On 'Stigmatizing Health' and Orthorexia Nervosa

The Huffington Post is great at stirring up controversy with its opinion pieces. That's partly why I love it. It's a good (and fairly benign) forum for people to engage with different thoughts and think critically. What I don't love, though, is when people write things that are not accurate or informed. Case in point- the other day, someone wrote an article on orthorexia nervosa that was very misinformed. It's okay if people have differing opinions (based on empirical evidence) regarding how to effectively treat an eating disorder, or if people disagree on how we can improve and increase accessibility of treatment. What is tough though is when someone in a public forum, who has no psychological training, refutes the validity of a mental illness.

The article is HERE if you are interested in checking it out. Or, I can save you the four minutes and give you a brief synopsis. In all honesty, you might want to read it just to get a sense of her perspective, but Christina Pirello argues that orthorexia nervosa has been made up by psychologists and health professionals in order that the status quo is maintained, which essentially fuels an industry (pharmaceutical) created to profit from our unhealthy eating. She believes that healthy eaters should not be marginalized for choosing to eat healthily and that healthy eating does not equate with being mentally unstable. While I agree with her on that last part, I think the problem with her argument is that she really doesn't get that eating disorders are not a lifestyle choice, like healthy eating is. Eating disorders are a mental illness. Someone who suffers from an orthorexia is no more choosing to eat healthy than someone who suffers from bipolar disorder chooses to have a mood disorder.

Orthorexia nervosa is not just the desire to eat healthy. Orthorexia interferes with one's ability to live a normal, high functioning life due to the pursuit of eating only pure and healthy foods. This may mean avoiding work, family and social commitments or events to avoid having to eat anything that is not pure, raw or healthy. Orthorexia is also pathological in nature. This means that the disorder goes beyond someone's desire to adhere to healthy eating; there are negative consequences that result from the behavior. If someone is just eating healthily, that is not pathological! It is pathological though when this pursuit of healthy eating interferes with one's ability to lead a normal life. The preoccupation with healthy eating can become an interference in everyday activities, relationships and life. It also becomes pathological when one's health is compromised. Often, one who is orthorexic may avoid eating anything but fruits and veggies- the way that this can affect one's body can be detrimental. Your brain needs carbs to function properly (maybe Pirello needs some carbs!) and your body needs other essential nutrients that cannot be utilized from a handful of foods. While I can appreciate a perspective that is different than my own, my fear is that Pirello's perspective serves to further perpetuate myths about eating disorders. For more information on orthorexia nervosa, follow this link.

A Diet is a Diet is a Diet

Lately I've been ragging on celebrities- Kim Kardashian, Jennifer Love Hewitt, and now... Jessica Simpson. I've written about Jessica Simpson in the past (here and here) because she has been involved in many efforts to encourage women to examine what real beauty is, both through her show, Price of Beauty, and through her work with Operation Smile. She was also on Oprah a few months ago, sharing her thoughts about beauty, body image, and her renewed sense of self. At one point, she got teary-eyed and when Oprah asked her what she was feeling, she responded that she was frustrated by the pressure put on women by the media to be thin.

Well, this week, Simpson posted on twitter that she has started a strict vegan diet. While she later added that this diet has nothing to do with weight loss, and only has to do with being healthy, I was a little disappointed and surprised that after her campaign to focus on health, beauty and accepting her body, that she would publicly discuss her 'strict vegan diet' that she says 'shocked her system.' Because she has made body image and beauty her platform, it seems irresponsible of her to mention her latest fad restrictive vegan diet. Diets, as I have preached and preached about, are ineffective and BAD (why? find out here). If Simpson chooses to follow a vegan diet, that is her choice, but to announce that she has started a new diet puts the focus in the wrong place, whether this diet has to do with weight loss or not. Some may disagree with me, and that is ok! But I think that it would be better if she kept that information to herself, especially due to her history of engaging in fad and yo-yo diets and the ongoing scrutiny over her weight- as anyone hearing about her latest diet would naturally assume it has to do with weight loss (as all of her other diets have been in the past).

