The Thin Line Between Dieting, Exercise & Eating Disorders

Contributor: Staff at McCallum Place

We all miss gyms and restaurants. Getting a good sweat in with professional fitness equipment and dining out are two things we generally took for granted until a few months ago. But the COVID-19 pandemic made these nonessential businesses — places we could see and be seen staying fit or enjoying healthy, Instagram-worthy meals — largely shutter for months on end.

The reality, though, is that in a culture that lives online as much as ours does, even physical distancing doesn’t prevent us from knowing what’s going on with friends, acquaintances, and even those we only know by a social media handle. We can see how many miles an old college roommate ran this week with a few taps on a Fitbit. We can see pictures of a neighbor’s juice cleanse with a couple of swipes on an iPhone.

Even with our routines disrupted, one thing that remains true during these highly unusual times is that too much of what generally seems to be positive can still have many negative effects.

The Downside of Excessive Dieting, Exercise, and an Eating Disorder

We have known for years that dieting, particularly fad diets or fasting, can be negatively linked to the development of eating disorders. According to the National Eating Disorders Association, a large study of 14- and 15-year-olds in 2016 found that those who dieted moderately were five times more likely to develop an eating disorder compared with those who didn’t diet. Those who restricted extremely were 18 times more likely [1].

Diet culture is all around — and, as mentioned earlier, you don’t need to be sharing physical space with people to be immersed in it. After all, for an industry that’s worth $66 billion, it’s almost impossible to distance from the world of weight loss [2].

Dieting is the most important predictor of an eating disorder. That same study from 2016 found that dieting was associated with greater weight gain and increased rates of binge eating in both adolescent boys and girls. Habits formed at a young age are often harder to break, particularly when a person may not have developed the social and emotional wherewithal to understand the risk factors.

But while a fixation on continued dieting has long been correlated with the development of eating disorders, fewer people seem to realize that excessive exercise can have the same effects.

While we can debate the benefits of dieting, there’s no question that exercise can have staggeringly positive effects on a person. From preventing cancers to boosting energy and mood, improving blood pressure, and much more, exercise is the world’s best drug.

What it doesn’t typically do — at least by itself — is lead to significant weight loss. Increasing an exercise program often leads to larger caloric intake or more sustained periods of relaxation to recover, making it difficult to create the substantial calorie deficit needed to lose much weight.

But that’s often not a consideration for many people who are determined to lose a specific amount of weight. How can you tell if you or someone close to you may have a problem with excessive exercise? It’s often hard to see, but generally, it lies in the motivations behind working out instead of the quantity of the sessions. Other warning signs include:

• Secretive exercise
• Exercise as permission to eat
• Discomfort with inactivity
• Intense irritability, depression, or anxiety if unable to exercise
• Withdrawal from loved ones
• Keeping strict regimen despite injury or illness

Excessive exercise has been linked to a number of eating disorders, but it is a particularly common symptom among those who have anorexia nervosa. One study found that between 37% and 54% of anorexia nervosa patients excessively exercise in an attempt to keep weight off [3].

As a patient from another study about exercise explained, “Before I attended treatment, I only sat down during meal times, or else I felt I did not deserve to sit still. I was incredibly restless, so it was difficult to relax. … I feel like I am being compelled to exercise… [4]”

This can be a particular concern for athletes who are fighting to stay fit in order to excel at their respective sports. One survey among college athletic trainers who worked with female athletes discovered that 91% reported dealing with an individual who had an eating disorder [5].

Much like excessive exercise isn’t listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a diagnosis, neither is the term most commonly associated with eating disorders among athletes — anorexia athletica. All the same, the consequences can be dangerous.

What Can Be Done to Help Prevent an Eating Disorder

Some medical professionals argue that it’s important to officially recognize compulsive exercise as a highly prevalent symptom of eating disorders by providing a transdiagnostic definition [6] of where to draw the line between healthy and harmful.

Because eating healthy and regularly exercising are good things when done in moderation, it can be difficult to determine if someone has crossed the line from positive to problematic.

Pay attention to the warning signs — whether they’re your own or those of someone close to you. Spending hours filling out food or activity logs, constantly utilizing food tracking apps, or obsessively analyzing data from workouts generally isn’t a good thing. It’s ignoring your body and simply adhering to numbers to find satisfaction. Spending too much time on social media chasing manufactured perfection is another key problem area.

With the right help, the right people, and — possibly — the right treatment, you can find yourself back on the other side of what’s become a rather murky line of diet and exercise gone too far.

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References

1. Golden, N. H.; Schneider, M.; and Wood, C. (2016). Preventing Obesity and Eating Disorders in Adolescents. Pediatrics, 138(3). doi:10.1542/peds.2016-1649.

2. MarketResearch.com. (2017). U.S. Weight Loss Market Worth $66 Billion. Cision/PR Newswire. Retrieved from: https://www.prnewswire.com/news-releases/us-weight-loss-market-worth-66-billion-300573968.html.

3. Muhlheim, L. (2020). Excessive Exercise as an Eating Disorder Symptom. VeryWellMind. Retrieved from: https://www.verywellmind.com/excessive-exercise-eating-disorder-symptom-4062773.

4. Kolnes, L. J. (2016). Feelings stronger than reason: conflicting experiences of exercise in women with anorexia nervosa. J Eat Disord. 4:6. doi:10.1186/s40337-016-0100-8.

5. Greenleaf, C.; Petrie, T. A.; Carter, J.; and Reel, J. J. (2009). Female Collegiate Athletes: Prevalence of Eating Disorders and Disordered Eating Behaviors. Journal of American College Health, 57:5, 489-496. doi:10.3200/jach.57.5.489-496.

6. Dittmer, N.; Jacobi, C.; and Voderholzer, U. (2018). Compulsive exercise in eating disorders: proposal for a definition and a clinical assessment. J Eat Disord. 6:42. doi: 10.1186/s40337-018-0219-x. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260729/.

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About The Sponsor

McCallum Place is an eating disorder treatment center with locations in St. Louis, Missouri, and Kansas City, Kansas. We provide comprehensive treatment for adolescents and adults. We also offer a specialty treatment program for athletes who are living with eating disorders. Our experienced treatment team works closely with each patient to ensure that they play a central role in their recovery process. We offer a full range of services to meet the unique needs of each patient and address all issues related to the treatment of eating disorders.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published May 18, 2020, on EatingDisorderHope.com
Reviewed & Approved on May 18, 2020, by Jacquelyn Ekern, MS, LPC