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When Eating Good Is Bad
Eating organic, non-processed foods is a good idea, no doubt about that. But obsessively eating only those types of foods isn't such a good idea. If you or someone you know, has extreme compulsions about eating, you might be crossing the line from healthy eating to an eating disorder called orthorexia.
Translated literally to "correct appetite" or “fixated on righteous eating,” orthorexia nervosa differs from anorexia nervosa in that anorexics abstain from food to lose weight, or control their weight, and orthorexics abstain from certain foods in order to remain “pure” and “healthy.” But both conditions can lead to health problems and even death in extreme cases.
The term orthorexia was coined by Dr. Steven Bratman, a Colorado M.D., in his book Health Food Junkies. Though it’s not classified in the Diagnostic and Statistical Manual of Mental Disorders as a formal eating disorder, practitioners who have documented the damaging results of the condition in their practices do use it as a diagnosis.
What’s the difference between a "normal" healthy eater and a compulsive healthy eater?
Jessica Setnick, author of The Eating Disorders Clinical Pocket Guide and founder of UnderstandingNutrition.com, says motive is one of the crucial differences. “The healthy eater’s motive is to nourish a healthy body and mind and enjoy a happy and healthy life,” she says. “The compulsive healthy eater is motivated by fear — fear of death, disease, imperfection, what others will think, or weight gain.”
At times the food intake of both types of eaters might look the same, but underneath, the compulsive healthy eater is struggling with intense anxiety and attempting to soothe it with “perfect” or “healthy” eating, Setnick says.
In addition to their motives, their behavior differs as well. A person with an eating disorder might avoid social situations or be unable to deviate from their eating routine, such as eating certain foods at certain times. An orthorexic will often shun food that is not “pure,” even if it is the only thing available. Trying to eat only organic is good, but not being flexible enough to eat something that’s non-organic is bad.
Elizabeth Lombardo, Ph.D., says she knew of a client who stayed with a friend who wasn’t the healthiest eater, and her client ate only a few pretzels the entire weekend. “Eating something that is not healthy is often seen as a huge failure for the compulsive healthy eater,” she says. “These adults and children often based their sense of self worth on the willpower to eat healthily.”
Lombardo also points out that compulsive healthy eaters are not always the most pleasant to be around. “Because of the stress associated with eating for the compulsive healthy eater, they can be irritable and short-tempered," she says. "Not too fun for those around them."
Another pattern of compulsive healthy eaters is to divide foods into “good” and “bad” lists, feeling virtuous for eating “good” foods and filled with guilt for eating “bad” foods. They will often look down on or criticize other people’s eating habits. For example, often an orthorexic parent will be overly critical of her children’s eating habits — unfortunately setting her children up to have similar issues.
How is compulsive healthy eating harmful?
Compulsive healthy eating can lead to psychological (i.e., obsessive-compulsive disorder, feelings of worthlessness, anxiety) and physical (i.e., not getting enough nutrients or fat) problems, says Lombardo. Compulsive healthy eaters often don’t get enough calories in their bodies, causing them to be hungry all the time. “Chronic hunger is not helpful to the body or mind,” she says.
An extreme obsession with food takes all the joy out of eating and can interfere with your productivity if you’re thinking about food and your next meal all day. “If all the enjoyment of eating has been replaced with fear, the compulsive healthy eater is spending hours a day in an anxious, fearful place and may be unable to enjoy other activities that involve food in some way,” says Setnick.
There are different degrees of compulsive healthy eating, and not all people who suffer from it experience any severe adverse effects. Many healthy normal women, to some degree, worry about their weight and food intake. But it’s when you start eliminating more and more foods from your diet, and your restricted eating patterns affect your health and/or other areas of your life, that you’ve crossed over.
Kristen McGee of New York City, a successful yoga instructor and fitness model, has been a compulsive healthy eater for years. She has been diagnosed with low bone density and has not menstruated in over a year. “Ever since I can remember, I’ve been hyper-conscious about eating well,” says the svelte 35-year-old. “Sometimes it’s resulted in my going the other way and binging. I’m now so concerned that if I relax I’ll lose control. I’ve almost lost all pleasure in eating.”
She says her day revolves around food, and she can no longer be spontaneous and meet friends for lunch. Going out for dinner with her is “stressful and not relaxing” because she considers the fat content and preparation method of everything on the menu.
“You’d think because I work out all the time I could let loose,” she says. “But it’s really hard for me to do that.”
How can you overcome orthorexia?
The first step is to get the person to recognize she has an eating disorder, which is not always easy for either party. On the one hand, it’s hard to broach the subject of eating too healthfully with someone because, in theory, it doesn’t sound like a bad thing. That person will most likely reply, “What’s wrong with eating healthy?”
Lombardo says you must explain that when you are obsessive and compulsive over your food intake, even if you’re just trying to eat well, there is something very wrong. Initial treatment might help those who are reluctant to admit there’s a problem.
A therapist can help a patient determine why the patient has orthorexia in the first place, and identify specific thoughts that are causing it, notes Lombardo. “For example," she says, "is it related to poor self-esteem, feelings of being out of control, high levels of stress, perfectionism, or attempts to distract herself from something that is causing her pain, such as a previous trauma? A therapist can help find behaviors that are healthy, coincide with her values, and are more liberating.” Yoga and meditation are two examples.
Setnick suggests a dual approach of nutrition counseling and anxiety management. “A registered dietician skilled in treating eating disturbances can help this person learn to accept foods in a more holistic manner, rather than placing them in ‘good’ and ‘bad' categories,” she says. “A counselor or therapist can teach anxiety management techniques and help the person recognize their self-worth is completely separate from how they eat.”
For an orthorexic to be helped, she must realize that healthy eating means focusing on the food in front of you rather than worrying about what you ate for breakfast or planning what you’ll prepare for dinner. Healthy eating means not caring what people around you are eating or comparing your portion sizes to theirs. It allows for flexibility in your diet and your life and excludes feelings of guilt, shame or embarrassment. It means not being so wary and restrictive about food choices that you miss out on enjoyable foods or stop enjoying food itself.