Healthy eating becomes unhealthy:
Veena Prasad, M.A. Lilo Burda, M.S., LPC-Intern Adriana Dyurich, M.S. Texas A&M Corpus Christi
A BRIEF HISTORY… • Traditional native American foods mixed with foods brought from Europe by settlers • Before the industrial revolution food was seasonal and regional, home grown on small farms. • By the late increased immigration and industrialization changed American food culture. • One major game changer was the invention of the can.
Industrialization and processed foods • Domino’s sugar, Heinz, Kellogg and Quaker started to produce some of the first processed foods. • Canned, frozen, processed and packaged foods started to replace traditional cooked meal choices • With food rationing the need for cheap food alternatives, including corn based products and vegetable oils, arose. • People could not afford fresh produce or meat products any longer. • The need for cheap, mostly meatless foods paved the way for macaroni and cheese and other meals out of the box.
FOOD CULTURE FOLLOWS THE AMERICAN WAY OF LIFE • Food industrialization became an enormous business. • The production of traditional food essentials (flours, oils, jams, butter, cheese…). What was formerly prepared manually was now the product of mass production. • Women take the jobs of men and home cooking is replaced by fast and easy ways of food preparation • In the
Mc Donald's rings in the fast food way of life
FOOD CULTURE FOLLOWS THE AMERICAN WAY OF LIFE • After the war ended, the new food preparation customs and society evolved.
• Women shift from their role as housewives, and female emancipation opens the way for ready-made foods.
• Expanding means of transportation and world trade make it possible to consume exotic products independent from seasons.
FOOD CULTURE FOLLOWS THE AMERICAN WAY OF LIFE • The first controversial discussions about pesticides used in foods started to surface, creating a split in the American food culture. • Urban gardens were created to grow pesticide free foods. • Vegetarianism was a new lifestyle aimed at challenging the corporate food production in America. • The civil right movement considered common foods such as white bread, white rice and industrialized foods a symbol of oppression. • To show solidarity with the civil right movement SOUL FOODS (brown rice, whole wheat bread…) were substituted for their white counter parts
THE RISE OF OBESITY IN AMERICA • Research: the BLISS POINT • Media expands food advertising • Catering to younger population • Advertisement shifted to portray food as healthy
• The issuance of the Dietary Goals was met with a great deal of debate and controversy from both industry groups and the scientific community
Recommended Dietary Goals for the American people: •Increase carbohydrate intake to 55 to 60% of calories •Decrease dietary fat intake to no more than 30% of calories •Decrease cholesterol intake to 300 mg per day •Decrease sugar intake to 15 percent of calories •Decrease salt intake to 3 g per day
THE RISE OF OBESITY IN AMERICA Portion sizes GMO foods Hormones and antibiotics
Sugar content Preservatives Food label confusion and contradictory claims Rapid fast paced lifestyles demand quick food solutions
Diabetes, obesity, heart attacks , cholesterol Media images of healthy living
Things that make PEOPLE happy: • • • •
I wish I could always be healthy I wish I could be fit and trim I wish I could be more attractive I wish I could be smart
When I wish becomes I “must”… • • • • • • •
Must eat healthy Must be organic Must be wholesome Must be freshly cooked Must be from US and Canada Must be healthy Must eat on time. • What is wrong/right with these statements?
Orthorexia Nervosa For people with ON, eating healthily has become an extreme, obsessive, psychologically limiting and sometimes physically dangerous disorder, related to but quite distinct from anorexia. Often, orthorexia seems to have elements of OCD, as does anorexia. Some people with orthorexia may in fact additionally have anorexia, either overtly or covertly (using pure food as a socially acceptable way of reducing weight.) Steven Bratman, MD, MPH
Most often, orthorexia merely creates psychological distress and impairs various life dimensions, but does not present a physical danger.
Orthorexia Nervosa • Condition that includes symptoms of obsessive behavior in pursuit of a healthy diet. • Orthorexia sufferers often display signs and symptoms of anxiety disorders • Frequently co-occur with anorexia nervosa or other eating disorders.
The first to speak out about orthorexia was Dr. Steven Bratman, author of the book “Health–Food Junkie”.
SYMPTOMS • Worrying about purity • Strive for perfect meal. • Judgmental attitude: – Good people always eat healthy – Bad people eat junk – Good people shop at WF – Bad people eat from anywhere.
First Stage: Adopting a theory of healthy eating:
Second Stage:
• Many theories tend to change from year to year. • Popular dietary theories associated with Orthorexia: • Clean eating, Paleo, vegan, raw foods and elimination diets.
• More time spent thinking, preparing and planning meals. • Self-imposed eating rules difficult to follow.
