"Fit Life" and Body Dysmorphia

Drawing by Elizabeth McNair

Confession: With the exception of needing to know for calculating macros, I rarely weigh myself. I still have days where I stand in front of a mirror to pinch and jiggle and flex to see what needs improvement.

I've been a mostly-healthy eater for years now. Protein, vegetables, carbs -- the typical "healthy diet". I have also been working out for years; gym, obstacle racing, and crossfit. I'd have periods of time where I was somewhat satisfied with my physique, and others where I just absolutely hated it. I was in the hate phase, and since I'm always up for learning and a challenge, a "nutrition challenge" in 2021 seemed like a great idea. Through Ryan Fischer's "Earn Your Carbs" challenge, I learned a lot about how to properly calculate macros and how to fuel my body for performance.

I learned my "healthy diet" was nowhere near the caloric intake I needed, despite it being a lot of food. Upon calculating my macros for this challenge, I learned I was about 800 calories under what I actually needed. That explained why I was just soft and not taking the shape I wanted. I bought a food scale and a biometric scale, and I was set. 30 days later on "maintenance" I was down 8lbs and looking much leaner. I won the challenge that month (and some money). Mind you, I had dislocated ribs at the time so results from this challenge were all nutrition-based. Not from working out.

Although I felt great and now have the knowledge to properly fuel myself going forward, I feel that the measuring and weighing and having to stick to certain numbers reprogrammed my view of self and achievement of bodily goals. I'm very aware of the tiniest changes to my size and stress quite a bit if I see myself getting soft. I mostly avoid looking in the mirror, but when I do catch a glimpse, I go for the pinch. I stress when pants don't fit right. That's actually what kicks my ass in gear to be more disciplined so I double-down on nutrition. I don't go and buy the next size up.

We see it everywhere. Fitness posts have taken over social media. Some for the betterment of self, some to keep up with the latest fit-body trends, and some simply for the validation. It appears the physical/mental health benefits are being sidelined to the gym culture aesthetics. Cue overtraining and undereating; The perfect storm for Exercise Addiction ("EA"), Eating Disorders ("ED"), and Body Dysmorphic Disorder ("BDD"). Social media has normalized obsession with working out, unrealistic body expectations and goals, and extreme caloric deficits through promoted fad diets and detoxes.

Although I have gotten better with picking at myself, I had to investigate just how common this is, and came across Corazza et al's. (2019) study which "identified a high risk of EA, appearance anxiety and BDD amongst a cohort of gym users internationaly." [3]

Boom. Rabbit hole.

Let's get nerdy -

There are studies that emphasize the connection between EA and BDD which, in recent years, was described in the "obsessive-compulsive" chapter of DSM-5. Lennon (2022) [1] "found that “bulking and cutting” was linked to an increased incidence of muscle dysmorphia and eating disorders among all genders." Muscle dysmorphia ("MD"), also known as Bigorexia, is a subcategory of BDD where the individual's obsession is inadequate muscularity and is most common with men.

"Characterized by attempts to increase lean muscle mass and reduce body fat, muscularity-oriented disordered eating and weight-control behaviors may include excessive exercising and weight lifting, high protein intake, “bulk” and “cut” cycles, intermittent fasting, appearance- and performance-enhancing drug and substance use, and “cheat meals” There is growing recognition of the overlap between muscularity-oriented disordered eating and weight-control behaviors and drive for muscularity (i.e., striving for muscle mass), eating disorder psychopathology, and muscle dysmorphia psychopathology.. These are important concepts given they may precipitate and perpetuate one’s engagement in muscularity-oriented disordered eating and weight-control behaviors." (Ganson et al., 2022) [2]

(Grieve, 2007) [4]

MD diagnostic criteria straddles anxiety and ED. With MD and ED, the person's opinion of self correlates with their body shape and size versus their ideal shape and size. [4] Although MD is found to be most common among men, as are the focused studies surrounding it, I expect there to be an increase in studies focusing on its impact in women as the gym culture is shifting towards accepting and attaining a more muscular female physique.

1. Lennon, A. (2022, September 21). “Bulk and cut” dieting linked to eating disorders, muscle dysmorphia in youth [Review of “Bulk and cut” dieting linked to eating disorders, muscle dysmorphia in youth]. Medical News Today. https://www.medicalnewstoday.com/articles/bulk-and-cut-dieting-linked-to-eating-disorders-muscle-dysmorphia-in-youth

2. Ganson, K. T., Cunningham, M. L., Pila, E., Rodgers, R. F., Murray, S. B., & Nagata, J. M. (2022, September 9). “Bulking and cutting” among a national sample of Canadian adolescents and young adults [Review of “Bulking and cutting” among a national sample of Canadian adolescents and young adults]. Springer Link; Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. https://link.springer.com/article/10.1007/s40519-022-01470-y#ref-CR1

3. Corazza, O., Simonato, P., Demetrovics, Z., Mooney, R., van de Ven, K., Roman-Urrestarazu, A., Rácmolnár, L., De Luca, I., Cinosi, E., Santacroce, R., Marini, M., Wellsted, D., Sullivan, K., Bersani, G., & Martinotti, G. (2019). The emergence of Exercise Addiction, Body Dysmorphic Disorder, and other image-related psychopathological correlates in fitness settings: A cross sectional study. PLOS ONE, 14(4), e0213060. https://doi.org/10.1371/journal.pone.0213060

4. Grieve, F. G. (2007). A Conceptual Model of Factors Contributing to the Development of Muscle Dysmorphia. Eating Disorders, 15(1), 63–80. doi:10.1080/10640260601044535. https://sci-hub.ru/10.1080/10640260601044535