Our society is obsessed with dieting, who is eating what, losing weight fast, bodies, etc. It's tough to go onto facebook or twitter anymore without reading a status update or tweet about some kind of disordered behaviors/thoughts regarding food and exercise. I'm not calling anyone out here or thinking of certain people as I write this (well, maybe Jessica haha), but the more we call attention to these things, the more we are playing into the unhealthy dynamic created by the media. As much as Jessica Simpson has experienced criticism and pressure from the media, I would think that she would not want to perpetuate the focus and value on such things herself. I am afraid that by making a public point to share her latest diet plan, she is compromising the stance she has been trying to model with health and beauty. It's not that all of her progress and encouragement to women has been completely wasted and forgotten, but she is sending some pretty mixed messages. From here on out, it might be more helpful for her to refrain from promoting or discussing her current meal plan. And so should everyone else. We don't need a play by play via facebook or twitter about how many pounds you lost last week or how fat you feel or how intense your exercise routine is or how you can fit into your skinny jeans again. Food nourishes our bodies, it gives us energy and fuel to think well and be active. Let's keep the focus there and spend the rest of our energy, time and thoughts on things that matter more, like family, friends, our careers, and making the world a better place.

EDNOS

I have posted in the past (here) about 'eating disorders not otherwise specified' -- commonly referred to as EDNOS. As a diagnosis, EDNOS is not very specific-- if one does not meet the criteria for anorexia or bulimia, then he or she is lumped into the EDNOS diagnosis. In this way, it can sometimes be seen as the 'kitchen sink' diagnosis. This can be problematic for many reasons-- mainly, a single diagnosis used for people that experience a range of different behavioral symptoms (binge eating- no purging, purging- no bingeing, night eating, etc) is not necessarily effective when it comes to treating the eating disorder. There was an article published in the NY Times awhile back that I have been meaning to post that you can access by following this link which addresses this very issue. I would encourage you all to check this article out! It helps to bust a few common eating disorder myths and provides a little more background on EDNOS. For more info on EDNOS, follow this link.

Race For The Cure and Body Image

The Susan G. Komen Race For The Cure took place in Raleigh, NC this past Saturday, and it was such an inspiring event. It held special meaning for me, as I have a grandmother and an aunt who have both battled breast cancer-- and survived!!! My aunt was actually in town from Oregon for follow up care at Duke, and so we formed a group and all participated together in this event. I have heard that participating in a Komen race is very different than other races, and as a first time participant, I think I saw why. First, there were SOOO many people that participated. If you look at the picture below-- it is a little tough to make out-- but as far as you can see, there are people that fill up the streets.

The other thing that seemed different to me was the heart and spirit in this event. I think that most people participating had been touched in some way by breast cancer. While my grandma and aunt are survivors, not everyone wins their battle with breast cancer. One of my friends that participated on our team lost her mother to breast cancer. Many, many people have lost loved ones to this illness and it is really heartbreaking.

The picture below is actually a shot of a few of the women that were on our team-- "Breast of Friends" : ) and you will notice the hot pink paper on these women's backs. These hot pink sheets of paper served as memorials to write names of people that you were walking in celebration of (survival), or in memory of, for those who have passed away. It was really sobering and emotional to see all of the names of people who have lost their lives to this illness. I think anytime, with any illness or disease, seeing names or faces make an impact because it personalizes the illness. In talking to my aunt over the course of her visit to Raleigh, she shared with me that battling and surviving breast cancer has changed her life and the way that she lives it in so many ways. One thing that she said that stood out to me was that she is thankful every single morning when she wakes up and realizes how blessed she is to be alive, and to have a body that works and is healthy.
This really impacted me and made me consider how her wise words can be applied to those of us who have not battled breast cancer! First, I think that her attitude of thankfulness is one to be emulated. There are a million ways that having an attitude of gratefulness and thankfulness can impact us-- as well as those around us. Whether it means that we worry a little less, we appreciate what we have more, or take our eyes off of what we lack and what we wish we had and focus on what we do have, it is always good to have perspective, and to live in a way that reflects that attitude.

Secondly, I think that this relates to body image and the ways that we think of and care for our bodies. I want to be clear, like I am often, that eating disorders are a mental illness. Part of having an eating disorder (diagnostically) is experiencing a severe disturbance and preoccupation with one's weight, shape, size, body-- so this is in no way meant to minimize the severity and nature of these thoughts. What I will say though, is that for those of us who struggle with body image and have a negative self-image, this may be a good reminder and an encouragement about all that our bodies can do for us, and how blessed we are to have bodies that are able to function how they are supposed to, that allow us to be active, and that allow us to experience life! Yes, it may be upsetting when our jeans fit more snug; yes, it may get you down when you flip through a magazine and see nothing but airbrushed 'beauties'; and yes, it may be frustrating when you don't feel good about yourself! These are all feelings that most women have experienced before, so you are not alone! But I will encourage you with the words of my brave aunt, who said that she wakes up every morning, thankful to be alive and to have a body that works. Rather than focus so much on the way that our bodies look, maybe if we start to appreciate all that our bodies do for us, and the fact that they allow us to experience life, we may begin to embrace our bodies a little more and appreciate them for what they are and what they do for us.

