When Does “Healthy” Cross the Line?
The other day I had a great conversation with a client about willpower. I was explaining to her that willpower is finite, and that the best strategies for long-term healthy eating (and weight loss, if needed) are positive, preventative actions and habits. It’s easier not to eat candy if there’s no candy around, right?
I compared willpower to a glass of water (a common analogy) – every time you use a little bit throughout the day, you’re pouring a bit of water out. In other words, at the end of the day, if your glass is empty and your spouse wants takeout… you’re probably eating takeout. You’ve got no willpower left to make a better decision at that point.
I ended my inspirational talk by saying, “You need to reserve your willpower for times when you really, really want and need to say ‘no’ to a particular food.” And her totally legitimate question immediately was:
“Isn’t that approaching an eating disorder?”
The truth is, I love when clients help me pause and clarify my own thinking on a subject!
The short answer is…
No. Making healthy eating choices is definitely not an eating disorder.
There is actually a colossal difference. However, there is a lot of confusion about this topic in our current psychosocial climate, and it is understandable that people fear being too stringent. Food is abundant, a sedentary lifestyle is normal, orthorexia has gotten a lot of press, and we’re “healthy at any size,” so anything that even hints at deprivation or a desire to lose weight can make you wonder…
How Does Overly-Healthy Eating Morph into Disordered Eating?
Just like occasionally feeling sad doesn’t mean you’re depressed, exercising your willpower every once in awhile to decline a cookie doesn’t mean you have an eating disorder. Or even close.
I think that the fear of eating disorders simply reveals a lack of knowledge about what disordered eating and eating disorders really are, and the intensity of their grip on the lives of the people who suffer. Anyone who has lived with or loved someone with an eating disorder knows that, while healing is possible, actual eating disorders are all-consuming and life-threatening diseases that require treatment. Declining cake at a birthday party is not necessarily in that league of intensity.
That being said, there are common behaviors that are thresholds to disordered eating, and actions like restrictive dieting, while socially acceptable/encouraged, can put one on the path to overthinking food. The pressure to have a perfect body affects many women deeply, but like I say in a previous blog post about body image and disordered eating and exercise habits:
Before you freak out because you now think you have an eating disorder, I will say it again: these behaviors occur along a spectrum. You may have boarded the perfect body train, but you are allowed to get off at any stop.”
I have learned a great deal about dysfunctional and functional food behaviors from Geneen Roth, Steven Bratman, and Ellyn Satter, and my philosophy is greatly influenced by these authors and researchers as well as by my own personal experience.
If you are struggling with your philosophies around food, exercise, and weight, please read and share this post, because it contains some crucial ideas that make up the cornerstone of my approach to balanced, healthy eating and why it’s important to care for your physical and mental health — in other words, the “long answer.”
Our eating culture is based around the extreme polarities of excess and dieting.
We can’t talk about an individual’s behavior without talking about the larger cultural context, so that is where I like to start. Right now, our eating culture tends to exist only on opposite sides of the spectrum – either not “minding” food choices at all, or, at the other end of the spectrum, extreme dieting and “trying to lose weight.”
Many, many people find themselves on a nonstop pendulum swing between these two polarities, and these behaviors are two sides of the same coin. Restrictive eating tends to lead to binging, and vice versa.
What you eat matters.
I frequently work with clients who want to lose weight. Sometimes, a lot of weight. While exercise plays a significant role, I feel that I am misleading a client if I do not impress upon them that what they eat is crucial for both weight loss and health. Nutrition is the foundation of a wellness plan.
While I am not a dietitian and I can only offer tips and guidelines and support, I cannot emphasize enough that creating workable strategies is essential to attaining and maintaining the best level of leanness for your individual body. What you eat matters, and may initially require a higher level of attention than usual in order to put routines into place, and that is not “dieting” or “overdoing it.”
This is an unpopular opinion right now. However, I think it’s dangerous to sugarcoat the fact that maintaining a too-high-for-you body weight can create a whole host of health problems, and my opinion is that the body positivity movement has overshot its goal of promoting self-acceptance and has landed many people in unhealthy territory.
