In today's health conscious society we are inundated with information touting the benefits of exercise and encouraging us to do so. Regular exercise is said to reduce the risks of developing heart disease, type 2 diabetes, cancer and to have long term health benefits including weight control, improved mood, improved energy and better sleep. So what happens when the eating disordered individual wants to exercise but they are barely eating?
This is a dilemma that constantly comes up in the treatment of eating disorders. So many of my clients are runners, athletes, dancers and yes, just plain exercise obsessed. It's amazing how many eating disordered individuals will skip meals and yet perform in their sport or at the gym, seemingly fine.
The bottom line is simple: One can't run on empty for long. Just like a car running on gas fumes, at some point, the ride will just stop. Now, despite the reality of this, the eating disorder is literally screaming at my clients to "keep going," "you have to work off that snack!," "you are weak, ugly, a loser if you stop!" At some point, the love of activity or one's sport can become an obsession — a necessary evil to grant permission to eat, a form of self-punishment for not being worthy.
As a clinician, I make a contract with every client. This contract is essentially the boundaries that allow for my client to stay in treatment with myself versus being recommended to a higher level of care. I make it very clear that if the client is underweight or continuing to lose weight, they will be asked to stop physical activity until they demonstrate an ability to maintain a safe weight and to nourish themselves properly.
Ironically, this is where the family support is not always where it needs to be. I have had spouses, parents and siblings say "go for a run and you will feel better" or "maybe if they exercise they will get their appetite back." Yes, exercise releases endorphins and is normally great for our psyche. When the eating disorder has stepped in and taken charge however, the priorities change. The first priority is to stop weight loss. The next priority is to have gradual weight gain.
By the way, anorexia has nothing to do with physical hunger. It's about control, a way of making things predictable, feeling unworthy, being terrified of not measuring up. For my clients who feel hunger, they deny themselves food. If they no longer recognize the sensations of hunger, then their eating disorder is extremely progressed and they are likely starving themselves — not exactly the ideal time to encourage them to exercise to "get their hunger back."
Exercise should not be used as a reward in recovery. The reward in recovery is recovery! As a client stabilizes, they get their life back. If exercise was off the table for a while, after some progress, activity can be slowly introduced in limited amounts. Of course, all kinds of factors need to be considered: potential triggers, demanding coaches, or just what one needs to add to their diet on the days that they engage in their sport.
My hope for all of my clients is that they can enjoy being in their bodies, moving their bodies and feeling great! This is different from the eating disorder driving them to do activity. This is about feeling free!