When the “healthy eating” message goes very, very wrong

It seems you can’t go anywhere without seeing “healthy eating,” anti-obesity, weight loss messages. They’re literally everywhere. Besides the magazines in the grocery store checkout lines, Pinterest boards, and mass media, children are receiving lots of these messages in school. More and more schools, it seems, are limiting sweets that can be brought in for kids’ birthdays, requiring mandatory measuring and reporting of BMIs, and directly teaching the anti-obesity message.

I’m all for removing vending machines and fast food from school cafeterias. Kids need higher quality food than that provided by Taco Bell. We owe our kids better than that. I’m in favor of providing activities at recess and helping kids discover that physical activity can be fun in gym class. I’m all about talking about ways to improve our health. Although more schools have jumped on the anti-obesity bandwagon, there is very little research done to back-up the efficacy of these efforts as well as their potential risks.

Many in the ED community have raised concerns that this focus on “healthy eating” (grammar wonks will know that to be technically correct, the term should be “healthful eating,” but I will use healthy eating simply because that’s generally what it’s called) and the anti-obesity message generally increasing fat phobia, the obsession with thin, and an over-focus on calories and weight. Seeing that these things are frequently (though not always) seen in disordered eating and eating disorders, perhaps they are right to be concerned. The problem is that there really hasn’t been any real research on this until now.

A group of researchers in Ontario have just published a very preliminary study in the journal Eating Disorders that was a case series of four children seen at ED clinics who stated that they started restricting their food intake after a health class or other lesson on the dangers of obesity (Pinhas et al., 2013). Two of the patients were 13; two were 14. As well, two patients received diagnoses of restricting anorexia, while the other two were diagnosed with EDNOS. One patient was male. Two patients (both female, both with AN diagnoses) were ultimately hospitalized for their eating disorder. All of the patients were described as perfectionistic, anxious, and over-achievers (check, check, and check, here). The researchers didn’t provide any information on outcome.

One girl (age 14) began restricting her food intake after doing a class assignment on the dangers of eating disorders. The material presented caused her to start worrying about her own weight and intake. I found this particularly interesting because my own eating disorder escalated dramatically when one of my friends in college relapsed with her own ED. I wasn’t copying her or even competing (I was really, really worried), but the constant focus on food started to really increase my own paranoia about my eating and exercise habits.

The boy (age 14) really highlighted the relationship between perfectionism and the potential dangers of healthy eating messages.

According to the family, they understood the goal of this ["healthy living"] program was to help students to eat less fat and to increase intake of better quality, low calorie carbohydrates. It also encouraged a more physically active lifestyle. The patient was determined to be “the best” at healthy living. He began “eating healthy” and increased his exercise. {Emphasis mine}

Perfectionism has very strong links with eating disorders (Bulik et al., 2003), as well as body dissatisfaction. When you take a perfectionistic mentality like in the boy above and combine it with even some innocuous sounding anti-obesity messages, it’s easy to see how it would be taken to the extreme. You worry that someone will judge you for eating “bad” foods. You are determined to do this healthy eating thing right, to be the best at it. There is no room for junk food or lazing about in your life, nope. Of course, many things can trigger this, but it is one potential path to an eating disorder.

So do anti-obesity messages cause EDs?

I have increasingly seen that healthy eating has become the new language of EDs, rather than traditionally what you would see about wanting to be thin. The zeitgeist is still very much focused on body shape and appearance (at least culturally speaking), but there’s a lot more health talk in there now. I see a lot more orthorexic-type obsessions rather than the old fat-is-bad standby. It’s still an eating disorder- that hasn’t changed- although the lingo surrounding it has.

What does this study tell us? Given the design of the study (just reporting on four teens who presented to an ED service in Ontario), we can’t really conclude a whole lot. The background on the patients was very brief, and the study, by its nature, can’t account for many of the accompanying factors that contribute to eating disorders. The researchers mentioned perfectionism, but they didn’t formally assess it. Nor was anything mentioned about many other experiences in their life, their current stage of puberty, potential cultural differences, and so on. No family history of EDs was mentioned, so I don’t know whether there wasn’t any (unlikely in all four cases) or it wasn’t assessed or just not included. It’s also impossible to know what other messages they might have been exposed to.

