Interview about Orthorexia

I had the honor this week to be part of an interview about the dangers of orthorexia, which is an obsession with healthy eating.  Many people don’t realize that trying to eat healthfully can be taken too far, but it definitely can and when it does has severe physical and emotional consequences.

Watch the interview below.


What Is Orthorexia?

celeryWe all know that super healthy eater. The one who makes us feel guilty about ordering a burger and a beer when they are munching on a quinoa stuffed celery stick with a side of kale kombucha. Yummy. They might shop exclusively at Whole Foods and follow a complex list of dietary rules as long as the dictionary itself. You may start to wonder if you should be following these rules too. But is this person someone to aspire to, or to be concerned about? How do you know if someone is just a healthy eater or if they are struggling with the disordered eating pattern called orthorexia?

Simply put, orthorexia is an obsession with healthy eating. Orthorexia often starts with good intentions: an attempt to cook at home more instead of eating out or to add more vegetables to one’s diet, but it slowly (or sometimes not so slowly) becomes an obsession with having the perfect diet. Orthorexia is not an officially recognized eating disorder, but whatever it is, it’s becoming more prevalent. In a society where obesity and over eating are the norm, it’s hard for many people to even grasp the concept that there could be such a thing as paying too much attention to healthy eating, but the truth is orthorexia can have devastating consequences.

You may be thinking, why is being concerned with healthy eating a problem? And the truth is, sometimes it’s not. Clearly, health is important and paying attention to what you eat usually isn’t a bad thing. The problem is when this concern becomes a full blown obsession that controls one’s life. If taken too far it can destroy your health and your emotional well being. It can pull you into depression, and it may even lead to a more serious eating disorder such as anorexia nervosa. Someone suffering from orthorexia may miss out on vital nutrients or suffer from malnourishment due to their limited food choices. Their weight may get dangerously low, even if not intentionally. They may also lose relationships and friendships due to scheduling their life around their food regimen and avoiding social situations that revolve around foods, which, let’s face it, a lot of social situations revolve around!

The obsession with having the perfect diet is self propagating, because, how does one define the “perfect” diet? If you haven’t noticed, there is a lot of conflicting nutrition information out there. One could very well drive themselves mad trying to figure out what the “best” diet really is, so the orthorexic’s quest is never over. To them, their diet is never good enough, which leads to feelings of guilt and shame, as well as the need to be constantly perfecting their diet.

So how do you know if someone is just a healthy eater or if they have crossed the line into orthorexia? The simple answer is when the focus on health becomes all consuming and starts to negatively impact one’s life. The following are possible signs that someone is suffering from orthorexia:

–          Unplanned weight loss due to limited food choices

–          Avoidance of social situations that revolve around eating

–          Inability to be flexible when healthy choices are not available, possibly choosing to go hungry instead of eating something off the plan

–          Feelings of guilt or that one’s day is ruined after eating something unhealthy or “bad”

–          Feelings of satisfaction or worth when following food rules

–          Elimination of multiple food groups

–          Spending a large amount of time thinking about and planning what to eat

–          Feeling the need to compensate or make up for unhealthy food choices


What should you do if you recognize these signs in yourself or someone you know? If you recognize these signs in yourself the first step is to admit that you may have a problem. Cliché, I know. I would recommend seeking professional help from a therapist and a dietitian to address your nutrition and the underlying causes of the orthorexia. Usually there is a need for a sense of control that is not just about the food. If you can, challenge yourself to let go of your food rules. Practice all things in moderation and allow yourself to eat the foods you enjoy, even if they aren’t health foods. Try to incorporate new foods and to increase your variety of foods, maybe using the support of a friend. Take the judgment out of eating. Choosing to eat a certain way does not make someone better than someone else. It does not make a person good or bad. After all, at its most basic level, food is just fuel.

If you recognize these signs in someone else, gently point out what you notice and express your concerns for that person’s well being. Be sure not to blame or point fingers, but simply express your concerns using “I statements”. Possibly offer to accompany them to see a therapist or dietitian, if they are open to that.

So the next time you start to feel guilty about that burger and beer, remember, life is too short to spend it worrying about everything you eat. Be healthy but don’t let it rule your life. Food isn’t just fuel, it’s meant to be enjoyed, after all.

