Orthorexia--when Healthy Eating is Taken to an Extreme

My grandfather’s mantra was “everything in moderation.” He drank a small scotch at 5 o’clock six days a week and lived to be 95.

There’s a growing problem in the US with the concept of moderation when it comes to eating and drinking—but not in the way you might guess. This issue isn’t always with people eating too much of food deemed unhealthy, explains Sumathi Reddy in a recent issue of the Wall Street Journal; the problem is with people being overly restrictive in the foods they will eat. The condition she describes is orthorexia nervosa, an unofficial term for when the effort to eat healthy or “clean” becomes extreme and obsessive, affecting either physical health (through weight loss or malnutrition) or mental health (anxiety or avoidance).

What may start out as health-promoting—becoming a vegetarian, going gluten-free or avoiding processed foods—can devolve into something very unhealthy. The condition, says one professional familiar with it, is more akin to an obsessive-compulsive disorder than it is to anorexia nervosa, the eating disorder characterized by overly strict limits on any type of food.

How can you tell if you’ve gone too far? It can be difficult to distinguish between healthy planning and obsessional avoidance. One way is paying attention to how much anxiety you feel. A red flag is when someone's eating habits makes him or her avoid social engagements, according to Marjorie Nolan Cohn, a dietitian quoted in the article.

If you are sacrificing your social life because your need to maintain your diet seems more important, then it may be time to ease up. Similarly, look at how much time you are spending thinking about and preparing food. If other important interests and commitments are getting pushed aside, that may be a signal that you’ve gone overboard.

Saying No to Body Shaming

In a recent New Yorker piece, Lizzie Widdicombe writes about the plus-sized fashion industry, describing how plus-sized women (size 14 and up) have felt stigmatized and marginalized by the types of fashions available for them. Some women have circumvented this, and there are now companies out there producing fashionable clothes in larger sizes.

In the article, she writes that the views we typically hold about weight and fat are recent, developing since the industrial revolution. Around that time, clothing became mass produced, so people started needing to fit their clothes, rather than the other way around.

In addition, fat had previously signaled affluence. Once that ceased and thinness signaled affluence, we started to devalue fat and weight. The author quotes Madeline Jones, the editor of the online magazine Plus- Model: “People become plus size for all sorts of reasons, not all of which involve lifestyle choices. And it’s not clear that shaming people—or requiring them to wear muumuus—is an effective weight loss tool.”

This is certainly true: fat shaming is hardly conducive to weight-loss.  

From Drugs to Diet

To really change behavior is a very difficult task. I was reminded of this reading a story this week about increasing attention paid to diet and wellness within addiction programs.

Traditionally, programs designed to treat alcoholism and drug addiction have focused only on helping people withdraw from the problematic substance. Diet hasn't been a worry, as Abby Ellin explains in her New York Times piece. In fact, sweets and snacks are typically available to ease the adjustment.

The experience can be similar with people who are trying to stop smoking. When people give up the comfort of their tobacco habit, it's easy for them to seek relief by eating more. There are so many things we can use to soothe and comfort ourselves, and they all have their downsides, though to a varying degree.

For some people in addiction treatment, Ellin explains, the process leads to an overreliance on foods with high fat and high sugar content. Now, few people would argue that eating poorly is more damaging than cocaine addiction, but weight gain can still cause problems if it becomes an obstacle to maintaining abstinence. The issue also highlights the importance in addiction programs of addressing multiple aspects of a person’s life: self-care, life skills--a varied arsenal of strategies to manage distress.

Ending Fat Talk

A recent post on the Motherlode blog describes a summer camp’s effort to ban not only “fat talk,” but any talk about appearance. “Fat talk” refers to the almost automatic way people (often but not always women and girls) comment on their bodies. It’s a stream of “I know I shouldn’t eat this, but” “Does this make me look fat?” and “I hate my body part.” It also extends to comments on others’ bodies, as in “You look like you gained/lost weight.” It’s such a pervasive part of conversation that you almost don’t notice it.

For myself, I have tried to disengage from fat talk. I have heard enough from others about how uncomfortable it makes them to have their weight commented on, whether those comments are positive or negative. When it’s negative, it’s pretty straightforward why it’s troubling. When it’s positive, it can make you wonder what people have been thinking all those other times they didn’t say anything about how you look.

However, this camp is taking it a step further and trying to eliminate any commenting on any aspect of a person’s appearance. In place of saying, “You look nice,” they encourage “I feel happy to be around you.”

