Exercise Excess?

Last Editorial Review: 1/30/2005

Too Much of a Good Thing

WebMD Feature

Nov. 27, 2000 -- Jessica Weiner's exercise routine was unlike that of most 14-year-olds, an age when many girls drift away from exercise. Weiner spent four to six hours every day working out. She devoted the wee hours of the morning to the gym, returning after school to take a turn on every exercise machine. "Bike, treadmill, stair machine, weights -- you name it, I did it," she says.

Late at night when other teens were studying or relaxing with a book, Weiner was still sweating away. "Exercise was the first thing I thought about when I woke up, and the last thought I had before bed," she says. Her friends commended her for her self-discipline. She seemed the picture of good health.

She was, in fact, miserable. "I felt a real emptiness," says Weiner, now 26. "I had an incredible disconnect between my body and soul." Her workouts brought her no sense of accomplishment or exhilaration. Instead, each session represented a tick in a grim accounting process. "Everything I ate had to be worked off -- and then some," she says. "I viewed my body as an outsider, an enemy to be controlled and punished."

At a time when more than half of American adults are overweight, and few can manage even the recommended 30 minutes of moderate daily activity, it would seem that people who exercise for hours are examples for the rest of us. But there's a growing recognition among experts that some people push fitness to a harmful extreme. Ira Sacker, MD, director of the Eating Disorders Program at Bookdale Medical Center in New York, estimates that about 4% of Americans struggle with excessive exercise. And the numbers, he says, are on the rise.

There's even a name for the problem, though most people have never heard of it: exercise bulimia. Also called compulsive exercise, it's similar to classic bulimia. But instead of using laxatives or forced vomiting, an exercise bulimic purges with exercise. And unlike classic bulimia, the disorder is nearly as common in men as it is in women.

Bad for bones

The consequences can be severe: most exercise bulimics eventually develop overuse injuries, which can have long-term repercussions. Weiner, like many exercise bulimics, ceased to have periods, a condition called exercise amenorrhea. "Many women rejoice when their periods stop, but this is a red flag -- a sign that you're headed for trouble," says Barbara Drinkwater, MD, of the Pacific Medical Center in Seattle.

When a woman's menstrual cycles stop, it means her estrogen levels have dropped to those of a postmenopausal woman. Estrogen, of course, is vital for the normal development of bone -- which reaches its peak in women in their mid 20s. If a woman's estrogen levels dip too low during this critical time, she may start losing bone mass instead of building it, Drinkwater says. She's seen 25-year-old women with eating disorders who have the bones of an 80-year-old. Though treating amenorrhea can stop bone loss, "It doesn't appear that this bone loss is reversible," Drinkwater says. Despite these risks, most exercise bulimics never seek treatment, in part because excessive exercise is often viewed as a healthy obsession.

One reason exercise bulimia has gone unrecognized for so long is that it can't be diagnosed simply by tallying up the number of hours a person exercises. "There's no single cut-off or dosage where we can say, 'Aha, you've gone too far,'" says Jack Raglin, PhD, a sport psychologist at Indiana University in Bloomington. The person's mindset provides a better indicator, says Raglin. "Exercise addicts don't exercise to improve their health or train for a specific event, they're exercising for the sake of exercise."

Weiner had plenty of signs that something was amiss. "I became withdrawn and isolated," she says. "And I was very focused on my appearance. I was hypercritical of myself and had drastic mood shifts." Sacker says exercise bulimics also tend to be anxious and agitated when they're not exercising, and to keep working out even if they're hurting or fatigued. In fact, most seek help only when they're faced with injuries severe enough they can't push through them, says Sacker.

Because she didn't fit the label, Weiner never thought she had a problem. She always equated eating disorders with self-starvation or induced vomiting, and she did neither. Then came her defining moment. One day, at the age of 17, Weiner was unable to meet her daily exercise quota, and she panicked. She decided, for the first time, to make herself throw up. But as she bent over the toilet, something stopped her. "I could die from this," she thought.

Asking for help

So Weiner sought the advice of a nutritionist. Her nutritionist sent her to a therapist, who helped her sort through the emotions underlying her exercise addiction. "Once I learned the language of this problem it was a lot easier to talk about," she says. Weiner also attended group therapy. "It was really empowering to meet with seven other women who had gone through the experience. I realized that I'm not alone."

Weiner received both individual cognitive therapy, aimed at changing harmful thought patterns and emotions, and behavioral therapy in group sessions, aimed at shifting destructive behavior. This sort of multifaceted approach is typical, says Sacker. He recommends that exercise bulimics find a team for support, including therapists and a physician who can help diagnose and treat the physical effects of overexercise.

Weiner has a message for others who are struggling with an exercise addiction: "Recovery is 100% possible." The first step, she says, is admitting you have a problem. "Take a risk and talk to someone about it." And find a doctor or psychologist who can help you work through the root cause of your problem.

Finding new ways to deal with emotions is an important part of the healing process, says Sacker. Many women in Weiner's therapy group discovered that journal writing helped them work through their emotions in a constructive way. Most also sought other ways of expressing themselves, often through artistic pursuits like dance or painting. One woman even wrote songs about her experience.

Weiner turned to theater as an alternative outlet. She began scripting one-woman plays about body image, exercise addiction, self-hatred, and other issues facing young people. Today she travels around the U.S. acting out her play, Body Loathing, Body Love, which chronicles her struggle with exercise bulimia. Her latest project is a television show focused on teen issues.

"Recovery is a continuum," she says. "It took years and years to build these attitudes; you can't fix them overnight. But you can choose to stop relying on exercise as a coping mechanism."

Christie Aschwanden is a freelance science writer in Nederland, Colo. She is a contributing editor to Health magazine.
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