Large Study Analyzes Compulsive Exercise and Eating Disorders

Vol. 29 / No. 6 — Eating Disorders Review

One finding: Nearly half of eating disorders patients were compulsive exercisers.

In the largest study to date of compulsive exercise in adults with eating disorders, more than 9,000 female and male patients were examined for tell-tale symptoms (J Eat Disord. 2018; 6:11). Dr. Elin Monell and colleagues at the Karolinska Institute and the Stockholm Health Care Services, both in Stockholm, Sweden, gathered their data from the Stockholm database, a clinical database for specialized eating disorders treatment centers throughout Sweden. The database includes all treatment modalities, including medical, psychosocial and nutritional data and records the length and intensity of treatment.

In Sweden, about 60% of treatment is given as outpatient care; approximately 25% of patients receive day treatment and residential care. Records of patients registered from March 2005 to October 2017, were identified, and 9,117 patients with histories of eating disorders were included in the final study. All participants were studied with semi-structured interviews and questionnaires, including the Structured Eating Disorder Interview, the Eating Disorder Examination questionnaire(EDE-Q), The Structural Analysis of Social Behavior,and the Structural Clinical Interview for DSM-IV-Axis 1 Disorders(SCID-1).

Compulsive exercise at admission

Of the total sample of 9,117 patients, 96.3% were female, and the patients’ ages ranged between 18 and 81 years. Compulsive exercise was noted in 48.2% of female patients at admission and in 45.5% of male patients, where it was most often linked to eating disorders not otherwise specified or to bulimia nervosa. Both males and females who compulsively exercised had more general eating disorders pathology and restraint than did those who did not compulsively exercise. Females with compulsive exercise diagnoses were slightly younger, had a fairly shorter duration of eating disorders, and a slightly lower body mass index than did non-compulsive exercisers.

Compulsive exercise predicted a slightly lower remission rate in men, and women who had never engaged in compulsive exercise or had ceased using it remitted twice as quickly as those who continued to use compulsive exercise during treatment.

The authors noted that compulsive exercise was a transdiagnostic symptom in their study. Their results are similar to those of a prior study of adolescents with eating disorders. This growing body of literature suggests that while exercise has received relatively little attention, it deserves greater focus, both in research and in clinical practice.