If someone wants to "eat healthy" or "values health" does that mean they have an eating disorder?

Why that's an interesting and loaded question and my thoughts on the matter as an eating disorder therapist (and someone who also values *gasp* ... wellness).

I recently saw an IG post that read, “Apparently if you want to eat healthy these days that means you have an eating disorder”, and I immediately had so many thoughts buzzing in my brain. Then I immediately thought, “No WAY am I touching THAT topic!” You say one “wrong” thing these days and you’re canceled. But not only that…I found myself thinking, “There are a lot of assumptions and beliefs wrapped up in that single statement…this feels scary to tackle. There are so many things to say…” Then I thought, “Bump that…let’s goooooo.” (*cue 90’s rap music blasting in my brain and visions of Snoop Dog dancing…ayeee aye ayeeeeeee) !!!

So here I am sharing some thoughts that you may or may not agree with which is totally fine. I actually wish, culturally, we were more fine with that than we are. Disagreeing with each other and not being assholes…that sounds blissful, doesn’t it? I just want to shed some light on my perspective as an eating disorder therapist and someone who is aligned with the anti-diet movement and Intuitive Eating community.

First things first: valuing health and eating healthy does not automatically mean that someone has an eating disorder or is engaging in disordered eating, and this statement indicates that the person saying it or thinking it doesn’t have an accurate understanding of what an eating disorder is. And the reality is, not many people have a very accurate understanding of eating disorders because of the way they’re typically portrayed in the media! So, let’s start there.

Eating disorders are mental illnesses that- broadly speaking- have to do with having a challenging, dysregulated, and chaotic relationship with food. In our field, we often say that we cannot know if someone has an eating disorder simply by looking at their body or based on a single meal or meals a person is or isn’t eating. Why? Because it’s not enough data.

External behaviors, the way that a person interacts with food, are one part of an eating disorder, and I think people forget or simply don’t understand that they are so much more about the mind: the thoughts, emotions, and beliefs that motivate certain behaviors to come to fruition. The actual behaviors that a person does with food, what they do and don’t eat, is a fraction of someone’s experience with an eating disorder. It’s not unimportant; it’s just a fraction, not the whole.

Because of the largely inaccurate portrayal of eating disorders in the media, they’re incredibly misunderstood. Living with an eating disorder is like living with an evil tyrant in your brain who is constantly shouting rules, orders, commands, and shoulds. Guilt and shame are permanent residents, familiar foes. Eating disorders are about control, rigidity, and scarcity. Deeper than that and at their core, they are about how a person is dealing with (or not dealing with) pain, trauma, loss, insecurity, and danger. They are about emotion regulation and avoidance. There is nothing glamorous about living with an eating disorder, and I can assure you of that.

Despite the fact that our media only portrays one very singular picture of what an eating disorder looks like (thin, young, white, …), eating disorders can look like SO many things which is another reason we need to not make assumptions. For some people, an obsession with what our culture labels “healthy eating” is very much a part of their disorder. And yet for others, “eating healthy” has absolutely nothing to do with it—another reason why we shouldn’t say that someone with a desire to “eat healthy” must mean they have an eating disorder or are engaged in disordered eating.

It's not black or white…or that simple…

A cultural trend that I’ve noticed (that really drives me bananas) is this phenomenon of dwelling only in the ways of black-and-white thinking and two opposing extremes. I think people find safety in belonging to either side of an extreme or a “side”: things must be ‘this’ or ‘that’, and there is no space for nuance or complexity. We like blanket statements and platitudes and “one size fits all” kinds of ideas and explanations. While I do think that sometimes things can be black and white, when this becomes our default way of seeing the world and the perspectives of others, we fail to stay curious about the many shades of grey that lie between polarities. And it’s largely unhelpful.

Along the same vein, something that I also notice- especially on social media- is that people will have a reaction to certain ideas based not on what a person said or wrote but on their own interpretation of what they think that person is saying or implying about a similar or related idea. I see this a lot especially when my anti-diet colleagues post content about health and wellness ideology. People are quick to become reactive and defensive instead of seeking to understand anothers perspective that might be different or unfamiliar.

When we say, “Dieting is dangerous”, people hear, “OMG THEY’RE SAYING WE SHOULD ALL EAT 5 BOWLS OF ICE CREAM A DAY.”

When we say, “An obsession w/ healthy eating can be a sign/symptom of an eating disorder”, people hear, “OMG THEY’RE SAYING IF YOU EAT SALADS AND BUY ANY KINDS OF ORGANIC FOODS YOU HAVE AN EATING DISORDER.”

When we say, “It is actually disordered to use exercise as a way to punish your body or “earn”/ “burn” foods”, people hear, “OMG THEY’RE SAYING WE SHOULD LAY ON THE COUCH FOR 5 HOURS A DAY AND NEVER MOVE OUR BODIES AGAIN.”

