Eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder, are serious, often life-threatening mental illnesses that are associated with great distress, chronic health conditions, and even death. Anorexia nervosa is a condition in which a person does not eat enough to sustain normal body weight and experiences fear related to gaining weight or becoming fat. Bulimia nervosa involves binge eating (eating large amounts of food in a short period of time) with attempts to avoid gaining weight by making oneself vomit, fasting, or excessively exercising. People with binge eating disorder (BED) binge eat but do not vomit or use other methods (like purging or excessive exercise) to prevent gaining weight after a binge.
What is Excessive Exercise?
Many terms are used to describe exercise that is outside the realm of “healthy” or “normal.” These terms include:
- Excessive exercise – Exercising more often or longer than is recommended.
- Compensatory exercise – Exercising to compensate for the number of calories eaten during a binge.
- Compulsive exercise – Feeling you have to exercise and feeling distressed if you can’t, keeping a rigid exercise routine, and being motivated to exercise primarily to control your weight or shape.
Additional terms used to describe excessive exercise that overlap with compulsive exercise include ‘obligatory exercise’ and ‘exercise addiction.’ Research shows that it is the compulsive need to exercise along with feeling you must exercise to compensate for something you ate, rather than high frequency or amount of exercise, that are related to distress, reduced quality of life, disordered eating patterns, and eating disorder diagnoses (1,2). In this article, the term excessive exercise will be used to describe the problematic patterns of exercise associated with eating disorders.
Excessive Exercise and Eating Disorders
Excessive exercise is observed in people with and without eating disorders but is more likely to affect quality of life or functioning when it occurs along with an eating disorder. Increased physical activity has long been identified as a feature of eating disorders, especially anorexia nervosa when food intake is restricted. People with anorexia nervosa often report that increased physical activity preceded eating disorder symptoms, but describe their levels of physical activity becoming increasingly compulsive and seemingly out of their control as their eating disorder progresses (4).
We now know excessive exercise plays a role in both the development and maintenance of a variety of eating disorders, and it occurs commonly, with estimates ranging from 50-80 percent (5). Excessive exercise is observed most frequently among those with anorexia nervosa who purge or greatly restrict caloric intake, but is also observed in those with other eating disorders such as bulimia nervosa (6,7,8).
As described above, excessive exercise is one way that people with eating disorders may attempt to offset episodes of binge eating (similar to purging). However, the relationship between excessive exercise and eating disordered behavior is complicated, extending beyond a simple desire to shed calories or avoid weight gain. Increased physical activity may place an individual at risk of reducing food intake and engaging in disordered eating, and disordered eating can, in turn, perpetuate patterns of excessive exercise.
Biological factors associated with eating disorders, such as food restriction and serotonin dysfunction (a chemical imbalance in the brain, related to depression and anxiety), and psychological factors such as anxiety, rigidity, obsessive-compulsive symptoms, and perfectionistic traits play a role in the relationship between excessive exercise and eating disorders (7, 9, 10). Excessive exercise may also be observed among competitive athletes with or without eating disorders, and it may be a key feature of muscle dysmorphia, a pathological obsession with muscle building and extreme dieting that is observed most commonly in men.
In people with eating disorders, excessive exercise is often used as a way to manage their mood or affect, either by producing positive mood states, or by avoiding negative feelings associated with not exercising (4, 11). Strict adherence to exercise routines, exercising primarily to alter weight and shape (12), and experiencing intense guilt when exercise is missed(13) are also characteristic of excessive exercise among people with eating disorders (1). Excessive exercise is often one of the most persistent symptoms of eating disorders, and it can interfere with recovery. It may continue after treatment for an eating disorder, and can place individuals at risk for relapse and/or rehospitalization following treatment (14, 15).
Consequences of Excessive Exercise
Even among people who do not have eating disorders, engaging in excessive exercise is associated with restrictive eating and other risk factors for eating disorders, such as dissatisfaction with your body and a desire for thinness. If excessive exercise is interfering with your functioning or quality of life, seeking help from a mental health professional is warranted even if an eating disorder is not apparent.
For those with eating disorders, excessive exercise is generally associated with worse eating disorder symptoms, poorer quality of life, and extended inpatient eating disorder treatment stays (16). Excessive exercisers can experience health problems including dehydration, stress fractures, and overuse injuries to muscles, tendons, ligaments, and joints. For many, these issues occur in the context of numerous other serious physical consequences of eating disorders. For these reasons, it is imperative that individuals engaging in excessive exercise who are also experiencing symptoms of an eating disorder get professional mental and medical help immediately.
Exercise and physical activity level should be monitored closely in those diagnosed with eating disorders. Physical activity may be restricted or completely eliminated as part of the treatment for an eating disorder like anorexia nervosa, during which stabilization and weight restoration are the most important initial goals of treatment. Later in treatment, exercise may be reintroduced and incorporated into therapy and the treatment/recovery plan. Click here for more information on available treatment for eating disorders.