The more weight that you gain beyond your “happy place” (which can encompass a large range of weights for each person, by the way, and doesn’t necessarily mean “super lean”), the more problems like inflammation, heart disease, digestive issues, and mobility issues you will encounter.
I say this because it is important not to shame wight loss. As long as the behaviors and strategies used to lose weight are healthy, balanced, and self-caring, weight loss can be an extremely positive act that radically improves health and lifestyle. My philosophy, however, is to focus on the behaviors and the lifestyle choices, not necessarily the number on the scale.
Structure is healthy, and everyone needs to start somewhere.
Therefore, a reasonable middle ground is some structure. “Mindful” or “intuitive” eating does not work for everyone at first, because they may not have the baseline of order and structure from which to operate. Limitless options often do not lead to positive choices, and for someone who is attempting to build healthier life patterns, guidelines do help. Habits have to come from somewhere, and a little rigor is helpful.
Sometimes, guidelines require someone to “just say no,” exercise reasonable self-discipline, and create new routines. Following basic guidelines, in fact, helps to prevent the restrict-binge cycle. If you don’t binge in the first place, you won’t feel the guilt and need to “cleanse” or “detox.” On the other hand, if you don’t restrict, your body won’t fight back with obsessive cravings. Guidelines help to prevent the swing of the pendulum, and also create lasting positive habits that go on autopilot and allow for more “intuitive” choices.
Flexibility allows us to respond to life.
However, the reason they are guidelines and not rules is that they are flexible. Rigidity is a hallmark of troubling food behaviors. Guidelines, on the other hand, give us the freedom to try new things, enjoy vacations, make exceptions, have an adventurous palate, and celebrate holidays. However, guidelines keep those spontaneous moments in the realm of “enjoyment” and out of the realm of “regret.” Euphemisms like “over-indulging” don’t lay out the truth that eating or drinking until you are sick is not actually fun.
Attention isn’t the same thing as obsession.
Here’s where I start drawing the line between healthy eating and disordered eating. The spectrum of disordered eating and eating disorders is characterized by varying degrees of an intense need to control food intake, exercise, and physique. The extreme focus and emotional fixation, whether you are overweight, underweight, or anywhere in between, begins to negatively affect other parts of your life – your relationships, your work life, your mood, and your social life.
Mindfulness, on the other hand, is simply paying attention and responding to the actual needs of your body and psyche. Mindfulness is practicing awareness that sometimes you’re not hungry, and sometimes your cravings are not legitimate – like when you’re bored, stressed, emotional, or tired. As I alluded to before, the startup of a wellness plan does require more attention than usual, but the level of active focus should gradually recede as the habit takes over. Disordered eating’s obsession only becomes more intense over time.
Competency is the goal, not perfection.
I have borrowed the word “competency” from Ellyn Satter because I love her approach (the “Satter Eating Competence Model“). Some of the qualities of a “competent eater” include eating regularly, enjoying food, and trusting yourself to eat well. The word “competency” doesn’t indicate all-or-nothing perfection, but instead connotes skill combined with ease.
Regularly choosing and preparing food that tastes good and meets your body’s nutritional needs is simply a skill that many people don’t have, but could build with practice, patience, and guidance.
Dieting bypasses eating competency skills by temporarily eliminating the “bad” foods, instead of learning how all foods are part of the joy of life. The result of “eating competency” is that you are healthier and probably leaner, but the focus is on the process and the habits, not the physique outcomes.
Enjoying food is extremely important.
Food is supposed to be enjoyable, and the basis of a lasting, good-for-you lifestyle change is satisfaction. If you decide to “get healthy” or “clean up your diet” by cutting out all of the foods you truly like, your diet will last about two weeks (if that).
I have socially eaten with people who literally eat nothing but salad greens with dressing for a meal because they are trying to lose weight. This does not cultivate a healthy relationship with food, because (1) nutrition needs are not being met and (2) it can’t possibly taste appealing.
