"We live in a culture that celebrates and encourages disordered eating," my dietitian tells me. We meet every other week, and talk about how to eat intuitively; how to dissociate the words "good" and "bad" from food, and how difficult that is, especially when diet talk is everywhere. This conversation is especially pertinent in light of the new Weight Watchers app for children, Kurbo, which perpetuates the very behaviors I now go to therapy to unlearn.

When individuals want to lose weight, the most common advice they receive is to eat less and move more. Counting calories is widely heralded as critical to weight loss-Jillian Michaels recommends eating "no less" than 1,200 calories per day for women, or 1,600 calories per day for men. For some, these guidelines may work. For others, they will undoubtedly fail. And extreme weight loss, like the weight loss shown on NBC's hit show Biggest Loser, underscores the incredibly nuanced difficulty of maintaining extreme weight loss.

A study published in the journal Obesity found that all but one of the former Biggest Loser contestants from seasons 1-8 had gained back at least some of the weight they lost during the 30-week reality TV competition. Long term, all of the study participants had dramatically slower metabolisms and drastically less leptin-the hormone that signals hunger and satiety. Combined, these factors make maintaining dramatic weight loss in the long run extremely challenging, if not impossible.

Biggest Loser contestants were given advice and guidelines that, when adopted by a very thin person, raise red flags for an eating disorder. Kurbo does the same thing. Disordered behaviors are actually recommended to those living in larger bodies. If a clinically obese person strictly counts calories, cuts out entire food groups (carbs, fats), and exercises obsessively, they are widely applauded. Those same behaviors are huge signs of disordered eating, but because these behaviors are largely condoned and taught, eating disorders have risen steadily in recent decades.

Susan Ice, MD, an expert in eating disorders and medical director of the Renfrew Center in Philadelphia, wrote, "The incidence of eating disorders has doubled since the 1960's and is increasing in younger age groups, in children as young as seven. Forty percent of 9-year-old girls have dieted and even 5-year-olds are concerned about diet."

Because diets are over-emphasized, many people fall into cycles of chronic dieting that border on obsessive. For a long time, there was not a word or phrase to describe obsessive dieting, and the term "orthorexia" is relatively new. In 1996, Dr. Steve Bratman, M.D., coined the term, "orthos" meaning "right," and "rexia," meaning "hunger." "Orthorexia" literally means, "righteous eating," and can deeply affect an individual's quality of life, detracting from their mental health, social life, and physical well being.

While focusing on consuming healthy foods doesn't seem like a bad thing, it can quickly and easily spiral into an obsession. Personally, an obsession with eating "clean" foods meant restricting anything I chose to deem unhealthy. Restriction is a key characteristic of anorexia, and before I knew it, I went from "eating clean" to restricting everything from sweets to crackers to potatoes to canned goods to pretty much anything that was sold in a package or bag.

I leaned hard into veganism, consuming literature that touted the benefits of a whole food, plant based diet for healing nearly any ailment known to humans (cancer, diabetes, thyroid disorders, depression, hypertension, arthritis, muscle spasms, migraines, etc, etc, etc). One of the most common side effects of orthorexia is malnutrition, which can cause women to lose their menstrual cycles, disrupt hormones, and ironically enough, lead to decrease in overall health.

The obsessive, ritualized nature of orthorexia is one of its most compelling underlying traits. Below are some common signs of orthorexia; if you notice any of these habits or actions in yourself or someone you love, contact the National Eating Disorders Association helpline at (800) 931-2237, find local resources HERE, or speak to your physician.

Signs of Orthorexia

- You bury yourself in food research, or spend hours thinking about or planning meals. I used to constantly look up recipes on Pinterest and meticulously calculate the calorie content for each serving-this is not normal or healthy behavior because the bulk of my time and energy was spent thinking about food.

- You refuse to eat a broad range of foods, or cut out entire food groups. Certain diets (Keto) encourage the elimination of carbs, even completely unprocessed carbs from fruit or vegetables. If you take a step back, it's considerably insane to believe that a banana is egregiously unhealthy. Refusing to eat a wide range of foods negatively affects your social, mental, and emotional health.

- You fear losing control. Fear is an underlying characteristic of most eating disorders, and going out to dinner at a restaurant or eating something you didn't cook yourself can be devastating if you're struggling with orthorexia.

-You criticize what other people eat, yet have no rational expectation for the rules you've created surrounding food. Again, restricting fruit in the name of better health will look pretty crazy to a lot of people. Many individuals struggling with eating disorders talk about food often, and criticizing the food intake of others is a roundabout way of justifying their own food choices.

-A preoccupation with food that affects how you feel about your own self-worth. If you eat something "off-limits," your self-worth dips, whereas if you eat something "healthy," you feel good about yourself. This is an exhausting and futile cycle that reinforces the incorrect notion that value or worth is not inherent, but something to be earned or "won."

It can be difficult to differentiate orthorexia from simply striving to eat healthfully. If you're not obsessing about food, if it's not negatively impacting your life, and if you allow yourself to ingest a wide variety of food, you're probably okay. People with orthorexia *typically* don't have an extremely poor body image, and it's not necessarily rooted in obsession over appearance. Rather, orthorexia is marked by a deep need to only eat "clean" and/or "healthy" food. It has become increasingly common in a landscape where food is scrutinized, lauded, and demonized beyond belief.

Watch the following video about orthorexia from the National Eating Disorder Association (NEDA)

P.S. I'm not a doctor, eating disorder specialist, or dietitian. I can't diagnose anyone with anything, but I can provide information that is *hopefully* helpful. If you think you may be struggling with an eating disorder, I highly recommend seeking professional care. If you don't think you can afford it, contact NEDA and they can help you find the care you deserve.

xoxo

Sarah Rose