An Inadvertent Consequence of “Diet” — Orthorexia

Doctors and other health care providers: What if your profession perpetuates disease? What if all the healthy things you try to teach your patients actually bogged them down and hindered their health? What if all the natural, evidence-based nutritional advice you give your patients actually contributed to their distorted concept of “health” and “nutrition?” Consider this possibility carefully, as I have recently been confronted with this.

I was asked impromptu to chat with someone about their health challenge of losing weight. An average-sized, fit young woman was looking to lose weight, and confided to me that she rarely eats more than 1000 calories per day. The reason is because she is afraid of eating too much food. 1000 calories per day wouldn’t even cover her baseline needs if she just lay comatose in bed all day long, let alone adding in activity.

If you are a doctor who has ever given somebody nutrition advice, especially advice to reduce portion sizes or watch the amount of food you’re eating, this will break your heart. Scrolling through news headlines, tweets, and Facebook newfeeds, dietary advice is rampant. The lay public takes in all this information, but cannot decipher what is relevant to their lifestyle and physiology. So you wind up with a patient who self-imposes all kinds of dietary restrictions: no potatoes, legumes, or grains because they see their Crossfit friends berate modern agriculture, healthy fats because old school dieticians spew the “fat makes you fat” dogma, gluten because they read a “Twenty-Eight Signs You’re Gluten-Sensitive and going to die!” article, fruit because the morning talk show said fruit is high in sugar, eggs because the surgeon general says eggs are too high in cholesterol, green leafy vegetables because the juice-cleanse proponents are getting sick from too many oxalates — I could go on and on, and if you’re a healthcare practitioner, chances are you’ve encountered this. And you can easily see how this kind of perverted diet will absolutely harm your patient.

At its best, this is just someone confused because Western culture has an obsession with the “right” kind of body, diet, and lifestyle. At its worst, this is orthorexia, an eating disorder characterized by obsessive preoccupation with avoiding foods thought to be unhealthy for one reason or another.

If you are a lay person with health challenges and have not been able to get anything under control with your diet, here’s my advice: take a break for four weeks. Eat whatever you want for four weeks. Do not look at the scale, do not obsess over symptoms or progress. After four weeks, talk to a nutrition professional that you trust, and they will help you come up with a healthy diet based off of your own physiology (based on history, exams, and/or bloodwork). Remember that Dr. Oz is not your doctor, nor is he a nutritionist. Also remember that food is not the enemy. You need to eat in order to live, nutrition is much, much more than “calories in, calories out.”

If you are a healthcare provider and you encounter somebody that you suspect suffers from orthorexia that is impairing their health, here’s what I’d suggest: ask them to put aside their dietary restrictions for four weeks. You may need to work with them to slowly add foods back into their diet, as the fear of ruining their health with any one particular food may be debilitating for them. Look at a food log and identify nutritional gaps. Work at adding back in whole foods that will bridge these gaps, with the most urgent nutritional need first. People’s relationships with food are complex; you may need to call in back-up from a therapist, psychologist, or psychiatrist if you suspect the disordered eating is more than just confusion over popular nutrition dogma. My goal with the orthorexic patient is to re-acquaint them with the therapeutic effects of all kinds of foods, and to turn restrictive eating into smart, whole-food eating.

It is strange to consider disordered eating–we are born already knowing how to consume food (well, breastmilk). We have internal processes that let us know when we’re hungry and when we’re full. We even have internal processes that make us crave foods our body thinks we need. Eating is a primal activity that our bodies are well-equipped to do successfully. But when you bombard the average person with endless, non-specific nutritional advice, misleading marketing slogans, and outright or subtle body shaming, it is no wonder that person’s perception of food is skewed and basic food instincts suppressed. Doctors and healthcare professionals, be actual deliverers of health-care and reignite your patient’s internal drive for real, whole foods. Everybody else, remember a time when food made you feel good–not guilty, not anxious, not scared–but sufficiently full and happy. Before you make another dietary change, first get to that place and don’t lose sight of that. Food from then on out should never make you feel anything but full and happy.

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