Exercise bulimia is becoming a real problem in gyms, but it can be a difficult disorder to detect. Ciarán Brennan reports
Among the 4,228 calls that eating disorders support group Bodywhys received last year were some from gym managers and instructors concerned about members who are exercising excessively.
The gym instructors were concerned about a relatively new eating disorder - exercise bulimia. People with exercise bulimia work out to purge what they have eaten in much the same way that people with bulimia vomit after eating. Like other eating disorders, the condition is usually attached to feelings of guilt about eating.
"We took a number of calls from people in gyms who would be concerned about people who maybe were excessively attending the gym," says Jennie O'Reilly, Bodywhys chief executive."They would come across it particularly where somebody is being assessed for a programme and the person would feel they were overweight when it is clear they weren't. Gyms have been in touch with us and ask what can they do and how can they manage the situation and people like that."
Kevin Doyle, a fitness instructor with Westpark Health and Fitness in Tallaght, says he has encountered the condition on a few occasions in the past, where a member - whether it is for low self-esteem, poor body image or addictive personality reasons - would exercise to excess, often changing their routine from a few visits to twice-daily workouts.
"When they get to that stage it usually is some kind of psychological condition, be it anorexia or something else, where the image they feel they have is totally different from what the facts say," he explains.
Westpark assesses members every six weeks, looking at body mass index, body fat levels, attendances and time spent at the gym, which Doyle says helps identify exercise bulimics.
"Questions are asked by their individual trainer as regards why and what they are trying to aim at, and we track attendances and time spent so we are able to tell them they are doing too much," he says.
"A gym that lets somebody train with a body mass index that is just going well below average and continue to see them training twice a day, six days a week is irresponsible."
Although it has been a recognised eating disorder for more than a decade, the condition was recently catapulted into the limelight when Jamie-Lynn DiScala, the actress who plays Meadow in the TV series The Sopranos, disclosed that she had suffered from the disorder.
DiScala's obsession became so strong that she would wake up at 3am to exercise for hours. At one stage DiScala, who was a teenager at the time, weighed just 80lbs and wore children's clothes.
"It would be common sense that anything in excess is going to potentially have harmful effects. It is about moderation and balance," explains O'Reilly.
In the United States, it is estimated that five million people suffer from eating disorders and that up to 12 per cent of gym goers may be suffering from exercise bulimia.
The problem may be on the increase in the Republic, although it is difficult to quantify the extent of the condition.
"It is known that people do present with this kind of pattern to psychotherapists as well as to other types of health clinics," explains Dr Brion Sweeney, chairman of the Irish Council for Psychotherapy.
"It is just taking a different form rather than the person vomiting food. The classic two methods that are most thought of when you think of bulimia is vomiting and the other is laxatives to induce early or transitive food through the gastric intestinal system quickly so it doesn't get absorbed.
"But the exercise method does occur, is recognised and is more prevalent in our society at the moment because of emphasis on jogging for fitness and the growth of health gyms."
A major problem with exercise bulimia is that it is very difficult to identify and detect, particularly as there is currently huge emphasis on the benefits of exercise to combat problems of sedentary lifestyles such as obesity and heart disease.
"One of the problems with it is it has a hidden dimension," says Sweeney. "Part of the problem is that people may not identify it. It is more hidden and may become quite entrenched over a period."
O'Reilly agrees that the problem can be very easily camouflaged because exercise is generally seen as a good and healthy thing.
"What we are trying to do is distinguish between someone who is a regular gym goer and someone who has an eating disorder and is using the gym as part of that eating disorder," says O'Reilly.
"It is all about level of compulsion and how consumed they are, because I get asked a lot, particularly around dieting, when is it a diet and when is it an eating disorder?
"And the same point would be true of exercise - when is somebody just into sports and when is somebody doing it because it is an eating disorder issue?"
It would appear that people with exercise bulimia have the same hang-ups about body image and self-worth as people with other eating disorders. "It is really important to get across that any of these behaviours are motivated by someone who has emotional distress or some level of anxiety in their lives and this is their way of coping with that," says O'Reilly.
"If you look at any eating disorder, the motivation, the low self-esteem and low self-worth, is nearly all the same.
"I would listen to people on the helpline and it is literally the same kind of emotional stuff they are talking about, they are just dealing with it differently. It is usually a symptom of something else."
The key issue to stress is that help is at hand, according to those working with eating disorders.
If the problem is diagnosed, treatment is similar to other eating disorders and usually involves therapy and counselling to improve self-image and deal with feelings about self-worth.
"Psychotherapists might be involved in working with both the symptom and also working with deeper issues at the same time," says Sweeney.
"In other words, working with the symptom in trying to get people to address not doing those things, not over-exercising, not adopting artificially for calorie intake, at the same time as looking at the deeper issues that might be arising."