Saying that anti-obesity campaigns cause EDs is wrong. We don’t know that from this study. We know that it appears to have contributed in these four cases, but who could say whether these teens would have gotten sick even without such healthy eating messages. The study isn’t bad, but just reporting on four cases doesn’t leave us with very much information with which to draw conclusions. Still, the authors’ own conclusions are worth sharing:

Children predisposed to develop weight-related disorders might interpret messages about healthy eating and weight in extreme ways resulting in dangerous behaviors. Also at risk are children who are going through the normative transition of early adolescence, where the stressors such as natural increases in body weight and fat, increased desire for peer acceptance, and peer pressure to diet are known to trigger weight and shape preoccupation.

I blogged on it because it’s the first study of any type that I know of that actually looked at the link between healthy eating messages and the development of EDs. I also read the study with interest because there has been so little research done on the efficacy and potential harm of anti-obesity campaigns. Every day, it seems, more and more places are going ahead with broadcasting the anti-obesity message. I have several problems with this, but one of the major ones is that the programs are far outstripping the research. We don’t know if they work, if they cause harm, if they’re neutral, if they help some and harm others, none of that. We just don’t know. I think that before we invest time, money, and our children’s futures into these programs, we should ask some really basic questions about it.

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14 Responses to “When the “healthy eating” message goes very, very wrong”

  1. I remember when I was little we had two good sized recesses, a lunch period, and gym class every day. Now kids usually get one recess that’s less than half an hour. They sit and sit and sit all day long. Then they come home and they are too drained to want to run about and play- and even if they had the energy, they have mounds of homework to complete, even in the first grade. It’s not about the way they eat- it’s about the lifestyle they’re forced to live.

    I love our country and I love our teachers and I believe they do the best they can. But when it comes to education, our country is floundering- they promote more testing and more homework over natural exploration and social interchange/questioning between teacher and students. It stinks.

    Little children need to hear fewer words about “healthy eating” and have more time to run and play, while the ADULTS concern themselves with providing the healthy food FOR them. That should not be the children’s concern- at least, not while they are so young.

    And, how old is appropriate to introduce this subject matter? I do not know. I know that when my junior high PE teacher “educated” us about healthy eating habits and had us record all of our food intake for a weekend, that was a really bad move for me, and I was already 12. I was already finicky, perfectionistic, and had odd food rituals, but I had never, EVER felt “shame” about food until that weekend.

    I painstakingly recorded every bite and found I was overwhelmed and completely ashamed of myself- it wasn’t “good enough.” Too much of one category. Not enough of another. I looked like a pig. I was terrified about how it all looked on paper. I ended up erasing and changing a bunch of things and lying about things on the assignment because I wanted it to look better- I wanted it to look more “healthy.”

    Then I promptly set about eating differently so that the things I recorded wouldn’t be “lies.” I hated lying and felt painfully guilty. I never lied or cheated. I had to eat differently so that it wouldn’t be lies. I remember I had eaten a chocolate poptart that weekend one morning- which I erased off of the paper, of course, since it was not “healthy”- and I decided I would never eat another one of those horrible, UNHEALTHY things again. Or if I did, I sure wouldn’t tell anyone. I was so ashamed. I still shudder when I walk by chocolate poptarts in the grocery store- “Remember when you were so out of control???” goes through my head.

    I’m not saying I developed anorexia solely because of that one assignment. But I can tell you for sure- that assignment was a major stepping stone on my way from finicky kid with odd food rituals to anorexic shitting her pants from too many laxatives.

    I think adults need to be in charge of keeping a child’s food menu healthy. I think that keeping food healthy, like paying the bills, is an adult responsibility. Children should be safe from the grown up worries like how to pay the bills. They should not have to shoulder burdens meant for adults. Food is a matter of health and ultimately of life and death. Instead of pawning the responsibility of it onto the small unready shoulders of our children, ADULTS should be stepping up and making changes. Taking out the crappy vending machines. Providing healthful meals and snacks. And giving children room to run and play and burn calories without ever knowing they are doing so.

