Page 39 - Today's Dietitian (March 2020)

they don’t currently have the energy
to exercise for longer durations.
Influence of Exercise on Weight
Many clinicians assume that eating
disorder clients will lose weight if
they exercise, but Cook says that’s
generally not true—even in under-
weight patients—when exercise is
used in a structured, therapeutic way
and accompanied by adequate nutri-
tion. That’s a very different scenario
from unsupervised, compensatory
exercise performed during times of
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nutritional deficiency.
“There is a huge misconception
that exercise influences weight loss,
but exercise is not an efficient way of
purging calories,” Cook says, with the
caveat that patients have to also be
eating for weight gain to happen. He
says the body prefers to use fuel from
food for energy rather than dipping
into our body’s fat or protein stores.
“Exercise triggers the body to use fuel
in a way that’s more productive.”
Cook says it’s easy to confuse
compensatory exercise—exercise
done to compensate for eating—with
starvation-induced hyperactivity, a
phenomenon also known as activ-
ity-based anorexia, which is largely
based on rat studies. In these studies,
food-restricted rats engage in excessive activity when She says this includes avoiding statements such as,
given free access to a running wheel, leading to a sharp “You’re able to exercise more now, so you need an extra
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drop in weight, self-starvation, and eventually death. snack,” which would feed into the compensatory mind-
However, that’s not how things work in humans. “Gener- set. “If a client is going to go for a walk on the beach, we
ally, when we ask our body to use energy, our body likes have to ensure that we’ve fueled their body for that 15-
to consume energy,” he says. to 20-minute walk so they have immediate fuel for that
A 2018 study looked at 244 patients admitted to an moment, but it’s an ongoing consistent fueling.”
inpatient eating disorder treatment unit in Norway
between 2003 and 2017. The unit used a multidisci- Perfectionism vs Excellence
plinary team and individualized exercise plans based While striking a balance between physical activity and
on each patient’s symptoms and needs. Researchers nutritional intake appears most beneficial, exercise
reported no cases in which exercise impaired patients’ dependence and eating disorders each reduce health-
recovery process or prevented weight gain. A 2013 related quality of life, and together those effects are
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meta-analysis found no significant differences in amplified, possibly because of pathological motivations
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weight outcomes between groups that included super- to exercise. Of the anorexia subtypes, the purging sub-
vised exercise training and groups that followed usual type is most associated with excessive exercise, espe-
treatment, while the studies in the analysis that only cially in younger patients and those with higher degrees
included an exercise group found improvements in of anxiety, depression, obsession, and perfectionism.
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weight and body fat. Perfectionism is linked with both eating disorders and
“The biggest concern we see in clients is when food dysfunctional exercise, and exercise can straddle a thin
becomes compensatory—when they say, ‘I don’t need to line between perfectionism and excellence.
eat anything because I’m not exercising,’” Beasley says. “If you are striving toward excellence, you are striv-
“A lot of the work we do is to help the client understand ing to be the best you can be,” Cook says. This includes
that their body is incredibly active all the time, even accepting your limitations. “Perfectionism is more like,
when they’re not moving, so they’re able to embrace that ‘If some is good, more is better.’” Perfectionism is dis-
they need fuel at all times.” connected from reality and is externally focused, while
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