Some of you may have heard about the t- shirt that Urban Outfitters recently pulled from their online catalogue after much hate mail was received. The shirt said 'Eat Less' and was featured on a waif-y model. It is hard to believe that they actually went there! But they did, and while it may have been to generate some publicity (tacky, much?), enough people protested that they thankfully took it off of their website. I also heard that the shirt has been pulled from stores--so hopefully that is true!

A couple of my therapist friends who I got to know while doing some contract work at the Carolina House brought an awesome article to my attention that I just have to share. Below is this article that was published in Durham's Independent Weekly newspaper and written by Rebekah L. Cowell (follow this link to see the article) about some local women who are in recovery and working towards exposing myths about eating disorders that this t-shirt's message was perpetuating.

Amy Lambert used to tell herself what Urban Outfitters is telling millions of other young women: Eat Less.

It wasn't unusual for Lambert, who had an eating disorder for more than eight years, to consume little more than one container of yogurt in a day. Now recovering, Lambert led a protest last week outside of Urban Outfitters at Southpoint mall in Durham.

Last week, Urban Outfitters placed in their online catalogue a gray V-neck T-shirt worn by a rail-like young woman. On the front, in script, the words "Eat Less."

"Urban Outfitters targets a young demographic, and they are reinforcing the idea that eating disorders are a choice, not an illness," she said.

Four other women from a Durham Eating Disorder Support Group joined the peaceful protest, brandishing signs that read, "Messages Can Re-Enforce Deadly Beliefs" and distributing fliers titled "Messages in Media: 'Eat Less' is Humor That's Not Funny."

Mall security shut down the protest 30 minutes later.

"We want to make it a friendly family environment," said Public Safety Officer Sellers, who refused to disclose her first name. "We can't just have people here doing that [protesting and handing out literature]."

Urban Outfitters did not return the Indy's calls or e-mails regarding the ad campaign, but after national outcry the T-shirt was removed from the chain's website, though the shirts that have already been shipped will be in stores. When the Indy visited the store and asked for the T-shirt, it was not on the sales floor. An employee who didn't want to be named called the slogan "harsh."

At least 24 million Americans suffer from eating disorders, which have the highest mortality rate of any mental illness. Twenty percent of people with an eating disorder will die prematurely from complications related to their disease. Telling an individual with an eating disorder to "eat less" aggravates emotional, psychological and physical issues. And for those still stuck in dangerous patterns, it is a message of validation, says Chase Bannister, clinical director for Carolina House.

In fact, the T-shirt has been posted on "pro-anorexia" sites as a source of "thinspiration."

"The banner-statement 'Eat Less' can be a stinging trigger for women and men with anorexia, bulimia or binge-eating disorder," Bannister added, "ultimately providing reinforcement for the distorted belief our patients work so hard to stamp out: 'I will never be okay unless I'm thin.'

The women said by holding the protest, they sought to empower themselves and spread a message of acceptance for a healthy body. Sandy Yarnall had anorexia for more than half of her life. She finally received treatment in 2008. "I struggle every day with wanting to go back to a very unhealthy size, and where I was before recovery, and seeing that message did distress me."

Rebecca Clemins has had an eating disorder for 25 years. "Urban Outfitters put this tee on a waif-like model, which enforces the idea that being waif-like is preferred, and they are encouraging a lifestyle that is killing young women," she said.

"I can't imagine endorsing something that creates so much misery," said Carson Hadley, who developed her eating disorder in eighth grade. She had to drop out of high school during her senior year to get in-patient treatment at Carolina House. "That shirt reminded of what I can't be if I want to live."

I am so proud of the women who participated in this protest, shared their stories, fought to raise awareness and exposed myths about eating disorders. This can certainly be an inspiring act for those with eating disorders who are working towards health to see- that not only is recovery very possible, but that it can also be empowering to take a stand and work towards educating people about the truth about eating disorders.