Our daughter has anorexia nervosa and exercises excessively (mostly with running, but also some weights). How much and what type of exercise/fitness is she permitted during the initial phase? Does everything stop?
Kara Fitzpatrick, PhD responds:
The focus of this approach is actually on parent empowerment and parental decision making around healthy and non-eating disordered behaviors, so this is a challenging question to answer, as we would encourage these decisions to be made by parents in conjunction with their treatment team. One challenge in treating eating disorders is that there is overlap between eating disordered behaviors and things we would consider to be normal and healthy, such as exercise. This often makes parents feel disempowered, because most of us understand that exercise is one ingredient in a healthy lifestyle. The problem is that, in the face of AN, exercise is really only healthy when the body is able to repair itself and has reached a state of nourishment that supports basic bodily processing and when exercise can occur with adequate caloric intake.
Generally speaking, we never encourage exercise when someone is of very low weight and/or medically unstable. The amount and type of exercise that you permit is most often based on how well your daughter is eating her meals, the level of struggle in these behaviors, the course of weight gain and what has been typical and normal for her before the eating disorder onset. If your daughter is able to eat meals with relatively little struggle and is making adequate weight gain, it may be time to consider allowing in more exercise. If these are still a struggle and your daughter is hiding, sneaking or engaging in excessive exercise, it may be that this is an appropriate target for change in treatment. Most families find that return to exercise is a slow process. For example, it might start with gentle yoga or stretching, progressing to walks or return to school (Note: as much as we may think that school is largely sedentary, in my experience return to school requires far more calories than most people realize!). For some families, return to activity involves a return to supervised or team sports activities that are more structured or are time limited. Ultimately, the goal should be a return to a whole range of healthy behaviors, including exercise.
Kara Fitzpatrick, PhD
Dr. Fitzpatrick is a psychologist working with Eating Disorders at Stanford University/Lucile Packard Children's Hospital and serves as clinical advisor to Maudsley Parents. She is widely trained in a variety of models for treatment and performs research in applied clinical treatments for adolescents and neuropsychological factors associated with eating disorders.