Patterns of Maladaptive Exercise Behavior from ages 14-24 in a Longitudinal Cohort

Abstract

Exercise for weight loss and maladaptive exercise (exercise that results in negative consequences or interference with daily life) are common behaviors amongst youth and are associated with increased risk of disordered eating symptoms. The current study clarifies processes that influence exercise-related risk in adolescence and young adulthood, including the frequency with which young people transition between engaging in exercise for weight loss and experiencing negative consequences of this behavior. Method: Participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) reported on eating disorder (ED) cognitions at age 14, and exercise behavior at ages 14, 16, 18, and 24 years old. Analyses examined rates of transition between the categories of ‘No Exercise for Weight Loss’, ‘Exercise for Weight Loss’ and ‘Maladaptive Exercise’ over time, identified overall trends in endorsement of exercise for weight loss and maladaptive exercise, and clarified initial predictors of these behaviors. Results: Endorsement of exercise for weight loss and maladaptive exercise increased over time in both boys and girls. Those in the ‘Exercise for Weight Loss’ category were more likely than those in the ‘No Exercise for Weight Loss Category’ to transition to ‘Maladaptive Exercise’ over time. Body mass index (BMI; Age 13) and fear of weight gain (Age 14) were consistent predictors of maladaptive exercise across gender. Conclusions: Results support re-framing motivations for exercise in youth away from weight loss at a population level and targeting reductions in fear of weight gain for high-risk individuals.

Practical guidelines for eating disorder risk mitigation in patients undergoing obesity treatment for the pediatric provider

“…There has also been pervasive media content highlighting the health and social benefits of dieting and weight loss [36,37 ▪ ,38]. Wide-spread social acceptance of the ‘healthy’ benefits of dieting and weight loss means that people often receive positive reinforcement for weight loss from medical providers, family members, and peers, even if done in a dangerous manner [27].…”

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“…These in turn, they argue, could result in the development or exacerbation of eating disorders. Using longitudinal data from a cohort based in the United Kingdom, Schaumberg et al (2023) found that these unintended adverse effects of developing an unhealthy relationship with exercise were particularly common among boys and girls who were fearful of gaining weight and those who had a higher body mass index. Consequently, they proposed that exercisepromoting interventions should avoid citing weight loss as a key goal in youth populations and instead focus on promoting the benefits for improved regulation of emotions and greater social connections to minimise the likelihood of negative impacts.…”

“…Moreover, it is important to acknowledge that interventions designed to promote positive behaviours and outcomes could also have detrimental effects on some individuals. For example, in this issue of the Journal , Schaumberg, Bulik, and Micali (2023) caution that interventions to promote exercise with the goal of reducing the likelihood of poor physical and mental health outcomes can lead to maladaptive patterns of exercising when implemented among some groups of adolescents. These in turn, they argue, could result in the development or exacerbation of eating disorders.…”