Worried that you or a loved one is exercising excessively? Looks for these signs:
- Exercising following a binge to compensate for calories consumed.
- Exercising to allow oneself to eat/consume calories.
- Exercising to achieve a certain weight, body shape, or weight loss goal.
- Maintaining an inflexible exercise schedule that cannot be altered.
- Missing important social or other life activities in order to exercise.
- Experiencing significant distress, especially guilt, when exercise is missed.
- Continuing to exercise despite being sick or injured.
The Emily Program was founded in 1993, and is nationally recognized for their compassionate and personalized approach to treating eating disorders and related mental health and body image issues. They use evidence-based treatment, and customize each person’s treatment program to their individual needs. Several members of their staff actually have personal experience with recovery. Just follow this link to learn more about the Emily Program, and see if they can help you.
About The Author:
This article was written by Dr. Elisha Carcieri, a licensed clinical psychologist that specializes in treating those with eating disorders.
1. Adkins, E. C., & Keel, P. K. (2005). Does “excessive” or “compulsive” best describe exercise as a symptom of bulimia nervosa?. International Journal of Eating Disorders, 38(1), 24-29.
2. Holland, L. A., Brown, T. A., & Keel, P. K. (2014). Defining Features of Unhealthy Exercise Associated with Disordered Eating and Eating Disorder Diagnoses. Psychology of Sport and Exercise, 15(1).
3. Gutierrez, E. (2013). A rat in the labyrinth of anorexia nervosa: Contributions of the activity‐based anorexia rodent model to the understanding of anorexia nervosa. International Journal of Eating Disorders, 46(4), 289-301.
4. Davis, C., Kennedy, S. H., Ravelski, E., & Dionne, M. (1994). The role of physical activity in the development and maintenance of eating disorders. Psychological medicine, 24(04), 957-967.
5. Davis, C., Katzman, D. K., Kaptein, S., Kirsh, C., Brewer, H., Kalmbach, K., … & Kaplan, A. S. (1997). The prevalence of high-level exercise in the eating disorders: etiological implications. Comprehensive psychiatry, 38(6), 321-326.
6. Brewerton, T. D., Stellefson, E. J., Hibbs, N., Hodges, E. L., & Cochrane, C. E. (1995). Comparison of eating disorder patients with and without compulsive exercising. International Journal of Eating Disorders, 17(4), 413-416.
7. Shroff, H., Reba, L., Thornton, L. M., Tozzi, F., Klump, K. L., Berrettini, W. H., … & Bulik, C. M. (2006). Features associated with excessive exercise in women with eating disorders. International Journal of Eating disorders, 39(6), 454-461.
8. Dalle Grave, R., Calugi, S., & Marchesini, G. (2008). Compulsive exercise to control shape or weight in eating disorders: prevalence, associated features, and treatment outcome. Comprehensive psychiatry, 49(4), 346-352.
9. Holtkamp, K., Hebebrand, J., & Herpertz‐Dahlmann, B. (2004). The contribution of anxiety and food restriction on physical activity levels in acute anorexia nervosa. International Journal of Eating Disorders, 36(2), 163-171.
10. Meyer, C., Taranis, L., Goodwin, H., & Haycraft, E. (2011). Compulsive exercise and eating disorders. European Eating Disorders Review, 19(3), 174-189.
11. Taranis, L., & Meyer, C. (2011). Associations between specific components of compulsive exercise and eating‐disordered cognitions and behaviors among young women. International Journal of Eating Disorders, 44(5), 452-458.
12. Mond, J. M., Hay, P. J., Rodgers, B., & Owen, C. (2006). An update on the definition of “excessive exercise” in eating disorders research. International Journal of Eating Disorders, 39(2), 147-153.
13. Mond, J. M., & Calogero, R. M. (2009). Excessive exercise in eating disorder patients and in healthy women. Australasian Psychiatry, 43(3), 227-234.
14. Kron, L., Katz, J. L., Gorzynski, G., & Weiner, H. (1978). Hyperactivity in anorexia nervosa: a fundamental clinical feature. Comprehensive Psychiatry, 19(5), 433-440.
15. Steinhausen, H. C., Grigoroiu‐Serbanescu, M., Boyadjieva, S., Neumärker, K. J., & Winkler Metzke, C. (2008). Course and predictors of rehospitalization in adolescent anorexia nervosa in a multisite study. International Journal of Eating Disorders, 41(1), 29-36.
16. Solenberger, S. E. (2001). Exercise and eating disorders: A 3-year inpatient hospital record analysis. Eating behaviors, 2(2), 151-168.
Written – 2015