Eating Disorders:
Exercise Resistance in Women

continued from

by Francie White, M.S., R.D.

Just as binge eating disorder lies at the opposite end of the disordered eating spectrum from anorexia nervosa, exercise resistance is an activity disorder at the opposite end of the spectrum from addictive or compulsive exercise. As a dietitian specializing in eating disorders, I have noticed a common phenomenon in women with emotional overeating patterns, many of whom qualify as having binge eating disorder.

These women often suffer from entrenched inactivity patterns that are resistant to intervention or treatment. Many professionals assume that inactivity is due to factors such as a harried lifestyle, industrialization, laziness, and, in overweight individuals, the discouraging factor of physical difficulty or discomfort in moving. Behavior modification counseling programs, use of specialized personal trainers, and other types of motivational strategies to encourage a physically active lifestyle seem to be ineffective.

Over a three-year period, beginning in 1993, I began exploring what I call "exercise resistance" in a binge eating disordered population of six groups of ten to twenty women each. The following information is what emerged from studying these groups.

For many women with a history of body image problems, moderate to severe overeating histories, and/or a history of repeated attempts at weight loss, exercise resistance is a common syndrome that requires specialized treatment. Remaining inactive or physically passive appears to be an important aspect of the psychological defense system within the eating disorder itself, providing a balance of sorts from the psychological discomfort that accompanies exercising. This psychological discomfort varies from moderate to severe anxiety and is related to a profound sense of physical and emotional vulnerability.

Underactivity or physical passivity appears to offer a sense of control over body and feelings, just as disordered eating and over-exercise do. Exercise resistance may simply be another component in the menu of options from which men and women find themselves suffering in this time of epidemic eating and body image problems. If we are to begin to look at exercise resistance as a separate syndrome worthy of specialized understanding and treatment, here are some factors to consider.

WHAT DIFFERENTIATES THE EXERCISE RESISTANT INDIVIDUAL FROM SOMEONE WITH SIMPLE LOW MOTIVATION OR POOR EXERCISE HABITS?

• The individual strongly resists any suggestion to become more physically active (barring any physical impairments and given several workable options).

• The individual reacts with anger, resentment, or anxiety to any suggestion to become more physically active.

• The individual describes experiencing moderate to severe anxiety during physical activity.

RISK FACTORS FOR DEVELOPING EXERCISE RESISTANCE

• A history of sexual abuse of any kind at any age.

• A history of three or more weight loss diets.

• Exercise used as a component of a weight loss regimen.

• A larger body size as a boundary or defense against unwanted sexual attention or sexual intimacy (be it conscious or unconscious).

• Parents who forced or overencouraged exercise, especially if the exercise was to compensate for perceived, or actual, overweight in the child.

• Early puberty or development of large breasts and/or early significant weight gain.

THE MEANING OF EXERCISE RESISTANCE

To better understand exercise resistance, we can borrow from our understanding of how weight loss diets have affected eating behavior. We know that weight loss diets are a key aspect in the historical mistreatment of overweight individuals, in many cases actually contributing to binge eating, which increases over time. Responses from the women surveyed support the view that exercise resistance may be an unexpected, unconscious backlash against the current cultural emphasis on slimness and the overfocus on the symptom; for example, the weight, instead of the inner psychodynamic issues.

QUESTIONS TO ASK THE INDIVIDUAL WITH EXERCISE RESISTANCE

• What feelings and associations emerge for you at hearing the term exercise? Why?

• When did being physically active change for you from "playing" as a child to "exercise"? When did it shift from something natural, an activity you did spontaneously (for example, from an internal drive), to something you felt you should do?

• Has physical activity ever been something that you did to control your weight? If so, how was that for you, and how has it affected your motivation to exercise?

• How did your exercise attitudes change during and after puberty?

• Does being physically active relate in any way to your sexuality? If so, how?

A theme ran through the comments of the women studied that echoes the information in chapter 4, "Sociocultural Influences on Eating, Weight, and Shape." Most of the women expressed that they felt extremely degraded and vulnerable by their direct experiences of being encouraged to exercise as a means to achieve an acceptable body. Instead of being encouraged to exercise for fun, exercise for these women was connected to body image, or the pursuit of an acceptable body.

Many of the women's stories included experiences of deep humiliation, public or otherwise, at being overweight and unable to achieve this illusive standard. Other women actually acquired a lean, thinner body and experienced unwanted sexual objectification by peers and adults. In a significant number of the women, rapes and other sexual abuse occurred after weight loss, and, for many, sexual abuse was connected to the onset of exercise resistance and binge eating.

Many women are confused as they experience the desire to be thinner while at the same time feeling anger and resentment at what they have been told they have to do to achieve it, for example, exercise. For some, exercise resistance and weight gain may be symbolic boundaries, expressing a rebellious refusal to patronize a system in which the playing field for women is not about sports, or even achievement, but about sexual attractiveness to men—"We'll play, you pose." This system is one in which women and men equally participate and perpetuate. Women objectify one another and themselves right along with men.

The above discussion of exercise resistance by Francie White was written specifically for inclusion in this book. It is important to understand this area as another disorder on the continuum of those being discussed. The understanding and treatment of exercise resistance are similar to that of eating disorders in that the therapist must impart an empathy for the need for the behaviors instead of trying to take them away.

When working with an exercise resistant individual, one must explore and resolve the source of the resistance, such as underlying anxiety, resentment, or anger. The goal of treatment is that the individual will be able to become physically active by choice, not coercion. It is important to begin by validating the resistance and even in some cases prescribing it, making statements such as:

• It is important that you can choose to not exercise.

• Resisting exercise serves a valuable function for you.

• Continuing not to exercise is one way for you to keep saying "no."

By making these comments, the therapist helps validate the need for the resistance and eliminates the obvious conflict.

It is important to clarify that the issue of addressing exercise resistance is to help individuals who are compelled to "not exercise" just as we try to help others who are compelled to do so, both of which leave the behavior out of the realm of choice. Little attention has been paid to exercise resistance, but it is clear that those who have it, like those with exercise obsession or disordered eating, appear to be in a love-hate relationship with their bodies; derive inner psychological or adaptive functions from their behavior; and are involved in a struggle not just with food or exercise but with the self.

For an examination of the struggle with self and other dynamics that result in eating disorders, the next three chapters will deal with the main areas in which the causes of eating disorders are understood, with a chapter devoted to each of the following:

SOCIOCULTURAL

A look at the cultural preference for thinness, and the current epidemic of body dissatisfaction and dieting, with an emphasis not only on weight loss but also on the ability to control one's body as a means of gaining approval, acceptance, and self-esteem.

PSYCHOLOGICAL

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The exploration of underlying psychological problems, developmental deficits, and traumatic experiences such as sexual abuse, which contribute to the development of disordered eating or exercise behaviors as coping mechanisms or adaptive functions.

BIOLOGICAL

A review of the current information available on whether or not there is a genetic predisposition or biological status that is at least partly responsible for the development of an eating or activity disorder.

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