Orthorexia is NOT healthy eating

Orthorexia nervosa is a serious problem. It is loosely defined as an obsession for healthy food. In extreme cases, starvation can occur if the person refuses to eat any food they deem "impure" or harmful to their health. The biggest catch is that what is considered "impure" or unhealthy is decided by the sufferer, and is often arbitrary. Sure, they may have read that sugar or saturated fats are "bad" but these claims are then taken to the extreme. Rather than avoiding eating too much of these foods or ingredients on a regular basis, they are avoided at all costs. Also, the list of "bad" or "impure" foods can grow as the eating disorder advances. So, what once was an avoidance of sugary drinks turns into an obsession of eating nothing with any sugar at all (for example, this can include healthy foods such as milk and fruit).

Unfortunately, pro-eating disorder sites and some obsessive healthy eating bloggers claim that the new emerging eating disorder is health professionals exaggerating what the suffers believe is "just healthy eating". I believe that vehemently denying the very existence of the disease could be seen as a sign that the road to recovery will be a long one.

Well, if you are on the fence about orthorexia being a real problem or if you want to know if a friend is suffering from it, these questions may help. This is the The Bratman Test for Orthorexia and it has been validated (meaning science has proven that it helps you determine if you suffer from orthorexia).

If you answered yes to 4 or 5 of the above questions- you may have orthorexia. Speaking with a registered dietitian or psychologist who specializes in eating disorders may help you learn how to be more relaxed about food. 

If you answered yes to all of the questions- you most likely have orthorexia. Getting help from a professional can seem scary, but dealing with an eating disorder on your own is extremely difficult.

Where to turn when extreme dieting (ultimately) fails

Although I help people every day manage their weight, I also work with people with eating disorders. My counseling techniques do change depending on my client but one thing always remains the same: extreme dieting is bad. Understanding the difference between normal, everyday improvements with eating and extreme dieting can be tricky. Explaining this difference to anyone who does not have a skewed relationship with food (and even to those with this problem) can be a challenge.

Extreme dieting is a problem for so many reasons since both physical and mental health is compromised. Unfortunately, a new trend is emerging where dieting is called "lifestyle change" or "healthy eating", but the rigid rules of dieting are the same. Here are a few key points to help you decided if you are following an extreme diet:

Does your diet or "lifestyle change" involve delaying eating? this could mean fasting, delaying eating as long as possible during the day or many hours between meals.

Are you restricting the overall amount you eat? this likely means you are tracking calories and trying to eat under a certain amount. Generally, if you do not have an eating disorder, this can be done safely as long as you aim for a realistic amount- at least 1500 calories per day. Anything under 1200 is considered extreme.

Are you avoiding certain types of food? maybe this is due to their high fat or sugar content, or for some so-called "proven" reason that claims it leads to weight gain. In general this is not an issue if you are cutting down on certain foods and savouring them once a week rather than 7 days a week. However, when these foods become outright banned or forbidden, then the diet becomes extreme. The slippery slope to "yo-yo dieting" or developing an eating disorder may not be far away when this banned food list grows.

So what are the alternatives to extreme dieting? Try a mindful eating or intuitive eating approach. They have been proven to be just as successful (if not more successful) as other traditional weight management techniques. These approaches are more gentle and zen and allow you to develop skills that will help you for many years to come to manage your weight versus a diet plan that tells you what to eat and only works when you follow the strict plan.

Check out my suggested readings for some great books on mindful eating!

Are my eating habits normal? Use this tool to know when to reach out for help

There are a few ways to screen for an eating disorder. One short and easy questionnaire is called the SCOFF. SCOFF is an acronym that is used to help people & professionals remember the specific questions. It is touted as being simple, memorable, easy to apply and score. It is designed to raise suspicion of the presence of disordered eating rather than to diagnose. It is mostly used by health professionals but since it is easy to understand, it can be used by anyone. 

The SCOFF questions

Do you make yourself Sick because you feel uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you recently lost more than One stone in a 3 month period? (or about 6kg or 15lbs)
Do you believe yourself to be Fat when others say you are too thin?
Would you say that Food dominates your life?

To score the questionnaire, give one point for every “yes”. A score of 2 or more indicates that there are symptoms present similar to those in anorexia nervosa or bulimia. In other words, if you (or who ever took the test) scored 2 or higher, you may need help in re-establishing a healthy relationship with food and your body. 

There are other more in-depth questionnaires for helping to determine whether you have symptoms commonly associated with an eating disorder. One very popular one is called the Eating Attitudes Test-26 (or the EAT-26). You can take the test anonymously here.

Thinking that your disordered eating is not "bad enough" to seek help or the idea that you aren't sick enough to merit the help of a professional is one of the main reasons people suffer from eating disorders. Getting help sooner rather than later helps to speed recovery and lift the burden off your shoulders. 

Eating disorders: "simple" solution, complex issue

Eating disorders can be hard to understand. What seems like a straight forward “skewed vision of one's body” is rarely this simple.

Providing a fridge full of good food or begging people with an eating disorder to "just eat!" very rarely works. No matter how minor the problem seems to be (and it is common to scoff it off as not serious enough for therapy) professional help is needed to recover. One problem that tends to be underestimated is binge eating disorder. Unfortunately, many people who suffer from BED have the same body image problems as people with anorexia or bulimia.

