise classes, and loved the community environment and friendships I built through that.
This whole process above took me YEARS, but now I can honestly say I have a very healthy and balanced relationship with exercise, and I now move my body to have fun!
When you put in the hard work during recovery over time strict exercise regimens fall by the wayside, your self-compassion grows and you start to move your body because it feels good, not because you have to.
I used to go to a gym where an incredibly thin woman regularly worked out.
And by regularly, I mean she was there every time I went.
She’d be on the gym floor for hours, slogging away on the treadmill for hours – not really going at any great pace but no doubt covering miles.
It was painful to watch her as she doggedly carried on, looking increasingly frail.
My mum’s got gym pals who spend entire days on stepper machines. I’ve swum alongside ill-looking women doing hundreds of laps in my local swimming pool. Most of us have clocked someone who regularly cycles marathons on static bikes.
Don’t gyms have a responsibility to reject these guys who are on a mission to exercise themselves into the ground?
It seems morally wrong to make money out of ill people.
Anorexia obviously comes with a whole host of health complications. You’re way more at risk from osteoporosis which means that your bones basically start crumbling – not ideal if you’re hellbent on burning hundreds of calories on the treadmill.
You’re also more likely to suffer from low blood pressure (which makes you feel faint), blood pooling (leads to swelling in hands and feet), poor circulation and eventually, heart failure.
(Picture: Ella Byworth for Metro.co.uk)
There’s definitely an argument for gyms putting a stop to underweight people vigorously working out and I’ve never really understood why they don’t seem to intervene.
But when I put the question to a PT examiner at TRAINFITNESS, she explained that possibly the worst thing gyms could do would be to turn ill people away.
‘If an anorexic person is in the gym, they’re not off obsessively exercising on their own,’ she said.
‘I can keep an eye on them and there are enough qualified people here to step in if there is a medical emergency. If a gym were to ban them, they’ll go off and find a way to exercise anyway – but there’ll be no one around to help them if something happens.’
She’s right of course. The thing about eating disorders is that they’re sly and they don’t listen to reason. Someone in the grips of one will find any means to exercise if they want to – whether that’s in a gym or a bathroom floor.
So, what can PTs do about it?
‘It’s clearly a very delicate matter and a grey area when it comes to ethics and legality,’ celebrity trainer Scott Laidler tells Metro.co.uk.
‘It’s quite obvious that a blanket ban on anorexics or very slim people would be a bad move – recovering anorexics are encouraged to use resistance training to regain some healthy muscle mass, so it would be very heavy handed to interrupt someone in the early stages of recovery. On the other hand, we might consider it unethical to allow someone to engage in behaviour that was clearly detrimental to their health without at least some form of discourse.
(Picture: Ella Byworth for Metro.co.uk)
‘I’m not a legal expert but gym users will generally have agreed to use health club equipment in a healthy and safe manner when signing up, so if for example, they were both very underweight and doing hours of cardio in an obvious attempt to burn excessive calories, this may be deemed a breach of gym policy. However, on the surface, this behaviour could technically be likened to a healthy individual training for an endurance event, which could blur the perception of why they have been highlighted.’
Consider an opposite scenario, where a fast food outlet refused to serve someone who is dangerously overweight. Would that intervention be deemed discriminatory…or responsible? You can imagine the outrage if McDonald’s started to screen potential customers’ BMI before allowing them to order a Big Mac.
What if we had the additional knowledge that this person had exercised every day that week and eaten a healthy diet and their one reward for such dedication was a single cheat meal at their favourite fast food restaurant?
‘Unfortunately, we live in an age where even the best of intentions can be marred by political correctness, so it’s a bit difficult to imagine how a health club could bring plenty of negative intention upon itself by showing concern,’ Scott continues.
‘It’s not the responsibility or right of gym staff across the country to police their members but as health and fitness professionals, they’ll likely possess a quicker ability to get a sense for healthy and unhealthy behaviour and psychology as it relates to exercise than most people. It’s always going to be a matter of personal opinion but we have seen staff interventions such as in the case of Caitlin Miller save young people from pushing the limits of their health to such a low point that perhaps they would not have been able to return from.’
