I have been working as an Eating Disorder Dietitian and Therapist within the fitness space for over a decade and have witnessed the growth of the online fitness influencers sharing everything from their exercise regimes, diet plans and supplement stacks … and with that their discount codes.
With the growth of this space and the business potential for individuals to not only grow their following but also their bank accounts, there has been concerns about the potential harm this can do to both the influencers themselves and also the individuals they are influencing.
It is too common to open up an app and see self proclaimed influencers promoting restrictive dietary practices and extreme fitness regimes under the disguise of “dedication” or “health”. Fitness influencers have no requirement for a professional education and often perpetuate unrealistic regimes, sharing personal eating practices of excessive protein consumption and implying that the only purpose of food is for fuel and recovery. These content creators may set out to inspire their followers without acknowledging the risks of sharing their "what I eat in a day" videos, especially to those that are vulnerable such as teenagers and young people.
These content creators may set out to inspire their followers without acknowledging the risks of sharing their "what I eat in a day" videos, especially to those that are vulnerable such as teenagers and young people.
Anorexia athletica (AA), which is sometimes referred to as hypergymnasia falls into the eating disorder category; although it is not currently recognised within the DSM-5, research is growing within this area. Those with AA often meet some, but not all of the criteria for other eating disorders, so AA is “officially” classified as an eating disorder not otherwise specified (EDNOS).
It can be a common misconception that those with eating disorders are very underweight, this is not true and this research that explores AA indicates that most individuals experiencing AA have a “normal” BMI.
Most individual experience Anorexia Athletica have a BMI within the normal range.
AA affects individuals who are athletic; they may compete professionally in sport or do so as a hobby; there is not a set diagnosis but symptoms of AA include:
A dependence on movement; this may look like a strict training regime or/and a certain amount of steps to walk per day.
A dependence on movement is present if a tolerance has developed; for example there is a need to increase the frequency, intensity or duration of exercise sessions to get the desired effect. Withdrawal symptoms may also be present if for whatever reason exercise cannot happen, this creates feelings of anxiety, stress, fear or anger increase and a greater urge to exercise.
Dependence may also be suggested by both excessive time spent training, planning to train, researching nutrition around training or thinking about training; as well as feeling there is a loss of control over exercise, for example, all thoughts and feelings eventually circle back to training plans, performance or body changes;
If exercise creates conflict in other areas of life or leads to family disagreements or missing social events to maintain a routine, then this suggests a tolerance has developed, alongside continuance of exercise despite illness or injury.
Alongside exercise tolerance, AA symptoms include;
A restriction in food intake either to a strict calorie/energy allowance or limiting types of food. This does not necessarily mean a low calorie intake but rather strict control of eating behaviours.
An intense fear of gaining body fat or performance decreasing.
A perfectionist attitude in maintaining or improving self perceived peak physical performance.
A large amount of time dedicated to exercise, or thinking about exercise, eating, food preparation and body image.
A denial of there being a problem.
Some research suggests more specific criteria is useful in diagnosis such as a score of over 20 on the EAT-26, which indicates a preoccupation with food, body shape and weight.
When exploring the research into AA, which share symptoms with exercise addiction/dependence this paper looks at the current trends. It states that eating disorders are three times more prevalent in athletes compared to the general population and this study suggests that 14% of female athletes have eating disorders, compared to 3% of males. This difference between males and females is hypothesised to be due to both the specific request for leanness in female athletes such as gymnasts and swimmers; as well as the cultural pressures of thinness on women.
Eating disorders s are three times more prevalent in athletes compared to the general population.
There are risk factors that make some individuals more susceptible to AA, like all eating disorders AA is a "biopsychosocial condition" because it is not caused or maintained by one thing alone.
An individual is more likely to experience AA if they have a poor body image and an idealised body image and shape in mind; this can be where online influencers do have a role to play in their impact on their following. Additionally if someone has a history of partaking in weight related or esthetic sports such as dance, swimming or gymnastics they are at increased risk of AA, alongside if they have a perfectionist attitude or struggle to manage experiences of discomfort.
Risk of anorexia athletica is increased if an individual as an idealised body shape, history of competing in gymnastics, swimming or weight related sport or has a perfectionist attitude.
Much of this research has been performed on professional athletes; however with the growth of the online fitness space and commercialised fitness competition such as Hydrox, there has been an increase in AA in the “everyday” athlete. Research has indicated that we should screen for disordered behaviours and eating disorders as a standard component of preparticipation examinations for athletes.
Due to the nature of sport, fitness and athletic performance and intense training regimes being praised as dedication, the fitness space is a place where hyperfocus on exercise, body image and eating can hide well; and it is not unusual for an obsession with thinness to morph into an obsession with fitness; both being equally disordered and dysfunctional, just presenting differently from the outside.
