Americans are bombarded daily with messages about our diet, health, and exercise. We receive a constant stream of chatter from the media idolizing a lean and fit body, recommendations to eschew all processed food, or to try the latest and greatest diet. Food is often portrayed as “good” or “bad” and, more often than not, we feel we need to make excuses for why we are eating “bad” food. It usually sounds like “Oh, I ate ‘good’ all day yesterday” or “Tomorrow, I will start my clean eating.” We are told that, by eating the so-called perfect diet, we will be healthier, sleep better, have more energy, be less grumpy, and so on. Who wouldn’t want these things?
There is nothing wrong with improving your nutrition for better health, disease protection, or to reach a healthy body weight; however, a line is drawn when nutrition becomes an obsession. In our culture of more, faster, and better, nutrition information can quickly go from guiding principles to a strict diet with no room for error. Nutrition information is meant to guide you, not scare or leave you feeling guilty. It is nutrition over time—not necessarily one meal—that makes or breaks a healthy diet. While there are general guidelines for a healthy diet, an individual’s exercise, health status, and genetic risk for certain diseases may tweak those general guidelines somewhat.
For example: someone with high cholesterol may choose to focus on eating a higher amount of soluble fiber based on studies showing that soluble fiber may decrease cholesterol, while a marathon runner may choose to eat a diet higher in sodium before and after a long training run to replace sodium lost through sweat. Using the general guidelines and adapting them for you specifically is a good start to achieving a balanced diet. Eating a healthy diet is important, and I am not proposing you stop doing so; however, if your diet is causing you to avoid social situations, restrict entire food groups, or filling you with guilt and shame after eating certain foods, you may be missing out on a balanced diet.
Obsession with the Quality of Food
Over the past decade, there has been an increased focus on the quality of the food people eat. Organic food, less processed foods, and local foods are more widely available. This allows people who have personal reasons for choosing those foods the option to do so.
Unfortunately, this desire to be healthy can sometimes grow into an obsession with the quality of the food eaten. Orthorexia, the obsession with quality of food, is not an official eating disorder, but a term described in 1997 by Steven Bratman, M.D., author of the book Health Food Junkies. People struggling with orthorexia have the best intentions when they begin eating a healthy diet, but the quality of the food and/or the ingredients in the food become increasingly important and, ultimately, an obsession.
This obsession with the quality of food starts dictating what can and cannot be eaten and eating intuitively (eating based on hunger and fullness) is disregarded. This restrictive eating pattern helps the person feel in control and, to a certain degree, reduces anxiety—that is, until restraint is broken and a “bad” or “unsafe” food is eaten. Then, backlash begins. There is guilt and perhaps shame associated with the broken diet and rules, causing the individual to try even harder the next time with even more determination and thus the cycle continues, with each cycle becoming increasingly restrictive.
Dr. Bratman noted “most must resort to an iron self-discipline bolstered by a hefty sense of superiority over those who eat junk food. Over time, what they eat, how much and the consequences of dietary indiscretion come to occupy a greater and great proportion of the orthorexic’s day.”
When someone in my private practice expresses concern about their behavior around food, I often ask them how much time they spend thinking about food each day. Answers vary, but one statement is always consistent: the patient realizes his or her thoughts of food are obsessive and leave little time else to enjoy other aspects of life. Consider this example: an individual may initially want to start eating healthy and reduce the amount of pesticides and processed foods eaten. He starts off in a healthy manner, buying organic or local foods when possible and cooking at home more often. Soon, he is only buying organic foods (even if the budget doesn’t allow for the extra expense) and only cooking at home, refusing to dine out or eat at others’ houses because he cannot be assured the food is organic. The individual may even bring his own food to family holiday gathering because of concern about the quality of the food. Also, the person thinks about food for a large part of the day, thoughts such as where he will get organic food, how to pay for it, when he will get to eat again, and how to avoid foods that are non-organic without offending anyone. Soon, even the amount of food this person eats suffers; he has so greatly limited his diet that the options allowed are simply unbalanced.
People can become as equally obsessed with the quantity of the food they are eating as the quality. Most people are familiar with anorexia and bulimia, the first being marked by self-starvation and extreme weight loss and the latter by a pattern of binge eating followed by a purging method such as vomiting, laxative abuse, or over-exercising. In general, the ultimate goal with anorexia and bulimia is weight loss and thus a restrictive diet is adopted, one usually eliminating or drastically reducing a particular item (such as carbohydrates, fat, or “white food”). When the primary goal of weight loss causes the person to avoid social situations, to constantly think about food, or to restrict choices so much she cannot eat anywhere but home, there’s a problem.
Some may start a diet because of a desire to lose a few pounds and may begin by cutting out carbohydrates. Within a few days or weeks, there are inevitable cravings for the food that has been deemed “bad” or off limits. What happens when someone tells you not to eat something? It’s all you inevitably think about and then crave. If someone says I can’t eat bread, trust me—I am going to be dreaming about bread. This restriction generally leads to eventually eating this “bad” food or sometimes even commencing on a binge of “bad” food. Immediately following this consumption of “bad” food is a feeling of loss of control, shame and guilt, and (sometimes) weight gain. In the end, these feelings and weight gain cause a desire to lose even more weight and regain a sense of control, so ultimately the individual ends up starting her diet again with even more restraint and control. This cycle continues over and over with the dieter continually restricting the amount and type of food eaten all while losing weight.
I frequently see individuals in my private practice who may not suffer from the diagnostic form of anorexia or bulimia but who toe the line with disordered eating. For example: an individual may start a diet because he is training for a big race and has heard that losing five or ten pounds can shave minutes off his race time. In all good intentions, he sticks to his diet for weeks, maybe longer, and does lose weight; however, performance also starts to suffer from lack of food, usually carbohydrates, and his mental health begins to suffer as well. This patient will come to see me because he can’t quite understand what is going on and why he spends such a large part of the day thinking about food. He doesn’t want to eat with friends who aren’t following a strict diet like he is and every time someone compliments him on his weight loss, the dieter vows to try even harder and stick to the diet no matter what. A lot of the time, this person is at the lowest healthy body weight for that height so, to most other people, he seems to be doing all right. Unfortunately, the stress of following this diet has caused the individual to suffer both mentally and physically, and he knows no way out of this vicious circle. If he quits following the diet, the inevitable will happen; he’ll gain weight and, thus, have “failed.”
For a moment, picture yourself enjoying food without judging it as “good” or “bad.” See yourself eating this food without feelings of guilt or worry, using hunger and fullness cues to guide you as to when you start and stop eating. This is what intuitive eating feels like. Does that describe how you eat?
A balanced diet with food choices based on how food makes you feel and eating based on hunger and fullness, without classifying foods as “good” and “bad,” can lead to a healthy body weight as well as improve your overall relationship with food. This style of eating was coined “intuitive eating” by Evelyn Tribole, M.S., R.D., and Elyse Reich, M.S., R.D., F.A.D.A., C.E.D.R.D, as a way to jump off the dieting bandwagon, whether it is an unhealthy obsession with quality or quantity of food. Their book, Intuitive Eating: a Revolutionary Program that Works, outlines the principles for intuitive eating and I highly recommend it to those who want to change their relationship with food. If you are concerned about your own eating and have questions about whether or not it has become an obsession, a registered dietitian can help you decide and guide you in dietary changes as needed.