The old adage may be that the picture tells a thousand words, but when it comes to the glossy images posted on social media, it’s becoming increasingly clear that they are only telling half the story.
This is especially true when it comes to the legion of so-called fitness Instagrammers, or “Fitfam”, whose gobsmacking #quadgainz and astonishing #transformationtuesdays can make even the most diligent gym bunny feel inferior. Yet what these photographs don’t show is the negative impact that the dual stresses of overtraining and undereating can have on a person’s long-term health.
Take Nathalie Lennon, for example. Nathalie is a super-fit 24-year-old for whom posting her daily workouts and progress photos on Instagram (where she has over 56,000 followers as @nat_tilly) was as much a part of her daily routine as the heavy weights and interval routines she smashed in the gym.
Last year, however, self-confessed “fitness crazy” Nathalie received devastating news when a visit to a dietitian revealed she was firmly in the risk bracket for early-onset osteoporosis. Her passion for fitness had come at the expense of her long-term health.
“I was so focused on my physical appearance I completely neglected my bones and my own general health,” she admits to Health & Living.
Coming to the end of her degree in Earth Sciences a couple of years ago, like any college student Lennon was starting to feel the effects of a diet mainly based around fast food and takeaways.
“I just wanted to get on top of my health and fitness a small bit. That was just at the time when the Instagram was becoming popular. It all started out quite fun and light. As time went on, I started to see the physical progress, and I got passionate about health and fitness.” Nathalie even spent several months after leaving college saving up money in order to fund a qualification as a personal trainer.
With this, her Instagram really took off, and Lennon admits she began to crave the attention and admiration that her online presence brought. “My Instagram only ever started off as my own accountability tool, but it then grew to become a sort of business tool,” she says.
Indeed, Lennon freely admits she became “obsessed”. “The more I began to connect with other people online, it became less about my own health and more about my physical appearance. The passion turned into an obsession.”
In late 2016, the Dublin native took her training to the next level when she decided to enter a physique competition. These notoriously competitive events involve weeks of ‘prep’, with an intensive training schedule and restrictive diet.
“It seemed that every other personal trainer online had done such a competition, and their advertisement was themselves,” she says. “I didn’t go out of my way to cut out food groups, but obviously it’s a very restrictive way of living when you are dieting for one of these competitions. It instils a negative mind frame against certain forms of foods. You forget how necessary they are for general health. I forgot to ensure I included all food groups in my diet.”
When the competition was over, Lennon admits she looked “too small and skinny”. Realising she needed some professional advice on her diet and nutrition, she booked into see a dietitian in May 2017. At the appointment, she hopped on the body composition scales, which gives readings for body fat percentage, weight, metabolic age, muscle mass and bone density.
Shockingly, it transpired that Lennon’s bone density was far below the average expected for a woman of her age - the scale read 2.1g/cm3, compared to the average 2.9g/cm3.
This was the epiphany Lennon needed to break her obsession with diet and fitness. “The dietitian was shocked, it was clear. And that scared me so much, I couldn’t believe I was only 23 and had put myself at risk of osteoporosis. My personal training career would have been over if I had broken a hip or a leg,” she says.
Dublin GP Dr Sinead Beirne is keen to emphasise the negative impact a restrictive diet and an extreme exercise regime can have on someone’s long-term health.
Adolescent girls can become very conscious of their appearance and fixated on losing or not gaining weight, she adds.
“They are heavily influenced by people they see online who aren’t necessarily qualified to give diet advice. There are so many fad diets out there that eschew whole food groups, such as carbs or dairy,” she says.
“Yet these are the critical years for laying down the foundations for strong bones in later life. Between the ages of nine and 18, you need five portions of dairy every day, whereas for adults it is only recommended that you have three per day. That’s how much more important it is at a young age.”
Beirne has zero time for any fad diet. “I just think it’s total nonsense. Really, it’s all about the basics, eating a normal healthy balanced diet. Eating clean and all that, personally I just think it’s people making a lot of money. Certainly, there is no harm in people eating more of things like blueberries and nuts, but eliminating whole food groups is unnecessary and can be dangerous.”