I know that this might sound silly, but I see this kind of response to the anti-diet movement all the time. We’ve lost our ability to critically think (and it’s a bit spooky…)

Day in and day out those of us who work in the eating disorder field see the harmful impact of things like diet culture, the confusing and objectifying messages sent to people about how their bodies should look to be accepted by others, social media “experts” promoting disturbing food and exercise trends, weight stigma, anti-fatness, and our culture’s obsession with thinness at all costs. If you heard the stories that we hear, I think you too would start to question the things that we question.

When you bear witness to the deeply painful and distressing ways that an eating disorder has become someone’s whole life and identity, the way that it’s wrecked relationships and shattered dreams, you cannot help but become more critical of the cultural messages that are making people unwell, especially those related to health and wellness. Even when these messages are well-intentioned, they can have a detrimental impact on a person’s mental and emotional health.

And—just to set the record straight— none of us in our field are saying that what we eat and how we move our bodies doesn’t matter at all in terms of health outcomes. I think wellness influencers really fail to grasp this. What we are saying is that there has been an overemphasis on these things and a devaluation of the other determinants that influence a person’s health outcomes (Google: “social determinants of health”). What we are saying is that there are aspects of wellness culture and campaigns pushed in the name of “healthy eating” (i.e.: calorie counting homework assignments for kids, labeling foods as “good” or “bad”, fad diets, weighting yourself frequently…ect…) that we know don’t actually improve health outcomes at all (but definitely make rich people richer). 

No one is saying don’t eat vegetables. We’re just begging for people to start to critically think about how some of the mainstream messaging around health and wellness at best, might not land for some people depending on their unique indentities and circumstances and at worst, be making people mentally and physically unwell (and yes, contributing to the increase in eating disorders / disordered eating).

“But Rachel, I want to eat healthy. That’s important to me because I want to live a long and beautiful life. I want to nourish my body well.”

Guess what?

ME. TOO.

And I have some questions for you.

Couldn’t my use of the word “healthy” be entirely different than yours? Or maybe not entirely, but slightly or somewhat? Does your pursuit of health and wellness come from a place of freedom, or does it come from a place of fear, obligation, and self-denial? How much anxiety surrounds your relationship with food? Are you choosing certain ‘healthful’ foods because you genuinely want to or because if you don’t, something bad is going to happen?

Here’s where this gets a little bit tricky and complicated. When you’re struggling with an eating disorder, it’s common to try and mask your suffering or protect the eating disorder by telling people that your choices are coming from a place of freedom, “healthy” values, and because you want to eat / exercise in a certain way.

A person with an eating disorder might deny having ice cream and say they’re not craving it or their stomach hurts when it’s actually rooted in fear, restriction, and avoidance. A person with an eating disorder might mask a specific food fear by lying to others and themselves about their preferences. For example, they really might try and convince themselves they don’t like chocolate because it’s “bad” or “forbidden” so they say they don’t “like it” which is just code for “I’m scared of it changing my body and threatening my sense of belonging and acceptance.” They might also be faking a certain allergy to justify eliminating a certain food group so that people don’t ask questions. All of these behaviors serve to protect the eating disorder.

And yet, a person might pass on ice cream or chocolate or any food really and it doesn’t mean that they automatically have an eating disorder. A person might genuinely and honestly not be able to tolerate gluten or dairy. No one is denying that food allergies are real for some people. However, what we get to be mindful of is that where there is anxiety around food due to an eating disorder or a history of food restriction, there is often GI upset and discomfort which gets very easily mislabeled as an allergy or “sensitivity.”

My main point is this: a person might order a salad at a restaurant or prefer to buy organic eggs and grass-fed beef—behaviors that might look “orthorexic” or “diet-culture-y” and it doesn’t automatically mean they have an eating disorder. It means that they could. But it also means that they could have a true and genuine preference rooted in their values and coming from a place of freedom and alignment.

I think what I’m getting at is that it’s never really about what a person is eating or not eating that is indicative of a “disorder”. It is about intention, motivation, and underlying beliefs. It’s about your why. It’s about the distress and anxiety (or lack of distress and anxiety) underlying your decisions and choices. It’s about the mental gymnastics that may or may not be happening underneath what people can see.

You can “eat healthy” and have an eating disorder. You can also “eat healthy” and *not* have an eating disorder.

So like… how do we know if someone’s “healthy eating stuff” is an eating disorder or not an eating disorder?

I think that we would all agree that there are certain behaviors around food that are more objectively disordered. For example, eating 1200 calories (or less) a day, purging after eating, exercising without adequate caloric intake, and skipping meals.

