Orthorexia nervosa, or an obsession with "healthy" or "pure" eating, is generally considered a type of eating disorder, even though no formal definition exists. Clinicians have been saying that this unhealthy obsession with healthy food has been increasing the past few years, and I wouldn't be surprised if that was the case. Becoming more aware of what we eat (which is good) has also fueled the worries of those who aren't sure what to eat. Everyday, it seems, some new research adds another item to the litany of things we should and shouldn't eat.

How could you not be anxious?

Steven Bratman originally coined the term "orthorexia" in the 1990s, after himself suffering from the condition, and explains it as follows (excerpted from a Smithsonian Blog on the subject):

“Orthorexia begins, innocently enough, as a desire to overcome chronic illness or to improve general health,” he writes. “But because it requires considerable willpower to adopt a diet that differs radically from the food habits of childhood and the surrounding culture, few accomplish the change gracefully. Most must resort to an iron self-discipline bolstered by a hefty dose of superiority over those who eat junk food. Over time, what to eat, how much, and the consequences of dietary indiscretion come to occupy a greater and greater proportion of the orthorexic’s day.”

I started to twitch just a bit when Bratman says "willpower." Because it's not willpower. It's fear. And fear is a remarkably strong motivator. Sufferers of orthorexia aren't avoiding foods because they're "better" or "stronger" than those Oreo-loving, Cheez-Whiz guzzling "normal" folks. It might seem that way--when I was restricting, I often used words like "strength" or "willpower" as so-called motivation. Yet these words cloaked what was really going on: I was afraid to eat. It's a pretty bizarre concept, when you get right down to it, and my brain understood it much better when I thought I was super-strong because I could exist on a diet of lettuce and air.

A sub-headline on a MomLogic blog post about orthorexia explained it much better: Obsessive-Compulsive Driven Disorder. Although I've never been obsessed with food in a strictly orthorexic way, I do have OCD and anorexia, and I know quite a bit about food obsessions. I wouldn't call anorexia the same as OCD, but there does seem to be a significant amount of overlap, both in personality traits and the percentage of anorexics who also have OCD. And orthorexia also seems similar to OCD, with the obsessions focusing on quality of food rather than calories and fat grams.

But Bratman says there is one main difference between anorexia and orthorexia:

"Someone with anorexia does not see her/himself as emaciated, but as fat. Where someone with orthorexia is aware of their extreme thinness but is fine with this, as long as they feel pure."

Except there are well-known cases of non-fat-phobic anorexia, especially in younger children and non-Western countries. So I'm not sure this difference holds up. Another similarity is the fact that both disorders seem to be largely egosyntonic- their illness is giving them the "desired" outcome.

In the end, both disorders can be deadly and debilitating. We need to learn more about orthorexia so that we can start to define it and devise treatments for it.

Sometimes I think this series on "In the name of health" could go on ad infinitum (you can read the first episode here). For my own mental well-being, I won't write an endless series of posts about it, but an article I found on Facebook (h/t Libby and Amy) made me realize that I certainly needed to do more than just the two original planned posts.

The name of the article? Throwing out the wheat: are we becoming too tolerant of gluten intolerance?

Writer Daniel Engber takes a long, hard look at the sudden proliferation of gluten-free foods, sales of which have risen an estimated 28 percent each year to make an industry worth nearly $2 billion. Take a look at some of the boxes of Chex cereal these days- many are now prominently labeled "gluten free."Although avoiding gluten, a protein found in wheat and certain other grains, is necessary for those with celiac disease, this autoimmune condition affects no more than 1% of the population (or at least, less than 1% of the population has received an actual diagnosis of celiac disease). And though this proliferation may be beneficial for them, it doesn't seem that such a small segment of the population would drive such a large segment of the food industry.

Engber's hypothesis is that most people who cut out gluten don't actually have full-blown celiac disease. Rather, it's a way to avoid foods in the name of "health" and maybe lose some weight in the process. In other ways, the association is blunt and in your face, as Elizabeth Hasselbeck's latest book The G-Free Diet: A Gluten-Free Survival Guide contains a chapter titled "G-Free and Slim as Can Be!"

