By Cathy Cassata
Yes, you were shocked. I was shocked, and even the judges were shocked when winner Rachel Frederickson of The Biggest Loser revealed her 155 pound weight loss and 105-pound frame earlier this year. During the contest, Frederickson exercised as much as six hours a day and counted calories to slim down.
“At 5 foot 4, Rachel needs to add about ten pounds to her frame since 108 to 132 is a normal range for her,” said Lisa Payne, fitness and wellness expert in Chicago, Ill. “Rachel lost 60% of her body weight quickly, so it’s very possible that she’ll have heart and organ issues down the line. Plus, the mental component of why she was obese to begin with, and why she continues to stick to such a strict exercise regime and low calorie intake, is a big concern.”
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CONTINUING DESPITE ADVERSE CONSEQUENCES
Rachel Frederickson was competing to lose weight on a television show, but reality TV stars aren’t the only ones turning to extreme exercise regimes to drop pounds and stay fit. “I haven’t taken a day off from the gym in over two years,” said Katherine Schreiber, a 25-year old graduate student in Manhattan, N.Y. Schreiber exercises at the gym twice a day for 2 to 3 hours and then does 30 to 45 minutes of yoga before bed. Nothing gets in the way of her regime. Not even a herniated disk.
“Several doctors recommended back surgery to fix it, but there was no way I was doing that since it meant I had to take 2 or 3 weeks off from working out. I just suffered through the pain and adjusted my workouts to be the least painful as possible,” Schreiber said.
Heat stroke didn’t stop her either. “I was in Israel with my fiancé, and I came down with heat stroke because I insisted on speed walking the Masada in 3pm Middle Eastern heat. The next day I had a fever, I could barely get out of bed, yet I went to the hotel gym. My fiancé kept telling me I was too sick. I knew he was right, but in my head I thought ‘at least I’ll burn calories and feel like I achieved something today,’” Schreiber said.
Working out despite an injury or medical condition is one of the signs of exercise addiction, says Susan Blank, MD, psychiatrist and Chief Medical Officer at Atlanta Healing Center in Ga. “For instance, a runner who experiences a stress fracture is told by his doctor that he needs to stay off his leg for 6 weeks, but when he tries, he experiences withdrawal symptoms such as anxiety, irritability, insomnia, loss of appetite, depression, agitation, and a strong preoccupation with when he’s going to run next and how much he can get away with,” said Blank. “Many times exercise addicts can’t keep with the restrictions and they’ll work out anyway because that compulsion to do it is stronger than the intellectual understanding that this is very bad for them,” she added.
SIGNS THAT YOU HAVE AN UNHEALTHY RELATIONSHIP WITH EXERCISE
Although exercise addiction is not included as a disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), Blank says some mental health professionals define it as a compulsion, others as a part of an underlying eating disorder, and still others as an addiction.
“There are plenty of people who exercise regularly and sometimes excessively, who aren’t addicted to it, but when someone says they get a true runner’s high, that tells me that the exercise is causing not only the release of endorphins, which is a natural opiate, but also a release of dopamine at the nucleus accumbens, the part of the brain where stimulant drugs have their action in terms of addiction,” said Blank.
Other signs of exercise addiction, Blank says, might include the following:
Exercise that significantly interferes with important activities, such as skipping a daughter’s soccer game because you want to exercise, or not going home at night to interact with family because you have to go to the gym.
Exercise that occurs at inappropriate times or in inappropriate settings, such as leaving work early to get in a workout or skipping breakfast, lunch or dinner so you have time to work out.
Exercising to mood alter, avoid feelings, or get a runner’s high rather than exercising because it helps you stay healthy, cope with stress and assist in lowering cholesterol or blood pressure.
Thinking about exercise takes over your thought-patterns.
Not exercising leaves you feeling anxious, depressed, even physically ill yet when you’re exercising you’re not enjoying it.
Shelly Dammeyer, psychotherapist at Eating Disorder Resource Center in New York, N.Y., agrees with the above and says a big insight is the purpose behind the exercise. “One of the first things that I look at when I’m treating compulsive behaviors like over-exercising is helping the person uncover why they are exercising and what they get out of it,” she said, adding that there are different reasons why people become exercise addicts. “They may have an underlying eating disorder related to poor self-image, a compulsion disorder, struggle with anxiety, depression, perfectionism, or they may be displacing another addiction like drug abuse. Getting them to understand their motivation behind excessive exercising is a big step.”
Realizing the reasons behind her addiction was eye-opening for Schreiber. As an adolescent, her parents went through a divorce and Schreiber began abusing drugs and alcohol to cope with depression. “My parents sent me to a mental institution, and then a 9-week boot camp in Idaho. Then I lived in a residential facility in Connecticut. That is when my anorexia started. I noticed how much attention the girls were getting from not eating, and I started counting calories and carbs. I got a sense of empowerment from restricting my food intake and felt in control of myself. By 15, I was sober, but anorexic, and I also began going to the gym as a healthy outlet. It wasn’t until I was in college that I realized exercise was a problem,” she said.
