Exercise addiction can develop alongside eating disorders such as anorexia and bulimia – and it can be deadly.
Pushing a body that may already be malnourished and underweight can put an incredible strain on the heart, and gyms don’t seem to be fully equipped to deal with this problem.
If you see someone in your gym or fitness class who looks worryingly thin – what can you really do about it?
Public intervention in these cases can be difficult, and could even make the situation worse. Also, who’s to know what’s actually going on in any individual case? It’s impossible to tell if a person has a mental illness and needs help just by looking at them.
And would it ever feel appropriate to approach someone in the gym who appears to be overweight, with concerns about their health? Exactly.
Hope developed anorexia when she was just 13 and a fixation on exercise was part of her illness.
‘I had to do it at all hours, and at my worst, I would be running on the spot in my room into the early hours of the morning,’ Hope tells Metro.co.uk.
‘When you have an eating disorder so much of exercise is wrapped up in punishment.
‘You have a bad day, so you go and work out more and the endorphins make you feel better – but you get obsessed with that feeling. You panic that if you aren’t doing as much then your weight will increase.’
Hope thinks that gyms can be incredibly dangerous places for people with eating disorders and says that better strategies need to be put in place to help members who are struggling.
‘Gyms need a policy – but an open one,’ says Hope.
‘When I was unwell, my gym just used to call my mum and tell her – which only annoyed me and made me lie even more.
‘With PTs, it is about them having education, getting them to ask the right questions, working out whether their clients are obsessed or exercising for the right reasons.
‘Also periods – trainers should be able to ask these questions around periods. When I was over-exercising, mine stopped, and this happens to others too.’
If you break your leg falling off a treadmill or pull your back trying to squat with a heavy weight, gyms have a policy. They know how to treat your injury, refer you to the necessary medical care and help you ease back into fitness as you recover.
Why isn’t mental illness treated in the same way? Surely duty of care for patrons should include any detrimental effects that can be caused by using the gym – physical or mental. Particularly when the two are so intricately linked, as with eating disorders.
The difficulty is that no two eating disorder cases look the same. And being underweight may not be the only warning sign – in fact, some people with eating disorders or exercise addiction aren’t underweight at all.
‘While young girls and women aged 12-25 are most at risk, eating disorders can affect anyone at any age,’ explains Tom Quinn from Beat Eating Disorders.
‘Boys and young men are more likely to use exercise rather than extreme dieting to control their body shape and size. Gyms should be aware of these behaviours and realise that it isn’t just about being underweight.
Tom says that people with bulimia nervosa can also be over-exercising, and they are most likely to be at normal weight.
‘We would like to see gyms and health clubs becoming more aware of eating disorders and put in place policies and safe working practices that would reduce the known risks,’ adds Tom.
‘Policies could look at enrolment or membership systems and the types of health-related information collected; staff training; and ensuring confidential access to information and support for their clients and customers if necessary.’
Exercise addiction is more common than you might think. Endorphins produced when you exercise strenuously affect the body in the same way as opioids, a bit like heroin. The resulting ‘buzz’ can become addictive.
You might think that going to the gym all the time isn’t exactly a problem, but it can be incredibly dangerous.
Excessive exercise is hugely stressful on the body and can impair the immune system, lead to increased risk of infection, premature ageing, and injury. Couple that with a pre-existing eating disorder and things quickly become even more serious.
Signs of exercise addiction
Signs of exercise addiction include:
- Excessive training without sufficient breaks
- Exercising even when injured
- Persistent muscle soreness
- Frequent exercise-related injuries
- Excessive weight loss
- Poor appetite
- Increased infections
- Insomnia
There will also be withdrawal symptoms when the exercise is stopped. These may include anxiety, depression, and restlessness.
Dr Clare Morrison, GP and medical advisor at Medexpress
‘It is now well recognised that exercise addiction is strongly associated with eating disorders, principally bulimia and anorexia nervosa. There is also an association with body dysmorphic disorder,’ explains Dr Clare Morrison, GP and medical advisor at Medexpress.
‘When exercise addiction is combined with an eating disorder, the risk is even greater. These people can appear surprisingly well, especially if they cover their thinness with baggy clothes.
‘Those with anorexia can remain active until their reserves are dangerously depleted. In extreme cases, they may suffer fatal heart failure, with very little warning.
Dr Morrison says gyms are competitive environments that could ‘normalise’ excessive exercise behaviour.
‘Gyms also make a lot of money from those keen to use their services,’ she adds. ‘Therefore it is likely that gyms may not try to stop their clients from exercising excessively when perhaps they should.’
So, what are gyms doing at the moment?
We spoke to a number of well-known fitness facilities in the UK and found that, while attempts are being made at individual institutions, there is no consistent consensus on how to tackle this problem.
Virgin Active told us that member safety is always top of their list of priorities. They say they work closely with UKActive and ‘follow their duty of care as a fitness and health provider’, but they were vague about their specific approach to eating disorders and exercise addiction.
‘We give every new member a pre-activity health screening, where we work with the member to set an appropriate fitness plan to ensure they receive the best available advice and ongoing support,’ said a spokesperson.
