How common are eating disorders among young people?

Eating disorders are more prevalent in young females than males, though incidence in young boys has increased over the last decade. Approximately 60% of US high school females report struggling with low confidence or negative body image, indicating a scarily high prevalence of related issues.

What physical complications can arise from bulimia?

While individuals with bulimia can experience issues like esophageal erosion and electrolyte abnormalities, Holly fortunately did not suffer from esophageal erosion. However, she expressed concern about long-term risks due to the frequency of purging.

How did Holly eventually seek professional help for her eating disorder and anxiety?

At age 25, while expanding her business and experiencing severe anxiety and burnout, Holly sought therapy. This led to a 7-day intensive rehabilitation program in Melbourne. While not a complete cure, it exposed her to relaxation and communication benefits, prompting her to commit to weekly therapy once she moved to America in 2016.

What were the key aspects of Holly's recovery from her eating disorder?

Holly's recovery involved consistent therapy, self-reflection on past traumas, deconstructing dysfunctional beliefs, and finding spiritual purpose. A pivotal moment was a firm commitment to herself to stop purging and overcompensating with activity, forcing her to become mindful of her eating and develop self-compassion.

Can someone truly recover from an eating disorder, or is it a lifelong recovery process?

Holly believes that true recovery from an eating disorder is a lifelong process, similar to addiction recovery, rather than a complete 'cure.' It requires continuous mindfulness, self-compassion, and understanding one's triggers, as the underlying predispositions remain.

How does bodybuilding intersect with Holly's history of an eating disorder?

Bodybuilding presents a paradox for Holly, as it emphasizes extreme leanness and control, which previously fueled her eating disorder. However, through deep mental health work, she has found a way to engage with the sport without being driven by the disorder, instead aiming to be an advocate for healthy approaches.

Is it healthy for women to achieve extremely low body fat percentages for competition?

Holly states that extremely lean body fat percentages (like 10-11% for fitness competitors) are generally not healthy for women, often leading to menstrual cycle cessation—an evolutionary signal of unsuitability for reproduction. While it's common in professional bodybuilding, such leanness is not typically meant for a woman's body.

What is the typical muscle gain potential for natural female athletes in a building phase?

For natural female athletes, an optimal muscle gain rate in an 8-week period is approximately 1 kilogram (about 2.2 pounds) of fat-free mass. This rate depends significantly on consistent training, proper nutrition, and adherence to other variables.

How much training volume is effective for muscle gain in a beginner female client?

For a beginner female client, an effective program would start with low training volume, potentially just one working set per exercise, 3 days a week, lasting 30-40 minutes. The focus is on progressive overload and proper technique to prevent injury and promote adherence.

What are key lower body exercises recommended for women to build muscle?

Key lower body exercises include compound lifts like goblet squats or barbell squats to a box, deadlift variations (Sumo or Anderson squats for confidence), hip thrusters, step-ups, and abduction exercises. Single-leg work is also important for addressing imbalances.

What are optimal protein intake recommendations for women aiming for hypertrophy?

Protein intake to optimize hypertrophy in women is similar to men, ranging from 1.8g to 3g of protein per kilogram of lean body mass. The specific target depends on individual dietary preferences, with consistency being crucial due to protein's higher thermogenic effect on food.

What is the recommended rate of weight loss during a cutting phase to preserve muscle?

During a fat loss phase, the recommended weekly weight loss rate should not exceed 1.5% of body weight to minimize the risk of metabolic adaptation and preserve muscle mass. Losing weight too rapidly can lead to a greater proportion of muscle loss rather than fat loss.

What is a 'reverse diet' and why is it important after a fat loss phase?

A reverse diet is a strategy to slowly and incrementally reintroduce calories after a fat loss phase to restore metabolic function and appetite-regulating hormones to normal levels. It's crucial for preventing rapid weight regain (hyperphagia) and maintaining long-term fat loss success after dieting.

How does the menstrual cycle influence female training and recovery?

During the luteal phase of the menstrual cycle (when progesterone is high), some women subjectively report decreased strength. Conversely, performance may feel better when estrogen is high. Holly often defaults to scheduling deloads around a client's menstrual cycle to accommodate potential impacts on energy, mood, sleep, and motivation.

Key Moments

228‒Improving body composition, female-specific training principles, & overcoming an eating disorder

Peter Attia MD

Science & Technology5 min read153 min video

Oct 24, 2022|398,573 views|6,545|473

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Key Moments

TL;DR

Nutritionist Holly Baxter shares her journey overcoming an eating disorder and becoming a bodybuilder.