The trainer from Train Fitness told me that your only real option as a fitness professional is to build a rapport with people and hope that eventually, they feel able to open up to you.
(Picture: Ella Byworth for Metro.co.uk)
Even if that doesn’t explicitly happen, just knowing that someone is interested and cares might be the thing a potentially ill person needs.
Gyms have an opportunity to help ill people – if they have the time and resources.
Laurence Fountaine is a founder and PT at Salus London and he’s got a whole raft of experience training former and current models and fashion-y types. His approach to fitness is very much a holistic one – focusing on wellbeing rather than weight.
I asked him if he’d ever turn someone away for being underweight.
‘No at all – we’d try and work on the concept of being healthy over anything else and that looking good is just a side effect of that,’ he tells Metro.co.uk.
‘I’d probably also try to limit their training but only like I’d do anyone – only until they could handle the stress of training at a higher frequency. And then when it comes to goal settings, we’d make it more about strength than body composition so they have something else to focus on. Generally, if you want to get stronger, you need to focus more on your food so that’s a good way to inspire someone to eat a little more.’
But it’s obviously a lot harder to intervene when you work for a mainstream gym. For PTs who collect clients on the gym floor at chain gyms, their hands are sort of tied.
Rob Leiby, a PT at Virgin Active, tells Metro.co.uk that the whole thing’s a bit of a grey area.
‘It’s such a tricky one. Imagine if gyms started banning “dangerously fat” people! Also, anorexia – for example – is a mental health issue, so you really have to tread carefully.
‘Personally, if I was training someone or they came to me, I would do all I could to help in terms of educating that person on the importance of proper nutrition and lifestyle then I’d make sure I kept an eye on them. If I just saw someone working out on the gym floor, it would be such a difficult one to approach without it becoming a tricky situation.’
The potential for awkwardness and making people feel even worse, you can imagine, would be huge.
Even so, Beat – the eating disorder charity, want gyms to take more responsibility for the wellbeing of their potentially vulnerable clients
‘We would like to see gyms and health clubs becoming more aware of eating disorders and put in place policies and safe working practices that would reduce the known risks. Policies could look at enrolment/ membership systems and the types of health-related information collected; staff training; and ensuring confidential access to information and support for their clients and customers if necessary,’ a spokesperson tells Metro.co.uk.
(Picture: Ella Byworth for Metro.co.uk)
It’s not just a female issue.
Body dysmorphia can affect men and women, with men being particularly at risk from things like Adonis Syndrome – obsessing over the size of their muscles. And that can be incredibly dangerous, both mentally and physically as that person exercises ever more excessively.
Beat’s spokesperson again: ‘While young girls and women aged 12-25 are most at risk, eating disorders can affect anyone at any age. Boys and young men are more likely to use exercise rather than extreme dieting to control their body shape and size. Gyms should be aware of these behaviours, and realise that it isn’t just about being underweight. People with Bulimia nervosa are over-exercising too, and they are most likely to be at normal weight.
‘Eating disorders are serious mental illnesses that cause lasting damage and may be fatal if they are left untreated. But they are also entirely treatable and full recovery is possible. The earlier someone gets the right treatment for their eating disorder, the more likely they are to make a full and sustained recovery.
‘Over-exercising is one of the signs of somebody suffering from an eating disorder, if a person is worried somebody is showing a sign of ED they should act quickly and get in touch with us or their GP.
‘Our ‘spot the signs’ poster has been displayed in many GP practices, schools and community centres and gyms are welcome to contacts us if they would like to display one for their customers.
‘We know that it can be very difficult to tell somebody you are worried about them having an eating disorder – you might feel like you’re accusing the person of doing something wrong, or that it’s insulting to them. But they haven’t done anything wrong, and you’re concerned for a reason. It’s always better to approach the person with compassion and understanding so that they can get the help they need as soon as possible.’
If you’re struggling with an eating disorder or know someone who is, you can contact Beat on their helpline: 0808 801 0677, their youthline: 0808 801 0711, or via their website.
