In prepubertal anorexia nervosa, problematic physical activity is linked to dysregulation of hormones involved in appetite regulation.
- Problematic physical activity (PPA) appears to be a characteristic feature of early-onset anorexia nervosa in a large number of cases, or even a cardinal symptom of the disorder.
- It is linked to dysregulation of leptin-ghrelin hormones.
- This frequent symptom is associated with a more severe eating disorder, more comorbidities, and a negative bodily, endocrine and psychological impact.
More severe and rapid weight gain, inability to swallow, fluid restriction, nausea… These signs can indicate early-onset anorexia nervosa (EPA). However, “problematic physical activity (PPA), which can be voluntary or involuntary and compulsive, is also a common symptom” of this rare disorder. This was clarified by Briac Daniel, psychiatry intern at the Robert-Debré Hospital (Paris), during the “Endocrinolympiads” organized by the French Society of Endocrinology on April 5. In fact, it is present in 30 to 80% of cases.
Problematic physical activity, a warning symptom of the onset of a TCA
“Physical activity is considered problematic when children play sports excessively and this endangers their health. For example, one of our patients did jumping jacks to the point of having vagal discomfort. Some were constantly in position They are called plank champions! In short, these young people, who are malnourished, cannot stay seated or lying down, except during their sleep. explained Coline Stordeur, child and adolescent psychiatrist at Robert-Debré Hospital. She pointed out that in cases of prepubertal anorexia nervosa, we do not speak of hyperactivity, because “Patients affected by both MPA and attention deficit disorder with or without hyperactivity (ADHD) are rare. In the hospital, we only have two patients in this case.”
According to Briac Daniel, problematic physical activity is associated with markers of severity of eating disorders (TCA). “We observe a greater speed of weight loss, longer hospitalization and a brake on renutrition. Patients also suffer from anxiety, depressive symptoms and sleep disorders.” PPA also has consequences for the long-term course of prepubertal anorexia nervosa. “There are more relapses and more chronicization, a worse prognosis and a poorer quality of life.” In the event of problematic physical activity, the two child psychiatrists reported more secondary amenorrhea, lower levels of thyroid hormones and gonadotropins, higher risks of cardiovascular diseases and osteoporosis, “regardless of BMI or age”.
AMP: dysregulation of the leptin-ghrelin hormones involved
To determine how problematic physical activity occurs, specialists have put forward two pathophysiological hypotheses. “An experiment carried out on rodents shows that dietary restriction leads to a reduction in food intake associated with an increase in physical activity.” Under the hormonal hypothesis, doctors found that PPA caused leptin levels to drop and ghrelin levels to rise. “In animals, problematic physical activity combined with a leptin injection leads to a disappearance of hyperactive behavior!” Thus, APP is linked to dysregulation of leptin-ghrelin hormones. Regarding the behavioral hypothesis, child psychiatrists have observed that patients suffering from MPA present an addiction to physical activity. “This is a consequence of a tendency to use sport as a means of emotional management.”