Key Insights

Holly Baxter battled a 15-year eating disorder (anorexia, binge eating, bulimia) stemming from a need for control, sexual trauma, and a lack of validation.

Her path to recovery involved consistent therapy, self-compassion, and ultimately finding purpose through spirituality, leading to a healthier relationship with food and her body.

Bodybuilding, while seemingly high-risk, can be approached healthily with a focus on longevity, listening to one's body, and prioritizing mental health alongside physical training.

Sustainable body composition changes require a balanced approach, including progressive overload in training and carefully managed caloric surpluses/deficits, especially during dieting phases.

Female physiology, hormonal cycles, and the postpartum/menopausal periods significantly influence training and recovery, requiring tailored approaches distinct from male programming.

True recovery involves ongoing management, not complete eradication, and shifts focus from aesthetic ideals to overall well-being, including bone density and mental health.

EARLY STRUGGLES AND THE ROOTS OF CONTROL

Holly Baxter, a dietitian and competitive bodybuilder, reflects on her early life in Tasmania, Australia, marked by a childhood passion for sprinting and track events. Her decision to pursue nutrition science was deeply intertwined with a 15-year struggle with an eating disorder, beginning with anorexia and evolving into binge eating disorder and bulimia. This battle was fueled by a profound need for control, stemming from a strained relationship with her mother, a distant father, and significant trauma, including sexual assault around age 15. The pressure to excel in various activities, coupled with a lack of emotional validation, created a fertile ground for these issues to develop. Her early experiences with the medical system, including ineffective therapy and medication, compounded her challenges.

THE BATTLE WITH EATING DISORDERS: A CYCLE OF RESTRICTION AND COMPULSION

Baxter detailed how her eating disorder manifested, initially through restrictive behaviors that were unsustainable given her athletic demands. This led to cycles of binge eating and purging, becoming a daily struggle for approximately five years, continuing into her university years. Despite pursuing higher education in nutrition, she kept her condition a secret, fearing stigma and personal judgment, especially as a "high achiever." She describes herself as being "right in the middle" in terms of weight, making her condition less outwardly apparent. A suicide attempt at age 16, met with a lack of empathetic response from her father, further underscored her isolation and the ineffectiveness of external support systems at the time.

THE PATH TO RECOVERY: PROFESSIONAL HELP AND SELF-DISCOVERY

A turning point arrived around age 25 when Baxter experienced burnout from her business and intense anxiety, prompting her to seek professional help. A brief, intensive 7-day rehabilitation program provided initial insights into relaxation and transparency, but consistent weekly therapy, which she began after moving to the U.S. in 2016, became the cornerstone of her recovery. This ongoing therapy allowed her to deconstruct dysfunctional beliefs, understand the "why" behind her struggles, and foster self-compassion. Crucially, finding a sense of purpose and belonging through a non-denominational church offered profound healing, enabling her to feel valued beyond her physical achievements and begin to shed the identity tied to her disorder.

RETHINKING BODYBUILDING: LONGEVITY OVER EXTREMISM

Baxter addressed the apparent paradox of her passion for bodybuilding, an extreme sport that could heighten the risk of disordered eating. She emphasized that her journey in bodybuilding now prioritizes longevity and a healthy relationship with her body, rather than extreme leanness. Competitions, particularly in federations like IFBB, push participants to very low body fat levels (around 10-11%), often leading to the cessation of menstrual cycles in women, a sign of significant physiological stress. Baxter now advocates for a balanced approach, focusing on building muscle and maintaining bone density through resistance training, even if it means a higher body fat percentage, thus promoting overall health and well-being.

PRINCIPLES OF PROGRESSIVE TRAINING AND NUTRITION

Discussing her coaching methodologies, Baxter highlighted that while elite athletes have higher training demands, the fundamental principles for physique transformation remain similar for general populations. Her approach involves detailed goal setting, often using visual references, and implementing progressive overload. For women aiming to build muscle, she stresses the importance of evidence-based training, focusing on muscle groups like glutes and shoulders, and often employs a higher volume of lower body work. Nutrition is critical, with protein intake mirroring male recommendations (1.8-3g/kg lean body mass) and controlled caloric surpluses during building phases (around 10-20%) to optimize muscle gain while minimizing excessive fat accumulation.

