What happens when exercise *isn't* healthy?


It's going to come as no surprise that we firmly believe that all women-all people-have a right to work out in a way they love. Run, kick-box, power-lift, do yoga, play basketball... As long as you're happy and sweaty, we're happy (and probably sweaty).

But for one group, at least, things can get a little complicated: women with a history of disordered eating. "For people with a history of eating disorders or disorderd eating, the dangers of exercise are both physical and psychological," says Sarah K. Ravin, Ph.D., a licensed psychologist and ED specialist. Physically, exercise puts a strain on your body-if your body is already weakened from fasting or at best insufficient nutrition, it might not be able to handle that strain.

Even if you've been in recovery for years, though, there's a psychological risk to getting into a workout routine. Exercising means paying attention to your body in a way that can quickly turn critical and competitive. "Just walking into a gym with mirrors can trigger competition between your body image and other females," says Harriet Beitscher Campbell, a certified eating disorder specialist at Ocean Breeze Recovery. That's true even for women without EDs, but for those who have dealt with them, it's an especially big risk.

"Eating disorders are sneaky," adds Ilene Fishman, LCSW. (This woman didn't even know she had one.) "They hide out. You might be saying, 'I just want to get fit!' but really, you have this hidden compensatory relationship with exercise-working out gives you permission to eat a certain way." Again, this isn't something that's limited to women who have been diagnosed with an ED in the past. How often have you said, or have you heard someone say, "I worked out today, I earned this," talking about a cupcake or a cocktail? (We address this more here: What It Feels Like to Have Exercise Bulimia.)

Still, Fishman says, "It's absolutely possible to exercise if you've had an eating disorder in the past. The key is to truly know yourself and understand where the eating disorder might still be hiding out and motivating the desire to exercise." That might be easier said and done-but these strategies can help.

Get support. Meet with, at the very least, an eating disorder specialist before hitting the gym to determine whether you're in a good place mentally, recommends Campbell. Also smart: getting a physical to ensure you're at a healthy and appropriate weight and do get blood work done to make sure your body can handle the exercise.

Figure out the food. Exercising means burning more calories, which means you need to eat more to ensure you stay at a healthy weight. But tracking your meals or counting calories, even if it's just to figure out how much more you need to eat, can be triggering. "It can become too compulsive," says Fishman. Campbell suggests working with a nutritionist to develop a plan.

Start slow. The type of workout you want to do matters a lot. "Solitary endurance sports like long-distance running can be very triggering to people with eating disorders, because of the extremely high energy needs combined with the false perception that thinness improves performance and the solitary nature of the activity," warns Ravin. Strength-training may seem safer, but more serious body builders often implement super-strict food plans and seriously emphasize the physical outcome (getting ripped), cautions Campbell. (Even some workout DVDs aren't safe.)

Fishman says that yoga and other similar grounding, stabilizing forms of exercise are probably best, especially when you're first getting back into a fitness routine. She says that group workouts are also better than solo sports. But Campbell notes that eventually with the right prep and team of support, it's possible to do almost anything safely-she counseled a woman in recovery who went on to run the Boston marathon healthily.

Limit yourself. You should never be exercising for more than 45 minutes to an hour at a time, says Campbell. And when you're just starting out, go for less. (All you really need for fitness is four minutes!)

Watch for these red flags. Feeling guilty if you miss a workout. Becoming overly rigid about your gym plans (like refusing to skip a run if it's raining or you're not feeling well). Modifying your diet based on your exercise ("I didn't work out today, so I can't eat X"). Comparing your body to other people's. Exercising for longer and longer periods of time, and rationalizing it away. Frequent injuries like pulled muscles or stress fractures. These are all signs that you need to step back and meet with your therapist-your gym habit is getting out of control.