In response to Dr. Drew ~ Exercise bulimia is not a mild mental health issue

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Recently the well-known celebrity internist, Dr. Drew Pinsky, shot this video for CNN iReport. During the segment he answers viewers’ questions about mental and physical health,  including one about healthy exercise and another regarding diet pill addiction in which he references underlying eating disorders as a serious concern.  What seems to be warranting concern is not the answers he’s giving to the viewers so much but the opening statement of the video in which he lightheartedly discloses his own struggle with something he refers to as a “mild” mental health issue called exercise bulimia.  Dr. Drew’s remarks were as follows:  

I got a whiff of exercise bulimia. You sort of exercise too much, and if you miss it you freak out. You have to constantly exercise.  I don’t feel right if I don’t do it.  But, you know, a little whiff of mental health issue never hurt anybody. 

In actuality, “exercise bulimia” is not a formal diagnosis but is a popular term often used to describe a subset of individuals with anorexia or bulimia diagnoses who feel compelled to engage in excessive exercise as a form of compensation for calories.  Some of the signs and symptoms associated with excessive exercise include:  

  • Engaging in exercise even when sick or injured
  • Becoming seriously depressed if you can’t get a workout in
  • Exercising above and beyond what would be considered a normal amount of time 
  • Refusing to build in any days of rest or recovery days
  • Inflexibility as to time of day and mode of exercise
  • Prioritizing exercise over social dates, family functions, work, or school
  • Intense fear at states of rest
  • Intense anxiety at situations where preferred method of exercise is unavailable
  • Intense guilt when forced to stray from exercise routine
  • Refusal to eat if unable to exercise
  • Defining self-worth in terms of exercise performance

Upon seeing the video above, The Center for Eating Disorders’ Director, Harry Brandt, M.D., had serious concerns regarding Dr. Drew’s statement about exercise bulimia and specifically the public interpretations that would follow. 

“In the age of the internet and personal blogs there will always be misinformation out there, but it’s particularly concerning to see high profile medical professionals, in this case an internist, minimizing what is a very serious disorder for a lot of people”  said Dr. Brandt.  He went on to say that “eating disorders are difficult to identify and treat partly because they are a socially normative disease.  Common symptoms like weight loss, dieting, negative body image and excessive exercise are all reinforced in our society.   This can make it very difficult for people with serious eating disorders to recognize their behaviors as problematic and part of a more significant mental health problem.  Statements like Dr. Drew’s trivialize a dangerous behavior and unfortunately make it more difficult for individuals to justify getting help.”       

Dr. Drew’s opinion that, “a little whiff of mental health issue never hurt anyone“ is actually far from true.  Something that may seem minor or mild could actually be indicative of a full-blown eating disorder or might represent the first signs that one is developing.   Eating disorders have the highest mortality rate of any mental illness.  Without treatment anywhere from 5-20% of individuals with eating disorders may eventually die from complications related to their illness.  Individuals with eating disorders who struggle with excessive exercise in particular are at risk for the following health problems: 

  • Increased injuries such as stress fractures, strains and sprains
  • Possible permanent damage to bones, muscles, joints, ligaments and tendons
  • Increased susceptibility to infections, fatigue and exhaustion
  • Muscle wasting (the body begins breaking down muscle mass as a source of energy)
  • Fatigue
  • Dehydration
  • Osteoporosis (bone loss)
  • Arthritis
  • Menstrual irregularities and reproductive problems, including infertility
  • Heart problems

Excessive or compulsive exercise does not always occur alongside an eating disorder but when it does, it can provide some of the first signs that someone is struggling with food and eating. We encourage influential health professionals like Dr. Drew to be mindful of the messages they share with the public and to take great care not to normalize or trivialize behaviors that could indicate someone is suffering from a serious mental health problem.

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If you are concerned that you are a loved may have an unhealthy relationship with exercise, please call us at (410) 938-5252 or visit our website at www.eatingdisorder.org .

Momentum of Positive Change: The AMA’s Photoshop Policy & Beyond

On its website, the American Medical Association (AMA) states that its mission is to “help doctors help patients by uniting physicians nationwide to work on the most important professional and public health issues.”  It speaks volumes then, that in their most recent press release, the AMA announced the adoption of a new policy to discourage the rampant use of photoshopping and American Medical Association Logophoto editing by advertisers.  In the policy, AMA cites the connection between unrealistic/altered images and adolescent health problems, particularly body image and eating disorders. A press release about the new policy included the following statement:

Advertisers commonly alter photographs to enhance the appearance of models’ bodies, and such alterations can contribute to unrealistic expectations of appropriate body image – especially among impressionable children and adolescents. A large body of literature links exposure to media-propagated images of unrealistic body image to eating disorders and other child and adolescent health problems. The AMA adopted new policy to encourage advertising associations to work with public and private sector organizations concerned with child and adolescent health to develop guidelines for advertisements, especially those appearing in teen-oriented publications, that would discourage the altering of photographs in a manner that could promote unrealistic expectations of appropriate body image.

Its important to note that eating disorders are biological illnesses with a myriad of  genetic, hormonal and neurobiological factors.  Just as parents do not cause eating disorders, nor do airbrushed magazine ads. (In fact, Carrie Arnold over at Psychology Today’s Body of Evidence does a great job of examining this aspect of the AMA’s statement).  But our hope is that this new policy is not just focused on removing a risk factor for those who may be genetically more susceptible to the “thin ideal”.  A society saturated with computer-generated images portrayed as real bodies is unhealthy and harmful whether it contributes to an eating disorder or not.   Its harmful to females and males.  Its harmful to kids and adults.  Its harmful for anyone that struggles with negative self-esteem or body image.  In this way, the issue of photoshop and media ethics is more than an eating disorder prevention issue but one that addresses self-esteem and body image on a societal level.

While some will say the policy doesn’t accomplish enough, its encouraging to see a well-respected, national organization like the AMA acknowledging the issue and prompting further attention to it. What’s most encouraging isGirl Scouts of America logo that this recent action by the AMA, seems to be part of a larger momentum of change including the Girl Scouts’ announcement of its’ project, Healthy MEdia: Commission for Positive Images of Women and Girls which is being co-launched by the National Association of Broadcasters (NAB), the National Cable & Telecommunications Association (NCTA), and The Creative Coalition.

The new policy also arrives amidst several specific wins in the fight against harmful media practices surrounding weight, food, beauty ideals and sexualization.  Most recently, the Federal Trade Commission (FTC) won a settlement against Beiersdorf, Inc. (parent company of Nivea) Inc. that prohibits them from making continued false claims that its Nivea My Silhouette! skin cream can reduce consumers’ body size.  In June, the National Eating Disorders Association (NEDA) publicly applauded Yoplait for agreeing to pull a troubling ad campaign after being warned by NEDA that it normalized dangerously disordered thoughts around food and weight.  And thanks to international body image advocates Sharon HaywoodMelinda Tankard Reist and more than 5,000 signatures on a petition at Change.org, major networks MTV and VH1 both agreed to ban a violent and misogynistic music video starring Kanye West and other high profile music stars.

Lots of individuals and organizations are pushing back against the tide of false bodies, diet myths, weight prejudice and general negativity in the media.  They’re making great strides in the promotion of positive body image, self-esteem and overall health (vs. weight).  In addition to those we mentioned above, here are just a few more organizations and individuals that are doing good and speaking out for change:

When it comes to body image and media literacy, what other successful campaigns and positive social changes have you noticed lately? 

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