266: Overcoming Exercise Compulsion with Henry

Chris Sandel: Welcome to Episode 266 of Real Health Radio. You can find the show notes and the links talked about as part of this episode at www.seven-health.com/266.

Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. I’m a nutritionist and a coach, and I help clients who are stuck in quasi-recovery restore their health and end eating disorder behaviour so they can regain their period, sleep through the night, improve body image, and have a peaceful relationship with food and exercise.

Today on the show, I am chatting with Henry. He’s a client that I started working with back in September of 2021. As you’ll hear, he’d been struggling with an eating disorder for many years, which included lots of overexercise and exercise compulsion. While he’d worked with other practitioners, he was still struggling.

It’s always hard to cover everything in a conversation like this, and one of the first things that Henry mentioned after we finished the recording was just how much we didn’t get to talk about. But despite these limitations, hopefully this conversation gives you a bit of an idea of where Henry was at and what has changed over the time we’ve been working together.

Henry was honest that there are still areas, like body image, that he’s still working on. Let me say that there is just a night and day difference between where he’s at now and where he was, and yet he still wants this to improve, and I have no doubt that it will. With more time and continual work, that will happen.

I always get lots of great feedback about these kind of conversations, that it’s nice to hear from real people that I work with or to hear stories of others who’ve struggled with an eating disorder and what their road back from this place has looked like. The reason I’m releasing this now is that this week, I’ve opened up my practice again to new clients. At the time of recording this intro, I have six spots available.

If you hear parts of yourself in Henry’s words, in his story and his experience, then I would love to help. You can head over to www.seven-health.com/help, and there you can read about how I work with clients and apply for a free recovery strategy call. The address, again, is www.seven-health.com/help, and I’ll also put that in the show notes.

With that intro out of the way, here is my conversation with Henry.

Hey, Henry. Thanks for coming on the show and chatting with me today.

Henry: Not at all.

Chris Sandel: There’s a lot that I want to go through. We’ve been working together since September 2021, and so I think it would be great to be able to share this journey with the listeners.

00:02:56

What Henry was struggling with before working with me

I guess as a starting place, what was your life like before working with me? What problem or problems were you trying to solve when you got in contact with me?

Henry: When I got in contact with you, I had been struggling with my eating probably since I was 20.

Chris Sandel: And how old are you now, just for reference?

Henry: Sorry, I’m 29 now. When I got in contact with you I was 27, just about to turn 28. I had really been struggling with food since I was 20, but it got particularly bad around 2018. I got in contact with you in 2021. It’d been a slippery slope up until then.

Chris Sandel: When you say it was not great with food or you were struggling there, can you give a bit more detail about what was going on or if you’d received any diagnosis? Just more detail.

Henry: I had awful problems with exercise, extremely isolated, lots of ‘productive’ stuff – work, exercise, limited food. Quite a miserable, solitary person, I suppose. I had received a diagnosis of osteopenia in 2020. Found out from a running injury. I had a DEXA scan. I made one attempt to recover in 2020 but failed. Then it wasn’t until about a year and a half later when I got in contact with you.

Chris Sandel: Had you received a diagnosis by the time you’d got in contact with me?

Henry: Yeah, I got it in 2020, beginning of 2020. I think March, just before Covid.

Chris Sandel: What was your reaction when you received that diagnosis? Was it a surprise for you? Was it like, “I know this”?

Henry: A very odd reaction, because I remember feeling somewhat relieved because I thought I’d be able to justify being able to eat more food again and exercise less. But even then, even when that happened, it still took me – as I said, I did three months of a very painful recovery that I just couldn’t maintain. It was too much. So that was in – I think I started that one in April 2020, and by July, I remember when I was on summer holidays with my family, I was pretty poorly again. At least mentally.

Chris Sandel: How did it feel getting in contact with me? Did this feel like a big deal?

Henry: When I got in contact with you, I was travelling, 2021. For whatever reason, I think perhaps because of the chaos of travelling, I hadn’t been able to keep to my normal routines and weirdnesses. I started eating a lot more than usual, and for whatever reason didn’t really decide to fight it that much this time.