I imagine it feels a little forced for campers. At the same time, it brings a helpful focus on how much of our thoughts and conversation are tied up with weight and appearance.

It is almost reflexive to think about appearance. I think about it when I see babies. Research has shown that we are more likely to comment on a baby girl’s looks and a baby boy’s strength and ability. I always try to remember that and think of something else to comment on with a baby girl. It’s an extra cognitive step, because it is so ingrained to think about beauty.

I applaud this camp for at least trying to address this issue. It gives campers a summer to think about what else there is to notice about people other than the way they look. Perhaps they can carry it with them the rest of the year.

Letter to my Fat Son

In What I’d Say to My Fat Son, Joshua Max writes movingly about his experience as a fat kid.

He began as a chubby kid with a belly who didn’t hate himself or his body, and grew into a bulimic teenager and adult--a man who may have been of normal weight, but who was filled with shame and body hatred.

It took years--plus $5,000 worth of dental work to fix teeth damaged by stomach acid from repeated regurgitation--but Max has come to a place of peace and body acceptance. What helps him? Making peace with his body and with other people. Surrounding himself with supportive friends. Focusing on small ways to help others when he starts to feel badly about his appearance.

Max’s plan for his potential future son: encourage him to be active, teach him about healthy eating, and help him not to focus too much on his weight. Finally, Max hopes to help his son avoid making value judgments about weight. “If someone hurts his feelings about his size,” writes Max, “we’ll talk about how people are uncomfortable with fat people because they see them as lazy, stupid, incompetent and ugly, but that fat people are none of those things inherently and some skinny people are also those things.” These are wise words from which we all could learn.

Boys' Body Image Worries

Eating disorders are usually considered the realm of women and girls. Boys, however, make up a growing share of those with body image concerns and eating disorders.

A recent study of adolescent boys, described at The Atlantic, concludes that boys, in contrast to girls, are usually less worried about thinness and are more worried about being muscular, leading them to fell pressure to gain weight.

Boys are increasingly susceptible to media images of men’s bodies. Like girls, they increasingly seek to emulate unachievable body types; but instead of trying to look like a supermodel, they’re trying to look like a superhero. Their ideal is to be like the Batman or Superman toy from their childhood, but only 1 or 2 percent of men naturally have the body type that is typically represented in action figures, according to Raymond Lemberg, a psychologist specializing in male eating disorders.

So rather than focus on thinness, boys are more likely to try to bulk up with steroids and protein powders, and through overexercise. But just as parents and professionals should be on the alert for signs of eating disorders among girls, they need to do the same with boys—looking for overconcern about weight and shape, as well as high-risk behaviors such as using steroids.

This development among males is disappointing. When people hope for equality of the sexes, I don’t think that the phenomenon of boys and men grappling with unrealistic body image standards is what they have in mind. 

What You Lose When You're a Perfectionist

When people think about perfectionism, they usually do so in relation to psychology; they look at it as a personality trait and see it as a reflection of someone’s character. In contrast, “The Agony of Perfectionism,” an article recently posted on TheAtlantic.com, explores perfectionism through the lens of economics. But despite the different approach, the economic takeaways arrive at the same conclusions as the psychological ones.

Economists once believed in the existence of the rational consumer. In theory, when a person had to make a purchasing decision, he or she would collect all available information about that potential purchase, weigh all the options, and in the end make a reasoned, well-informed choice about what to buy.

Anyone who has tried to buy a camera on Amazon or book a hotel on TripAdvisor, however, knows this is not possible. You face a vast number of choices and a wide range of passionate opinions. At a certain point you have to cut off your research and make a decision.

So some economists have divided consumers into two groups. One comprises people who strive to make their decisions in a rational way, seeking out as much information as they can get before they make their pick. These folks, called “maximizers,” want to examine all possible choices and to feel that they have made the best choice. Maximizers, in other words, are economic perfectionists. In contrast, the other group of consumers, called “satisficers,” aren’t perfectionists; they tend to settle for something they consider “good enough.”

So who’s happier with their purchase? The people who exhaustively research their purchases to find the best possible choice? Or the ones who put much less thought before they pull the trigger and buy? The satisficers, oddly enough. Despite all their research, maximizers are more likely to be filled with regret. Because the amount of information they can collect is limitless, they are always left wondering whether they made a mistake by not looking for more information, or by paying attention to the wrong information. There is always room for them to wonder whether they could have made a better choice.

