Healthy Eating Revisited, Part II

In a culture that thrives on competition, food choice and diet have become new ways to indirectly express a sense of superiority. Materialism and achievement trump the desire for community and connectedness in our current climate. Ironically, using food as a proxy can level a playing field that is often skewed from the start. Even for people unable to compete on another level, the perceived virtue of a diet or weight can imply success.

About fifty years ago, the media latched

onto a trend for thinness, often extreme thinness, in women. At a time when the reach of available media first encompassed the entire country, the impact of this preference was much greater than would ever have been anticipated. It began a cultural revolution around women focusing on not just weight loss but extreme weight loss towards unattainable goals.

This shift created a new experiment: sanctioned starvation in the form of extreme dieting. Without any awareness of the repercussions, this dieting exposed a large number of people to the most powerful risk factor for having an eating disorder, prolonged decreased food intake. The concomitant rise in the incidence of eating disorders is no surprise.

In order to maintain its power, the diet industry latched onto other cultural trends and transformed the concept of a diet into the cultural capital of the moment. Currently, the most popular trend conflates dietary choices and health.

Nutrition recommendations refer frequently to health as a source of information to justify diets even though there is scant data to prove these assertions. Food companies like Halo Top propose a way to healthily eat a pint of ice cream. Casual fast food chains like Sweetgreen capitalize on the erroneous concept that salads are by definition healthy. Cleanses propose healthy starvation as a way to detoxify the body. Clinicians create lines of products and diets many to improve overall health or health-related issues like skin or hair.

All of this advice turns out to be diets masquerading as ways to promote health. 

With so many people searching for a sense of meaning and value in the modern world, clever and convincing marketing by the diet industry fills a huge void in many people’s lives. Sanctioned starvation provides the answers to many of our questions about how to make our lives matter. The only issue is that the premise is false and the values empty.

Healthy Eating Revisited, Part I

The diet industry has realized that strict diets focused solely on calorie restriction and limiting of foods are no longer in vogue. Healthy eating and clean eating are the new catch phrases that may mean the same thing but invoke a different understanding of what food means today.

Diet foods created in the lab and filled with chemicals that we as humans can digest but are not a part of naturally occurring foods are no longer the center of the diet industry. Instead, healthy eating has supplanted the idea of dieting.

Currently, diets are comprised of actual foods eaten in very limiting amounts and usually in the forms that have the least amount of calories. The idea of health masks the fact that these diets have minimal calories and insufficient nutrition to sustain a person’s actual health.

At the extreme, most dieting turns into the concept of orthorexia, a variant of anorexia which involves obsessive thoughts specifically about healthy foods and thinness. It’s minimally different from anorexia except that the thoughts about health confuse people into believing the eating disorder is somehow less serious and more health focused. That is not the case.

When actual health is taken into account with eating, the available substantive advice is limited: eat mostly real food, be sure to include fruits and vegetables and eat the right amount, in other words enough to sustain your body and brain.

This last piece of information can be very challenging and relies on an understanding of one’s own body, something the diet industry encourages us all to ignore. 

Most advice from the diet industry involves eating insufficient food, being hungry all the time and constantly feeling uncomfortable and bad about your body.

Conflating eating and health is a dangerous way to figure out how to eat in today’s world. If someone is ill, for instance with diabetes, then dietary changes are necessary to maintain health, but an ordinary person needs to learn how to eat as a part of their daily routine and not consider what and how they eat as symbolic of who they are and how they live.

The next post will address why and how the concept of healthy eating has taken off. Why are we as a culture so susceptible to using food as a proxy for our identity and our reason for living?

Adolescence: a Risk Factor for Eating Disorders: Revisited

Here is a post from 2014 that needs to be revisited:

Adolescence is a time of physical, mental and emotional growth. The rate of internal change is so fast that mistakes of poor judgment are inevitable. In fact, one of the last parts of the brain to mature involves planning and judgment, qualities clearly lacking for most teenagers. Combine this decision-making difficulty with the penchant for exploration and much of the risk for teenagers is perfectly clear.

In every generation, there appears to be a new, tantalizing frontier that transforms into a universal rite of passage for adolescents. Alcohol, drugs and sex are the three most common concerns, but others have crept in like prescription pills and self-harm such as cutting.

One of the newest adolescents crazes is the drive for thinness. With the expectation for both boys and girls to have unnaturally thin bodies, especially unnatural during the hormonal shifts of puberty, the appeal of weight loss has grown into a standard experience for teenagers. Peer pressure to restrict food, purge meals or take pills such as Adderall, laxatives or diuretics have grown almost unavoidable. Kids can find any number of weight loss guides on line as well to steer them towards these dangerous behaviors.

The thrill of seeing an effect on one's body can be exhilarating to a teenager who feels like life is an out-of-control roller coaster. The sense of pride and accomplishment, albeit one that is small and in the long run meaningless, quiets the constant feeling of confusion and replaces struggling self-worth with an immediate burst of confidence.