I had known about you probably for about two years, because I’d been listening to your podcast since about 2019, on and off. Because for whatever reason this time I wasn’t really stopping myself, I thought maybe you’d be a sort of thing on the side. [laughs] I didn’t think it would be as integral to recovery as it was. But honestly, when I got in contact with you I was on that initial high of just starting recovery before the real work starts.

00:06:48

His previous attempts to recover

Chris Sandel: Was I the first person you’d worked with?

Henry: No, I’d worked with two people before. One I’d started end of 2019. Maybe middle of 2019, where things were starting to spiral a bit. She was not great, because she wasn’t – what I really, really needed was to stop my exercise, because I had an awful exercise compulsion, and she was quite triggering for not doing that. She would say things like, “It’s healthy to do some sort of exercise”, which made it a lot tougher because I felt – obviously, it’s easy for me to say now – I really needed a big period of abstinence from all that stuff. Not only physically but also just to prove to myself that it’s not the end of the world.

I think I was probably with her maybe for four or five months, and then it ended quite badly when I told her I stopped exercising and we had this argument over Skype or whatever it was. So that ended. And then I had someone else for that main first recovery attempt in 2020. She was really good at getting me to not exercise and eat, but there wasn’t much beyond that, really, so I wasn’t able to sustain it.

Chris Sandel: I’m sorry in terms of the first person that you had that experience. I think it’s really tough when you can recognise, even in the depths of your disorder, that “I need to stop exercising” and you’re vocalizing that, to then be told, “No, that’s not a good idea. It’s really healthy to exercise.” I think that really can play into the hands of the eating disorder. And yes, there’s definitely nuance around different health aspects and exercise, etc., but with a situation like yourself, the best thing and the thing that you really, truly needed was to rest and repair. So I’m glad that you were able to see that and to say, “No, I’m going to speak up for myself on this” and then to try and find a different solution.

Henry: Yeah. I think also I was lucky that my body was really failing at that point, so I was pushed into it as well. I had received this odd thing that I’d never heard about, and not many people have, during an MRI scan. I’d found out I had something called serous atrophy of bone marrow, which is – you probably know the specifics about it more than I do, but basically it’s very common when you’re malnourished. Well, it’s not very common, but it happens mainly when you’re malnourished, and it shows up on the MRI scan, basically making MRI scans unreadable.

Around that time I was seeing an ankle specialist for an ankle injury, and I went in the MRI scanner and they couldn’t get a good signal on the machine. The radiographer actually got in the machine, tried themselves, and they were like, “It’s fine.” We found out afterwards it was because of this thing. I was so malnourished that I was now unable to be scanned in the MRI scanner.

Chris Sandel: I had not heard of this condition before you brought it to my attention, and I looked into it and then I’ve subsequently written an article all about bone health, and I included information about this. I’ll put that in the show notes as well. But yeah, this is something that is very uncommon but is connected to malnutrition and was a real indicator of just how much your body was at that breaking point.

Henry: Yeah. And it’s odd because I remember that day very well, and even then, it was just so hard to make a change. Hearing anything, any medical result that I had which was just crying out to me to change the way I was living – that and low testosterone and all these things – it still took me months and years to make any sort of change.

Chris Sandel: Which is the unfortunate reality for most people. I think there is this idea that “I’m going to hit this point of rock bottom” or “When I find out this bit of information, then I will make a change”, and the reality is that’s just not usually what happens. Sadly, as eating disorders get worse and worse in terms of being in a more energy-depleted state, it changes your mind, it changes your brain, it changes how you perceive things. So as things get even worse, it becomes even more challenging to make that change.

Henry: Yeah. So true. No doubt a correlation between the lower my weight got or the more I restricted, the harder it got to get out of that cycle because it all became “That’s just what I do now.”

Chris Sandel: I know you said you’d been listening to my podcast for a couple of years, but was there anything in particular that made me stand out as a coach or a nutritionist or as someone who was going to help solve this problem? Why did you pick me?