Caoileann Murphy, dietitian and research fellow at the School of Public Health, Physiotherapy, and Sports Science at University College Dublin, agrees.
“Cutting out any food group increases the risk of nutritional deficiencies,” she says. “There is a lot of noise out there surrounding nutrition and I think as dietitians we have a responsibility to shout a little louder with evidence-based nutrition advice.”
Avoiding dairy products has become increasingly popular, especially among school-aged girls and young women, says Murphy. While this may be due to a variety of reasons – ethical, cultural, religious, preferences etc. – in many cases it is because of general misinformation around dairy, such as the misconception that dairy is fattening or causes acne, she explains.
“If girls simply cut out dairy and do not adequately replace it with other food sources of calcium (and protein), this could interfere with peak bone mass accrual and may put them at higher risk of osteoporosis later in life. As such, I think we need greater education in this group to clear up these misconceptions about dairy and also provide support on how adequate calcium intakes can be achieved from non-dairy sources if the person chooses to avoid dairy.”
According to Dr Beirne, while some people may need to avoid dairy or seek alternatives as they are lactose-intolerant, this is far less common than the proponents of certain fad diets would have people believe.
“There is only a tiny percentage of people who are truly lactose-intolerant.”
Restrictive diets become even more dangerous when combined with an obsessive approach to exercise, she adds. “I do remember a case that has really stuck with me. I saw a girl in her twenties who came in with an unusual type of pain, around her hips. I sent her for an X-ray and an MRI and it turned out she had multiple fractures. It was a shocking report for a young girl and it turned out this girl has osteoporosis. She had a previous history of an eating disorder, but had become obsessive about running and she had to stop to begin treatment for osteoporosis.”
Women should be aware of other risk factors, such as their family history of the condition, says Dr Beirne. If they are concerned, they should ask their GP to refer them for a DXA, or bone density, scan.
“Young girls and women are at such high risk as that’s the skeleton they will be stuck with for life. You can try and treat osteoporosis, but you will have to deal with lifelong complications of it.”
Lennon is keen to share her cautionary tale, particularly in advance of World Osteoporosis Day this Saturday, and, along with Dr Beirne, is working with the National Dairy Council, in association with Cappagh Hospital Foundation, on their ‘Mind Your Bones’ awareness campaign to educate consumers on the importance of bone health through the life stages.
Her Instagram page is now focused around messages of body positivity and illustrates her efforts to contrast her previous way of life with the far more rounded approach to general health and well-being she takes nowadays.
“I listen to my body a lot more now and have so much more variety in my diet, different sources of carbohydrates and vegetables.
“I make sure I eat several portions of dairy every day and take calcium supplement to make sure I am getting my bone health back to where it should be.
“Building bone density is very difficult, but it can be done. I have fallen in love with my training all over again.”
⬤ Osteoporosis causes bones to become weak and fragile, so that they break easily - even as a result of a minor fall, a bump, a sneeze, or a sudden movement. It is often not diagnosed until a fracture occurs.
⬤ Fractures caused by osteoporosis can be life-threatening and a major cause of pain and long-term disability.
⬤ Although women are more likely to develop osteoporosis, it also affects men and even children.
⬤ Osteoporosis is more common in white or Asian women older than 50 years of age, but osteoporosis can occur in almost any person at any age.
⬤ At present it is estimated that 300,000 people in Ireland have osteoporosis.
⬤ One-in-four men and one-in-two women over 50 will develop a fracture due to osteoporosis in their lifetime.
⬤ Osteopenia is the early stage of osteoporosis. Having osteopenia places a person at risk of developing osteoporosis.
⬤ Also known as a bone density scan, the dual Energy X-ray Absorptiometry (DXA or DEXA scan), is used to measure the density of your bones. This test is currently the most accurate and reliable means of assessing the strength of your bones and your risk of breaking a bone.
⬤ World Osteoporosis Day takes place this Saturday (October 20). See mindyourbones.ie for more information.