Why professional help? Because they help the sufferer deal with all the major complexities of an eating disorder. Believing yourself to be “fat” when you are thin (or a normal weight) is only one of the symptoms of an eating disorder. A major component that goes one step deeper is the fact that self-worth is based on weight. The higher the weight, the lower the self-worth. Rather than looking at all aspects of life that make up an evaluation of one’s self, like being a nice person, a good student, a kind daughter/son, punctual, reliable, etc-  weight is the most important aspect.

This is why exploring more than just body weight is needed for recovery. Specialized psychologists and dietitians can help with all behaviors of an eating disorder to help increase other aspects of life that make up self-worth.

When weight loss is the goal, no amount of weight lost is enough. Food becomes feared since it brings the person farther away from their goal of weighing less. This fear can be compared to a fear of dogs. If someone has an intense fear of dogs, they will likely do anything they can to get away from one or avoid being close to one. This intense fear can lead them to do things that puts their life in danger. Imagine running into traffic after being scared by a dog on the street or being confining to the house since there may be a dog outside. Neither of these behaviors are healthy but they are done to avoid the dog. Similarly, if someone is scared of food, they may avoid social situations where food is the main event, live with a dangerously low body weight or even sacrifice their teeth to get rid of any food eaten.

So, would offering food to someone who is scared help to decrease this fear? Well, in the short run, no. It is a process that takes time. Small exposures to the thing that is feared (whether it be dogs or food) and working up to the equivalent to petting a dog works best. Although someone who is underweight would benefit from eating high calorie foods, it takes time to work up to being able to do it. This process is best done with the help of a professional to help guide and provide support. Usually it starts by adding “safe” foods to a routine and progress to more “scary” foods.

One thing that has been proven time and time again, is that returning to a healthy weight by eating the foods your body needs is the most effective treatment for an eating disorder. 

NEW Binge eating disorder group starting in MAY at the "Clinique de psychologie cognitive comportementale"

The Change Clinic therapists are THE EXPERTS in eating disorder recovery.
Check out their website or the picture below for contact info!

skinny is the OLD "healthy". Welcome to 2013!

Study upon study has proven that it is more important to focus on living/eating healthy rather than just "being skinny" for healthy living. One major issue that perpetuates the misconception that skinny = healthy is the fact that other health professionals (doctors, nurses, etc) often focus on weight to help decrease risk for certain diseases or disease progression. Although it is true that excessive weight (if all other aspects of lifestyle are disregarded) may put certain people at risk, there are far more aspects to look at when evaluating a persons health. Perpetuating the idea that higher weights translate into unhealthy lives is also the result of weight bias in non health professionals.
On a similar note, ff you or someone you know can relate to the questions below, you may want to consider learning more about disordered eating (check out ANEB Quebec for more information):

I think that people who are thinner than me are happier and have a better life?
I am extremely afraid of getting fat?
I have difficulty maintaining an appropriate weight for my age, sex, and height? (a BMI between 20-25).

If the above facts don't change your mind about weight versus health, consider this: other studies have proven that people who focus on health and healthy living while making changes to their lifestyle (i.e. an overall improvement in their eating and activity habits) actually lost more weight than those people who only focused on losing weight. Imagine that! While not focusing on the numbers and the scale, people actually made more meaningful changes! This along with the fact that those people who "love" their bodies, accept their shapes and have higher self esteem tend to live healthier lifestyles (compared to those who have low self esteem and are unhappy with their shape/body) are great example that positive health goals can lead to positive changes.
So let's recap- focusing on healthy living rather than a specific weight (or losing weight) may lead more naturally to weight management and accepting and respecting ones body also leads to healthier living....perhaps the concept that thinking negatively (believing you have no willpower, are not motivated enough, are not good enough, not worth it) may actually lead to "negative" results.

Picture from Equilibre.ca

How can binge eating be related to dieting?!

As discussed in earlier posts, binge eating can be a difficult problem to identify, especially by people who are suffering from it.
After understanding that further dieting does not help reduce binging, the next challenge is to find ways to improve your relationship with food (among other things like self worth and self esteem).

One of the first steps to decrease binge eating is to start eating 3 meals per day along with a few snacks. By eating regularly, you will avoid feeling deprived and very hungry, which contribute to binges. Your body will start to expect nourishment on a regular basis (rather than sporadically) and will better digest and metabolize the energy. Your mood is also likely to improve since you won't be swinging between feeling very hungry and too full.

Sometimes when our relationship with food is skewed, so are our signals of hunger and satiety. So it is not always easy to listen to these signals and only "eat when you are hungry and stop when you are full". By having a routine with meals and snacks, you don't have to rely on those signals. The ultimate goal is to listen to your internal cues but that takes time and practice.
Ideally you want to eat every 3-4 hours. Planning out meals and snacks may seem time consuming at first, but once you get into the habit, it becomes easier. It can help to use a guide to determine what to eat over an entire day (like the food guide) or even an outline of a meal plan that suggests ways to include the food at meals and snacks. Over time, you will find that you can plan out your meals and snacks in you head rather than rely on a written plan.
For example, most adults require:

One example of how those requirements look in terms of food is:

Planning a routine visit to the grocery store is a good start to having healthy food on hand- so make sure you make time during the week for a shopping trip.
Focusing on balanced meals can also help to reduce binging. The combination of protein, carbohydrates and fibre (from the meat and alternatives, starchy foods/grain products and vegetables) will help to sustain you between meals. However, it is important to remember that eating perfectly is not necessary! It is ok and certainly normal to have a less balanced meal occasionally.