Henry: Firstly, there is the fact that you’re a man, and most of the people that I found were women. Not that I had a problem with working with women, but I felt – even now, most of the talk around eating disorders and all that stuff is around women, and that can be relatively isolating and stigmatising in its own way. So there was the fact you’re a man.

Also, I knew from listening to your podcast that you were going to make me abstain from exercise, and I really knew that that was massively key to this. Probably more so than the food, because it was really my struggle. And I guess maybe just the fact that I enjoyed listening to your show, so I assumed that I would enjoy working with you as well.

00:13:26

His experience working with me

Chris Sandel: From your perspective, can you describe what the work we did together looked like? How was it for you? What stands out?

Henry: There was obviously a lot of practical stuff. I think we started by making sure I had one rest day a week, and then maybe introducing something like – I remember introducing milk back into my diet one week. I think when I first started seeing you, I would see you every fortnight. So every fortnight, we’d knock something down. But obviously it wasn’t linear like that. There were a few times where I regressed or I struggled, and in those cases we stayed the course rather than adding anything new into the mix at that point.

Then there was the other side, which is the more psychological aspects, “Why am I doing this?”, and learning things about self-compassion, which people always think they know because it’s a relatively – people talk about it a lot now. But it’s one of those things that’s much easier said than done. It really does require – it’s work. It is work, and it’s challenging, and I definitely didn’t always do it right. But yeah, it’s massively effective when you look back, those other things we were doing. The body image exercises. You had me take photos of myself, which I absolutely hated doing, for weeks and weeks and weeks, just until it became normal.

We did lots of journaling in the beginning, and we did food diaries. I know you said you don’t do food diaries with everyone, but I hadn’t kept a diary during my disorder, so it was less triggering for me to do that. It was very personalised to my own illness, I suppose.

Chris Sandel: Yeah. I remember when we first started out, you were travelling around Europe, so it was like, how could you be doing food challenges while you were in that situation, or how could you be, as you said, taking one day off, then two days off. Yes, we eventually built up to you taking time off exercise, and I think, as you said, you knew that was the direction it was heading, but we had to eke our way to get to that place.

Henry: Yeah, undeniably. I still remember the first time I didn’t go for a run. I think I was in Slovenia. It was just awful. The worst sort of pain you could imagine for someone like me at that time. Sounds pedantic saying it, but it was so incredibly difficult. But it’s like exposure therapy; it becomes normal after a while. And that’s not ‘normal’ in an unhealthy way or whatever. It’s just if I don’t want to do it, I’m not going to do it.

00:16:42

Positive results from the work we did together

Chris Sandel: What is the best thing or one of the best things that’s happened as a result of our working together?

Henry: The absolute best thing, without a doubt, is the fact that I’m not always scared anymore. What I remember most from my disorder is that constant fear of having to start over again the next day, being physically exhausted at the end of the day, getting into bed knowing I was going to have to get up and do it again the next day.

I became really miserable and really – I guess the best description I can give you is I was a bit of a loser. Just a tiny little world, whereas I’d always been, growing up, pretty carefree. And I would say most people who know me now would say I’m pretty relaxed and carefree. Maybe too much of those things. But during my eating disorder, I was just such a neurotic.

Chris Sandel: I think what you’re speaking to is, one, the freedom that you now have with this, but two, just how much an eating disorder changes your personality, changes your beliefs, changes your perception of who you are and perception of the world and how much it really shifts you while you’re in that.

Henry: Yeah. As I said, the problem started as I was becoming an adult, so for a long time I just assumed that “This is me as an adult. Adults are serious, and I’ve become this serious person.” But I always, always had this very nagging sense that something – obviously things were wrong with the exercise and with the food, but something was fundamentally different about my personality than it had been growing up, and that doesn’t usually happen to people. You mature and things, but you don’t shift from black to white in terms of your personality.

00:19:04

His relationship with food now

Chris Sandel: Yeah. What about your relationship with food now? What does that look like?