Writes Engber:

The fact that "going G-free" means eating fewer cupcakes and less pasta suggests another source of relief. It is, after all, an elaborate diet—and so delivers all the psychological benefits of controlled eating and self-denial. "Once G-free, you are no longer simply robot-eating bag after bag of pretzels," writes Hasselbeck...Gluten intolerance may be a medical condition, but according to Hasselbeck, it's also an approach to eating—like South Beach or Skinny Bitch—that's supposed to make you lose weight and feel good about your body.

One of the most fascinating parts of the article is the graphs that compare the rise in newspaper mentions of "gluten intolerance" with the rise in popularity of the Atkins diet.




Coincidence? Perhaps. But it strikes me as kind of unlikely, especially when you compare the rise in "lactose intolerance" that happened alongside the popularity of the Mediterranean diet.


Engber makes his key point here:

I'm not suggesting that anyone who avoids gluten is secretly trying to lose weight. The purpose of a gluten-free diet is, naturally, to feel better. But there's a complicated relationship between feeling good and eating less. When a restrictive diet becomes an end in itself, we call it an eating disorder; when it's motivated by health concerns, we call it a lifestyle. That's why Hasselbeck says going G-free will make you slim (a sign of wellness) rather than skinny (a symptom of anorexia). It might also explain the relationship between food sensitivities and fad diets: People who are intolerant of gluten or lactose get a free pass for self-denial.

And it's the last one that concerns me. When people say they are doing something for "health reasons," we become automatically less likely to question it. Dietary changes for health reasons can be totally legitimate, and suffering caused by undiagnosed food allergies and intolerances is very real. But I think the new surge in "cutting out..." gluten, corn syrup, dairy, meat, food in general has less to do with an increase in food allergy diagnosis and a lot more to do as a way to avoid food and not get called out on it.

How do you think this ad reflects our current attitudes about food? Would you be more likely to buy a Starbucks baked good because of the change?

Full disclosure: I'm probably going to go. I like the lattes at Starbucks, and it's probably good for me to try and work something different into my meal plan. Starbucks, like all of the other businesses out there, is trying to sell their product. I don't eat their baked goods enough to tell if the taste has changed any, so I won't try. It's a sales pitch, pure and simple. And if I get a free muffin out of the deal while being caffeinated, I'm okay with that.

The more I read, and the more I think, the more I'm becoming aware that the things I'm striving towards in recovery--a normalized, healthy relationship with food--don't exactly exist in our culture. Sure, they exist here and there, the occasional glimpse that temporarily restores my faith in the idea that such a thing is even possible.

But then I read articles that talk about Frito-Lay's new ad campaign geared at women,* I pause and begin to doubt that I have a chance.

Though Frito-Lay had often tried advertising snacks as guilt-free, this led to the conclusion that “we’re not going to alleviate her guilt,” Ms. Nykoliation said. “This is something in her life. So the question for us was, how do we not trip her guilt?”

Part of the strategy was to follow the success of SunChips by toning down the packaging and showing off healthy ingredients in the snacks.

“She wants a reminder that she’s eating something better for her,” Mr. Jones said.

So basically, the new premise in food advertising is this: our foods will make you feel less guilty for eating. What's next: an oxygen tank to make you feel less guilty for breathing? A toilet that makes you feel less guilty for taking a leak? What this tells me is that people (women in particular, since this is the segment of the population at whom the campaign is directed) are expected to feel guilty about eating. It's standard. Normal.

This has literally become normalized eating- and it's not my goal. I've lived this life for too long, and it SUCKS.

Jezebel had this to say about the new Fling candy bar, marketed as a low-calorie (well, lower anyway) indulgence, just for women. And in case you missed the girlie stuff, the package is pink and the bar contains sparkles**.