Coconut Water is Not a Real Snack

 I recently read a line in a famous fashion magazine from a certain waif-like starlet who claimed “I love to snack”. As a professional in the eating disorder field, this was so refreshing to hear! Except that she followed this comment by saying that she “is constantly reaching for coconut water and fruit”. * Sigh* Seriously? Coconut water and fruit?! That’s not a real snack!

It’s not that I have anything against coconut water. I actually find it a quite refreshing way to rehydrate after some of my longer runs. And obviously fruit has health benefits. It’s the message the statement sends that concerns me. I worry that women and girls who struggle with their body image will think that if they just have coconut water and fruit all day they will look like her, when in reality they will miss out on the real nutrition their bodies need, and potentially set themselves up for problems with disordered eating.

A small (11 oz) container of coconut juice has about 60 calories in it, roughly the same as a small piece of fruit. That’s not nearly as much as the average person needs for a snack and it’s certainly not going to keep anyone satisfied until the next meal or snack. No wonder she is “constantly” reaching for that snack! I for one would be hungry again in less than 5 minutes if that’s all I ate. Even for those trying to lose weight healthfully I wouldn’t recommend a 60 calorie snack. That being said, I am a fan of having snacks in between meals, but it’s important to snack effectively.

Here is what I recommend for snacks:

• Space meals and snacks out as evenly as possible throughout the day, typically every 2-4 hours. Don’t wait until you are starving for your next meal or snack, but don’t feel you have to eat a snack 2 hours after a meal if you are still full. Listen to your hunger and fullness cues.

• Be sure to include a source of protein at all snacks. This will help keep blood sugars and energy levels steady until your next meal or snack. It will also help ensure that you meet your protein needs for the day.

• Try to include fruits and veggies whenever possible. It’s not easy to get the recommended 5-9 servings of fruits and vegetables in every day so if you rely solely on meals, you’re not gonna hit the quota. Try carrots or other cut up veggies with hummus, an apple or banana with peanut or almond butter, greek yogurt with fruit, or blend a smoothie with the milk of your choice (dairy, soy, almond), some frozen berries and a handful of spinach or kale. Add protein powder to make it a little more satisfying. Oh, and by the way, you are never too old for “ants on a log”- celery sticks with peanut butter and raisins.

• Plan ahead. If know you’ll be on the go, throw a protein bar or a bag of mixed nuts into your purse or bag so that you don’t have to rely of fast food or a vending machine.

Happy (and healthy) Snacking!

Exercise and Eating Disorders

 It’s not always easy being an eating disorder professional and an athlete.  As I started thinking about writing a blog about my half marathon training (coming soon!) I had the thought that it’s a bummer I have to keep that part of myself somewhat hidden at work. The patients I work with are very sick and compulsive exercise is a common struggle for them, so personal exercise talk is pretty taboo, and understandably so.  When my patients ask what I do on the weekends I tend to play things down.  I say I went for a short hike when in reality I climbed a 14er.  A training run becomes a walk in the park.  A bike ride up Vail Pass a casual cruiser ride.  It’s not that I like lying, it’s pretty awkward actually, but it doesn’t seem appropriate to delve into my athletic adventures.  Exercise and eating disorders is a complicated subject.  While I fully believe my exercise is healthy, I understand how it would be difficult for patients to understand. But I do it because I love it, not because I am trying to change my body or because I feel like I have to.  I live for the adventure. I fuel myself properly before, during, and after my activities. Heck, the sports nutrition is sometimes the most fun part for me!  And I don’t stress too much if I miss a workout or if it doesn’t go as planned.

