About a year ago, psychiatrist Adel Eldahmy began noticing an alarming trend among his patients with eating disorders--many were obsessed not only with food but with exercise.
As founder of the Long Beach Eating Disorders Clinic and Anorexics-Bulimics Anonymous, Eldahmy was familiar with the topic, but not with the twin symptoms.
He coined a word for the malady--hypergymnasia--which although not recognized by the American Medical Assn., describes what psychiatrists nationwide have been treating with increasing regularity.
They are "people who are hooked on sweat," 94% of them women, typically professionals 25 to 30 years old, who eat and work out to extremes because of deep-rooted psychological problems, Eldahmy said.
Hypergymnasia, he said, "hides under a thick cosmetic coat of good looks and trim figures.
"But inside, hypergymnasia sufferers are hurting just as much as anorexia and bulimia victims. They have the same problem in common--terribly low self-esteem."
Eldahmy said that, in some cases, hypergymnasia replaces the bulimic's bingeing on food and then purging, or self-induced vomiting, to avoid gaining weight, and the anorexic's self-starvation to control weight.
"They abuse food and also abuse exercise," he said. "They mask the pain by taking anti-inflammatory drugs, like aspirin. They don't have a concrete athletic goal, like training for a marathon.
"They have only one thing in mind--'I'm going to work out to lose weight.' They get obsessed with weight and calories. They feel high because of the endorphins they get from working out.
Can't Stop Running
"When they stop, they go through withdrawals, anxiety and insomnia--exercise attacks. They're unable to stop running and doing aerobics even when it hurts."
It is a cyclical behavior, Eldahmy said, that is best treated through group therapy similar to Alcoholics Anonymous.
"I have a patient who wakes up in the morning, looks in the mirror and sees herself larger than she is," Eldahmy said. "She runs three miles in the morning, two miles during her lunch break and after work goes to the gymnasium and works out for two hours.
"Then she goes home and binges all night, knowing that she's going to work out in the morning."
Eldahmy emphasizes exercise is vital to good health, but in moderation.
'Stop When It Hurts'
"Good exercise is somebody who exercises three to four times a week, for about 45 minutes each time. They also listen to their body, and stop when it hurts."
Eldahmy cites Kenneth Cooper, head of the Aerobics Center in Dallas, who maintains, "If you run more than three miles a day four times a week, you do it for something other than fitness."
Eldahmy blames the "national love affair with fitness," which he said is fanned by the media, particularly women's magazines.
"The ideal woman in the media is as skinny as a hanger," he said. "Men should also be educated. A woman told me recently she was walking on a beach with her boyfriend, who said, 'Look at that pretty skinny girl.' She said she went home and didn't eat for two days, then binged and began feeling terrible abdominal pain until she vomited."
Problems as Children
Anorexics-Bulimics Anonymous, which Eldahmy founded four years ago as a support group for people with eating disorders, has expanded its services to aid people with hypergymnasia. The ABA now has 15 chapters, most of them in Southern California but also in Maryland and Illinois.
Most sufferers had weight problems as children, were children of alcoholic parents or were sexually abused, Eldahmy said.
"In health clubs, spas and running tracks throughout the country, people are running their hearts out to combat overindulgence," he said. "What they're actually doing is fighting to achieve self-esteem."
The ABA program, however, differs in its philosophy from the AA program.
"You cannot abstain from food," Eldahmy said. "You have to learn to live with food."