Maximizers are also more susceptible to looking at others’ Facebook and Instagram posts and feeling badly about themselves and their choices. In the past, you were limited by your imagination in thinking that others were doing all sorts of cool stuff that you weren’t doing. Now, however, you can see actual photos of what they’re up to. You can Google them, easily learn about their achievements, and fuel your dissatisfaction and feeling of not measuring up.

In summarizing the research, the author makes the sad point that the maximizers/perfectionists work harder and perform better, but are also more likely to feel depressed and regretful. Whether you look at them from the psychological or economic point of view, the article encapsulates the challenge of striving to achieve and make good choices without pushing yourself to the point of dissatisfaction with all your choices.

My Age of Anxiety: Fear, Hope, Dread and the Search for Peace of Mind

After reading this excerpt in The Atlantic, I had to read the book itself. My Age ofAnxiety: Fear, Hope, Dread and the Search for Peace of Mind, by Scott Stossel, is an exhaustive look at the author’s experience with debilitating anxiety. He is trying to understand why he is so anxious and also how best to treat it. He has every reason to be anxious: his genes, his parents, and his own temperament. He describes some harrowing early experiences with separation anxiety and the less–than-sensitive ways his parents dealt with it. But in another chapter, he describes how his own kids, despite a much different family environment, exhibit some of the same phobias. So after a thorough examination of the research, he sees his anxious self as a product of both nature and nurture.

The book seems more positive about treatment than the magazine article. Stossel has been treated by a bunch of different therapists and psychiatrists over the years. Some of the therapeutic choices seem questionable. For example, Stossel’s father, when he needed a therapist, started seeing his son’s longtime psychiatrist. (It’s nearly always a bad idea for people that close to one another to be separate clients of the same psychotherapist.) The author is most positive about his current therapist, a psychologist who has tried to help him understand the sources and meaning of his anxiety, to provide him with concrete skills to reduce and cope with his anxiety, and who is supportive of medication.  This doctor also makes a point of helping the author to look at his strengths and what he has overcome, rather than simply focusing on his deficits.

This book is filled with information about anxiety and its sufferers—I did not know that Charles Darwin suffered from so much anxiety or that Matt Lauer was phobic about vomiting. There is also much about the history of anxiety and how our definitions and diagnoses have shifted based on research and medication; some disorders, such as social phobia, were popularized after medications were developed. But the most interesting parts are the author’s descriptions of his own struggles. It was terrifying for him to feel so much fear at such a young age. It’s impressive that he has been able to accomplish so much despite it.

Surviving Anxiety: One Man's Story

This month’s Atlantic Magazine features its editor Scott Stossel’s brave discussion of his longstanding and crippling anxiety. What makes it brave? His willingness to graphically describe some of his most shame-filled moments, such as clogging the toilet (loose bowels being one unfortunate symptom of his anxiety) while at the Kennedy compound in Hyannisport researching a book on Sargent Shriver.  I was feeling his pain as he described the experience and his awkward efforts to deal with it.

Where did all this anxiety come from? The author describes himself as something of a perfect storm for anxiety and depression.  There’s a family history of anxiety on both sides of his family going as far back as great-grandparents --including a set of grandparents who fled the Nazis and hid their Jewishness after they were safely in the United States. More immediately, the author’s mother had a host of her own set of fears and phobias, stemming in part from two miscarriages and other difficulties getting pregnant before he was born. In addition, he had a hard-drinking father with little empathy for his son’s emotions. It’s not difficult to see how both the genetic links and the environmental effects might produce an anxious person.  

He describes a host of treatments beginning at age 10 for medication and 11 for therapy. According to the author, nothing has worked. The article certainly gives you a sense of the great variety of treatments for anxiety and also the complexity of helping someone with such a number of symptoms and issues. His article also has you hoping that there is a less dangerous solution out there for a fear of public speaking than Stossel’s own remedy of Xanax, Inderol and scotch and vodka. One thing that struck me in his treatment descriptions was that his therapists and psychiatrists seemed to be very either/or in their approaches—either therapy or medication—so it didn’t seem that there was too much coordination between them.  It seemed he almost needed to hide one from the other.

On a bright note, this man, despite his severe anxiety, has managed to marry and become the editor of the Atlantic. It’s impressive, given the struggles he describes. He describes himself as a duck: “To some people , I may seem calm. But if you could peer beneath the surface, you would see that I’m like a duck—paddling, paddling, paddling.” How brave to let others see how hard you have to paddle.