Anorexia nervosa takes the fun out of exercise

Anorexia nervosa takes the fun out of exercise

Exercise is good, but excessive or compulsive exercise can be dangerous.

At age 13, Kristen embraced the outdoors and enjoyed cross-country running at school. She was not overweight, had never been a big eater, ate little junk food and was not concerned about her body image, but she did want to improve her personal best running times. One way to do this, she decided, would be to lose a little weight so she would have less to carry.

“I thought ‘if I am thinner, I will run faster’,” Kristen said. “I don’t think there was any trigger to this thought except one day at school we had a ‘Beep test’, where I was weighed and ran for a fitness assessment, and I became determined to improve my times. I just started to cut back on my food, and I kind of had my own set of rules, which got bigger and bigger.

“First, I got rid of all takeaways. No more fish and chips, hamburgers, chocolate, sweets, sauces, gravy or cream. My mother didn’t seem to mind so long as I still ate healthy foods.”

Kristen stepped up her exercise at the same time. Her cross-country times were improving; she ran until she was exhausted and then would run some more. “We have about an acre in our backyard, and I ran in the dark at night and in the morning before my parents got up,” Kristen said. “I did this until they started catching on to it.”

Her parents’ concern grew when Kristen’s sports teacher called to say that weight and height measurements taken in a second Beep test had revealed a marked weight loss. The sports teacher confronted Kristen and asked if she was okay. Kristen broke down, feeling scared at her ‘secret’ being revealed, and said, ‘I think I have anorexia’.

Her dad said:  “As a parent, to see your child want to exercise is great. We had begun to think she was becoming a little obsessive about her cross country training, running laps around our backyard, but we didn’t know that was only part of it – we didn’t know she was exercising behind closed doors, so her illness was out of control before we knew about it.”

Kirsten was right: she had developed anorexia nervosa.

Kelly

Kelly’s childhood was filled with a love of the outdoors. She played soccer and netball, did surf lifesaving and competitive swimming and later on took up long-distance running.

A conscientious student, Kelly enjoyed school and achieved high marks with little effort. But when she was 14, kids at school called her fat. She became more self-conscious and food-conscious and began to compete in cross-country running.

Kelly began avoiding desserts and food containing fats and preferring fruit and vegetables. She started Year Nine and stepped up her involvement in sports, especially netball. She played in as many as five teams and was selected for the regional schoolgirls’ team that played at the State level. She also trained with a squad for cross-country running. She had never been overweight, but people were commenting on how fit and athletic she looked, and she was clocking personal best times with her running. At this time, Kelly’s exercise program did not seem obsessive to her parents. “We thought she was just ‘doing sport’,” her dad said.

Shortly after, Kelly went away to compete in a netball championship and came home 2kg lighter. Although not consuming enough food to compensate for her activity, she was determined to next play in her team’s netball grand final – but she was beyond being able to participate. Her weight crashed. She had to pull out of school, unable to complete Year Nine. She had developed anorexia nervosa.

Matthew

At first, Matthew’s parents thought his rapid weight loss must be part of a growth spurt because ‘surely 10-year-old boys don’t get eating disorders?’ Matthew had been a typical chubby little boy, full of laughter and happiness. The nightmare had accelerated when Matthew became obsessed with exercising and increasingly fussy about what he would eat. He developed a self-loathing, which deepened each time he looked in the mirror, checking his fat.

“I’m a hippopotamus!” he shrieked in horror when he looked into the mirror and tugged his cheeks with his hands. Matthew had a beautiful round face, complete with dimples, but to him, it appeared fat and ugly. He remembers how his life began to change. “I decided I had been eating quite a lot and was feeling fat, so I began to go for a little jog to help me feel on top of things,” Matthew said.

Small but significant events heralded the onset of his illness. A friend had celebrated a birthday by bringing a cake to school to share with the class, but when slices were passed around, the cake-loving Matthew said he didn’t want any. He was on a get-thin mission, progressively eating less and jogging more. His jogs became hour-long, and he cut his meals to one a day. Very soon, this was still too much, so he added cycling to his exercise routine.

Matthew clung to the belief that losing fat was the key to making everything in his world seem manageable. So, therefore, he would need to exercise more and eat less.

Matthew was diagnosed with anorexia nervosa.

Fine line

A fine line exists between healthy exercise and too much or compulsive exercise. Over-exercising can become a tool for gaining a sense of control over life – for example, to manage anxiety or low self-esteem. It’s not a good sign when exercise “has to be done, no matter what” rather than being part of healthy living. Often, children and adolescents who engage in excessive exercise also have disordered eating.

Some signs that indicate a child is exercising too much:

• Rigidity about exercise and sports sessions, persisting even if ill or injured.
• Signs of frustration or anxiety if an exercise session is missed.
• Exercise is a ‘must do’: a way to lose weight or feel good.
• Obsessive about not only exercise but also calories and weight.
• Adds exercise sessions if extra food is consumed.
• Noticeable weight loss.
• Skips social activities and responsibilities to exercise.

Symptoms of eating disorders include:

• Extreme weight loss or a refusal to maintain a healthy weight for age.
• Over-valuing thinness in that nothing in life seems more important than the number on the scale.
• When a child thinks they are overweight or fat, while everyone else can see that they are thin.
• For females, missing three consecutive menstrual periods when at an age where regular menses are expected.

If your child has two or more of these over-exercising signs or eating disorder symptoms, consider discussing your concerns with a doctor. It is far better to see a doctor and receive reassurance that an eating disorder is not developing rather than to postpone the doctor’s visit and allow an eating disorder to become entrenched in your child’s brain. The sooner treatment is accessed, the better the chance of fast and complete recovery.

Further information

• The National Eating Disorders Association
• F.E.A.S.T.
• Beat 
• The Butterfly Foundation 
• The vignettes in this article are drawn from My Kid Is Back – Empowering Parents to Beat Anorexia Nervosa – by June Alexander with Professor Daniel Le Grange. Stay tuned for upcoming announcements regarding the release of the second edition, titled My Kid is Back–Empowering Parents with Family-Based Treatment for Anorexia Nervosa — by June Alexander and Daniel Le Grange.

Note: Recovery from an eating disorder is possible at every age. See my memoir, A Girl Called Tim – Escape from an Eating Disorder Hell.