By Ami Marsh, MFT, LCADC
Clinical Director, Center for Hope of the Sierras
As a society we are bombarded with ads and information about exercise. Turn on the television, flip through a magazine or peruse the internet and one will hear about the latest fitness craze, the best new workout and the list goes on. It is also true that exercise can be part of a healthy lifestyle. The American Heart Association recommends 30 minutes a day, 5 days week of moderate exercise to keep the cardiovascular system in check. There’s nothing wrong with an active lifestyle or exercise. There are many mental health diagnoses that can be improved when exercise is part of the treatment plan. However, for an individual battling an eating disorder, exercise is often part of the problem and the dilemma for both client and clinician is how and whether it can be part of the solution.
For someone suffering from anorexia or bulimia, exercise is often a way to purge and another coping mechanism for numbing out. It is a way to please the eating disorder voice, to calm and quiet it or even win its approval, though this is short-lived. While exercising, the singular goal is to burn as many calories as possible, to reduce the guilt and shame resulting from a recent binge and to attempt to grasp that elusive happiness that always seems just out of reach because there is always another pound to lose.
Moderate exercise has health benefits of improving mood and sleep, maintaining physical flexibility, increasing energy and improving mood, just to name a few. The key is moderation. Frequently, the barometer for moderation loses its calibration when an eating disorder is present both in regard to eating and exercising. Signs that one is engaging in over-exercising include working out even when ill or injured, avoiding social functions or daily responsibilities to workout, feeling guilty or depressed when a workout is missed, adhering to a strict routine when exercising and not engaging in rest or recovery days. The physical consequences of over-exercising can include dehydration, fatigue, osteoporosis, broken bones, amenorrhea, thyroid and heart problems. Each of these conditions can prove difficult to treat and is even life threatening in some cases.
The challenging part of treating an eating disorder where exercise is used as a compensatory behavior is re-calibrating that moderation barometer. For some individuals exercise can be part of recovery and for others, it becomes a trigger and must be avoided, at least during the initial stages of recovery. One of the benefits of residential treatment can be that it breaks the cycle of excessive exercise. Yoga and mindful walking are ways to re-establish the mind/body connection and encourage clients to listen to their bodies instead of the eating disorder voice. Recovery is possible and working with a team of therapists, nutritionists, psychiatrists, doctors and even exercise physiologists help identify the appropriate amount of movement and activity is appropriate for each individual.