Eating disorders, orthorexia, and recovery

by Mimi Cole

In this article, Mimi Cole tells us about eating disorders, orthorexia, and recovery. Mimi has lived experience with all three and is pursuing her Masters in Clinical Rehabilitation and Mental Health Counseling so she can help others recover from eating disorders.

Mostly when we talk about eating disorders, we’re talking about underweight anorexia. This misses the vast majority of eating disorders, and I think it’s time that everyone understands the other signs and symptoms. For example, here are some common signs and symptoms of an eating disorder that have nothing to do with weight: 

• A new interest in clean eating or diets
• Changes in eating patterns that result in cutting out a food group or switching to “healthier” ingredients. 
• Trying to get everyone around them on the same eating bandwagon, such as “eating clean” or gluten-free
• Focusing on a lot of niche or specialty items that narrow and specify dietary behavior
• Asking permission to eat certain foods, i.e. “Are you sure it’s OK if I eat this?”
• Reading labels, worrying about grams of fat, carbohydrates
• Emotional distress after eating food that they believe is bad. 
• Sharing exercise plans after eating
• Fear of eating certain foods
• Becoming hyper-focused on unattainable sports goals
• They suddenly start doing something intensely every day like a new sport or exercise
• Noticing a change in relationship with exercise (i.e. hates exercise and suddenly really into it)

It’s important to recognize orthorexia when we think about eating disorders and recovery.

When to seek support

If your child is showing any of these symptoms, it’s a good idea to see a dietitian who understands all types of eating disorders. It may feel extreme to you, but it’s really better to be safe than sorry. Orthorexia is a serious eating disorder that is focused on eating a certain way and exercising. It may or may not result in drastic weight loss, but the condition is still very serious.

A lot of parents think it’s a good sign when a child suddenly becomes interested in “healthy” eating and exercise, but a sudden and intense change in a person’s relationship with food and their body is often a warning sign. It’s important for parents to seek support so they can understand how to parent through food and body issues. 

If you’re seeing these signs in your child, then they may need some nutritional counseling. A lot of parents forget that they can begin with a dietitian. Many kids may be more willing to speak with a dietitian than they are a therapist, and as long as the dietitian is trained in eating disorders, they will know whether to recommend psychotherapy who can play a vital role in recovery from eating disorders. 

Just be sure you work with a dietitian who is qualified to identify eating disorders – most dietitians do not have this training. While these professionals mean well, they can miss symptoms and accidentally cause more harm.

Eating disorders, including orthorexia, often require varied treatment to bring about recovery.

Understanding diet culture

I wish that more parents understood diet culture and its dangers. There are so many misconceptions about the efficacy and importance of weight loss. Our culture perpetuates these through powerful authority figures, including doctors, teachers, and celebrities. Doctors’ recommendations to lose weight are based on racist and fatphobic roots, and it has a very negative impact on our health. I get really sad thinking about how many people think weight loss is a good recommendation, but it’s actually very harmful. 

A common phenomenon throughout my lifetime is that parents become afraid when their kids gain weight. What they don’t know is that it is very normal for kids’ bodies to change, and we need to normalize adolescents gaining weight. It shouldn’t be something that is shamed. Intentional weight loss during adolescence has long-term consequences such as the development of disordered eating and eating disorders, a compensatory and restrictive minded relationship with food, and a fixation on the body. 

Parents should do their own body work and recognize the effects of diet culture on their own beliefs and behaviors. Negative comments about parents’ own bodies are easily and often picked up by kids. It’s important to be very conscious of how parents’ own beliefs affect their kids’ thoughts about food and their own bodies. 

Healthy doesn’t mean weight loss

Unfortunately, diet culture has co-opted the word “healthy,” and it no longer means what you think or want it to mean. Healthy has become an idea that you need to exercise and eat a restricted food diet: more fruits and vegetables, and less sugar. But health is not achieved by restricting your food groups. You can have a healthy diet that includes carbs, sugar, and fats. In fact, the more that you restrict those foods, the more you crave them. 

A classic example is telling your kids they can’t have sugar because it’s “not healthy.” This only reinforces the idea that sugar is “off limits” and kids tend to want it even more. The foods we restrict gain power that they don’t deserve. They become much more attractive because we restrict them. 

An “all foods fit” mentality works really well. Focus on building: an add, not subtract mentality. Add more fruits and vegetables, add more fiber, but don’t take things away. We have this image in our minds that if we allow our kids access to sugary foods, they will only eat that food forever, but that’s just not true. 

I eat dessert almost every day. It’s okay to have dessert every day. I also eat vegetables every day. I incorporate a lot of different foods in my diet, and that’s actually healthy.

Forget the BMI

The BMI is an outdated, narrow tool that doesn’t adequately measure for health. I really think it does a lot of harm for kids to be told they are “overweight” for a number of reasons, including that the standards changed in 1998, so people who were “normal” went to “overweight” overnight. The BMI is not backed up by research. We know that health indicators and biomarkers like blood sugar levels are not determined by weight, but by health promoting behaviors. 

People in larger bodies can be healthier than people in smaller bodies. What changes the relationship between weight and health is usually weight stigma and discrimination, and this weight based treatment can lead to suboptimal health behaviors independent of weight. 

Also, we know that intentional weight loss stimulates your body’s stress response leading to chronic inflammation: that’s definitely not healthy. And since almost nobody maintains intentional weight loss, it’s an unnecessary stressor. 

Recommendations for parents

1. It is never appropriate to comment on the amount of calories in food (on or off the table). When you say something like “I wonder how many calories are in this” it immediately causes others to think about their own food. A healthy relationship with food should never include calorie counting but joy, relationship, and satiation.

2. Eating disorders are frequently missed in marginalized bodies. Fat people, Black and Hispanic people, and transgender people get eating disorders, too. 

3. Recovery from eating disorders, including orthorexia, is possible. Yes, it really happens.

4. Recovery takes time, sometimes a long time of doing the right recovery things (e.g. sticking to a meal plan, eating fear foods, etc), to unlearn sometimes years of a chaotic relationship with food. It takes time to put space between anxiety and compulsions. Celebrate progress and the smaller moments throughout the recovery process.

5. Recovery typically includes gentle nutrition, intuitive movement, and body trust and intuition. Gentle nutrition means meeting nutrient needs for vegetables and fruit and fiber, while not getting stuck in a dieting / restrictive mentality. Intuitive movement means engaging in movement that makes you feel good and isn’t forceful. Body trust and intuition mean knowing that our bodies are wise, and can be listened to and trusted. 

About Mimi Cole

Mimi Cole is a graduate student studying Clinical Rehabilitation and Mental Health Counseling at UNC Chapel Hill. She plans to specialize in the treatment of eating disorders and disordered eating. You can follow her on Instagram @the.lovelybecoming

See Our Parent’s Guide To The Different Types Of Eating Disorders