Exercise Excess?

Nov. 27, 2000 -- Jessica Weiner's exercise routine was unlike that of most 14-year-olds, an age when many girls drift away from exercise. Weiner spent four to six hours every day working out. She devoted the wee hours of the morning to the gym, returning after school to take a turn on every exercise machine. "Bike, treadmill, stair machine, weights -- you name it, I did it," she says.

Late at night when other teens were studying or relaxing with a book, Weiner was still sweating away. "Exercise was the first thing I thought about when I woke up, and the last thought I had before bed," she says. Her friends commended her for her self-discipline. She seemed the picture of good health.

She was, in fact, miserable. "I felt a real emptiness," says Weiner, now 26. "I had an incredible disconnect between my body and soul." Her workouts brought her no sense of accomplishment or exhilaration. Instead, each session represented a tick in a grim accounting process. "Everything I ate had to be worked off -- and then some," she says. "I viewed my body as an outsider, an enemy to be controlled and punished."

At a time when more than half of American adults are overweight, and few can manage even the recommended 30 minutes of moderate daily activity, it would seem that people who exercise for hours are examples for the rest of us. But there's a growing recognition among experts that some people push fitness to a harmful extreme. Ira Sacker, MD, director of the Eating Disorders Program at Bookdale Medical Center in New York, estimates that about 4% of Americans struggle with excessive exercise. And the numbers, he says, are on the rise.

There's even a name for the problem, though most people have never heard of it: exercise bulimia. Also called compulsive exercise, it's similar to classic bulimia. But instead of using laxatives or forced vomiting, an exercise bulimic purges with exercise. And unlike classic bulimia, the disorder is nearly as common in men as it is in women.

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.