I tell clients all the time that I don’t diet – I just eat healthier versions of comfort foods. I eat meat, cheese, pasta, pizza and chocolate on a pretty regular basis, and no, I don’t need to detox or cleanse, because I also eat a ton of vegetables, greens, and whole grains, I swap out ingredients to make a healthier version of a popular food, I eat moderate or small portions of everything, and I am a highly active person. In order to stick with healthy lifestyle changes, your food choices must continue to be enjoyable and satisfying.
Healthy food behaviors come from a “higher self.”
Here’s where the distinctions become very fine. Accessing the “higher self” means letting your inner adult, instead of your inner child, address your real needs instead of your perceived needs. When we feed people or things that depend on us – children, pets, etc. – we probably are more attentive to meeting their needs than we would be our own.
We need to treat ourselves with the same level of care, taking into account biological needs, stress levels, energy levels, and emotional states. Most parents have no problem recognizing when their child is tired, cranky, and/or hungry, and most pet owners go to great lengths to buy the right type of pet food and measure it out at pre-determined times each day. But most of us cannot recognize these needs for ourselves.
The “higher self” mentality is a self-caring, need-meeting, and big-picture mentality, while disordered eating behaviors often distort true self care and focus on lifestyle factors that don’t improve your wellbeing.
Some food behaviors are more troubling than others.
Here is where I am a big fan of Steven Bratman, MD, who coined the term “orthorexia.” Here is how he defines the “tipping point” (his words) when healthy eating cross the lines into disordered eating:
Orthorexia is an emotionally disturbed, self-punishing relationship with food that involves a progressively shrinking universe of foods deemed acceptable.”
He points out that simply adhering to health-conscious eating practices – even ones that may seem extreme to some people – do not qualify as an eating disorder. However, the more limiting the diet, the more likely it is to “tip” a healthy eater across the line. For example, someone who will only eat organic foods may seem neurotic to some, but as long as the person is eating a varied, robust diet of all-organic foods, they are miles away from any kind of distorted thinking. The same goes for people who are vegetarian, gluten-free, or sugar-free – the field of food choices is still extremely open and flexible.
On the other hand, if someone is a disciple of a diet with very narrow boundaries with little chance for variety (Dr. Bratman uses raw veganism as an example), that lifestyle can easily cross the line into an eating disorder. When you cut out large swaths of nutritional food groups and your choices are limited, your thinking is more prone to distortion.
Personality plays a significant factor.
No behavior happens in a vacuum. If you are perfectionistic and “intense,” with an all-or-nothing personality (I’m raising my hand right now), you should be cautious in implementing major lifestyle overhauls on your own. It doesn’t mean you shouldn’t try to lose weight if you need to, but it means that you need to do it with a great deal of support and structure.
Food issues are hardly ever about food.
Here’s the big one. It’s the one that transcends calorie counting, macro counting, points, or any other way of handling nutrition. In my experience, food issues are usually related to stress, career issues, burnout, relationships, and other energetic and emotional drains. The weirdest food behaviors that I have ever had in my life occurred over a nine-month period in my early 20’s when my commute was more than an hour, I didn’t like where I lived, and I didn’t like my job.
In cases like these, all of the “intuitive eating” in the world is not going to help you eat more mindfully. To resolve food issues, you may need to look at changing big parts of your life. You may need to look for a different job. You may need to set better boundaries with your family. You may need to give up a volunteer commitment to create more space in your schedule. You may need to hire help for your home so that you have more headspace. You may need more creative expression and fulfillment in your life.
It’s challenging to implement change, but you may be amazed at how much food fades as a locus of stress and control when you get to the real roots of the stress! My tip: focus on one thing at a time!
So, to go back to the conversation with my client…
I reassured her that no, making healthy choices does not equal an eating disorder. I didn’t give her the “long answer,” though, because I understand that nutrition is an ongoing conversation. It changes throughout life, responds to varying circumstances, and manifests differently when we’re healthy or ill, single or partnered, with children and without children. It’s an ongoing conversation for all of us, as we try to create the best lives we possibly can.
You can say “no” to foods that don’t fit your lifestyle without feeling worried that you’re too strict, just like you can say “yes” to the slice of pumpkin pie for Thanksgiving without feeling like a failure! So celebrate the holiday, make new memories, and remember that food is a gift that should taste good and feel good!