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How To Work Out When Recovering From Anorexia Athletica
There are two forms of the eating disorder known as Anorexia. Usually, when we think of this condition, we think of Anorexia Nervosa, however Anorexia Athletica is its other form. Anorexia is recognized by the APA (American Psychiatric Association) as an eating disorder, and while Anorexia Athletica is not yet recognized as its own distinct version of this illness, it is a well-known and often used term within the mental health sector.
How Is Anorexia Athletica Different From Anorexia Nervosa
Anorexia Athletica is characterized by disordered behavior patterns that center around obsessive and excessive exercise. This is in contrast with Anorexia Nervosa which primarily focuses on weight and food.
Anorexia Athletica is sometimes known as Sports Anorexia, Hypergymnasia or even Compulsive Exercise. It is seen in people of all ages and from all walks of life, although it is most frequently observed in serious athletes playing sports which emphasize a petite or lean body type.
Unlike people with Anorexia Nervosa, those suffering from the Athletica form of the eating disorder don’t tend to focus on the way they look. Instead, their focus is purely on their athletic performance. Usually, they measure their own self-worth through comparisons with successful competitors within their sporting field.
The Problems With Detecting Anorexia Athletica
A major problem with diagnosing someone with Anorexia Athletica lies in the fact that exercise is supposed to be good for us.
This makes it difficult for doctors to pinpoint the difference between an unhealthy and a healthy pattern of exercise. However, those suffering from Anorexia Athletica will spend considerably more time working out than necessary for their athletic performance or health and well-being. In fact, they will continue to work out even if they are injured or sick.
People with chronic emotional problems such as depression, poor self-esteem and anxiety are more at risk of developing Anorexia Athletica. This is also the case with Anorexia Nervosa, and some of the symptoms are quite similar. For example, both forms of the condition see the obsessive preoccupation acting as a coping mechanism or outlet for emotional issues. However, there are other symptoms which are specific to the Athletica form of the condition, and these include:
- A long-term preoccupation with working out and exercise
- A weight loss of more than 5 percent of their body weight
- Feelings of anxiety or guilt for not following a self-imposed exercise regime
- Exercising rather than going to school or work
- Working out even when injured or ill
- Feeling isolated while working out
- Lying to others about how much or how often they work out
- Only thinking about food in terms of its relationship with exercise
- Basing own self-worth on how much exercise has been completed every day
- Blaming weight loss on exercise and training necessary to stay competitive within chosen sporting field as a way of hiding the condition
If somebody obsessively exercises on a daily basis, their body has no opportunity to heal, recover and rest. Overtraining syndrome causes many problems including:
- Chronic fatigue
- Reduced athletic performance
- Increased risks of injury
- Suppressed immune system
- Menstrual irregularities
- Lost muscle mass
- Damaged joints, tendons, ligaments and cartilage
- Heart irregularities
It’s clear from all of these symptoms and risks that it’s important to get professional help for anyone suffering from Anorexia Athletica, and there is medical support available for those who are ready to get better. However, what happens for those in recovery from this eating disorder when the time comes to start exercising again? How can they work out safely while in recovery without falling back into the trap of their eating disorder once more?
The Early Stages Of Recovery
Usually, the formal treatment given to those suffering from both forms of Anorexia involves minimizing physical activity so that all calories the individual consumes will support the restoration of their weight and their nutritional rehabilitation. Experts also maintain that avoiding exercise during this early recovery period is important to avoid the psychological damage which could be caused by carrying on the obsessive compulsive elements of this disorder.
While this makes sense, it’s also important to recognize that at some stage of recovery, a healthier relationship needs to be established with activity and movement. It’s impossible to simply abstain from all physical activities after recovering from an eating disorder, and indeed it wouldn’t be desirable to do so since staying active is a key part of being fit and well in the long term. So, how do you manage to adhere to sensible guidelines on physical activity without becoming obsessed with working out once more?
