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How to know if eating healthy and exercising crosses the line to compulsion — or worse

October 29, 2020
Houston Chronicle
Deb Michel talks to the Houston Chronicle about how to tell when "healthy" eating and exercise goes too far

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Your “healthy” lifestyle might not be that healthy after all - especially if diet and exercise become extreme.

Dr. Deborah Michel, regional clinical director of Eating Recovery Center and Pathlight Mood and Anxiety Center, The Woodlands, explained that what appears to be a healthy habit on the surface could, in reality, be obsessive exercise and disordered eating.

The difficult part is knowing the difference, she said.

Compulsive exercise, sometimes referred to as exercise addiction, occurs when physical activity becomes too much. Injury, illness, socializing with friends or an incoming storm cannot stop an individual who exercises obsessively.

Similarly, what begins as a restrictive diet can become obsessive and result in disordered eating and heightened concerns about body image.

Another area of concern is nervosa orthorexia - an obsession with eating healthy, explained Dr. Sophie Schneider, assistant professor in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine.

Individuals with this disorder become so preoccupied with eating right that it actually becomes damaging.

Schneider agreed that it is tricky to identify when exactly a behavior goes from improving health to hurting an individual.

“We don’t have well-defined definitions of when we cross the line,” she said.

And quitting is complicated.

“You can stop drinking alcohol, but you can’t stop eating or exercising,” Schneider said.

Dr. Kimberly James, at Stepping Stone Therapy, said that increasing awareness of disordered eating and compulsive exercise is critical to early intervention by licensed psychologists and medical professionals.

Here, these three local experts offer advice for staying healthy - and avoiding extremes:

 Watch for warning signs. Exercise becomes obsessive, when it interferes with other important activities, like work, school or relationships, Michel said. Individuals might treat exercise as permission to eat or to purge when they consume too many calories.

“Exercise becomes something that you must do,” Michel said. “When you don’t work out, you become angry, your mood changes. You exercise regardless of whether you’re sick, exhausted or injured.”

While exercise can help lift moods and manage stress, too much physical activity can result in more anxiety.

“It becomes a way to escape at the cost of everything else and negatively impacts interpersonal relationships,” Michel said. “Exercise is part of a healthy lifestyle, but it can’t become the only way to cope. You need to have a wide array of coping skills.”

Disordered eating can manifest in overly restrictive dieting, as well as bingeing and purging.

Symptoms of orthorexia include eliminating entire categories of food from a diet, believing self-esteem is directly tied to one’s ability to stick to a diet, spending too much time planning meals, restricting calories or hiding food from others.

  Reach for more realistic expectations. Schneider said both men and women feel pressured to not only be trim but also muscular.

“For women, it’s not enough to just be skinny anymore,” she said. “You also have to be toned.”

Men are also trying to lose weight and bulk up simultaneously. “There’s been a heightening of this message to men,” Schneider said. “With male movie stars, for instance, they’re not just muscular, they’re cut down and have a physically not-possible body.”

She said that younger generations are often more aware that photos are retouched. Still a number of people aspire to look like the images of actors and models in magazines, movies and social media, she added.

Michel encourages patients to view these images with a critical eye and recognize that societal messages of what is “perfect” are often unattainable.

“This thin ideal is unrealistic,” she said. “Everyone has to accept their own body types. When a person is trying to mold their body into someone else’s ideal, that is a problem.”

  Consider your whole body. Individuals might say they only want to fix their arms or drop five pounds. In the meantime, they aren’t paying attention to their whole body and how they feel in general.

Take a patient who doesn’t like their nose, says Schneider: Suddenly, that’s all they see in the mirror.

“It distorts the way they see themselves,” she said. “Only paying attention to your flaws can stop you from seeing your whole appearance.”

  Does a day off from diet or exercise make you nervous? It shouldn’t. When exercise becomes obsessive, it can affect an individual’s ability to get enough sleep, Michel said. Maybe they stay up late or wake up early to fit in a workout.

“Or they totally ignore that a body needs time to rest or recover after a workout,” she said.

That time off from exercise shouldn’t be a problem, she explained.

Schneider added that anxiety can also result when people stray from their diets. She recommends seeking balance in both exercise and nutrition.

Group exercise might be the solution, she said. Not only will individuals learn healthy routines from trainers, they also benefit from the social aspect of a class.

Jamesworks with a professional trainer - and in her practice, often focuses on the relationship between nutrition, fitness and mental health.

The trainers help James work on different muscle groups during each session - and also time the routines.

“I’m not there for three or four hours,” she said. “I go, and I love the way I feel afterwards. But if a friend is in town or a family member - or there’s a ballet I want to see, I go. Exercise does not stand in my way.”

  Make decisions that are sustainable. Schneider suggests asking “Is this something I could continue for a while?” when making a change in diet or exercise.

For example, walking a certain amount of steps or exercising for a certain amount of time can be a sustainable goal. It’s easy to want to continue these healthy habits. But ruling out an entire group of food items — like carbs — is unsustainable, Schneider added.

“Balance is key,” she said.

There are no such things as good foods or bad foods, Michel added.

“Diets don’t work,” she said. “We really encourage a balanced and healthy lifestyle. It’s about lifestyle, not slashing calories or fad diets.”

  Is negativity part of your program? If so, get rid of it. Exercise should be fun, Michel said. “People sometimes lose the ability to see exercise as something that can be enjoyable,” she cautioned.

Consider it a warning sign if you no longer enjoy a stroll with friends and family or walking out in nature, because you would rather be pounding the pavement instead. Michel said to be careful if a workout routine shifts from being pleasant to being a punishment.

“There’s a difference between ‘I shouldn’t have eaten that donut’ and ‘I’m a really bad person because I ate that doughnut’,” Schneider explained.

Individuals who have struggled with weight can carry criticisms they have heard from others, even after losing weight.

There are also fears of regaining weight, or a desire for the positive reinforcement that comes with shedding pounds.

“If you’re being unkind to yourself mentally that’s a good sign that you could use some support,” Schneider said.

James recommends giving yourself grace. “You have to be compassionate with yourself,” she said. “Get out of that punishing mentality.”

  Remember, we’re still in a pandemic. Stress, anxiety and depression caused by COVID-19 can also exacerbate obsessive exercise and disordered eating.

For example, individuals can exercise continually at home without anyone knowing, or miss miss eating with others who can model healthy behaviors.

Isolation can also increase risk of eating disorders and compulsive exercise. The Eating Recovery Center, is currently experiencing a higher number of patients than normal.

“The demand for treatment right now is incredible,” Michel said.

  Build a team. James recommends working with a physician, a registered dietitian who can check nutrition plans and a psychologist or therapist to address issues that could come into play.

“You need a team,” she said. “Then you’re operating from a place of knowledge.”

Stress from work or school could be behind obsessive behaviors. And if a person is an emotional eater, it’s impossible to kick the habit without addressing its root cause.

“My job is to get in there and find out why, to help you feel more aligned,” James said.

Individuals sometimes carry fear that if they gain weight, they will no longer be attractive or loveable, she added.

“We’ve got to tackle those issues - and unpack all of that,” she said. “You have to recognize what’s stirring up inside of you, to know it, to name it and move onto something else.”

Eating Recovery Center and Pathlight Mood and Anxiety Center are accredited through the Joint Commission. This organization seeks to enhance the lives of the persons served in healthcare settings through a consultative accreditation process emphasizing quality, value and optimal outcomes of services.

Organizations that earn the Gold Seal of Approval™ have met or exceeded The Joint Commission’s rigorous performance standards to obtain this distinctive and internationally recognized accreditation. Learn more about this accreditation here.

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