‘Where possible and if appropriate, we are advised by a members’ GP, as in certain situations, exercise can be detrimental to a condition. However, removing it from someone’s routine can also hinder recovery.’
What to do if you're worried about someone at your gym
Over-exercising is one of the signs of somebody suffering from an eating disorder – if a person is worried somebody is showing a sign of ED they should act quickly and get in touch with Beat or their GP.
Our ‘spot the signs’ poster has been displayed in many GP practices, schools and community centres and gyms are welcome to contacts us if they would like to display one for their customers.
We know that it can be very difficult to tell somebody you are worried about them having an eating disorder – you might feel like you’re accusing the person of doing something wrong, or that it’s insulting to them. But they haven’t done anything wrong, and you’re concerned for a reason.
It’s always better to approach the person with compassion and understanding so that they can get the help they need as soon as possible.
Anytime Fitness told us that they take a detailed assessment of members at the induction stage, which aims to make staff aware of any pre-existing medical conditions – although that is dependent on members choosing to actually disclose that information.
They said that staff are automatically alerted if a member is coming to the gym too often – but they didn’t specify what qualifies as ‘too often’, or would happen if that were the case.
‘Anytime Fitness members can only access the gym via a fob which records when they visit,’ said a spokesperson for the gym.
‘All of this information is available electronically to the in-house team and highlights any members attending the gym too frequently. At this stage, clubs are alerted to contact the member.’
Traditional gyms are no longer the only venues for people to develop problematic relationships with exercise.
The boutique fitness sector is thriving and there are now more than 300 fitness studios in London alone. The good news is that the studios seem to have a more comprehensive approach to tackling mental health than the bigger, traditional gyms.
Barry’s Bootcamp is one of the originals. Its HIIT classes combine weights and cardio and are notoriously challenging. But they say that they are now getting tough on exercise addiction too.
‘This year, we introduced mental health first aid training for every instructor,’ says Barry’s co-owner and master trainer Sandy Macaskill.
‘It started off as a voluntary exercise but due to its success, and the feedback we got from the team, we have now made it compulsory. The training equips our instructors to be able to spot signs of poor mental health in one another and in clients who come to class.
‘Our instructors are now better-placed to offer assistance to Barry’s clients who are at risk from a number of mental health issues and disorders and, where required, recommend expert help where necessary.’
Barry’s recently appointed a mental health consultant and psychotherapist, Zoe Aston, who specialises in addiction and eating disorders. Zoe’s job is to advise the company on how they can do better in looking after their team and community.
‘Through things like mental health first aid training and bringing in experts such as myself, fitness and wellness brands are becoming increasingly able to spot when someone might be suffering – and more capable to offer support,’ explains Zoe.
Zoe says that it is not the food or the exercise itself that cause the problem, but a build-up of unprocessed emotion that can lead to ‘self-loathing’ and a ‘difficulty coping with life events’.
She says intervention from gyms and studios can only really go so far: ‘Although exercise communities must be careful not to enable self-destructive behaviour, only the individual and those very close to them can decide that something needs to change.
‘Exercise addictions can be difficult to spot because it is not about how much you exercise, it’s about the motives behind it.
‘Someone can exercise every day of the week out of self-love and someone else can exercise every day of the week in order to punish themselves – they would look the same to the untrained eye.’
Zoe says that it’s vital that people in the industry are brave enough to have frank, honest conversations about mental health, and a good awareness about the range of different conditions.
‘There are eating disorder sufferers of all shapes and sizes in every community and the main thing we can do is to make sure the community is safe enough that, if they want it, they can ask for help.’
Barry’s has chosen to bring mental health support in-house. This feels like a positive step that could connect people to the help they need at the earliest stage possible.
When Hope relapsed in 2016, she found that having an understanding PT who wasn’t afraid to engage with her illness was really helpful in helping her manage her approach to exercise.
‘She learnt what she had to say to me, to help with the nutrition, everything.
‘I still see her, every six months or so, for a few sessions to help me stay on top of my exercise and to ensure I am doing it for the right reasons, and in the right way. She even pointed out last time I saw her that healthy doesn’t mean thin. It is true!’
If someone is unwell and addicted to exercise, the gym or a studio isn’t the only place they could indulge in unhealthy behaviour.
Hope thinks it’s in everyone’s interest to keep these people in safe spaces to give them the chance to get the support they need.
Harsh measures like outright bans, approaching people directly mid-workout, or calling family members, she thinks, could lead to someone falling off the radar entirely and continuing to deteriorate without the possibility of intervention.
But gyms need to be equipped to cope with these problems sensitively and effectively – and that means looking at more than just the physical symptoms.
‘Exercise can be really helpful in recovery and it is important that people have the chance to learn that and develop a healthy relationship with it,’ says Hope.
‘Mental health care in gyms is needed, but I think gyms, and society as a whole, are still too scared to take that responsibility.
‘First off, it is about having resources available. We need to find a way to look beyond the physical symptoms and open up the wider discussions around mental health.’
We also approached David Lloyd, Pure Gym and DW Fitness for comment – we will update this article if we get a response.
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source https://metro.co.uk/2019/10/11/gyms-enough-protect-members-eating-disorders-exercise-addiction-10847249/
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