Asking The Right Questions
The lines that divide unnecessary and necessary movement can be difficult to see clearly, and this means that those in recovery from Anorexia Athletica need to ask themselves the right questions when it comes to physical activity levels during recovery:
- What kind of activity, sport or exercise is most and least likely to be harmful or helpful?
- Where does the boundary lie between optional and functional exercise, and what risks or benefits exist of doing either?
- How do the psychological and physiological benefits and risks compare?
By defining the answers to these questions, it’s possible to determine the right level of physical activity during the recovery period. However, there are other factors to bear in mind that we’ll take a closer look at here.
Is Exercise Healthy For Someone Recovering From Anorexia Athletica?
When someone exercises excessively, their body endures severe physical stress. This results in hormonal dysfunctions, an adverse effect on body composition, negative impacts on metabolism and the physiological consequences that all of this brings. However, once the sufferer has undergone nutritional rehabilitation and are intaking a sufficient amount of food, the effect of any physical activity will be much more positive. Therefore, as long as someone in recovery from Anorexia Athletica is eating well, has restored their bodyweight and has a normal hormonal physiology, in physiological terms, working out is advisable and safe for them.
Exercise even offers some positive health benefits for those whose body has suffered as a result of an eating disorder. When someone exercises excessively while malnourished, their bone health deteriorates, with osteoporosis being a serious risk and the chance of fractures increasing. Once their nutrition has improved, however, and they have returned to a normal bodyweight, all forms of exercise actually improves bone density, helping to reverse some of the damage caused by Anorexia Athletica.
Once someone has restored their body weight after suffering from Anorexia Athletica, they may also find that taking some exercise improves their mental health. Exercise is known to release endorphins which are feel-good hormones in the brain. This helps to stave off the anxiety and depression which can co-occur alongside eating disorders, helping to improve quality of life and boost recovery in the long-term.
How Much Exercise Is Too Much?
Since it seems clear that once someone who is in recovery from Anorexia Athletica can benefit from taking some physical exercise once their bodyweight has been restored and once they are properly nourished again, the next question is how much exercise is too much?
Lying in bed while you’re waiting for your bodyweight to be restored is certainly a bad idea, but so is plunging right back into a high-intensity workout schedule once you’ve been given the green light to start exercising. This is why doctors suggest that moving during the process of becoming nutritionally restored is important to ensure recovery is sustainable. Some experts believe that if people are forbidden from any kind of physical activities, inadvertently, the disordered perception may be exaggerated that the only reason for exercising is to guard against weight gain and burn calories. This can end up emphasizing the link between weight, calorie intake and exercise which only reinforces the beliefs that have perpetuated the eating disorder in the first place.
The key to success, therefore, lies in slowly increasing the amount of movement added into the individual’s daily schedule. Activities like free weights, walking and yoga are the best choice as a starting point for returning to exercise, but it’s important to have rest days between periods of exercise. With this in mind, here are some top tips to finding the right balance and making peace with physical exercise during recovery.
Top Tips For Exercising Safely During Recovery
- The first piece of advice that can be given to those who are trying to exercise safely during their recovery from Anorexia Athletica is to let go of all those old beliefs about diet and exercise. It can only be building up a new relationship with physical activity that a healthy attitude can be adopted.
- Bringing curiosity into your exercise regime. Try some new fun physical activities rather than sticking to the same old routine that you used when you were in the throes of your eating disorder. Try something you’ve never tried before such as ice skating or rock climbing rather than heading straight to the gym and hitting the treadmill. By varying your activities, you can avoid getting stuck in the rut that exacerbated your condition.
- Listen to what your body has to say. If you feel tired, stop. If you feel unwell, don’t work out.
- Establish a safety net. You can benefit from having structure to your exercise regime. Set yourself a maximum amount of activity time and stick to it. 20 minutes per day or one hour 2 times a week is quite enough in the first year of your recovery.
- Be truthful with yourself. If you’re finding it difficult to control your impulse to exercise excessively while you’re in recovery, acknowledge it and seek advice from your therapist or treatment team. It’s important to accept the help that you are offered but you can only do this by admitting that there is still a problem to be overcome. Hiding away from the issue or pretending that everything is fine is a surefire way to sabotage your recovery.