But sometimes it’s not so black or white and we (eating disorder therapists and dieticians) get to ask questions in order to gain more insight and determine whether someone’s way of eating is disordered or not – though usually if someone has found their way to my office, they already have at least a hunch that their “healthy eating” might not be so healthy based on what it’s like to live inside their brain currently.

These questions are by no means exhaustive, but they are some questions that I like to ask people in order to do some deciphering and to build some curiosity around a person’s relationship with food and body:

• Does your way of eating consume your whole life or is it a part of your life that allows you to live your purpose and pursue other goals?

• How much time and energy in each day do you spend thinking about food and your body?

• Are you able to enjoy a wide variety of foods?

• Do you make space for cultural foods that matter to you?

• Does your way of eating interfere with your relationships?

• Are you able to experience flexibility with food?

• Do you allow spontaneity, pleasure, and fun to exist within your relationship with food and your body?

**How someone answers these questions does not automatically mean someone gets an eating disorder diagnosis by the way. This is just a starting place.

One thing that I think is really interesting is that there can be so much talk on the internet and on social media about whether a stranger does or doesn’t have an eating disorder. There is a really popular cookbook author and influencer who I’ve noticed is getting slammed in her comments recently for looking very sickly and emaciated. Does she have an eating disorder? Maybe…probably (based on other things I know about her outside of how her body looks). I think it’s really sad, though, that she is having so many assumptions made about her in the comments…the comments are MEAN, ya’ll. Not all of them. Some are empathetic and kind, expressing genuine concern for this human, concerns that make sense. I think we have to remind ourselves though that there is so much about a person’s life that we don’t see / that they don’t post on social media.

Let’s leave the eating disorder diagnosing abilities up to the professionals, okay?

If you are concerned about a loved one or a friend, there are far better ways to go about it than shouting on the internet - THEY HAVE AN EATING DISORDER, OMG!

…

But Rachel…you’re actually kind of crunchy and holistic, and I know your story, I know you’re recovered from an eating disorder, too. So like…how?

Are you ready for things to get spicy? Buckle up, buttercup.

There is some stuff in the wellness space that does resonate with me and that I even align with. And sometimes I feel scared to say that because I’m automatically like, “They’re going to think I’m a fraud!!! The eating disorder world is going to cancel me!!!” But the reality is that I can be anti-diet and Intuitive Eating aligned *and* I can practice certain things that might appear more “wellness-y”.

We don’t have to put ourselves in boxes, okay?

I know myself, and I’ve done a whole lot of therapy to be able to say that with integrity. I know where I’ve been in the past, and for a large portion of that time, it was in the depths of an eating disorder that almost took my life. And I know that now, I can allow my preferences to be my true preferences because I’ve done the work to detangle unhelpful and disordered beliefs and heal.

Have I mentioned that I’ve gone to therapy?! (*insert cheesy, squinty eye, laughing emoji*)

If you came to my house and opened my fridge you would see pasture-raised eggs, grass-fed beef, and lots of fruits and veggies— some organic, some not. You might even see some fancy AF parmesan cheese because I’m Italian, and I don’t mess around with my cheese. Which is a privilege.

It is a privilege that I get to buy cheese like this and boy do wellness influencers like to forget that *most people* can’t spend hundreds of dollars a week on groceries. I can’t spend that either (I don’t always get to buy fancy cheese…*sigh*).

Wellness influencers and healthy eating advocates often fail to recognize and understand the systemic inequalities that exist in terms of food accessibility and availability. If you’re poor and you have a family to feed you are going to be motivated by one thing: survival. And you cannot calorically survive off of peas and kale (assuming you have access to peas and kale). So of course you’re going to choose what might look like an “unhealthy” option and we *have* to start recognizing this. When we demonize “processed foods” and “unhealthy foods” we fail to recognize what we’re inherently saying about the people buying those foods. And then we blame and judge those people for making “poor choices”…have you ever considered that it might be the only choice they can make?

*Also, the fact that there are billionaires in this country but like 1 in 6 children are food insecure…make it make sense. It makes me sick. And so sad.

I knew I would digress. But that was an important detour. Conversations about health have to coexist with conversations about wealth and privilege. And, if you’ve never watched this Ted Talk, you should.

Okay, so back to my fridge.

You would not just see foods that wellness purists would give me gold stars for having. You’d also see some stuff that wellness purists would scoff at (i.e.: beer, non-organic condiments, Trader Joe’s cinnamon rolls and frozen meals, and … brace yourselves for this one.. stuff with SUGAR IN IT. Ice cream remains in our fridge at all times). Such a rebel, I know…

Our family is also a bit holistic and hippy-dippy. I’m trying to work on reducing our plastic use, I prefer stainless steel, and we use a Berkey water filter. My favorite shoes are my Birkenstocks (I liked them before they were cool again…for the record), I like the Genexa brand for medicine, and using non-toxic cleaning supplies in our home is important. I also believe in yoga, and breath work for nervous system regulation, and literally last week I made homemade immunity gummy bears for my kid using supplements from a brand that wellness people love. And yes, just to complete your mental stereotyping of me, I do make sourdough bread and homemade granola.

