The Cooper Institute

Founded in 1970 by the "Father of Aerobics"
Kenneth H. Cooper MD, MPH


Individuals Who Over Exercise: Body Distortion Image

Posted in
Live well

Monday, Jan 17, 2011

How prevalent is “over exercising” for poor body image? Are you one of the individuals spending an excessive amount of time in the gym? If you are a Personal Trainer how likely is it that you will have any clients with this behavior? How will you address the issue?

According to Karen Ritter, a licensed clinical social worker, “Your body image has to do with your health, your various talents, (and) how able you are to be in tune with sensations in your body.”(1) For many people their body image is negative. They perceive that parts of their body are unlike what they really are. They are convinced that other people are attractive, but that their body size is not and that it signifies a personal failure. They often feel ashamed, self conscious and anxious about their body.

A survey done by the Centers of Disease Control found that more than a third of girls (33%) considered themselves to be overweight compared with fewer than 15% of the boys. Body distortion doesn’t just cross gender lines, though. It is influenced by our culture and environment. An example is white American women have much worse body image distortion than Black American women.(2)

The focus of one study(3) was to determine if individuals who overexercise more resemble people with eating disorders (ED) or with those with muscle dysmorphia (MD). What is “muscle dysmorphia“? According to Wikipedia, it is a disorder in which a person becomes obsessed with the idea that he or she is not muscular enough. It is a "disorder" because they are often above average in musculature but they think they are “skinny” or “too small”.

People with muscle dysmorphia (MD) or “bigorexia” often display several of the following behaviors: • Constantly examine themselves in a mirror • Frequently compare themselves with others • Hate their reflections • Become distressed if they miss a workout session or one of their many meals a day • Become distressed if they do not receive enough protein per day • Neglect jobs, relationships or family because of excessive exercising • Take potentially dangerous anabolic steroids 

Individuals with Eating Disorders (ED) display many of these behaviors: • Constantly dieting or rigid eating patterns for weight control • Exercise dependence and compulsory body monitoring • Skipping meals • Taking diet pills • Inducing vomiting after eating, • Obsessing with the “perfect” body image as seen on TV, magazines or runway models • Fear becoming fat or gaining weight

Muscle Dysmorphia is most observed in men aged 18-35 years, but can be seen in some women. Furthermore, MD is often masked by the demands of sport. In particular, elite body builders are at higher risk for this disorder.

This particular study totaled 134 subjects (86 men and 48 women with gym memberships and 20 women with eating disorders not allowed a gym membership but recruited into the study from a clinic). The 134 subjects were put into the following 4 groups: Group A: Men who wanted to gain weight Group B: Men who wanted to lose weight Group C: Women who wanted to lose weight Group D: Women with an Eating Disorder (ED)

Fifty-five percent of the men wanted to increase their weight and 90.4% of them actually followed a high protein diet to increase their muscle mass. Forty-five percent of the men wanted to become thinner and 41.2% of them consumed a high protein diet. The women all wanted to become thinner and 50% practiced self-induced vomiting to control their weight. However, all of the groups showed a similar use of diuretics and laxatives (10-21%), a behavior that is unhealthy for the purpose of weight control. 

Men and Women follow different strategies for their desired outcome: The women mostly followed restrictive diets and many induced vomiting. They exercised as a complement to dieting. However, the men who wanted to lose weight preferred exercise or physical activity to dieting. The women with an ED were restricted from gym memberships but they admitted they exercised a great deal to burn calories. It is just that they did it in “loneliness” in order to burn those extra calories. The men who wanted to gain weight spent most of their time exercising. While almost all of them had a “normal” body mass index they were dissatisfied with their physique. Furthermore, most augmented their diet with large amounts of protein; some of them admitted to use of anabolic steroids; and many used the supplements L-caritine, creatine, and vitamins to enlarge their muscle volume, reduce anxiety levels, and decrease perceptions of fatigue rather than to improve their sports performance.

Discussion: Most of the substances the men in Group A ingested were without prescription. The men made a decision to overlook, even deny, the very real and potentially severe complications such as hypertension, tendon damage, atherosclerosis, carcinomas, blood coagulation and other blood issues, influence on insulin production, long term renal damage (kidneys), and psychiatric/behavioral alterations. 

One to three percent of all women in the United States are anorexic and as many as 20% of all college women might have eating disorders. Moreover, nearly 150,000 women in the U.S. die from anorexia every year. (Lask & Waugh 1999; MacSween 1996). It is a very real issue! 

So, trainers, what are you to do? As personal trainers, you cannot diagnose nor treat these types of disorders (ED or MD), but you should be aware of the behaviors associated with body distortion anxiety. The recommendation is to professionally address the observed behavior with the client or gym member privately and recommend them for psychological counseling. To make this easier, your club or manager should identify local clinics or hospital programs that specialize in helping individuals with these disorders. Have pamphlets from those qualified clinics/organizations to place in the hands of the member to make it more likely that they will pursue help. Also, provide all gym clients with the benefits of a healthy, balanced diet and what that looks like: Then, balance the healthy diet and healthy exercise information with handouts to increase knowledge about health risks associated with compulsive behaviors (MD and ED), the consequences of the misuse of laxatives and diuretics, the consequences of use of steroids and/or abuse of supplements. 

   1) Body-Image Distortion a Growing Problem Among Women and Men.; December 10, 2008. 2) Merry N. Miller, MD. And A Pumariega, MD. Eating Disorders: Culture and Eating Disorders, December 12, 2008. 3) Segura-Garcia C, Ammendolia A, Procopio L, Papaianni MC, Sinopoli F, Bianco C, De Fazio P, and Capranica L. Body Uneasiness, Eating Disorders, And Muscle Dysmorphia In Individuals Who Overexercise. Journal of Strength and Conditioning Research. 24 (11)3098-3104, 2010.