Preventing Exercise From Being Obsessive
When you’re in recovery from Anorexia Athletica, it’s important to be able to take responsibility for yourself and your own well-being. That means being honest with yourself about the purpose of your exercise. Are you working out because you feel you have to or because you actually want to? If you feel as if you’re obliged to worm out, it’s time to stop. It may feel uncomfortable, but it’s important to get used to that feeling in order to break your addiction. The feeling of guilt when you don’t exercise can be hard to overcome but with the right support, you can get through it. Using distraction techniques can be helpful. Finding hobbies and activities which don’t involve exercise such as DIY, art or learning a musical instrument are all useful alternatives to add into your life.
Staying Successful In Recovery
You can successfully recover from Anorexia Athletica and keep exercise as part of your life as long as you take the right precautions and accept the professional support that you are offered. It’s important to remember, though, that you mustn’t exercise until your doctor has cleared you to do so. This won’t happen until you have reached a healthy bodyweight and until your nutritional intake has returned to normal. If you ignore your doctor’s instructions and start exercising too soon, you could cause yourself even more physical harm not to mention delaying or even preventing your long-term recovery.
By staying truthful to yourself and analysing your reasons behind exercising in recovery, you have the best chance of still being able to reap the benefits that physical activity brings without falling back into the eating disorder trap. Keep a check on your motivations for working out and stop (or seek help) if you find that you’re doing it for the wrong reasons. Try introducing some non-physical activities and hobbies into your life to distract you from the compulsion to hit the gym, and remember to introduce sporting activities slowly and steadily into your life rather than plunging straight back in.
Follow these top tips, and you’ll have the best chance of a full and healthy recover from Anorexia Athletica.
If you’re looking for help getting on the road to recovering from Anorexia Athletica, you have options. The Meadowglade is a luxurious facility in Southern California that is well and widely known for its team’s dedication to helping people recover from eating disorders. If you’d like to learn more about how our facility can help you, reach out today!
Should gyms step in on anorexic members?
THERE’S a girl in my gym class who looks like she’s about to faint.
She has large, ‘deer in the headlight’ eyes, her hands are shaking and she looks like she may burst into tears at any moment.
And we haven’t even started training.
She’s so frail she literally teeters and has to do little half squats instead of our regular exercises. A breeze would knock her over.
The personal trainer ignores her.
I don’t know if they have a prior arrangement, if she’s known to the gym or perhaps just the trainer but I do know she’s not the first I’ve seen.
If you’re like me and find yourself at the gym most days, chances are you’ll see someone like I described above. Maybe a few.
They stick in your mind, out of concern at first, but then your thoughts trail to something a little deeper.
Should she be here?
Do they see her?
Should someone who clearly doesn’t have medical clearance be exercising here?
media_camera To date, it’s hard to know just how much gyms are doing to help its clients who clearly have disordered eating and exercise habits. (Pic: supplied)
Fitness Australia has guidelines for these clients that seeks to define, identify and provide step-by-step recommendations for the “sensitive management of clients who fall under the categories of anorexia or disordered exercise”.
The guide, detailed and 47 pages long, was created in 2004 in collaboration with the Fitness First chain and the Centre for Eating and Dieting Disorders. While this certainly sounds good and proper, the ‘2004’ date gives me pause; it predates Instagram (with all its #fitspo glory) and the document itself uses the cheesy WordArt headings of your primary school reports.
Anachronistic headings aside, a couple crucial questions remain: is it being implemented? And should it be updated for a world that now includes social media’s booming #fitspiration?
To test this query, I asked a number of gyms across NSW a simple question: “Do you have a policy regarding clients with anorexia?”
The most common response was: “Not that I know of”. One club, open 24-hours said, “This is something that would be club specific — we don’t have an overall rule,” but conceded that, “There could be a restriction on a membership if requested by a parent or guardian for the person to only have access to a club in the staffed hours so their activity can be monitored what exercise they do.”
