Sometimes, healthy habits can hide exercise addiction and dangerous eating disorders like anorexia and orthorexia
At age 22, Julia Russell began an intense fitness regimen that would rival most Olympians'. From two-a-day workouts to a strict diet, you might think she were actually training for something. And she was: to feel good. The endorphin high helped her cope with an unfulfilling, post-college job that she took after moving back home to Cincinnati, OH. Between dealing with a miserable office life and missing her college friends, she made the gym her happy place, visiting it before and after work every day for seven years straight. (Did you know Runner's High Is As Strong As a Drug High?)
"My workouts were pretty intense. I became obsessed with counting calories too—I was eating less than 1,000 calories a day and doing two-a-day workouts, like boot camps, high-intensity cardio, spinning and weight lifting," Russell says. Despite having low energy that made her extremely irritable, she stuck to this rigid routine from 2004 to 2011. "If I had to skip a day, I would get very anxious and feel very bad about myself," she admits, though at the time, she kept her frustrations to herself.
"I never told anyone how I felt. I was also getting a lot of compliments, like 'Oh, wow, you've lost a lot of weight,' or 'You look great!' My body type is athletic, and although I was thin, you wouldn't look at me and say, 'That girl has a problem.' I looked normal," says Russell, who grew up doing gymnastics, practicing synchronized swimming, and playing tennis. "But for my body type, I knew that was not normal. So it was very deceiving for me and the people around me. In my mind, I didn't have a problem. I just wasn't skinny enough," she says, revealing that being slim was a notion she had been chasing for as long as she could remember, as far back as pre-kindergarten.
During those seven years, only one friend—an acquaintance, really—expressed concern for Russell while they were both attending graduate school at the University of New Hampshire in 2008. "Sometimes it's the people you're closest to who don't say anything. This stuff happens gradually so they might not notice. Also, in our society, everyone is so health-obsessed that nobody thinks it's weird. But this girl at school thought I was too workout-obsessed and too thin," she says. Though Russell brushed off her comments at first, she eventually visited her school's psychologist. "I went one time, cried through the whole session and never went back," she says of her session with the counselor. "It was too terrifying to confront. A part of me knew something was up, but I didn't want to deal."
And after graduate school, people actually congratulated Russell on her weight loss and talked about how jealous they were that she had such self-control. "That made me feel superior and made me want to engage more in the dangerous exercise and dieting behaviors," she says. Plus, "I was in grad school. I had a boyfriend. From the outside, I was doing just fine. Other people have way worse problems than me. I was just being emotional. So I dissociated and moved on."
It wasn't until Thanksgiving in 2011 that Russell's denial caught up with her. "I hadn't been able to keep a relationship for a while. I was always canceling on dates because I didn't want to go out to dinner or because I wanted to work out. I had eating disorder things to take care of. Also, I was a very stressful job working at the public defender's office. I felt like part of my life was failing," she says. That November, Russell invited people over for a Friendsgiving potluck before a night out on the town. When she got home later, she was so hungry, she had some leftover chocolate cake...and couldn't stop eating.
"I literally ate half of it and made myself throw up. I had never thrown up for that reason before. I remember sitting in the bathroom crying. At that moment, I realized things were not right. It had gone too far. I called my best friend and, for the first time, told her what was happening. She was so supportive and told me to see my doctor. My primary care physician referred me to a psychiatrist who referred me to my psychologist, who then referred me to a dietitian and group therapy," she says. Even after being diagnosed with an eating disorder—a condition that affects 20 million women and 10 million men in the U.S. alone—Russell wasn't convinced she had a serious problem.
"I remember her telling me that I was anorexic and I responded with a sassy, 'Are you sure about that?' I do things that are healthy. I work out, I eat well, I don't eat dessert or engage in bad diet habits. Maybe I have some anxiety and depression, but an eating disorder feels too farfetched. Those people are extremely skinny and look disgusting. They don't have any friends. I didn't think that that was me," Russell recalls. "When I started going to group, I was around 10 other girls who had very similar lives to me. That was really shocking. Some were bigger than me, some were smaller. They all had friends and came from good families. It was just a realization. It was so overwhelming." (Read how another woman's Healthy Habits Turned Into an Eating Disorder.)
For the next two years, Russell worked with her team of mental health and nutrition experts plus support group to learn how to get to a new happy place. She didn't enter a facility, but rather kept her full-time job to help pay for her treatments and squeezed in appointments into her busy schedule. Four years later, Russell finally understands what it truly means to be healthy.
"Now I try to work out maybe three times a week—in only fun ways. I ride my bike. I do yoga. Exercise is good for you, but I don't let it become a chore. I have no idea how much I weigh. I haven't stepped on a scale since 2012. Also, I try not to restrict foods. All foods have good and bad things; it's all about proportions and ratios. And I live with my boyfriend of two years. We have a healthy relationship that's awesome," says Russell, now a 30-year-old MBA student at DePaul University in Chicago. Despite her excellent progress, Russell continues to see her psychologist every other week to avoid a relapse and keep daily stresses from leading to harmful thoughts like, 'You're fat. You need to work out. You have to count your calories.' (Fat Shaming Could Actually Lead to a Higher Mortality Risk.)
