Imagine Me…, LLC

We all know that exercise has many benefits.  It improves mood, helps sleep, improves cardiovascular function, increases strength and endurance, and is helpful in maintaining ideal weight and lowering blood pressure and cholesterol.  This is to just name a few, general effects of exercise.  But can there be a limit to what is good for you?

The purpose of this article is to discuss when exercise becomes destructive instead of productive.  You might be thinking, “How can that be?”  The “more exercise, the better” is what we often hear.  How about “no pain, no gain?”  These are destructive messages, especially in the minds of people with disordered eating and/or body image difficulties.  Just as eating, or not eating, can become compulsive, as in compulsive overeating and anorexia, respectively, exercise can become compulsive as well.

What are the criteria that make exercise compulsive?  One thing to look at is “why” you are exercising?  Is it because you want to get moving and improve fitness, or is it because you have to exercise to be OK with yourself?  Do you feel guilty if you miss your work-out?  Do you punish yourself by then not eating or doing twice as much the next day?  Do you work out even when you are ill or still recovering?  Do you push yourself to work through injuries by continuing to exercise?  Does your exercising interfere with your personal life?  This includes, withdrawing from friends because you have to be working out, or not being present in your relationship or family because you are exercising or working out several hours a day.  If you answer yes to these questions you might need to take a step back and sort out if your exercise habits are compulsive or not.

For someone whose career is as a professional athlete, or an Olympic contender, it will be normal for them to work out many hours a day.  But someone who is in school, has a career, and/or family, isn’t expected to work out as if they were a professional or world class athlete.

Compulsive exercise also includes being more focused on the time or quantity of the work-out rather than the quality.  Which sounds more compulsive?  Taking your dog for a walk and returning home before either of you get too tired, or walking three miles within 30 minutes no matter how you feel because those are the rules you have set in your head?  There is nothing wrong with walking the three miles as long as you are connected to how your body feels and you feel like walking that distance.  That is different than a rule that you have to walk that distance no matter what.

Let me give you a few examples of compulsive exercisers that I have worked with.  The first was a severe anorexic, taking in very few calories, and working out several hours a day.  She had weakened her bones through the calorie restriction but continued to exercise.  While doing a kick-turn when swimming laps, she misjudged her distance and both feet hit the edge of the pool, breaking many bones in her feet.  The pool would no longer allow her to swim there, so the next day she was out walking for miles on feet with broken bones.  That is a very severe, self-destructive case of anorexia coupled with compulsive exercise.

The second example is a high school girl of normal weight.  She used to be overweight and when she got to a normal weight she loved all the compliments she received.  She started working out more and getting into some restrictive eating habits (lots of “good food, bad food” like we talk about in the book).  As I started asking her about her friends, she became quiet.  As it turned out, she previously had a very active social life, especially hanging out with her friends after school.  However, she had started turning down friends’ invitations in order to work out.  Eventually, her friends became tired of asking her to do things since she always turned them down.  In therapy she realized how lonely her life had become and began to turn it around and reconnect with her friends.

So, take some take time reflect on your exercise habits.  Maybe even take the word “exercise” out of your vocabulary and talk about moving your body instead.  Remember, working out in a gym is not the only way your body moves.  Your body doesn’t know the difference between you taking the stairs at work and getting on an elliptical machine.  It also doesn’t know the difference between walking to and from your car, different offices, around your yard, in your neighbor, etc. or walking on a treadmill.  Ask yourself, the “why’s and how’s” of your daily “movement” and connect to your body rather than just listening to the rules in your head.

According to some reviews over 40 million Americans are affected with severe obesity.  Concern about health problems such as diabetes, hypertension, arthritis, heart disease, high cholesterol, joint problems and back problems resulting from obesity is continuing to increase.  Diet and exercise plans designed for weight loss are numerous.  Millions have tried these only to lose and regain weight.  So is bariatric surgery the magic that Americans are looking for after many failures with diet programs? Perhaps surgery is a good solution for some people and is necessary for their individual health issues.

Does the cost and medical risk always justify this choice? What about potential psychological problems associated with lifestyle changes? Have you considered differences in your relationship with your family and friends? How do you evaluate your chances for a successful outcome? These questions are extremely important.  Awareness and education before the surgery is crucial.  Many researchers fear that the surgery’s downside is being taken too lightly, especially as the surgical procedures have become increasingly available.

As a psychotherapist who has worked with eating disorders, food and body image issues for many years, I have seen some sad, tragic failures following poorly screened bariatric surgery.

For example I have worked with people who have regained their weight plus more, thinking that was impossible.  A few other situations include people who require periodic blood transfusions due to chronic anemia, medications are not absorbed, increases in depression or other mental health problems, embarrassment from vomiting in public, divorce, promiscuity or addiction to drugs or alcohol.  Many people cannot manage food or exercise before surgery and have a very difficult time with the specific requirements after surgery.  Many people believe their life will be perfect and they will have very few problems if they are thin.  Are you choosing surgery for health reasons or image?

I have seen both pre and post op complications which might have been avoided by a comprehensive assessment.  In my opinion a thorough evaluation cannot be done quickly.  Some people with failed results have reported they received one interview and were then told to find a mental health professional to approve surgery in one session.  They were not assessed for an eating disorder prior to surgery.  Some counselors have been asked to guarantee that an individual is a good surgical candidate and report that surgery is imperative.  Others have been asked to insure the person will attend counseling.  Surgery is a medical decision.  Counseling requires a commitment.  There are testing instruments and assessment tools available which can greatly assist your surgeon and medical team with managing your treatment.  I hope anyone considering gastric bypass or lap band surgery will be proactive and decide to seek a complete psychological evaluation which includes counseling before and after to learn appropriate coping skills. The cost of your evaluation is insignificant even if it is not covered by insurance.  Why would anyone make such an enormous decision and ignore this part? Please don’t underestimate the importance and the value of your psychological evaluation.