Anorexia Nervosa: Being Too Thin – An Inside Story – BBC FULL DOCUMENTARY
How is exercise approached in the treatment of anorexia nervosa?
Restoration of normal weight is a key aspect of recovery from anorexia nervosa. Studies show that patients who remain underweight are at a greater risk for relapse and for complications.
Thus, patients are often restricted from exercising until a normal weight has been achieved. In some cases, the duration of inactivity may be considerable. Generally, the caloric and nutritional needs of a patient with acute anorexia are so great that it is very difficult to sustain weight gain if the patient is engaging in even moderate exercise. When medically necessary, patients who are unable to comply with exercise restrictions may need to be hospitalized to ensure healthy weight restoration. Often exercise can be resumed, in increasing levels of duration and intensity, as established goals of weight restoration and physical health are achieved.
While some studies indicate exercise should be avoided until weight gain is achieved, eating disorder specialists note various approaches to exercise and weight restoration. For example, some suggest that when exercise is well regulated, it may in fact contribute to the recovery process. Those with this viewpoint suggest that a supervised exercise program, such as those frequently provided in residential treatment centers, allows for the mental and physical benefits of activity to contribute to a patient’s feelings of normalcy, independence, and social pleasure. In these instances, care is taken to model a balanced approach to physical activity such that moderate exercise is seen as one aspect of a healthy lifestyle. In addition, physical activity may be used in treatment as a means of reinforcing weight gain. For example, a patient who desires to reengage in physical activity may be permitted to do so as a “reward” for achieving a moderate goal of weight restoration. Treatment centers and treating professionals may vary in their approach to the role of exercise in recovery, but in every case, decisions need to be made that are in the best interests of the health and well-being of each individual. A medical doctor should always be consulted when considering the introduction of exercise into the recovery process, and a dietitian should be consulted to ensure adequate dietary and nutritional support.
For patients with the added diagnosis of exercise dependence, a treatment team may suggest some changes in the pattern of exercise. For example, changing the order of activities, changing the type of activity (e.g., swimming instead of jogging), or changing the location of an activity may in fact decrease some of the exercise compulsions experienced by a patient. “Changing it up” in an exercise routine may seem simple, but even simple changes can influence a rigid pattern of over exercise. In addition, exercise dependent patients may need assistance in developing alternative methods for coping with stress and anxiety.
Sarah shares:
Going into treatment, I was afraid that I would never be able to exercise again and that I would turn into an out-of-shape blob with atrophying muscles and no sense of self-control. In fact, things turned out to be quite the opposite. My treatment team never ruled out exercise as an option; they just taught me how to exercise for the right reasons.
I’ve always been a runner, but instead of running to fulfill a persistent compulsion, I’ve learned to run because I truly enjoy the way it makes me feel. In 2006, I came in 8th place in my age division at the Freescale Austin Marathon, and when I was done, I didn’t give a second thought to the number of calories I had burned. The feeling of accomplishment I get from running now is so much different than it used to be. Instead of running away from things I didn’t want to face, now I can run with an end in mind and achieve entirely different goals.
Are athletes at greater risk for developing anorexia and eating disorders?
Focus, determination, competitive drive, dedication, these are some of the coveted qualities associated with athletes who excel at the highest level of competitive sports. It is these very qualities, however, that may also put some athletes at greater risk for developing an eating disorder. While some evidence suggests that sports and sport participation can provide general benefits to one’s overall mental and physical health, experts note certain caveats that apply to various competitive sports and sport environments.
According to a meta-analysis published in a 2000 issue of the International Journal of Eating Disorders, sport participation may protect some athletes from eating problems; however, it may contribute to an increased risk of such problems for others. Specifically, studies show that athletes who compete in sports in which there is an emphasis on thinness are at greater risk for engaging in unhealthy weight control measures. Performance sports such as dance, cheerleading, gymnastics, swimming, diving, and figure skating are associated with higher rates of eating disorders than other sports. Similarly, athletes who engage in certain elite sports (such as wrestling, jockeying, weight lifting, rowing, cross-country skiing, and long-distance running) and athletes who compete at national or professional levels are also at higher risk.
Estimates of risk for anorexia and other eating disorders among athletes vary, but the numbers are sobering. Studies show that at least one-third of college-aged female athletes demonstrate disordered eating behavior. The American College of Sports Medicine found that eating disorders affect up to 62% of females in such sports as gymnastics and figure skating. Additional findings suggest that female, adolescent ballet dancers are eight times more likely to develop an eating disorder than their non-dieting peers. The prevalence of clinical eating disorders among male athletes appears to bellower than among females, however, expert’s caution that such cases may go overlooked or underreported.