Henry: To be honest, it’s pretty – I live with my girlfriend, and we eat really liberally and a lot of kids’ food, fish fingers and chicken kievs and things like that. When I met my girlfriend, it was April of 2022, so I was about eight months into recovery at that point, and the foods that I eat now even then were much more of a challenge. She definitely noticed, and she noticed things about my routine.

But I asked her in the lead-up to this and she said she really does not notice any issues with food. As I speak to you, I’m about 16 or 17 months into recovery; sometimes I don’t enjoy being very full, I suppose, and sometimes I still struggle with my body. But in terms of the food that I consume and the amount and the types, I would say it’s well back to normal, just as I was when I was a child.

Chris Sandel: You mentioned there about your girlfriend. I would put you getting into this relationship up there with one of the most important parts of your recovery. Do you agree with this?

Henry: Oh yeah, undoubtedly. As I said, I was eight months into recovery when I met her, and I remember it being a real struggle at that point. I think we’d started to up our session frequency again at that point, and it being pretty shitty at that point.

Chris Sandel: The way I remember it, you were having more of a wobble at that point; your body image had got a lot of worse again, connected to the fact that your exercise had started increasing again at a rate that was higher than where your body was at. There was a lot more worry and anxiety and everything coming back.

And connected to that, just fears around getting into a relationship and fears around “What would the opposite sex think about my body?”

Henry: Yeah, massively. I was actually saying this to my girlfriend last night: I feel so incredibly lucky that I met my girlfriend when my body image was at its worst because then there’s never that fear with me – if I had met my girlfriend at a time where it’d been better and then I had a dip, I might think something like, “Now what’s going to happen?”

Chris Sandel: I think it was serendipitous that you met her at that point, and I also think it really did help you get through certain things with this, because there’s only so many times I can say, “Look, people aren’t going to care, you’re going to be able to meet someone” etc., but that’s all in theory. So for you to actually get to experience that and experience it when you did, when your body was at a point where you were like “I’m happy with this” and to see that that wasn’t a problem and that you could have a relationship – I really do think that was quite a lucky turning point that happened at that point.

Henry: Absolutely. When I met her, I still had a relatively rigid routine, like ‘productive’ routine, and it just fell away so quickly after meeting her. She would not put up with me getting up at 6:30 in the morning. She would not have it. Just a lot of things that being in a relationship means you can’t do certain things. And I mean that in a good way. It’s so freeing to not have your whole day planned out ahead of you.

Chris Sandel: Definitely. Even on the food side, having her help you go and have fear foods and to help normalise that process.

Henry: Yeah. She won’t let me into the kitchen, so I never know what she’s cooking anyway. [laughs]

00:23:53

His relationship with his body now

Chris Sandel: What’s your relationship with your body like now?

Henry: I should preface this by saying it’s certainly way better than it ever was when I had an eating disorder. Even when my weight was extremely low, my body image decreased along with it, which you never think. You always think it will get better if you just lose a little bit more, but it never does. So it’s miles better than it was.

I still struggle with it a little bit. Never enough for me to contemplate messing around with my food again or increasing my exercise, but I guess it’s like someone who maybe doesn’t like their nose or something like that. It’s a bit of a niggle, and maybe if I had a magic wand I would change it, but I’m not really willing to put in any amount of significant effort to do it.

Chris Sandel: I think, though, what you’re speaking to is kind of the reality of what a lot of body image work looks like. Body image work isn’t about getting to the place that you think every part of your body is stunning or “I should be on the front page of Men’s Health Magazine.” It’s recognising, “There are parts of my body that I like, there are parts of my body that I don’t like as much, but how I see my body isn’t going to have an impact on how I live my life. It’s not going to stop me going and doing certain things that I want to do” or “It’s not going to stop me eating certain food.”

So it’s not necessarily about liking every part of it, but can you have respect for your body? Can you live a life that is still in alignment with your values even though the body isn’t the thing that you would design if you did have that magic wand?

