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Bad for bones

The consequences can be severe: most exercise bulimics eventually develop overuse injuries, which can have long-term repercussions. Weiner, like many exercise bulimics, ceased to have periods, a condition called exercise amenorrhea. "Many women rejoice when their periods stop, but this is a red flag -- a sign that you're headed for trouble," says Barbara Drinkwater, MD, of the Pacific Medical Center in Seattle.

When a woman's menstrual cycles stop, it means her estrogen levels have dropped to those of a postmenopausal woman. Estrogen, of course, is vital for the normal development of bone -- which reaches its peak in women in their mid 20s. If a woman's estrogen levels dip too low during this critical time, she may start losing bone mass instead of building it, Drinkwater says. She's seen 25-year-old women with eating disorders who have the bones of an 80-year-old. Though treating amenorrhea can stop bone loss, "It doesn't appear that this bone loss is reversible," Drinkwater says. Despite these risks, most exercise bulimics never seek treatment, in part because excessive exercise is often viewed as a healthy obsession.

One reason exercise bulimia has gone unrecognized for so long is that it can't be diagnosed simply by tallying up the number of hours a person exercises. "There's no single cut-off or dosage where we can say, 'Aha, you've gone too far,'" says Jack Raglin, PhD, a sport psychologist at Indiana University in Bloomington. The person's mindset provides a better indicator, says Raglin. "Exercise addicts don't exercise to improve their health or train for a specific event, they're exercising for the sake of exercise."

Weiner had plenty of signs that something was amiss. "I became withdrawn and isolated," she says. "And I was very focused on my appearance. I was hypercritical of myself and had drastic mood shifts." Sacker says exercise bulimics also tend to be anxious and agitated when they're not exercising, and to keep working out even if they're hurting or fatigued. In fact, most seek help only when they're faced with injuries severe enough they can't push through them, says Sacker.

Because she didn't fit the label, Weiner never thought she had a problem. She always equated eating disorders with self-starvation or induced vomiting, and she did neither. Then came her defining moment. One day, at the age of 17, Weiner was unable to meet her daily exercise quota, and she panicked. She decided, for the first time, to make herself throw up. But as she bent over the toilet, something stopped her. "I could die from this," she thought.

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