The problem keeps escalating. “It’s to the point where exercising is all I think about until I get to the gym and burn at least 400 calories. When I’m working out, I get some anxiety relief for a bit, but then I just want it to be over. I feel trapped in it and know I can’t live without it,” she said. “I hit plateaus too and need more exercise to get that bit of relief, so it’s never-ending. Such a hard realization, but this addiction has taken a toll on my body, relationships, work. It controls my life.”
ENOUGH IS NOT ENOUGH
So what is a healthy workout routine? Payne says shoot for 30 minutes, 6 days a week at a moderate intensity, which could include a fast walk or elliptical trainer. “When you take a day off, your body’s still working so you’re really not taking a day off because in order for you to gain muscle, which burns fat, you have to let your body have time to repair and get stronger,” she said.
If you’re trying to lose weight, Payne says losing two pounds a week is a healthy way to keep it off. “For people who want to lose more than 10 pounds, I suggest five days a week for 45 minutes to an hour, mixing in a combination of cardio and strength training. A good routine might be exercising on the elliptical for 30 minutes and lifting weights for another half hour,” said Payne.
Weight loss is also about what you eat, adds Payne. “A lot of fitness people will suggest eating 1,200 calories a day to lose weight. In fact, that’s what the contestants on The Biggest Loser consume, but I think it’s hard for people to sustain that,” she said. “I recommend 1,400 to 1,700 calories as a ballpark figure for an active person who is working out hard and trying to lose weight. It all depends on the types of workouts you’re doing and the quality of food you’re eating,” she noted.
Working out just so you can eat what you want is dangerous territory, warns Payne. “I see a lot of people use exercise as a purge or preemptive purge to offset what they’ve [eaten] or are planning to eat. It becomes a warped way of thinking. You want to be able to eat what you want and feel good, but there’s more to it than just that. We all have different chemical makeups and our calorie expenditure depends on the day and what we’re eating,” she said.
For marathoners and triathletes, Payne says a good way to check in with yourself is to incorporate cross training and days off. “Not everyone who runs marathons or does triathlons is addicted. A sign that you’re training correctly is if you take days off, enjoy the training for the most part, and do other things like yoga to take care of your body,” she said.
WHAT TREATMENTS HELP?
Treating exercise addiction is different than treating other addictions, Dammeyer says. “With substance addiction, you start by cutting out the substance, but with exercise addiction, you can’t completely stop moving since we need some exercise to stay healthy, so we have to try to cut back, and really focus on how to make exercise less associated with bad feelings. Cognitive behavioral therapy [CBT] and a mix of techniques like dialectical behavior therapy can help,” she explained.
Blank notes that while CBT works well by helping people find more healthy ways to modulate their mood and find alternative outlets to help cope, they have to be careful. “You learn to love the drug or behavior you’re with. For someone who has the disease of addiction, it’s not alcohol or drugs or exercise that’s the problem, it’s their brain that’s the problem and their brain doesn’t have the feedback loop that says ‘stop you’ve had enough.’ I’ve seen drug addicts turn to exercise and then when they can’t limit exercise turn to food,” she said. “Exercise addicts can get help, but it’s a constant process. Just like a drug addict, they need to spend part of their day thinking through how they are not going to use exercise that day.”
Besides therapy, Blank says medications that help with decreasing cravings like Naltrexone, which works on the opiate receptors, may be effective, and anti-depressants may help some people who have an underlying depression or anxiety disorder.
NEGATIVE POSITIVE REINFORCEMENT
While treatment options are out there, taking action is challenging like with any addiction. In a society that praises working out and looking fit, exercise addiction can be especially difficult to overcome. “People don’t say, ‘what? You drank 50 beers last night, that’s awesome!' But they do say ‘wow, you’re running another triathlon? Good for you.’ or ‘I wish I worked out as much as you do.’ Behavior addictions are particularly difficult to manage because not only do addicts get the runners high, but they get a lot of support and positive feedback from people around them,” Blank said.
Dammeyer agrees and says that looks can be deceiving too. “Not all exercise addicts look underweight, like say someone with anorexia may look, because they might be obsessively counting their calorie intake and outtake and keeping their weight stable, so often times they’re perceived as healthy,” she noted.
Schreiber can attest. “I always get people telling me I look amazing and have a great body. Even if I tell them I’m addicted to exercise, I’ll get nonchalant responses like ‘wish I had that addiction,’” she said. “It’s so off of people’s radars as being a problem or detrimental. If they only knew the psychological turmoil and isolation I feel, they’d respond differently.”
Perhaps The Biggest Loser execs should ponder that.