What the candy companies don't quite understand is that for those of us who truly love candy, we don't see it as gender-specific. And for every bar like the "Fling," which CandyAddict.com described as "a wanna-be Twix, minus the caramel," that arrives, the idea that candy is something women should feel guilty or careful about is perpetuated, leading to a public perception that some things are "bad" and "good" for women to eat. It's already happened with frozen dinners: you never see a man sitting down to eat a Lean Cuisine in a commercial; the men are always marketed a Hungry Man dinner, complete with "one pound of food!"

Even kids are being sucked into this madness, as highlighted by a wonderful NY Times article today titled "What's eating our kids? Fears about 'bad' foods," featuring our very own Laura Collins. With the health and obesity hysteria that's being promulgated just about, well, everywhere, kids are picking up on the messages and some of them take it to extremes.

Part of it has to do with cognitive maturity: young kids think in black and white. They haven't yet developed the brain functioning to discern between shades of gray. The other part has to do with the way some kids' brains are wired. Some kids will obsess about every detail, fearful of doing something "wrong," of being "unhealthy." Because unhealthy and fat are bad.

“We’re seeing a lot of anxiety in these kids,” said Cynthia Bulik, the director of the eating disorders program at the University of North Carolina at Chapel Hill. “They go to birthday parties, and if it’s not a granola cake they feel like they can’t eat it. The culture has led both them and their parents to take the public health messages to an extreme.”

On a side note, the article does an excellent job looking at orthorexia, and whether it's a type of obsessive-compulsive disorder, or it's an eating disorder.

We've truly lost our grip on what's healthy. I would easily argue that a steady diet of fast food isn't healthy- you're missing fruits and vegetables that are very tasty and have lots of good vitamins and minerals. I'm not saying Ho-Ho's for breakfast every day. But jeez, if you wake up with a hankering for cold pizza and chocolate milk, remember, it's just food.

From Jezebel again (a different article this time, on servers being conspiratorial about dessert):

I choose to believe it's of a piece with the unhealthy relationship our society has cultivated between women and food, where matter-of-fact enjoyment has no place at the dining table. This is not the fault of any server - most of whom are not even guilty of conspiring - but rather of centuries of creepy marketing, a pernicious diet industry, and six seasons of Sex and the City. In answer to your question, yes, I will have that piece of pie. A la mode. And without a side of knowing winks.

Eating is not a crime. It's not a moral issue. It's normal. It's enjoyable. It just is.

*h/t Sarah for the link
**Okay, ew? Sparkles? Really? It might be safe and all, but still...
***But I bet I could get a 10 year old boy to try it and check to see if his poo is sparkly later.

I have two very lovely green bell peppers in my possession, and I was poking around the internet, trying to find a good recipe for stuffed peppers.

On one of the sites, I noticed a section called "Light and Healthy," which made me stop.

How did low fat get defined as healthy?

I mean, yes, it's somewhat obvious, if you read a newspaper these days: we're all freaking the hell out over obesity. And the underlying assumption there is that fat=unhealthy. Then, we take the assumption one step further and equate foods with fat with fat people. Ergo, low fat is healthy.

Right?

The obvious corollary is that everything else is unhealthy. I mean, if it's not in the section labelled "healthy," what what in the hell else are you going to define it as? When you're looking at a site with thousands upon thousands of recipes, and one small section labelled "Light and Healthy," then surely we're all doomed.

Not so much. Your health is very personal- when I had to gain weight, low fat wasn't healthy for me. Even now, the number of fat grams in a recipe doesn't say anything about how nutritious it might be. Or if it's what my body needs.

It's a pernicious little assumption, and on every cooking site, the low fat/low cal/low carb recipes are all in the "healthy" section. Other sites will "healthify" a recipe for you, by taking out as many "extra" or "unnecessary" calories and fat as they can and still leave you with a product that vaguely resembles the original. I don't care if there are sections labeled "low fat," because that's a description, not an assumption.

We need to stop assuming that low fat or diet food means healthy, and start defining food and health in different ways.