Page 36 - Today's Dietitian (March 2020)

EXERCISE

EATING

&
DISORDERS

BY CARRIE DENNETT, MPH, RDN, CD
T he health benefits of physical activity people with anorexia don’t have calories to burn,”

says Brian Cook, PhD, Monterey, California–based
are clear, but when someone is being
treated for an eating disorder—espe-
vice president of movement, research, and out-
cially anorexia nervosa (AN)—many
comes for Alsana Eating Disorder Treatment &
health care providers suddenly view
Eating Recovery Centers. He says one influencing
exercise as unhealthful. The idea
ciated girls with AN who had been engaging in
that exercise interferes with eating
hyperactivity. “This gives us the idea that exercise
disorder recovery has been sol- factor is the number of 1970s case studies of ema-
5
idly entrenched in the eating disorder treatment is the problem,” he says. In fact, he’s heard people
world, yet that idea is starting to be questioned— in the eating disorder field say that exercise causes
although not without some controversy. eating disorders, but if that were true, “we’d all
Dysfunctional exercise—typically described as have an eating disorder.”
exercise addiction, exercise dependence, or com- Cook says the belief that if eating disorder
pulsive exercise—includes maintaining rigid exer- clients are allowed to exercise, they’ll just go
cise regimens, exercising despite physical injuries, off the “deep end” isn’t what’s actually happen-
feeling anxious if unable to exercise, prioritizing ing in the structured exercise programs used in
exercise before other important activities, or rig- research and clinical practice.
idly imposing exercise before or after an eating A 2018 study in the Journal of Eating Disorders
binge. It’s listed as one of the compensatory (or found that in a population of women undergo-
1
“purging”) symptoms of bulimia nervosa (BN) in ing treatment for BN or binge eating disorder,
the Diagnostic and Statistical Manual of Mental a 16-week intervention that combined physical
Disorders, 5 Edition. activity and dietary therapy was as effective
2
th
Because dysfunctional exercise frequently is a as cognitive behavioral therapy (CBT) for
symptom of eating disorders—one that often pre- reducing compulsive exercise. 2
dates the full onset of the eating disorder, contributes The authors noted that
to relapse or persistence, and is one of the last symp- only 54% of the BN
toms to resolve—the common practice has been to patients didn’t
intervene by prescribing exercise abstinence. meet mini-
3,4
“We’re still hung up on the idea of calories in, mum recom-
calories out, that exercise burns calories, and mendations

36 TODAY’S DIETITIAN • MARCH 2020