Only one club said they had mandatory health checks when members (all members) signed up.
Another franchisee sticks out in memory as being nothing short of abysmal, undeniably the worst out of all those I contacted (a serious concern considering the chain’s prominence).
One of the club’s CBD locations told me, “Not that I remember” and then, “Actually no,” and “I’m not sure. You better call head office” Another said, “I don’t think there’s any policy. Nothing that I know of. I mean, technically it’s discrimination”.
It’s interesting that discrimination is brought up, as it’s a common thought for many.
And as The Butterfly Foundation CEO Christine Morgan points out: “Eating disorders and body image concerns do not discriminate, and can affect all ages, gender identities, socio-economic status, abilities and cultures,” she explains.
media_camera Australian gym guidelines have not been updated since the birth of social media, with its often damaging “fitspo” posts. (Pic: supplied)
This is entirely true and but perhaps in a health setting where an organisation, and its people, should have duty of care, a cry of ‘don’t interfere, it’s discrimination’ by staff is misplaced?
I also spoke to several trainers about the issue and without exception every single one jumped at the chance to speak out. They were deeply troubled about what is commonly regarded as the ‘open secret’ in the fitness community.
One trainer, working at a popular franchise for ten years said they had never had training on what to do if they saw somebody dangerously underweight or exhibiting behaviours consistent with anorexia. They were very concerned about this and had, from afar, encountered the worst imaginable:
“There was a girl who trained at who was severely anorexic and she used to come to classes and just kill herself pushing too hard,” the trainer said.
“It was horrible to watch. They ended up telling her she could only train if she was with a PT and not on her own.”
Another former gym employee spoke of a dangerously thin woman who used to come in every day and run at high speeds on an inclined treadmill.
“Often she would stop and run to the bathrooms and run straight back to the treadmill. Many times she would not make it to the bathroom and would either get diarrhoea on the treadmill or leave a trail of it to the bathrooms.
“She would leave for staff to clean then get back on the treadmill — such is the nature of the disease, making you so focused on the exercise.
“The manager tried to speak with her and get her to see a doctor or bring in a doctor’s letter but the woman would just go to other gyms and do the same, gym-hopping.”
media_camera When workouts move from healthy and into obsessive, should gym staff step in? (Pic: supplied)
Another told me she’d had a few girls faint on her after not eating and running on the treadmill:
“Low sugar collapses happen all the time! It’s so common and awful,” she said.
“The gym I was at, we’d call the ambulance and their guardian and pass the responsibility.”
So should gyms take responsibility for these clients?
After all, gyms certainly appear to be fully servicing other clientele. Those who are overweight, obese, have emotionally disordered eating or are trying to be ‘the best the can be’ consistently have the full backing and enthusiastic support of the gyms they visit. It’s reflected in every scrap of communication from every gym. One step inside and you know, they’re here for you and your health.
So would the gyms’ answers of “I don’t know” and “that’s discrimination” be the same if the client were overweight or obese? Or would they jump at the opportunity to demonstrate their care and ability to achieve results?
The rise of social media is no small issue according to experts.
“We now have constant access to images of people, their food, their lives and quite frequently their bodies,” Morgan explains.
“This can lead to unhelpful comparisons, pressure to achieve a certain body type and may contribute to body dissatisfaction.”
“Sharing your diet and exercise regimen on social media and #fitspo can potentially inspire copycat behaviour without seeking professional advice and guidance to ensure health for the individual. “
At the end of the day, the question is simple:
Should gyms have a greater responsibility/duty of care for the health of anorexic clients?
And Morgan’s response is simple:
“As a society, at the very minimum, we should all have an awareness of eating disorders. Ideally, personal trainers and fitness coaches should receive training to help recognise and refer clients who they think might be at risk.
“In addition to this, gym staff should be supported in their role through education and resources to be able to support their client’s needs both physically and mentally.”
If only this were being done.
If you, or anyone you know is experiencing an eating disorder or body image concerns, you can call the Butterfly Foundation National Helpline on 1800 33 4673 (ED HOPE) or email [email protected]