Why is exercise such a tricky topic with eating disorders?  I think it’s because it’s a healthy thing taken too far.  Sure exercise has health benefits, and it can be a great stress relief, but when it’s compulsive it can actually be detrimental to your physical and mental health.  And when it gets to that point it’s hard to cut back, so sometimes total abstinence is the way to recovery.  There is actually research about running and eating disorders that basically says it’s nearly impossible to recover from an eating disorder if you refuse to stop logging miles.  This all seems quite contrary to what we hear in the media about how most Americans don’t get enough exercise and this lack of activity is causing health problems.  I always have to reality check my eating disorder patients-are you more likely to suffer health problems from lack of exercise or the eating disorder?  I guarantee it’s the eating disorder.
So how do you know if your exercise is a problem?  Ask these questions:
– Is my day ruined if I don’t get in a workout?
– Am I working out because I feel guilty about food I’ve eaten?
– Am I eating enough to fuel my workouts?
– Am I avoiding spending time with friends and family in order to exercise?
– Is my workout routine interfering with my work, school, or other obligations?
A “yes” (or 4) doesn’t mean you have an eating disorder but it might be an indicator that you should further evaluate your exercise habits.  Remember, exercise should be enjoyable! If you’re forcing yourself to run on the treadmill but you hate it, not only are you creating an unhealthy attitude around exercise, but you’re probably not going to stick with it long enough to reap any health benefits.  Remember- balance and moderation are key.  Exercise is great if you are doing it for the right reasons and properly fueling yourself, but it’s also okay to cancel a workout in order to grab dinner with a friend, or because you are tired, sick, or injured. Be kind to your body.

Below is a link to a blog I was quoted in awhile ago about one woman’s recovery from an eating disorder and the role exercise played.  She has some good insight and is doing well with her recovery, but keep in mind this was just one woman’s journey.

The Pitfalls of the Quest for Perfect Nutrition

 bagelI once overheard a personal trainer at my gym say to another trainer “I was so bad today, I had a white bagel!”   The other trainer gasped in horror as I cringed to myself and debated whether or not it was worth telling the trainer how silly she sounded.  I don’t like when people refer to themselves as bad because of something they ate. That’s classic eating disorder talk and it’s sad to think that some people genuinely feel so guilty about something they ate.  Sometimes I think things like the trainer said are said as an exaggeration or for effect, but it’s still not a good habit.  Eating a less than healthy food does not make one a bad person! Lying, cheating, stealing…those things make you a bad person, but not your nutrition choices.
The problem I see with striving for perfect nutrition is that it doesn’t exist.  Think about it: two of the most popular ways of eating out there currently, vegetarianism and Paleo, are just about as opposite as you can get.  So how do you even begin to define what “perfect” would look like?  There is no consensus on what the best diet is, even amongst nutrition professionals.  Another problem with trying to attain perfect nutrition is that there is almost always a next step that could be taken.  Eating lean meats isn’t good enough; you have to marinate them to help reduce development of carcinogenic compounds during cooking.  Oh and make sure it’s grass fed and free range. And local.  Maybe it starts with decreasing sweets, then it’s decreasing refined grains, then it’s all grains, then it’s an eating disorder.  Okay, now I’m exaggerating but you know what I mean.  Where do you draw the line?  To me, this means that trying to reach nutrition perfection will result in inevitable failure, and you’ll end up feeling bad about yourself and possibly set yourself up for disordered eating.
So what do you do if health is important to you but you don’t want to feel bad about your nutrition choices?
  • Eliminate food rules.  If you have rules, you’re more likely to want to break them and then feel guilty about it afterwards.
  • Practice mindful eating. Pay attention to what you are eating and enjoy it.
  • Find balance.  A white bagel isn’t going to ruin your health as long as it’s not the main staple.  Set more realistic goals, like choosing whole grains more often than not, that way you don’t have to shame yourself for the occasional appearance of a white bread product.
  • Practice moderation.  Allow yourself less nutrient dense foods, such as dessert, on occasion. Totally denying yourself of it will just make you want it more.
  • Don’t stress about the occasional indulgence. That’s normal and that’s part of what makes life enjoyable.  One brownie will not change the course of your life (okay maybe if it has an engagement ring in it or something!)
  • Reward with food in moderation.  But also try to find other forms of reward, like getting a massage or buying yourself that new gadget you’ve been wanting.
  • Never punish with food (yourself or your kids).  Even taking away dessert can backfire. I once worked with a patient whose parents locked up all the candy in the house when she was a kid. Years later when she got a car she started driving to the store daily to buy her own candy to binge on.
  • Focus on the positive. Instead of thinking about what you “shouldn’t” eat, focus on getting plenty of nutritious foods.  If you’re getting enough of them you just might find you don’t even want the less nutrient dense stuff.
  • Get to the bottom of the bad feeling.  Chances are it’s not really about the food, so if you are feeling really guilty about your food or eating habits or your body enlist the help of a dietitian or even a therapist to explore your relationship with food and your body.