One of the most surprising lessons Russell learned from her experience is that eating disorders don't discriminate. "There's no weight requirement. People with eating disorders come in all shapes and sizes. No one looked the same, but we all had the same problem," she says of the women in her support group. When it's not visibly obvious that you might be taking your fitness and diet routine too far, then it's easier for your extreme measures to fly under the radar—that is, until you suffer severe medical consequences, such as an increased risk of heart and kidney failure, reduced bone density, tooth decay, and overall weakness and fatigue.
Where's the Line Between Normal and Disordered?
Eating disorders are tricky to notice and diagnose. So we tapped psychiatrist Wendy Oliver-Pyatt, M.D., an active member of the National Eating Disorders Association, to point out three seemingly subtle signs of unhealthy behaviors that can pass off as "normal" but could actually lead to developing an eating disorder.
1. Pursuing unnecessary weight loss. Every woman has a dream number they want to see on the scale. As some work towards that goal, they may discover along the way that if you're healthy, fit and feel good, it doesn't matter what the scale or BMI chart reads. "Weight is a very poor indicator of health," says Oliver-Pyatt, founder and executive director of the Oliver-Pyatt Centers in Miami, FL. "The World Health Organization (WHO) has their own definition of health, which actually encompasses a broader spectrum of health, including physical, mental, social, spiritual well-being. Oftentimes, people think they are doing something healthy when, in fact, it may not be," she says.
A perfect example of this is when people try to force their body to be in the "normal range" of 18.5 and 24.9 on the Body Mass Index (BMI), a measure of a person's weight in relation to height. "There are many people whose natural body weight would put them at higher than 24.9 BMI. Some of the most elite athletes in the world have a technically obese BMI," she explains. In other words, BMI is bunk. And the scale is no better. "One big problem is that people are losing too much body fat, which can bring about infertility and osteoporosis. Women, on average, should have about 25 percent body fat—it's a physiological necessity. Fat helps your body and brain function better. It's not a bad thing," says Oliver-Pyatt.
2. Exercising through an injury. The rise of intense workouts, like CrossFit, Tabata, and other HIIT or boot-camp-style programs, has unintentionally set us up for an increased risk of injury, including back, shoulder, knee, and foot pain. When this happens, you need to know when to pull back and rest before you exacerbate the problem, which could lead to surgery. People who are exercise-obsessed, however, might miss the cues when to stop. Instead they may adopt that old mentality of no pain, no gain. (BTW, that's one of our 7 Fitness Rules Meant to Be Broken.)
"When a person is working out while wearing, say, a stress-fracture boot, a lot of times, you may see this being applauded. They might hear, 'Wow, you're really tough! Good job!'" Oliver-Pyatt says. "When it comes to alcoholism or a drug problem, everyone agrees that you should stay away from those vices that are causing harm. But with exercise and healthy eating, a person can get into this area where they are having problems with it, and since it generally falls into this healthy category, people—from friends to doctors—may reinforce it," Oliver-Pyatt says.
"People do die from eating disorders and so if someone is injured or malnourished and obsessively exercising, it is important for people to step in. Try to use 'I' language so that you're not blaming anyone. Maybe say something like: 'I want to know if I could talk to you about something. It's a bit of a difficult subject, but I'm concerned and I wasn't sure how to approach you about it. I just have some concerns about your well-being, considering that you're wearing a boot and still putting so many demands on your body. I feel like you might need a break and it's hard for you to give it to yourself.'" Sometimes helping someone realize that they need to give themselves permission to relax is all they need to ease up and take better care of themselves.
3. Choosing to work out rather than hang out. "Someone who is an over-exerciser will forfeit social activities for the sake of having an opportunity to work out. The term is called normative discontent, which is the normalization of food and body preoccupation. It's normalized, but this behavior (i.e. always being on Weight Watchers or Jenny Craig or using being vegan as an excuse to bring snacks to a restaurant) isn't actually bringing about the definition of overall health that the WHO talks about," Oliver-Pyatt says.
When approaching someone about this behavior, try to put yourself in their shoes and bring up what you have in common to make sure you get heard. Also, always try to validate their emotional state, Oliver-Pyatt says. "For example, if you say, 'When you decided to go running instead of come to my birthday party, I understood that was really important to you because you really care about your health. At the same time, I was really hurt because our relationship really means a lot to me and I missed you.' Once you validate them and show them that you are emotionally vulnerable too, they'll be more willing to hear what you say next," Oliver-Pyatt says. "Appealing to the emotional experience you are having and trying to describe it can help you form a bridge of communication. That's really the best way to convey your concerns to this person." (Find out How One Woman Overcame Her Exercise Addiction.)