The ‘healthy’ dilemma
We live in a culture chalk-full of images and messages about how our bodies should look and how to best mold them into these ideals. Measuring ourselves against these idealized images can take a toll on our well-being. About 50% of men and 72% of women feel dissatisfied with their bodies¹. Girls as young as six years old want to be thinner than they are². At mid adolescence, 61% of girls and 28% of boys display unhealthy weight loss behaviours³. We buy gym memberships, swap low-carb, gluten-/dairy-/sugar-/fat-free recipes, try eating ‘clean’/paleo/keto, and poke, prod, and push our bodies to resemble that Spandex-clad person with 500K followers on Instagram. We are immersed in a culture obsessed with health and fitness, yet seem to be sliding further from being healthy. Many girls, boys, women, and men wrestle with their body shape, weight, and food. The National Eating Disorder Information Centre (NEDIC) estimates that somewhere between 725,800 and 1,088,700 Canadians meet the diagnostic criteria for an eating disorder. This said, one challenge is that the line between what is healthy and what isn’t is often blurry. As a therapist and researcher who devotes much of my time to eating disorders, body image, and embodiment, many of the people I talk with don’t fit the criteria for having an eating disorder. They may even be praised by others for being self-disciplined or ‘fit.’ But these same people often express feeling dissatisfied with or even ashamed of their bodies and struggle with anxiety and guilt related to eating, exercise, and the number on their bathroom scale.
Disordered eating and eating disorders: what do they look like?
So how might we begin to differentiate between healthy and unhealthy approaches to eating and exercise? It may be helpful to think about our relationship with food and exercise as existing along a continuum: ‘healthy’ at one end, and what is considered clinically ‘disordered’ at the other, with a whole lot of variation in between. The distinction between what is healthy and what is disordered eating then isn’t quite black and white. And what is healthy for one person may not necessarily be healthy for another. However, there are some specific thoughts, feelings, and behaviours that can signal that someone is closer to the clinical disorder side of the continuum. Here is the Coles Notes version of what the eating disorder side of the continuum can look like:
Anorexia Nervosa:
● Restriction of energy (food) intake leading to significantly low body weight.
● Fear of gaining weight, or behaviour interfering with gaining weight despite being underweight.
● Significant influence of body weight/shape on self-evaluation, or lack of recognition of the seriousness of low body weight.
● There are two types of anorexia nervosa: the restricting type (restricting energy intake and/or excessive exercising), and the binge-eating/purging type (pattern of eating large amounts of food followed by purging through vomiting, misuse of laxatives, etc.).
Bulimia Nervosa:
● Pattern of binge-eating (eating large amounts of food in discrete periods of time).
● Feeling a lack of control over eating during these times.
● Compensatory behaviours in response to binge-eating in order to prevent weight gain (vomiting, misuse of laxatives, fasting, excessive exercise).
● Significant influence of body weight/shape on self-evaluation.
Binge Eating Disorder:
● Pattern of binge-eating episodes that are associated with rapid eating, feeling uncomfortably full, eating when you’re not hungry, feeling embarrassed by how much you’ve eaten, or feeling depressed, guilty, or disgusted with oneself.
Orthorexia:
● Although orthorexia is not yet formally recognized by the Diagnostic and Statistical Manual of Mental Disorders as a clinical diagnosis, awareness of it is on the rise.
● From the Greek “orth,” meaning right and correct, and “orexia,” meaning appetite. It is often disguised as healthy eating or a focus on being healthy, but can negatively impact psychological and physical health.
● Characterized by an obsession with proper or ‘healthy’ eating (significant concern about the health of food ingredients, cutting out certain food groups, distress when ‘safe’ or ‘healthy’ foods aren’t available).
How can I recognize if my desire to be healthy is becoming unhealthy and what can I do about it?
There are a few key signals that someone may be moving away from the ‘heathy’ end of the continuum. The first is experiencing a persistent desire for control (over food, exercise, body weight or shape) and consequent restriction or lack of freedom in your daily life. This may show up as pushing away any snacks that you are offered when they aren’t on your meal plan, or avoiding social events that involve food. Along with this desire for control and decreasing sense of freedom, distressing feelings are a cue that something might be wrong. For example, you may feel anxiety, guilt, or even shame about food, eating habits, or body shape or weight. It’s understandable that the way we feel about our body affects our mood, but when difficult thoughts or emotions surrounding food or your body start negatively impacting your self-esteem and sense of self-worth, you may want to consider taking a closer look at these issues.
If you resonated with any of these ‘signals’ described, a starting point for how to work towards health and well-being involves shifting the way we live in and relate to our bodies. Try spending more time focused on how it feels to be in your body rather than on how your body looks. Generally, we are more concerned about what size and shape our body is, and how it looks in the mirror or to others around us, instead of thinking about how we may feel strong, energetic, or affectionate in and through our body. Rather than fixating on external characteristics (your body’s shape, measurements, or appearance), practice paying attention to what it feels like being in your body. You may ask yourself, “Do I feel strong, energetic, or free in my body?” or “What is my body telling me about what I’m needing?” or “What does my body allow or enable me to do?”. It may also be helpful to talk through your struggles with someone who cares about you. Depending on what’s going on for you, you may want to talk with a trusted friend, family member, mentor, or counsellor who has experience with these issues. A great litmus test for whether something is becoming a problem is noticing whether we have a tendency to be secretive about it. Shame also thrives in secrecy. It may feel vulnerable to open up to someone about your struggles with food, exercise, or body image, but it can be exactly how you find support to develop different, liberating ways of thriving in and with your body.
Sources:
- Fiske, L., Fallon, E. A., Blissmer, B., & Redding, C. A. (2014). Prevalence of body dissatisfaction among United States adults: review and recommendations for future research. Eating Behaviour, 15, 357-365.
- Dohnt, H. K., & Tiggemann, M. (2006). Body image concerns in young girls: the role of peers and media prior to adolescence. Journal of Youth and Adolescence, 35, 135-145.
- Neumark-Sztainer, D., Wall, M., Larson, N. I., Eisenberg, M. E., Loth, K. (2011). Dieting and disordered eating behaviors from adolescence to young adulthood: Findings from a 10-year longitudinal study. Journal of American Diet Association, 111, 1004-1011.
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