Lil Miss Fitness Freak

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Exercise As Part Of Treating Eating Disorders? Fitness Friday 35

Well ain’t that a controversial topic for discussion….

In the spirit of this week being #Eating DisorderAwarenessWeek, I thought I would bring that into our lil regular Friday Fitness chat.

ed-awareness

I knew it would be a big deal. I know that many will not agree with my words, but hear me out, have you ever thought that treatment and exercise could co-exist when looking at eating disorders?

hmmmm

I know what you’re all thinking.

Exercise is a method to fuel eating disorders

Exercise is a means of dropping weight and burning too many calories

How the hell is exercise going to help put weight on when clearly it just increases their energy requirements?

This is why this topic is a great one to discuss.

The points above are completely valid. In fact, those are the beliefs that many professionals give or yell if the thought of exercise is brought up.

Take me for example, during my short time at the Oakville outpatient program for family therapy, it happened to slip out that I was going to be starting to slowly get into training (this was a few months post-inpatient) and my therapist freaked the eff out. Like I’m not kidding, she actually called my house and my parent’s cells and left frantic messages saying  “Chelsea is not to workout!!!!”

Not that her words stopped it from happening, and honestly, we left that place faster than we came in (not because of that incident, but a bunch of other things..), but I’m just trying to give you an idea of how most clinicians feel about this topic

I.e. They are mostly against the thought of exercising.

no-exercise-today

…or ever…

Like I said, these arguments are all valid concerns and I see where they are coming from…

~I was a compulsive exerciser

~Most use it as a way to burn more calories and loose weight

~Most don’t know limits or when to stop

~Many can let it consume them and take over their lives

So I will say again, I understand their fears, but look at it from another perspective. When you just say NO and/or NEVER AGAIN, where does that get you? It teaches the individual nothing about control or other benefits aside from the superficial ones. It tells them that they have lost a free right to do something many people do. It places restrictions on them, which can lead to them deciding to go and do it anyways. Lastly, it prevents them gaining some of the many benefits you get from exercise that can be critical to the health of a person struggling with an eating disorder (*provided they are stable enough to perform exercises) such as bone and cardiorespiratory strength, helping with psychological disturbances, distraction from nagging negative and obsessive thoughts and potential social opportunities.

There are many people I have seen who have gone from treatment to the gym and are strong, independent people who are in control and did not slip back into old habits. They successfully took their health into their hands and chose to use exercise as a way to ‘come back’ and heal. A way to gain strength when their body was so weak before. A way to build confidence in themselves and eventually find that the gym is more than a place to burn calories. It’s gives them a place to deal with their emotions and re-build themselves physically and psychologically.

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So with all of that being said, I wanted to present you with some research on the topic and how these types of interventions have faired in the treatment of eating disorders. I mean, you have heard my story and I could give you anecdotal evidence of the possible benefits for some, but does it actually show more pros than cons in treatment settings?

Lets find out.

To be honest, I was shocked at the number of articles I actually found. I still believe most are completely dead set on NO EXERCISE but there was a surprising number of studies and pilot programs in treatment facilities exploring the use of exercise as intervention. 

I will stick to the main findings of each study and link each so that you can read more if you desire. I am also going to label them in order of earliest to latest. Lastly, I could have found more, but for the sake of your attention span, I left it to these interesting ones.

Thein et al (1999) –> “Pilot Study of a Graded Exercise Program for the Treatment of Anorexia Nervosa”

Main Findings: With the addition of exercise (amount based on % of ideal body weight IBW), the experimental group (diagnosed with AN) showed no difference in change in BMI or body fat, suggesting that the exercise did not inhibit the primary goal of weight gain. The EXPT group also saw a general increase in quality of life measures while the control saw a trend downward from their initial testing.

Szabo and Green (2002) –> Hospitalized anorexics and resistance training: Impact on body composition and psychological well-being. A preliminary study

Main Findings: Study included a non-AN group (exercise group and non-exercise group) with a group of girls currently in an inpatient facility for AN (exercise and non exercise groups). They were both on an 8-week training program of resistance-based exercises. There were trends found for the psychological variables, however it was speculated that perhaps 8 weeks was not enough. Interestingly enough, there was no decrease in weight of the ED-exercise group but a significant drop in those not in the exercise group.

Lutter and Smith-Osborne (2011) –>Exercise in the Treatment of Eating Disorders: An Alternative View

Main Findings: Exercise was significantly associated with greater improvements in eating disorder and depressive symptoms where the number of METS was associated positively with improvements in the measures of depression (BDI) and eating disorder behaviours (EDI). This study was interesting because the exercise was equine based.

Hall et al (2016) –> Use of yoga in outpatient eating disorder treatment: a pilot study

Main Findings: Adolescent girls (all met the requirements for AN/BN/EDNOS but were clinically stable) in an outpatient eating disorder treatment facility attended 12 yoga classes at one class per week. After the intervention, there was no decrease in BMI and significant improvements in anxiety, depression and body image disturbance scores. 

I did a yoga class or two when I was an inpatient at Sick Kids. This was for the advanced stages only but was a nice change of pace. Definitely saw first hand the mood enhancing features. 

This article by Hausenblas et al (2008) also provides a good overview of 6 further studies showing the benefits of exercise based interventions in eating disorder populations on social, psychological and biological factors if you’re interested in even more reading 😉

Finally, here is an article, Bratland et al (2009), that discusses how exercise based programs are managed in treatment facilities and how many places actually have them! It was limited to a few countries in Europe, but can provide some insight for how they could be implemented and managed here.

So…

To conclude, many articles find that there are benefits to exercise in both outpatient and inpatient treatments for eating disorders. Also, rarely did any study (I didn’t find any) report negatives (such as weight loss or stalling the weight gain process) of incorporating exercise into the programs.