  2. Spot-on reflections concerning the “changed lingo” surrounding ED’s. You are correct, in my opinion, about the “zeitgeist” concerning the pursuit of thin being ever-present..but with an orthorexic use of euphemisms newly added to the “new language of ED’s”…such as “Clean Eating”..and grain/sugar/starch banishment…more and more macro-nutrient exclusion… held up as a banner of perfect healthy eating. I am certain that many of the “clean-eating” blogs are written by the eating disordered..they are certainly READ by the eating-disordered…and sometimes I do wonder if many of the paleo or vegan sites are simply “covers” for frustrated dieters or the eating disordered searching for “a way to stay/become thin (anorexic)via a socially acceptable “front”..healthy/vegan/paleo eating.

    I have noticed that the bloggers are often very thin…intense runners or cross-fitters…and make all kinds of gorgeous yet garish food porn-ish “treats” using healthy ingredients and sugar substitutes (think Stevia). It is almost as if the message being sent is this: Eat my yummy, ultimately “faux” treat, and you too can become as thin as me!” Nevermind that these bloggers probably a)give most if not all of their “creations” away; b)run or cross-fit to the max, c) are in the 14-24 year old age bracket..with the metabolisms to boot.

    Why do all of these blogs provide us with a constant barrage of “just like the real deal” recipes?..It is if we are are being taught that the real food item is “bad” or “dangerous” and we need to be “Clean Eaters” in order to be good, clean people.

    Currently in “recovery” for anorexia nervosa (restricting)..with an occasional, albeit rare lapse of “control” around food..I find I have used the paleo movement as an excuse for avoiding major food groups ..This also “destresses” eating for me to some extent, as I have fewer food choices. Saying you are “Paleo” to people is far more socially acceptable..even laudable..than saying you are a recovering anorexic and have a “problem” with certain foods…Attention ED care-givers..this new wave of “Clean Eating” is providing the perfect security blanket for those with ED’s to hide under. I know I use it in that, unfortunate and regrettable fashion.

    Sorry for this long-winded comment…but this post really stirred the “aha!” chord from deep within. Thank you for bringing this important topic to light, and I will be personally very interested in the continued research regarding the healthy eating movement.

  3. First, I agree with Donna 100 percent in terms of “healthy living” blogs and the like. They are often a thin veil for accepted disordered eating and overexercise under the guise of fitness and “health.”

    Carrie, you know my history of exercise addiction and being underweight/restriction, so I won’t rant, but I will say that the hardest part about trying to successfully recover–after 10 years–is blocking out ALL the messages that surround me and remembering that I need to do my own thing, that for me MORE calories than an NFL linebacker are needed and not the amount of the cheerleader. It’s so hard, even for someone like me that is strong-willed and not easily swayed by the public, to go against everything you’re constantly told is accepted.

    Sitting more and exercising less? You’re lazy. Eating a ton, and not just vegetables? You should clean up your act and jump on a bandwagon. The problem for me is that when I have those moments of weakness and want to revert back, it’s easy to justify, as it’s what you read everywhere and it’s accepted as “healthy.” How can exercise be bad? How can restriction be harmful? Exactly.

    Sorry for the rant, but I’ve relapsed a bit and have been thinking about how I don’t have anywhere I can really go to surround myself with others facing the same challenge, others going against what we’re told we all “need” to do. Obviously this post provided that place, so thank you ;)

    • So in agreement with Abby here…ditto on all she has written. I too am in an unfortunate phase of relapse..and the anorexia demon has been on my frickin’ shoulder for neigh on ten years as well. I find that following your wise blog Carrie…as well as Gwyneth Olsen’s “Your Eatopia” is helping immensely in providing clarity in the apparent “fog” of what is healthy eating or not…especially for those of us struggling to extricate ourselves from the “clutches” of various ED maladies…I love and admire your strength Abby..to realize that we really must stop “comparisons” and learn to honor what will eventually lead to recovery. I know I need to eat more like the “linebacker” in this moment as well…for brain cell recovery and physical recovery. This..as I type STANDING UP ..because the “general opinion” of those-who-would-preach-health might consider sitting during such activity “as lazy”….I could go on and on…but I think you’ve opened up such an important topic of discussion that I want to leave the floor for other comments!