But don’t stereotype me, okay?

BECAUSE… I don’t totally fit in THAT WORLD either despite being pretty aligned with it. I’m not a purist in either extreme direction and that might bother some people (or just confuse people) but it’s honestly the space where I have found peace, flexibility, and sanity and that feels right and aligned for me and my family.

Some people might call this lifestyle “balance” or “balanced” but for me, that doesn’t capture it adequately because the word “balance” tends to carry the assumption that there are still rules and calculations, perfection and rigidity. And there is none of that in my relationship with food or my body anymore. My food choices (and lifestyle choices) are intuitive, based on what’s available and what sounds tasty, nourishing, and fulfilling. It’s not “balanced”, it’s just aligned, honest, and life-giving to me. Sometimes it might look balanced and other times it doesn’t and that is okay.

I can resonate with certain behaviors or eating preferences that the holistic wellness world encourages and still be recovered or in recovery from an eating disorder.

The wellness world doesn’t get to “own” things that might feel well and right for you, and I think sometimes when you’ve had an eating disorder history there tends to be some caution and consideration before engaging in things that might seem “diet-y” or “wellness-y” to certain people (or to yourself!) And I actually think that we, meaning those of us with an eating disorder history *should* take pause and be mindful / thoughtful about the “why” behind our decisions about food and lifestyle. I think it’s thoughtful and wise.

Not because we need to be afraid or make perfect decisions but because it’s a conscious way to protect our recovery and prevent relapse. Because we have different genetic predispositions than other people do and the reality is that for us, “healthy eating” and things associated with the mainstream use of that word can be a slippery slope. Because we’ve learned in recovery that responding mindfully is more fruitful than reacting and being truthful and honest is paramount for recovery.

Sometimes, even now, and I’ve voiced this more recently to my husband, I feel afraid that people won’t “believe” I’m recovered or have a peaceful relationship with food and my body if they see my grocery cart after a trip to Whole Foods. Heck, I’m an eating disorder therapist after all!? But guess what? I don’t actually owe anyone anything (and neither do you) and my being in alignment with my integrity, my purpose, and my beliefs is what’s most important.

I’ve said it before and I’ll say it again: it has taken me years of work to get to where I’m at now. Years of food exposures, trauma work, and MAJOR reevaluations of my beliefs about what it actually means to be “healthy”. Years of unlearning all of the lies I believed about my body and critically thinking about the messages I’ve received about how my body “should look”. I will never stop being vocal about the anti-diet movement and about Intuitive Eating because I care about it, I’m aligned with it, and I want people to be free from the chains of eating disorders.

I think what I want so badly for wellness influencers and purists to understand is that yes, sometimes some of what they say *is* disordered (but not always). I want them to understand that fearmongering about how certain foods are going to make you die or poison you isn’t actually helpful and that what might be the healthiest option for some people (depending on, yes, an eating disorder history or just issues of access and accessibility) might be the very food that they are demonizing and moralizing. I want them to understand the privilege that is inherently assumed when we think all people can afford to eat “clean”. I want them to understand that there is actually so much more nuance than what often meets the eye (or in what is said on Instagram). I want them to understand that rigidity, anxiety, and shame aren’t that good for your health.

…

So if someone values health or wants to eat healthy…does that mean they have an eating disorder? Maybe… possibly…but maybe not.

We can critique the “wellness world” *and* want health and wellness for all *and* sometimes be like, “Thank you, Karen, for that yummy recipe or DIY non-toxic cleaning solution.”

We don’t have to put ourselves in boxes, nor do we have to find ourselves exclusively on one far side of the spectrum. In fact, true health and wellness are rarely found through the means of extreme sides or beliefs. And also… rigidity is really boring.

We get to have integrity and peace. We get to take what works for us and leave what doesn’t. We get to be misfits, and we even get to be misunderstood sometimes.

Being anti-diet doesn’t mean anti-health. And if the people who are parading the internet saying, “Apparently if you want to eat healthy, you have an eating disorder” actually took the time to understand that and to really understand the heartbeat of the anti-diet message, well…they wouldn’t be saying the things they’re saying on the internet.

So in conclusion…

• Some people have eating disorders.

• Many people have undiagnosed eating disorders.

• Some people “eat healthy” and don’t have eating disorders.

Xoxo,

Rachel