According to the Handbook of Eating Disorders, eating disorders risk increases when athletes (or coaches) “lose contact with what is normal” with regard to healthy eating behaviors, due to the intensity of training for competitive athletics. Failure to achieve the desired weight for athletic performance can be a powerful trigger for unhealthy dieting behaviors and eating disorders. Furthermore, in some athletic subcultures, disordered eating may even be regarded as a natural part of being an athlete. Wrestlers, for example, are often expected to compete in weight classes below their usual body weight, and significant numbers use harmful practices such as restrictive eating, vomiting, laxatives, and diuretics to meet performance goals. In sports such as gymnastics or figure skating, where the athletes are judged by both technical and artistic merit, pressure for thinness increases if it is believed that judges will take body shape into consideration when awarding artistic scores.
Along that line, experts note that in 1972, the winning female gymnastics team had an average height of 5’ 3” and an average weight of 106 pounds, while in 1992, the average height was 4” 9” and the average weight was 83 pounds. Part of this trend in body size among gymnasts has been attributed to a “thin aesthetic.” Tragically, one of the world’s top gymnasts, Christy Henrich, after being told by a U.S. judge at a 1988 competition in Budapest that she needed to lose weight if she hoped to make the Olympic team, developed bulimia and anorexia.
Christy’s eating disorder took her life in 1994. Keeping the risks in mind, it should be noted that athletic participation can be a valuable activity that provides many benefits to general health. Indeed, studies show that for people whose physicians have determined they are healthy enough for regular exercise, athletic participation can contribute to higher levels of self-esteem, lower levels of body dissatisfaction, and fewer symptoms of depression. If you or a loved one are a competitive athlete, be aware of the eating disorders risk factors that have been identified by researchers. These include: over involvement in sports, perfectionism, extreme compliance, obsessive-compulsive tendencies, training when sick or injured, pressure from coaches or parents to lose weight, and changes in coaching personnel. Be sure to weigh the risks and benefits of athletic participation accordingly, and seek consultation with a physician if you are concerned about eating disorders risk. For more information about athletes and eating disorders, a recommended resource is “The BodySense Program” (http://www.bodysense.ca/en/home), an initiative of the Canadian Centre for Ethics in Sport that promotes positive body image.
I thought lower body fat percentage makes you a better athlete, but now I know this is not true. What are some other misconceptions about weight and sports performance?
Athletes and athletic communities may indeed be misinformed about various issues related to athletic performance and health. In the following list, each bolded statement represents a misconception or myth surrounding nutrition, body weight, and sports performance.
-The leaner you are, the better athlete you will be. While a drop in weight may initially increase performance speed in sports, persistent lack of nutrition depletes the body’s support system, resulting in decreased performance.
-Being thinner than your competition means you will perform better than they will. Research has not shown strong support for the notion that thinness can enhance athletic performance. Sports nutrition and eating disorders researcher Dr. Pauline Powers identifies three more important keys to athletic performance: genetics, muscle mass, and motivation. Comparing competitors by weight may increase the likelihood of unhealthy diet behaviors.
-Losing your period is normal when you are a female athlete. Amenorrhea is a sign of insufficient nutrition, hormone imbalance, or lack of adequate body fat. It is not normal for healthy development and increases the risk of bone fractures, osteopenia, and early osteoporosis, even among athletes.
-If an athlete is performing well, he or she must be healthy. Not necessarily. According to the Clinical Manual of Eating Disorders, athletes with symptoms of disordered eating are often able to perform well for some time. However, many of the most serious physiological complications emerge silently and without warning.
-Taking time off for treatment will interfere with sports performance. Returning to good health will likely improve sports performance. Sports may be an important part of an athlete’s life, however, good health is not only a key to sports performance but to overall quality of life.
-If a coach says an athlete has to lose more weight, it must be the right thing to do. Coaches can be a great source of support and motivation. However, decisions that affect medical health should be made by, or at least in consultation with, a physician. Well-meaning coaches may put undue pressure on an athlete by making comments about weight and may indeed be misinformed about the relationship between body weight and sports performance.
-Weight-bearing activities actually reduce the risk for osteoporosis, so an athlete is protected. Exercise alone does not protect against osteoporosis. Adequate nutrition and a healthy body weight curtail the risk of amenorrhea, which can dramatically increase the risk of osteoporosis.
-Daily training is necessary to maintain athletic performance. Actually, muscles need days without exercise to refuel and recover. Taking a day or two off from training does not decrease performance and may in fact have performance benefits.
Term:
Meta-analysis – A method of analysis that combines the results of a number of scientific studies, each addressing a related research hypothesis.
