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Johannesburg - There could be worse things to be addicted to than exercise, you might think. After all, shedding the kilos and getting well-defined triceps are high up on most people’s wish lists.
But, for some people, exercise moves into murkier terrain, into what eating disorder specialists refer to as exercise bulimia.
Exercise bulimia is regarded as a subset of bulimia nervosa, the disorder characterised by self-induced vomited and purging.
Much like conventional bulimics, exercise bulimics are obsessed with the food they eat and are overcome with guilt over overeating or having binges of “bad” foods with little self-control.
However, unlike bulimics who will head for a toilet bowl to purge or resort to laxatives, the exercise bulimic looks to neutralise the consumed calories by pounding the tarmac until they hit exhaustion point or they go to back-to-back gym classes and throw in an extra hour of weight training for good measure.
Their sole aim is to neutralise the calories from the burger they had at lunch or the chocolate bar they ate as a mid-afternoon pick-me-up.
Exercise bulimia is a particularly insidious form of the disorder, says Kathryn Mills, clinical director at Imani Addiction Services in Wynberg, Cape Town, a secondary care facility that specialises in helping those with eating disorders. After all, it’s socially acceptable, even desirable, to work out and stay fit in a society that puts pressure on people to be supermodel slim in order to be thought of as sexy and attractive.
Mills says: “Exercise bulimia is compulsive exercising with the sole aim to lose weight and to control calories, and it takes over that person’s life. Exercise becomes the key priority in their lives and the obsession will, of course, affect their emotional, social and physical life.”
Eating disorders usually start between the ages of nine and 13, says Mills. Even though eating disorders may emerge later in life, they are often a manifestation of a problem that has been lurking for years.
Take Paula, 37. When her boyfriend of four years cheated on her with a much younger woman, she showed him the door. He then put the blame for his infidelity on her – it was her fault for not being fun any more and for letting herself get fat.
For Paula the initial tears and anger turned to partying it up to prove to her ex that she could be fun. But the clubs and pubs she was hanging out in were filled with under-30s who still had nature and gravity on their side.
Paula couldn’t give up the sugary alcoholic coolers and still loved her takeaways and the chocolates that saw her through late night romcoms. So she started taking laxatives, then purging and the weight did come off.
Then came gym. Paula had more lapsed gym memberships than she cared to remember, but this time going to gym was driven by a different motivation that went beyond getting into shape or staying fit. Gym became her new obsession and ritual, and soon it was all she could talk about. She would pride herself on being able to outlast people in one aerobic class after another, and being able to lift more weights than other women at the gym.
Going to the gym four or five hours a day, five to six times a week, became a badge of honour for her.
Mills says for women like Paula exercise bulimia can also be a perfect cover for the use of the likes of laxatives and purging.
“Eating disorders can take years to diagnose because they are so well hidden, and exercise bulimia can be very seductive as sufferers start to get more and more compliments as they lose weight and they’ll say it’s all because they’re working out.
“The dangers come in when compulsive exercise starts doing them harm – they’ll exercise to the point of injury or exhaustion; in some cases there are women who stop menstruating from too much exercise. They can also suffer from electrolyte imbalance, bone density problems, and depression and anxiety.
“They continue to exercise even with injury and illness, they reorganise their family commitments and social life according to their exercise regime, and they will be unnaturally irritable, anxious or depressed when they have to skip their regular workouts,” she says.
But Mills says even in cases like Paula’s where it appears that they have suddenly developed exercise bulimia, there are very often underlying psychological issues that have not been dealt with for years.
Mills says treating exercise bulimia would be like treating any other eating disorders. It’s about getting to the root of the emotional issues leading to the imbalance, obsession and compulsion, and helping the bulimic develop life-long coping skills to break the cycle of bingeing and purging through exercise.
“Eating disorders are usually also about people not being able to control aspects of their lives where things are not working out – food and calories becomes the one aspect of their lives that they can control,” she says.
Professor Christopher Paul Szabo, head of psychiatry at Wits University, says exercise bulimia is nothing new. Non-purging bulimia, he says, is well documented and includes excessive exercise, fasting and enemas to compensate for binge eating. However, growing media attention and society’s general obsession with body image and exercise has focused the spotlight more sharply on exercise bulimia.
“Non-purging bulimia becomes dangerous when overexercising starts to compromise the general functioning of the person, be it occupationally, emotionally, physically or socially,” he says.
“Sufferers aren’t easily detected and they don’t come forward for treatment as easily because exercise, even excessive exercise, can go unnoticed given that society generally views exercise as a normal activity,” says Szabo. “You won’t find these sufferers at doctor’s rooms – you’ll find them at the gym.”
Mills says getting help for an exercise bulimic can be tricky.
“Physically the person may not look noticeably too fat or too thin. Then when they are confronted, they may be dismissive and even defensive because bulimia is really their ‘dirty little secret’,” she says.
The sufferer often isn’t ready to admit they have a disorder and that they need help. They may start to disassociate with family and friends who raise concerns and speak out about the bulimic’s behaviour and obsessions.
“Perseverance and support are key to helping that person realise that they may need professional intervention,” says Mills. “Professional help will get to the bottom of their issues and gives them the support and coping methods to stop their destructive behaviour.”
TIPS ON GETTING HELP
l Friends and family need to speak to the bulimic about their concerns without judgement or criticism. They should offer support and understanding, and persevere even when they are rebuked or when the bulimic denies there is a problem.
l Get professional advice and help. This could be through one-on-one counselling, dieticians and also later on with certified personal trainers who can work out safe, monitored workout regimes that are sensitive to an exercise bulimic’s problems.
l Remember that healing from eating disorders can sometime take years, so the bulimic needs healthy, adaptive support systems around them who are in it for the long term. It makes group therapy particularly successful in treating eating disorders. - The Star