Obsessive thinking and behavior:
• Cyclic episodes of “straying” or “cheating,” followed by increasingly severe cleanses and detoxes. • It becomes difficult to eat with friends or relatives, which leads to social isolation.
http://www.mirror-mirror.org/orthorexia-nervosa.htm#sthash.6sFwChAI.dpuf
Healthy and unhealthy state of mind Healthy state of mind: we use a variety of mechanism to cope with anxieties.
Unhealthy state of mind: use of food as the ONLY defense or coping mechanism for anxieties.
HYPOTHESIS • Self esteem • Identity crisis • Creating meaning and purpose through food • Escape from anxiety • Escape from fear of not being perfect • Perceiving of having more control of ones life
ORTO-15
Instruments Assessing Orthorexia Considerations about using the ORTO-15
Ortho 15 Ortho Anxiety scales OCD scale
• •
The most commonly used research test for ON. Tends to identify people who simply are followers of a theory of healthy eating as Orthorexia. • The adoption of a theory of healthy eating is a prerequisite for developing orthorexia, but it is not its equivalent (Personal communication, Steven Bratman, 2015)
Diagnosis: Words of Caution Orthorexia is not included in the DSM- 5: the following criteria is based on suggestions found in recent research and literature. Main consideration in any diagnosis: Intensity of the condition, Symptoms and/or behaviors Impairment of normal functioning. Not all individuals presenting symptoms are presenting the disorder. Many individuals with characteristics of ON lead joyful and healthy lives.
DIAGNOSIS • • • • • • • •
Criticize other’s food choices. Glorifying a “healthy” lifestyle. Thriving on perfectionism. Restricting even the good foods. Obsessively reading food labels. Lacking focus and joy. Healthy becomes “unhealthy.” Agonizing over eating out.
I eat healthy: Do I Have Orthorexia? The more questions you respond “yes” to, the more likely you are dealing with orthorexia: Do you wish that occasionally you could just eat and not worry about food quality? Do you ever wish you could spend less time on food and more time living and loving? Does it seem beyond your ability to eat a one single meal prepared with love by someone else and not try to control what is served? Are you constantly looking for ways foods are unhealthy for you?
Do love, joy, play and creativity take a back seat to following the perfect diet? Do you feel guilt or self-loathing when you stray from your diet? Do you feel in control when you stick to the “correct” diet?
Have you put yourself on a nutritional pedestal and wonder how others can possibly eat the foods they eat?
DIAGNOSIS
Differentiating orthorexia
DIAGNOSIS
SUMMARY Continually limiting the number of foods that they consider acceptable to eat.
Refusing to eat foods which do not meet their standards. Feelings of guilt or self-loathing when straying from their strict diet. Feelings of control when they stick to their diet successfully.
Being judgmental about those who eat foods they consider to be unhealthy. Failing to enjoy the foods they eat, even when sticking to their diet. Meticulous planning of meals, far in advance of when they occur. Malnutrition, often resulting in weight loss or fatigue.
Treatment: CONSIDERATIONS -It
is important to comprehend the complex emotional challenges that co-occurring psychiatric disorders can create for eating disorder treatment. -Individuals with Orthorexia symptoms commonly exhibit signs of obsessive-compulsive disorder (OCD), as well as other mood and anxiety disorders. -These conditions may either be related to Orthorexia or to other unaddressed psychiatric conditions.
Treatment: CONSIDERATIONS Co-occurring disorders commonly seen in individuals with Orthorexia may include:
Depression Bipolar disorder Obsessive compulsive disorder (OCD) Obsessive compulsive personality disorder (OCPD) Panic and anxiety disorders Post-traumatic stress disorder Substance abuse disorders
Treatment Options Healthy eating is part of life not life itself. Self esteem enhancing activities. Existential awareness. Find fun activates to do in social settings. Deliberately have them eat something “unhealthy”. Find and develop alternative coping mechanisms.
Treatment Options Identify emotional triggers for orthorexia symptoms, which may have an underlying cause that has not been properly identified or addressed.
Create awareness of healthy ways to respond to emotions of fear, sadness, anger or shame.
Avoid destructive "either/or" thought patterns that add to the experience of hopelessness or unmanageability. Develop confidence in the potential to make healthy choices to begin and sustain recovery.
Theoretical Approaches • Acceptance commitment therapy (ACT): – Cognitive diffusion: a person’s ability to switch between modes of thought and to simultaneously think about multiple concepts. Has been shown to be a vital component of learning. – Impoverished set-shifting, or cognitive rigidity, might explain the inflexible, rule-bound approach that Orthorexic individuals take toward food selection, preparation, and consumption.