  4. I feel more studies of this nature are warranted because of how much of an impact the media and these sorts of messages have on society, especially children. I know that my desire to eat healthfully was sparked during high school English when we learned a bit about health within our writing curriculum and, combined with all of the “thin guys get the girls” mentality that high school is filled with, everything went downhill afterwards.

    Like Abby stated rather nicely, we have such a negative outlook on behaviors that aren’t conducive to our health and even if the majority of the country is obese, those messages still affect everyone, not just the target. I can’t sit more than 20 minutes without thinking to myself “oh great, I’m going to die sooner because I’m being so sedentary.”

    *Sigh* I do hope more funding goes into research of this nature.

  5. Excellent, Carrie. I agree we need more studies.

    Let’s leave aside the causes of eating disorders for a moment.

    The anti-obesity message and the lengths schools and government go to push that message can make school feel like a very unsafe and triggering place to someone caring for a child who already has an eating disorder.

    We tend to focus on the causes of eating disorders and not how those same possible causes affect people who already have and/or are in recovery from eating disorders. This should matter too.

  6. My kindergartener daughter, who was diagnosed with anorexia in first grade, says she started restricting because of “healthy eating” messages from teachers. She first reduced desserts. On her 7th birthday, in first grade, she ate just one bite of birthday cake. I thought it was odd.

    You mention the perfectionistic personality–would you comment on what causes that? What causes a child to over-interpret and over-react to messages from those around them? How is this personality type created and maintained? I think a lot of people believe that this perfectionistic personality is created and maintained by demanding and belittling parents … I wonder if you might blog on this topic? This blog makes it sound a bit like the personality is at fault. Methinks that was not your intention …

    Anne

    • Perfectionism has strong genetic components as well as being influenced by the environment. Both my parents were extremely perfectionistic, and it had a pretty significant influence on me. Not because they were belittling and demanding (they expected a lot, but not anything untowards) but because it really normalized my own perfectionism. It wasn’t seen as odd for me to be up until 2am doing schoolwork because that’s what my mom did. And, hell, she was up until 2am every day cleaning, so no biggie. None of us ever realized just how toxic perfectionism could be.

      I think these environmental cues sort of amplified and normalized my innate perfectionism, but a lot of a person’s tendency towards perfectionism is genetic.

      But with regards to the personality being to “blame”: well, no, I don’t really want to assign or attribute blame on the subject. It’s not the sufferer’s fault that they started obsessing over the healthy eating messages. That being said, there’s also a reason why they started obsessing in the first place, why they got stuck on needing to be “good” at eating healthy and so many other kids couldn’t care less. That’s where personality comes in.

      And I’m actually planning a blog on a new study about perfectionism and EDs this afternoon. :)

  7. Wonderful! My daughter is extremely hard on herself, perfectionistic, and has a head full of negative voices. But, mom and dad aren’t perfectionists at all … we are high achieving, but not perfectionists. It quite seems to me that she comes to this personality” genetically, but not environmentally … I hope that this can be teased out, someday …

    • I think figuring out where it came from is much less important than your daughter learning how to manage her own tendencies. We’ve all got these tendencies, whether it’s towards perfectionism, alcohol, bad boyfriends, whatever. For me, accepting that I am very perfectionistic but trying not to let it run my life (ie, not working a story to death and instead spending time with my boyfriend and cat) was a big thing.

  8. Great post!

    I feel that ‘healthy eating’ messages can definitely contribute to disordered eating. Especially when ‘healthy’ is conveyed as synonymous with restrictive dieting.
    Take a look at our blog post about healthy eating in eating disorder recovery.
    http://sizedupedawareness.tumblr.com/post/64345476625/illusions-of-recovery

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Trackbacks/Pingbacks

  1. How to talk to kids about obesity | ED Bites - April 4, 2013

    [...] For starters, I blogged about the study my friend was referring to here. [...]

  2. Interpreting Anti-Obesity Campaigns with a History of Disordered Eating | Science of Eating Disorders - May 28, 2013

    [...] children (see Pinhas et al., 2013. Carrie Arnold of ED Bites wrote a great post about this study here), participants feared that the focus on obesity might lead to a glossing-over of self-starvation, [...]

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