"I will walk four hours to burn the cake": problematic exercise, the neglected symptom of eating disorders

And you… what do you train for?

It is the first question I ask when I start working with eating disorders (EDs).

These diagnoses, although it may not seem like it a priori, may be related to physical exercise.

These pathologies have increased exponentially in the last 50 years, as

admits .

And its detection is essential.

magazine

indicates that one in five children and adolescents in the world suffers from eating disorders.

“I am going to train to change the appearance of my abdomen”, “I will walk four hours on a treadmill without stopping to burn off the birthday cake that I have eaten” or “with these TikTok videos I am going to lose fat”.

At first glance they are phrases that seem normal, but if we look more deeply they can hide a symptom.

Exercise, like food, is not the problem, they are attempts at a solution.

Around 85% of the patients with these eating disorders could manifest maladaptive or problematic behaviors related to physical activity.

The issue is there and is of particular concern as it is associated with longer treatment times, shorter periods between relapses, exacerbation of disease symptoms, and is often one of the last symptoms to disappear.

healthy vs.

problematic

If I have learned anything during 15 years working with this population, it is that we should avoid quantifying their lives.

There are many "how many", perhaps too many, in the world around us: How many kilos?

How many steps?

How much food?

How many series and repetitions?

Recognizing the signs of problematic exercise can be key in addressing these conditions.

As recognized in recent research, this type of exercise includes two dimensions: quantitative, which refers to the frequency, volume, and duration of training, and qualitative, that associated with cognitions, among which should be taken into account. account attitudes such as obsession, compulsiveness, rigidity or the use of exercise as a tool to obtain a bodily change.

On the other hand, we have healthy exercise that is characterized by its flexibility and serves as a well-being tool that has an impact on a better quality of life.

These nuances could be key when marking the evolution of patients.

Compulsive exercise is present, above all, in two of these disorders: anorexia and bulimia.

So... why isn't it attended to?

A holistic approach

At present, there are discrepancies regarding the prescription of physical activity in these diseases.

Restriction and abstinence during treatment have long been prescribed to prevent it from serving as an obstacle to weight regain.

However, more and more studies and professionals (including psychologists, psychiatrists and nutritionists) are proposing another view: eliminating exercise completely during treatment is unrealistic and potentially detrimental to long-term results.

If we ban all activity, we would be depriving patients of a health tool for the rest of their lives.

Let's imagine someone who exercises three hours a day in front of a YouTube video with the intention of changing the shape of their abs and getting leaner.

If we don't address that symptom, when he leaves therapy and goes back to the gym alone or in front of his tablet, he'll do exactly the same thing again, because he doesn't know any better.

Under supervision

The proposal in the face of a problematic exercise pattern would start from avoiding ignoring it and changing it in a supervised way together with physical activity professionals.

The work towards recovery should be interdisciplinary (doctors, nurses, psychologists, nutritionists and physical trainers).

The goal is to educate.

Many patients are very confused about what is considered “normal” or healthy levels of exercise, and fear doing it again after treatment, in case it may cause them to relapse.

This can be avoided by including physical exercise within the comprehensive approach to these mental illnesses.

Some meta-analyses support that exercise during treatment might decrease drive for thinness, body dissatisfaction, and eating disorder symptoms;

promote weight recovery, strength, well-being, quality of life, mood;

as well as improve cardiac abnormalities.

There is sufficient literature to support that supervised training, especially resistance training, can be safely incorporated into treatment and is beneficial.

Focusing specifically on the

in treatment can help to improve negative beliefs about it and, in turn, promote recovery.

The body is a perfect machine that must be cared for, not worshiped.

Exercise is health, not punishment.

For some time now, my way of living has become my way of fighting against a scourge that affects millions of people, especially women.

Exercise is part of the problem, but also part of the solution.

Movement is life.

Don't take it off, change it.

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