The fitness space is a place where hyperfocus on exercise, body image and eating can hide well; and it is not unusual for an obsession with thinness to morph into an obsession with fitness; both being equally disordered and dysfunctional
The compulsion or “addiction” some individuals feel with exercise is maintained by various mechanisms; firstly through the reward pathways in the brain and the neurotransmitter dopamine. Dopamine is a neurotransmitter that is responsible for pleasure, satisfaction and motivation. Exercise, like sex and food triggers dopamine which is why we may crave it and why it makes us feel good.
The brain and body wants to be in a stable, balanced baseline and that includes its levels of dopamine. Too much and things start to feel fuzzy and manic and too little and things feel low and depressed.
This stable baseline is shown in how we regulate our temperature. If our nervous system picks up it is too cold, it sends a message to our brain, which we refer to as process A; and then the brain responds by sending a message to our muscles to shiver, we refer to this as process B.
Opponent process theory also suggests that feelings are maintained around this stable baseline or set point; any stimulus that alters the brain's function to impact how we feel, will trigger a response by the brain that is the opposite of the stimulus, for example we may be really excited over holiday, process A; but often feel “holiday blues’ afterwards process B.
This is the same with drugs, as an example we can use a very popular drug, caffeine; if we have never or rarely have coffee and consume it, we really notice the side effects; we often feel wired, energised and hyperaroused; this moves us away from the stable baseline. If we get into the habit of having a coffee every morning, the brain starts to anticipate this move away from baseline stability and adapts to the caffeine by suppressing it’s natural arousal and we start to need the coffee to achieve a baseline awake state to feel “normal”. If we forget our coffee we often feel exhausted and grumpy. This starts to explain tolerance, if we want to feel like the first time we had a coffee we will have to have two coffees or a stronger one to feel the same effect; without coffee we now experience withdrawal symptoms, this is called dependence.
This video explores the concept of dependence in a relatable way.
We can also relate this to exercise, exercise releases endorphins which stimulates dopamine release. If we exercise regularly and increase dopamine repeatedly which moves us out of the stable baseline our brain likes (process A), the brain responds to this release by decreasing general dopamine levels to maintain homeostasis (process B), this then develops a “need” to exercise in order to maintain a feeling of “okayness”; overtime; with the right genetics this can become a dependence.
Due to the effects of the neurotransmitter dopamine, repeating exercise can develop a “need” to exercise in order to maintain a feeling of “okayness”; overtime; with the right genetics this can become a dependence.
We don’t obsessively exercise because we feel anxious, we feel anxious because we obsessively exercise.
If we take into account the online fitness space; if someone post videos of there exercise on social media and receives attention this also triggers a dopamine response (A process) and they may become reliant on that validation from sharing their training to feel normal (B process). Without the validation they may experience feelings of low mood or anxiety.
In addition, if an individual believe that changing their exercise behaviours will lead to their body shape and size changing in a way they do not want, this subconsciously may feel like a threat to being loved and valued in a world of diet culture; this creates an anxiety response from their nervous system when even considering skipping a gym session if they are sick and maintains the hyperfocus and obsession.
Relating this to fitness influencers, if they get sponsorships as a result of their obsessive exercise behaviours, they are receiving more validation; if this leads to making a change in career because the sponsorship or coaching meets their financial needs, they have built a life on a disorder, which initially may feel good, but eventually keeps them trapped, increases hyperfocus further and shrinks their life to revolve around fitness, food and body image.
If a fitness influencer gets a sponsorship deal based on performing disordered behaviours, this can trap them within the disorder and prevent long term recovery.
If their income and thus survival is then dependent on promoting their dedicated/disordered fitness and eating routines; it would not be unusual for a schizoid state to develop, this would prevent feelings or acknowledgment of the potential harm that they are doing to their following; because not only is there a dependence on the validation from the following, but also on the financial dependence; this is often unintentional and happens subconsciously; and may present as a denial to their being a problem.
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Final comments
Exercise dependence and anorexia athletica are prevalent within the fitness industry, especially within the online fitness space. Fitness professionals and influencers who experience exercise dependence of anorexia athletica are deserving of the care and compassion to recover and heal; and also it is important to acknowledge if fitness professionals and influencers are promoting disordered behaviours as “dedication” or a “lifestyle”, they are part of the problem of increasing eating disorder statistics; our young people deserve to be influenced by individuals with a truly healthy relationship to food, eating and exercise.
As we scroll social media it is important we ask ourselves whether these these are the people we want to allow us to be influenced by, or are they promoting unrealistic body standards and disordered behaviours.
Rach x
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