June 5, 1998 Too much of a good thing, even exercise, may be dangerous for some people.
New research indicates that young women who are compelled to exercise at excessive levels are at risk for developing eating disorders and general psychological unhappiness. This finding comes from the first study to focus on the role of exercise as a way women suffering from bulimia nervosa avoid gaining weight.
Bulimia is a disorder primarily affecting women that is marked by episodes of binge eating that occur at least twice a week for at least three months. It is also characterized by a lack of control over eating during bingeing, a persistent over-concern with body shape and weight, and the regular use of self-induced vomiting, laxatives, diuretics, strict dieting, fasting or vigorous exercise to avoid gaining weight. Up to an estimated 13 percent of young women ages 15 to 25 suffer from bulimia, says psychologist Nancy Barnett, who conducted the study. In addition, a significant number of other women in this age group have some of the symptoms of bulimia but do not meet the full criteria for the disorder.
"Generally, Americans need to do more, not less, exercise because this is a sedentary society," she says. "But for a minority, exercise is not helping them because it is excessive and even dangerous. Some women are doing too much, such as those who feel that they must exercise every single day at high levels of exertion. This behavior affects their self-image, their relationships and how they eat. For these women, exercise becomes a compulsion; they feel bad if they stop and will give up other important aspects of their life to make time for exercise."
Barnett, who conducted the research for her doctoral dissertation at the University of Washington, is now an assistant project coordinator and post doctoral fellow at Brown University's Center for Alcohol and Addiction Studies in Providence, R.I. She says that for a number of years clinicians have been seeing a difference in the behavior and in the degree of related psychological distress between purging and non-purging bulimics. However, no studies of women with eating disorders had looked specifically at exercising bulimics to see if their eating and psychological symptoms were sufficiently less severe to be categorized into the non-purging group.
In her dissertation, she studied four groups -- purging bulimics, exercising bulimics, obligatory or over-exercisers, and women who did not over-exercise or have an eating disorder -- each composed of 20 women from Seattle, Boston and Providence.
Exercise was measured by a questionnaire that sought information about repetitive exercise behavior, the compulsion to exercise and an unwillingness to stop exercising. For the study, women who exercised vigorously for at least 30 minutes a minimum of five times a week for the last three months or more and scored above a cutoff point on the questionnaire were placed in the exercising bulimic or over-exercising groups, depending on their eating behavior. The study did not distinguish between types or intensity of exercise.
"People see two groups, one that vomits and one that exercises. They look at the first group and say that's 'unhealthy' and then look at the exercisers and say that's 'healthy,'" explains Barnett. "In reality, both can be unhealthy, but I found that exercising bulimics are not at the same level of severe behavior and psychological stress as purging bulimics."
The idea of a continuum of disordered eating behavior is not new, but certainly it is a fair way of characterizing the women in her groups, according to Barnett. Purging bulimics show the highest levels of binge eating, depression and overall psychological disturbance and would be at the top of the continuum. Exercising bulimics and non-purging bulimics have less-extreme levels of pathological behavior and would be one step down. Women who neither over-exercise nor have an eating disorder are at the bottom of the continuum. Barnett would place women who have a tendency to over-exercise below the exercising bulimics and the non-purging bulimics.
But, she cautions, "there are reasons to fear high exercisers are at risk for developing an eating disorder. These women have a greater degree of dietary restriction, preference for thinness and greater dissatisfaction with life than non-eating-disordered women. This indicates that young women who exercise at high levels are at risk for eating problems and general unhappiness
"Although over-exercise makes most people think of anorexia, as many as 91 percent of women who have bulimia engage in exercise to compensate for binge eating."
As a result, says Barnett, "doctors and other clinicians should ask questions about a woman's eating concerns and exercise habits. They also should be careful about prescribing exercise for someone with an already established eating disorder. Exercise needs to be monitored carefully so it doesn't get out of hand."
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