I want to say that, yes I know it may take more work and there will have to be strict guidelines in place, like ensuring they are stable enough to participate, etc, but from what I see from research and from my own experience I definitely think that it would be something to really look into further and do more pilot studies on.

Weight gain is already hard enough, try to make it easier on us all. Plus, by being exposed to it in a controlled setting it can also help to make the transition back to ‘reality’ potentially more smooth.

Something I would like to know is if incorporation of exercise during treatment can lower the risk of over exercising or going back to negative exercise habits when they are discharged. 

What are you thoughts?

-Chelsea

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The Only Voice That Should Never Speak

Screen shot 2015-02-27 at 9.40.10 AMClick on the thumbnail for the link to the video.

This is an amazing video to really sum up the points of this post friends. There have been many posts floating around the foodie blogger world lately all related to NEDA week

And I’m not trying to just jump on the bandwagon here. I truly think that being aware of this growing issue is very important. Eating disorders are so often misunderstood and judged as simply a choice or a cry for attention but the real issues are much, much deeper then that.

I have a very hard time looking past peoples judgements of this awful disorder due to lack of understanding, but perhaps that is because I know so much about the psychology behind these disorders and mental illness in general. I will say that I hope you choose to educate yourself rather then make hurtful judgments and comments because an eating disorder is not as simple as someone refusing to eat. Here’s a lil list of factoids for ya to show you just how serious and HARD this illness really is.

Did you know?

  • As far as total deaths related to mental illness, eating disorders are the number one killer of adolescent girls. It is estimated that 10% of individuals with [anorexia] will die within 10 years of the onset of the disorder (NEDIC, 2014).
  • There are line-ups of emaciated and dying boys and girls to get treatment. We just don’t have enough services to help all of the individuals plagued by this disorder.
  • Its not always all about food. Most often it has to do with control. Many individuals use food as their way to control something when they perceive the rest of their lives to be out of their control. Family issues is a common contributing factor to eating disorder tendencies.
  • It’s not a female issue. More and more males are being affected as well.
  • Those haunted by this disorder are truly haunted. There is a point where rational thought has left the individual and they are simply unable to truly see themselves as sick and unable to fight back the voice (compulsions) that is making them present the disordered behaviours

For more stats and tidbits, visit NEDIC here.

To follow-up that last point, I just want to add that THAT is why you cannot and should not judge an individual inflicted with an eating disorder (or any mental illness). It is not their choice. They have not chosen to harm their bodies in the manner that they do. They are simply not strong enough emotionally to fight back against the obsessive compulsive nature of the disorder.

They are literally in a battle with their own head. Do you know how hard it would be to try to turn your thoughts off? How exhausting that would be? Think about that for a second.

I have a lot of experience with eating disorders….

  • I have done research on children’s eating disorders during my first undergrad degree at McMaster University.
  • My thesis was on Binge Eating Disorder (BED).
  • I have many friends who have and, unfortunately, continue to, suffered with the grips of this disorder.
  • And well, I have a secret that I’m finally ready to share with you guys..

I apologize that they are so long (both part 1 and part 2) but that’s because they were difficult for me to record and because they are never scripted. I just let my thoughts flow. Click on the thumbnails for access to the videos. I hope you stick around for the full run through, but I can understand if 20 minutes is too long for you.

NEDA symbol part 1

And part 2, once again, clicky on the thumbnail. NEDA symbol part 2I have held this back for so long not because I’m ashamed of what I went through, because I’m not, but rather, because I have been afraid of what my friends (who I didn’t know through the ordeal) would think of me once they knew. I was afraid that they would think of me differently. Perhaps, they would speak to me differently or feel the need to not say certain things around me if it at all relates to eating disorders or body image related things.

I guess I was afraid to be seen as a victim of sorts because I’m not.

Yes I went through hell and back. Yes, I hit rock bottom in my life, but you know what?

That was ONE part of my life and for it, I’m a much stronger person. As I mentioned in my video, I have grown so much from that experience because I learned more about myself and my abilities during that struggle then I have throughout my whole life.

I am me because of that event. I am me because I made it through. I fought and I fought damn hard. I pulled through. I lived.

Yes, I continue to fight that voice every day because it never fully shuts up no matter how ‘recovered’ one is. He still likes to creep in when I’m vulnerable (like during exam stress) and make me feel small and weak again. When that happens it’s my job now to know that my body gave me a second chance to live and I’m not letting anything take that away from me.  I have worked too hard for that.

I also have help. I have my friends and my family there even when they don’t know it to help get me through those tougher times when I’m feeling overwhelmed. For that, I can never give enough thanks.

I also have you guys. This lil blog spot where I can say what I’m feeling is such a release for me and it only makes me even more happy that I can relate to you and help any of you beautiful people in any way. You too are my support system and for that as well, I thank you.

I can only hope that now that you understand my quirks and know that I am here to provide a listening ear to anyone who is struggling and needs help. No one is ever alone! I also hope you all know how much you mean to me. After all, I just spilled the biggest and hardest secret of my life to the world to you all and I hope that I haven’t scared you away. I’m human just like all of you and have my own struggles and my own demons to deal with. The main point is that I’m trying, forever growing and striving to reach a point where I can finally say….

I hope that this post has resonated with you all and please please please promise me that before you start to form a judgement about anyone with a mental illness, stop and think about why you are doing that. In most cases, you will come to realize that you are judging simply because you don’t understand and we don’t like to feel like we don’t know something.

Much love and thank you again for always being an amazing audience to share my thoughts and feelings with.

XO

Here is an interesting article to read up if you’re interested. Also, never be shy to chatter back at me in the comments.

Pause. Hover over submit. Take a deep breath. Publish. Done.

-Chelsea