NAVIGATING FAT LOSS AND SUSTAINABLE RECOVERY

The cutting phase, aimed at fat loss, involves a gradual reduction in calories to achieve a sustainable weekly weight loss rate (no more than 1.5% of body weight) to preserve muscle mass and avoid metabolic adaptation. Baxter also detailed the crucial recovery phase, or reverse dieting, which involves slowly increasing calories post-diet to find new maintenance levels without rapid weight regain. This process is vital for hormonal regulation and preventing the hyperphagia often experienced after restrictive phases. She stressed the importance of patience and consistency, acknowledging that achieving desired body composition changes is a long-term commitment, often requiring multiple cycles of building and fat loss.

FEMALE-SPECIFIC CONSIDERATIONS AND THE FUTURE OF FITNESS

Baxter elaborated on the physiological differences influencing female training, such as a higher percentage of Type I muscle fibers, leading to better endurance and recovery. This translates to potentially higher rep ranges (8-15) being more effective for hypertrophy in women compared to the lower rep ranges (1-6) often favored by men for strength. She also highlighted the impact of the menstrual cycle, suggesting programmed deloads around specific phases to optimize performance and recovery. The conversation touched upon the challenges faced by women post-pregnancy and during menopause, emphasizing the need for individualized, realistic goal setting, and the profound benefits of hormone replacement therapy and consistent, moderate training for long-term health and quality of life.

Mentioned in This Episode

●Tools

●Companies

●Organizations

●Books

●Concepts

●People Referenced

Common Questions

Holly pursued nutrition not out of passion for sport but from a desire to control her eating due to a 15-year battle with anorexia, binge eating, and bulimia, alongside depression and past trauma. Her recovery journey involved consistent weekly therapy and finding spiritual purpose.

Topics

Health & Longevity Mental Health & Psychology Human Performance Muscle Hypertrophy Hormone Replacement Therapy Mental Well-being Female Physiology Fat Loss Strategies Eating Disorder Recovery Bodybuilding For Women Strength Training Principles

Mentioned in this video

Concepts

Anorexia

An eating disorder that the guest struggled with for a short period before it evolved into binge eating disorder and bulimia.

Bulimia

An eating disorder characterized by binging and purging, which the guest struggled with for approximately 5 years every day.

PhD in neuropsychology

A potential future educational path the guest is considering to focus on mental health and eating disorders.

Aussie Rules Football

A popular sport in Australia that offers significant career opportunities for males, contrasting with the limited options for females in professional sports.

binge eating disorder

An eating disorder that the guest developed after anorexia, characterized by periods of uncontrolled eating.

flexible dieting

A dietary approach where the guest learned she could incorporate foods like ice cream and cookies, changing her restrictive habits.

Irritable Bowel Syndrome

A medical condition that the guest has struggled with for 10 years, influencing her preference to train on an empty stomach.

DEXA Scan

A method used to assess body fat percentages and lean mass, utilized by the guest for tracking client progress and her own body composition changes.

Locations

Melbourne, Australia

The city where the guest moved for college and later started her first business.

Tasmania

An island south of mainland Australia where the guest grew up, described as a small place with limited opportunities for females in sports.

Florida

The current location of the guest, indicating her journey away from her home island.

Hobart

A city in Tasmania where the guest traveled for therapy sessions during her teenage years.

Victoria, Australia

The Australian state where a well-known rehabilitation therapy location, involving counseling and relaxation techniques, is situated.

Italy

The destination for a hypothetical client's honeymoon, prompting discussion about post-diet recovery strategies.

Organizations

IFBB

A non-drug tested bodybuilding federation where the guest previously competed in the figure division.

Deakin University

The university where the guest completed her undergraduate degree in nutrition science and a master's in dietetics.

Tasmanian Institute of Sport

An institute where the guest trained as a sprinter and was introduced to weightlifting.

University of South Florida

Where the guest had her BMR and muscle thickness testing done, confirming significant muscle gain between competitions.

People

Peter Fortune

The guest's track coach at the Tasmanian Institute of Sport, who also coached Olympic 400m runner Cathy Freeman.

Cathy Freeman

An Olympic 400m runner who won a gold medal in the 2000 Olympics and was coached by Peter Fortune.

Beth Lewis

Someone mentioned by the host who is convinced that any human can be taught to do a bodyweight pull-up.

Kai Greene

A traditional bodybuilder whose physique, with significant back development, contrasts with the typical aesthetic goals of female fitness competitors.

Companies

Les Mills

A program offering various gym classes like combat, kickboxing, and BodyPump, which the guest participated in for light resistance training.

Books

The Complete Contest Prep Guide

A book mentioned by the guest as a resource containing a useful calculation for determining calorie deficits needed for weight loss.

Fat Loss Forever

A book mentioned by the guest as a resource containing a useful calculation for determining calorie deficits needed for weight loss.

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