Henry: Yeah. Something I always remember is there were times when I had a relatively desirable body, and even if I enjoyed how it looked, that would be offset very quickly with the fear of having to keep it up or the fear of losing it. And that’s a really miserable fear to live with. It’s absolutely not worth any of the benefits that a body may or may not be giving you anyway.

Chris Sandel: I know also alongside having low testosterone, having no desire to do anything with the body that is now apparently desirable.

Henry: Yeah, that’s very true. Completely true.

Chris Sandel: If there is something that you would like to improve in terms of your relationship with your body, what would that be?

Henry: My girlfriend likes to take lots and lots of photos, and I definitely wish I enjoyed that more, because I don’t really like doing them. I’m a lot better at it, and I do enjoy it more than I used to, definitely, but I suppose if I was honest, given a choice, when she says “Can I take a photo of you?”, most of the time I wish I could say no.

Chris Sandel: I think there’s probably, one, more work that needs to be done there, or two, it might be just you don’t like having your photos taken.

Henry: Yeah. Just from doing this for 18 months, often I find with a lot of these things, as long as I just keep heading in the right direction and allowing my photo to be taken, which I do, then I find it usually does get easier.

Chris Sandel: Yeah. You said before about exposure. I really do believe that eating disorders are anxiety disorders, and the treatment for that is exposure and doing things again and again and again until it becomes normalised.

Henry: Yeah.

00:27:48

Things he didn’t expect about recovery

Chris Sandel: With the work that we did, was it what you expected, or was it different in some way?

Henry: I definitely remember when we started, having that ideal of like I would just be delighted with whatever body I ended up with and I would be this bastion of how good recovery is and all those things, and it wasn’t like that. But to be honest, I’m glad, because this is what life is. It’s not perfect, and it’s not everything you want it to be, but I absolutely have my life back. I have a dog, girlfriend, I see my family more than I used to. I never used to go to the family events, all those things. Those sort of things, I didn’t really plan for them because all I wanted to do was stop feeling miserable. I didn’t think “I’ll be able to go to my nephew’s birthday party” or whatever. Seeing all those things and comparing it to the life I lived for most of my twenties, it’s still a novelty to me. I don’t take it for granted at all.

Chris Sandel: Were there any changes that were unexpected as part of this?

Henry: I certainly did not expect to be in a relationship so quickly, because I hadn’t been in a relationship for all of my twenties because of the illness. That definitely took me by surprise. And also reconnecting with all my old friends. Most of my friends could tell there was some sort of problem, pretty obviously – and my friends are lads, right? They’re not the types of people I would expect to really have understood this so well. But they were all extremely kind and welcomed me back with open arms.

00:29:59

Henry’s advice for others in a similar situation

Chris Sandel: Nice. What advice would you have for someone who is struggling with food and body and exercise in the way that you were?

Henry: My advice would be to definitely, definitely go and get some help. I would use the barometer to be like, do you feel that something is wrong? It doesn’t matter about your weight or any of those things. Like I mentioned earlier about my personality, always feeling that there was something wrong – the illness changes you mentally, and if you can get help, it’s amazing how quickly – it’s definitely a long road, but it’s amazing how quickly things can get better once you have a plan in place.

Chris Sandel: How long were you expecting it to take?

Henry: I remember having plans for doing things – probably exercise-related – but in December, and we started in August. That’s no time at all. It’s like four months. As I said, it was really eight or nine months before things really started to get better psychologically. Things got better physically very quickly. I started sleeping better. I used to get up to pee at night all the time and sweat a lot in bed and things like that. That I remember going pretty quickly. But some of the things like body image – well, body image is still ongoing, but those sort of things, it was really about eight or nine months. And I also had the boost of meeting my girlfriend, which probably sped me up a bit, I suppose.

Chris Sandel: The reason I’m asking is I think there can be this unrealistic expectation about how quickly things are going to improve. I’m pretty honest about this when I start working with someone, just how long it can take to do the nutritional rehabilitation, how long it can take for your perception and your thoughts and all of that to start to change, the psychological components connected to this.