It's scary to reflect on just how powerful the drive for weight loss can be in adolescence and how success feels downright magical.

As with all of the destructive behaviors for teenagers, the long-term risks always escape their notice. Engaging in eating disordered behaviors, especially restricting food, sets off a cascade of biological and psychological responses to starvation.

No one can predict how each child will respond. No one knows if that child will just give up after a day or two, get caught in a cycle of restricting and overeating or be genetically susceptible to develop anorexia. But the increasingly common exposure to starvation for teenagers means those kids are more and more likely to find out.

Until recently, no one would even consider these risks for a child. Eating meals through the day was a matter of course and the drive for thinness nonexistent. Accordingly, the incidence of eating disorders was very small, a rare and mysterious disease people fell into without any idea what was happening. That's not how eating disorders develop anymore.

Adolescence has become a breeding ground for eating disorders, replete with friendships encouraging the behaviors, online groups dedicated to provide support and the social normalization of irrational food restriction. Just as drinking or using drugs at a young age can set that child up for much larger problems, food restriction increases the risk of developing an eating disorder.

However, parents and adults are much less likely to worry about a teenager dieting than about using drugs. Those adults may themselves be restricting food or even encouraging the child to eat less. The social norms actually span generations, leaving teenagers without any idea their behavior is dangerous. The general obsession with thinness leaves children at sea to find a sane way to understand food and weight.

With teenagers dieting and engaging in eating disordered behaviors, there needs to be a public health campaign to counter the false advertising of the food and diet industries. More specifically, children need to understand the risks of their behaviors and the expected norms that will keep them safe.

Adolescents won't necessarily follow the rules because that's the nature of the stage of life. However, exposure to the risks and norms will at least offer them some guidelines to either heed or ignore. It will allow them to know when their decisions are leading them into trouble. It will also give parents, even those struggling with food and weight, a means to teach their children a saner attitude about their bodies.

True Recovery is about Living a Full Life

Since the majority of eating disorders start during adolescence, the illnesses interfere with emotional and psychological development. Just at a time when children begin to learn about their own identity and how to interact with others in a more mature way, those first diagnosed with eating disorders start out their lives devoting energy to treatment.

The time spent in therapy learning about themselves and their emotions actually may land them ahead of the curve of this part of becoming an adult, even if the path is an unusual one. But that’s only the case for the lucky ones who recover quickly.

Others who remain sick and take longer to get well can spend many of their formative years in programs that can help them try to get well but also encourage regression in a setting aimed at recovery and not the personal growth that is the hallmark of adolescence.

The process of treatment over time can inhibit some people from feeling empowered to face the realities of becoming an adult. So much of this time of life is about finding courage to face new, challenging experiences and learning how to manage all different outcomes. For people with eating disorders, the treatment world often becomes too comfortable and transforms into a convenient way to avoid life.

Although treatment needs to provide an environment that is safe and promotes recovery, it also needs to encourage people to engage in their lives and to challenge them to participate in the world. Too often, clinicians recommend opting out of school or work for extended periods of time when there is no evidence that doing so necessarily leads to more complete recovery. For adolescents and young adults, the new world of treatment can quickly become the world they choose and find comfortable. Although treatment is often necessary, decisions about long term help need to take into account the goal of fully reintegrating into that stage of life.

The goal of treatment is not just to quell the eating disorder symptoms and return to full health. The idea is to get right back on life’s path and find a full life again.

Respecting People with Eating Disorders

The role of mental health treatment in the world of people with eating disorders is complex. For those who clearly are seeking wellness and recovery, traditional therapy is the best alternative. Mental health practitioners act as a source of support and treatment to help that person create a path out of the eating disorder.

What about the people not looking for recovery who still want support? Even more critically, what about the people completely outside the treatment world not interested in the professional help available?

The standard approach for many clinicians is to label these people as either in denial or intractable. The implication is that they cannot be helped and need to find their own motivation first. It’s even acceptable for clinicians to end treatment because the person supposedly isn’t ready.

This categorical approach to the idea of treatment seems very punitive to me. Why should people be rejected, judged or criticized for doing their best with a very difficult illness? Shouldn’t their plight elicit compassion and not judgment?

Another complaint patients often have is that clinicians feel entitled to tell patients how well they ought to be. Although recovery is an option for people sick with eating disorders, and for many the goal, clinicians have to accept that many people remain in their eating disorder and need someone to meet them where they are. That’s not easy for clinicians to do, but it establishes necessary respect if therapy can have any benefit.

The increased power of residential treatment companies also encourage the mindset that wellness is the only option and that residential treatment is the only path. It threatens to limit to full scope of treatment options and label everyone else as unmotivated.

Clinicians who treat people with eating disorders need to be cognizant of the limitations of eating disorder treatments and to be open to all forms of treatment and life paths. Flexibility, humility and openmindedness make the best clinicians to help people struggling with eating disorders.