Joe was a very sporty and active boy before he developed anorexia. At the beginning he felt that if he ate a little less and did a little more exercise he would become an even better sportsman. However, after a few weeks he became obsessive about exercising more and more. He insisted on going to every after school activity which involved exercise. He was particularly keen on swimming club and athletics club because he could work really hard in them. Initially, his swimming and athletics coaches were both very pleased with the results he was achieving. However, within a few weeks they both became concerned about his rapid weight loss and his obsessive determination to do better and better. A month later Joe had become so weak he couldn't carry on with these clubs, but he soon replaced his sporting activity at school with repetitive exercise at home. On a typical day he would do:

• 100 sit-ups or more after every meal and extra in the evening

• 50 press-ups or more after every meal and extra in the evening

• 20 pull-ups or more every time he went up or down the stairs

• 20 pull-ups or more every time he walked down the hallway

• several hard work-outs on the exercise bike

• constant tensing of his stomach muscles as well as flexing his arm and leg muscles

• constant tapping of his feet if he wasn't actually exercising - he couldn't bear to be still for a minute.

These are the exercises we were aware of. It is likely he was doing other exercises in his bedroom. Anorexics have been known to set their alarm clocks for the middle of the night so that they can do more secret exercise whilst everyone else is asleep.

Stopping your son exercising is at least as difficult as trying to encourage him to eat. Normal sporty active boys will exercise a lot more than their non-sporty counterparts. It is almost impossible to know where to draw the line. In addition if your son has got to the stage where he is obsessively exercising at every opportunity, then it is unlikely that he will be able to stop without some outside professional help. The more you try to dissuade him from exercising the more likely he is to exercise in secret.

Excessive compulsive exercising can be very dangerous for anyone, but more so for a growing boy. Exercise puts strain on a heart already weakened by starvation; muscles become severely wasted and can no longer support the joints, which can become badly damaged.

It is important to try to dissuade your son from obsessive repetitive exercising. You might consider trying some of the following strategies:

• Explain that the normal recommendation for children and adults is that they should exercise for about 20 minutes three times a week. Of course athletes do a lot more than this, but they are supervised by qualified coaches and have qualified physiotherapists available to deal with any injuries.

• Watch your son carefully. He may tell you he has stopped exercising and instead be exercising in the bathroom, at night or anywhere else that you cannot see.

• Tell your son that if he continues to do so much exercise then he needs to see a doctor to assess his physical condition. This in itself might be a good deterrent.

• If this doesn't achieve the desired effect, then carry through the threat to go to the doctor. The doctor might be able to persuade him to reduce his exercising regime or he might feel it is appropriate to refer your son onto a specialist. At the very least he should check his weight and physical observations such as pulse and heart rate.

If your son has lost weight and continues to exercise obsessively, it is important to seek professional medical help before he does himself too much long-term physical damage.

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