So yeah, I’m glad that you were able to share how long you’ve been working at this and that there’s still work you’re continuing to do. I do think there are still changes on the horizon for you with this, and that this isn’t completely done. Just having a realistic understanding of how long this takes – that this isn’t something that is dealt with within a couple of months.

Henry: No. And there’s a lot of automatic thoughts that take a long, long time to remove. For example, me with the photos. It feels very automatic. It’s like if someone throws something at you and you put your hands up. It feels just like that. There’s no control over it. I remember having that a lot with random triggers. Seeing someone run when I wasn’t running, I remember it would cause me psychological pain, almost. It takes a lot of undoing once you’ve been in it for a long time.

00:33:45

His relationship with exercise now

Chris Sandel: I forgot to ask, what is your relationship with exercise like now?

Henry: It’s pretty normal. I jog a bit in the park. My girlfriend and I did go to a local leisure centre a bit. But I never do anything – I used to race run and run for much, much longer than I do now. I will putter about in the park with my dog, but I never go for very long anymore. I walk the dog as well. I used to do a lot of circuit classes, high-intensity stuff. I never, ever do that sort of stuff. One, I have no desire to, but two, those things are so linked to my disorder that I would just stay away from them, I think for a very long time. I did also play football for a bit, a few months ago, but I stopped because I was getting injured.

Chris Sandel: Is there anything that I didn’t either ask you or you didn’t mention that you would like to add?

Henry: One thing I would add is those issues that I had, the serous atrophy and the osteopenia, all developed whilst I was at a normal BMI. I think that’s always something that’s worth noting. I’d understand if someone was listening to that thinking I was medically underweight, but I actually wasn’t at that time.

Chris Sandel: Cool. I think that is definitely helpful to add, because someone’s listening to your voice, listening to your story, they have no idea what size your body was or what size your body is now as part of this. So for you to say that I think is really helpful for people to know.

Henry: Yeah.

Chris Sandel: Thank you so much for coming on and doing this. It’s been a pleasure working with you over this time. It is so nice to see where you’re at now and for you to have a girlfriend and to be doing all of these things in your life. We didn’t even touch on your love of piano and all these hobbies and things that you’re now doing, and doing in a way that is bringing joy to your life as opposed to it being rigid and where it’s, as you said, like “How do I have to get up and do another of these days again?”

Henry: Exactly. As I said earlier, I’m lucky that a lot of these things still are a novelty to me. It still makes me delighted when I can do all of these very normal things – going out for supper – and I just look back to a couple years ago and how enormously challenging that would’ve been.

Along with that, one of the great things about coming out of something like this is everything else in life becomes much easier because you can always compare it to either when you were sick or when you were recovering, because those things are – I mean, it’s certainly the most challenging thing I’ve ever done in my life. So when everything is falling apart around me, I can always think to myself “At least I’m not back there again.” It’s such a relieving thought.

Chris Sandel: I remember when we chatted most recently and you’re like, “Work’s really stressful.” I was like, “Sorry about that” and you’re like, “It’s fine. In comparison to what I’ve been through, that’s nothing.”

Henry: Yeah, exactly.

Chris Sandel: Thank you so much for doing this, Henry.

Henry: No worries, Chris. Thank you very much.

Chris Sandel: I hope you found that conversation helpful. As I mentioned at the top of the show, I’m now taking on clients again, and at the time of recording this, I have six spots available. If you’re interested in working together or finding out more, you can head to www.seven-health.com/help.

That is it for this week’s show. I will be back next week with another episode. I’ll catch you then.

Thanks so much for joining this week. Have some feedback you’d like to share? Leave a note in the comment section below!

If you enjoyed this episode, please ~~share~~ it using the social media buttons you see on this page.

Also, please leave an honest review for The Real Health Radio Podcast on Apple Podcasts! Ratings and reviews are ~~extremely helpful~~ and greatly appreciated! They do matter in the rankings of the show, and we read each and every one of them.