• Cognitive Behavioral Therapy (CBT). • Solution-focused therapies. • Brief supportive psychotherapy
HOLISTIC WELLNESS STAR - SIX DOMAINS • • • • • •
Physical resilience Mental resilience Emotional resilience Psychological resilience Social resilience Spiritual resilience
CASE STUDY • • • • •
Get into groups. Read and discuss the case study. Can you recognize some symptoms of ON? Can you recognize symptoms of a co-morbid disorders? What treatment modality do you propose?
CASE STUDY The Recovered Health Nut: The story and journey of a former orthorexic I struggled with orthorexia. There, I said it. I used to be fixated on healthy eating. I felt guilty when I’d stray from my pure diet. I felt at peace with myself and in total control when I’d eat only whole foods. As the quality of my diet skyrocketed, the quality of my life tumbled. I avoided going out to eat with friends because I knew the restaurants they’d want to go to would not meet my standards. I would opt to stay at home by myself so I could make and eat an all organic burrito while my whole family would go out to eat at my favorite restaurant (before I became restrictive). Most days, I’d rather be “perfect” than real, avoid life’s pleasures rather than just live. I lived like this for four years. Food and perfection were my two best friends (well, not including my best friend Sam) until I realized that my eating habits were slowly destroying my social life, well-being, and happiness. This realization came after talking with both a therapist and a nutritionist about my struggles. Today, while I still focus on incorporating nutritious foods in the meals I make (I especially love broccoli, sweet potatoes, and whole grains), I enjoy my grandma’s famous ginger snap cookies and pumpkin spice lattes WITH whipped cream every so often. I do not ban any foods from my diet anymore (I used to ban certain foods like butter, white flour, and sugar, even in small amounts), rather, I focus on eating food that makes me feel good, happy, and satisfied. Now, I’m striving for progress, not perfection. Move over orthorexia–I am in control of my life now. Besides being a person who once suffered from an eating disorder, I’m just a normal, busy college-aged woman. I practice yoga regularly, love my wiener dog named Charlie, nanny the funniest and smartest kids in the world, do organic chemistry practice problems in my free time, and spend way too much money at LuluLemon and Caribou Coffee. I am a student at St. Catherine University in St. Paul, MN, with a dream to go into medicine. I am especially interested in dermatology, neurology, and psychiatry– good thing I have a couple of years to figure out what I want to do for sure! Here, I will be posting my recovery and pre-health endeavors…with an occasional random post. I hope to show my readers that you can enjoy a treat every now and then and still be healthy! It’s all about balance. Once I became restrictive, food consumed my consciousness 24/7 and prevented me from living a normal life–I hope to inspire others to eat a variety of foods and not ban any specific ingredients from their diets like I did (unless it is for ethical/health/religious reasons, of course). Meghan McGraw For more information on orthorexia nervosa, visit http://www.nationaleatingdisorders.org/orthorexia-nervosa
References Brytek-Matera, A. (2012). Orthorexia nervosa -- an eating disorder, obsessive-compulsive disorder or disturbed eating habit?. Archives Of Psychiatry & Psychotherapy, 14(1), 55-60. Chaki, B., Pal, S., & Bandyopadhyay, A. (2013). Exploring scientific legitimacy of orthorexia nervosa: a newly emerging eating disorder. Journal Of Human Sport & Exercise, 8(4), 1045-1053. Cosh, C. (2002). Slaves to perfection. Report / Newsmagazine (BC Edition), 29(6), 48. English, K. (2001). Health Food Junkies: Orthorexia Nervosa, Overcoming the Obsession with Healthful Eating. Natural Health, (5). 100. Koven, N., & Abry, A. (2015). The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatric Disease and Treatment, 11, 385–394. Moroze, R. M., Dunn, T. M., Craig Holland, J., Yager, J., & Weintraub, P. (2015). Microthinking about micronutrients: A case of transition from obsessions about healthy eating to near-fatal 'orthorexia nervosa' and proposed diagnostic criteria. Psychosomatics: Journal Of Consultation And Liaison Psychiatry, 56(4), 397-403. doi:10.1016/j.psym.2014.03.003
References Turner, K. L. (2014). How the Other Half Ate : A History of Working Class Meals at the Turn of the Century. Berkeley: University of California Press. Smith, A. F. (2013). Food and Drink in American History : A 'full Course' Encyclopedia. Santa Barbara, California: ABC-CLIO. US Senate Select Committee on Nutrition and Human Needs. Dietary Goals for the United States. 2nd edition. Washington (DC): US Government Printing Office, 1977. Wallach, J. J. (2014). How America Eats: A Social History of U.S. Food and Culture. Maryland: Rowman & Littlefield Werner, R. (2015). Pathology Perspectives. Orthorexia Nervosa. Massage & Bodywork, 30(4), 44-47.
CONTACT INFORMATION:
Veena Prasad, M.A. –
[email protected] Lilo Burda, M.S. –
[email protected] Adriana Dyurich, M.S. –
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