Understanding Eating Disorders Educational Series (Part 5)

Is Food a Moral Issue, Health a Value, and Body Size a Virtue?

I haven’t stopped talking about diet culture, disordered eating, and eating disorders (ED) for months now.

Even though the topic isn’t trendy or popular, it is vital that it gets attention. It’s a literal matter of life and death.

Our society is steeped in diet culture.

Concerningly, its powerful, destructive messaging and memes have now etched their way into health and wellness protocols.

What used to be considered restrictive, carefully monitored diets are becoming normalized and even included into “healthy” treatment plans in some integrative medicine circles.

Even though I’m not upping my SEO (search engine optimization) love on google with this topic, especially being a naturopathic and functional medicine doctor, I feel called to keep on this subject until its completion.

According to Allied Market Research, “the weight loss and weight management diet market size was valued at $192.2 billion in 2019, and is projected to reach $295.3 billion by 2027, registering a CAGR (compound annual growth rate) of 7.0% from 2021 to 2027.”

The above means you won’t be seeing this message to stand up to diet culture in a lot of other places.

Yet, my pleading caution to not become a victim of the empty promises of the diet industry is not just being muted out because of money.

I think, as a whole, people have been put into a trance to believe that health is an ethical value, smaller body sizes are virtuous, and food has a moral significance.

Therefore, when I talk about all aspects of holistic wellness (besides nutrition and exercise), health at every size, and balanced eating, it could be jarring.

It seems that to be accepted into the wellness culture and cool healthcare communities, one must (1) be striving for optimal health, (2) be of a societal accepted body size (or at least dieting, exercising, and punishingly restricting themselves to get there), and (3) eating only the foods deemed “good” by the most popular dietary trend or health influencer.

The problem with these societal norms is threefold:

1. Pursuing health is a choice. Obtaining it can be a means to explore one’s purpose unencumbered by body woes and does have many advantages.

Yet, health is not an ethical value. Viewing someone’s health choices as a moral issue is termed healthism, and it’s bad news bears. Furthermore, true holistic wellness is more than diet and fitness choices.

2. Body size stigma leads to mental and physical damage. By focusing on one’s weight as a problem and body shaming, our nation is not getting any healthier. In fact, we are making things worse for everyone.

3. Food decisions should be the result of personal preference, education, bodily awareness, and physical and emotional needs (including pleasure). They shouldn’t be related to morality (unless it is a true religious observance) or societal pressure.

Regarding number three, I’m not advocating that junk food is good and that organic food is useless.

I believe that food can be medicine and organic and regenerative practices are important for our planetary and personal health. However, I don’t feel that making people feel guilty for having a Twinkie is a solution to our healthcare problems. I also feel socioeconomic access to what is available should be honored, and poor food quality should be confronted with policies, not food shaming.

The bottom line is this….

Due to people literally buying into diet culture’s fake promises, eating disorders are on the rise, and they are going unnoticed and undertreated. Eating disorders are fatal.

We need to pay attention and be educated about this.

Recently, we already explored several categories of ED:

• Anorexia Nervosa (AN)
• Bulimia Nervosa (BN)
• Binge Eating Disorder (BED)
• Other Specified Feeding and Eating Disorder (OSFED)

In this post, I want to discuss two categories in “Other” of the subtypes of eating disorders.

These are muscle dysmorphia and orthorexia. These two disordered eating patterns will be the focus here because they could easily be disguised as “healthy” due to what is being normalized at this time.

In my conclusion to this series, I will provide a brief description of the remaining categories of eating disorders and what I believe may be a wholistic solution.

The ED Category of “Other”: Muscle Dysmorphia & Orthorexia Nervosa

What is Muscle Dysmorphia

According to Healthline:

MD is a mental health condition in which people see their bodies as small and lacking in muscle. People with MD are often considered very muscular by other people, since they routinely engage in muscle-building activities.

The American Psychiatric Association classifies MD as a subclass of BDD (Body Dysmorphic Disorder). Informally, it’s sometimes referred to as “bigorexia” or “reverse anorexia.”

There’s still debate as to whether MD should be considered an eating disorder, a behavioral addiction, or a form of obsessive-compulsive disorder. People with MD often become so preoccupied with their appearance that their lives are centered on building more muscle.

Diagnostic Criteria for Body Dysmorphic Disorder/ Muscle Dysmorphia

Inside Out lists the following criteria for Body Dysmorphic Disorder:

• Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.
• At some point during the course of the disorder, the individual has performed repetitive behaviours (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns.
• The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.

Specify if with muscle dysmorphia: The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case.

Note: While MD is currently classified under Body Dysmorphia, it belongs with the eating disorders and the skill set the ED clinician possesses make them best placed to assess and treat the illness.

Mistaking Muscle Dysphmoria as Healthy

Going to the gym and being “buff” is a societal acceptable pastime. One could easily rationalize this preoccupation with being “fit and healthy.” The result could be devasting to one’s life and health. Raising awareness is imperative for sufferers.

Orthorexia Nervosa (ON)

When one becomes fixated with dietary lifestyle patterns and “healthy living,” a fine line can be crossed from self-care to a pathological obsession.

In the wellness community, this form of disordered eating pattern can most often turn into orthorexia nervosa. Orthorexia is an evolving term surfacing in the late 90s that is still not well-defined, but it is becoming more pervasive as “an eating disorder not specified.”

Proposed Criteria for Orthorexia Nervosa

Proposed Criteria are divided into two sections and include: (source)

Criterion A

Obsessive focus on healthy eating, as defined by a dietary theory or set of beliefs whose specific details may vary; marked by exaggerated emotional distress in relationship to food choices perceived as unhealthy; weight loss may ensue as a result of dietary choices, but this is not the primary goal. As evidenced by the following:

• Compulsive behavior and/or mental preoccupation regarding affirmative and restrictive dietary practices believed by the individual to promote optimum health;
• Violation of self-imposed dietary rules causes exaggerated fear of disease, sense of personal impurity and/or negative physical sensations, accompanied by anxiety and shame;
• Dietary restrictions escalate over time, and may come to include elimination of entire food groups and involve progressively more frequent and/or severe “cleanses” (partial fasts) regarded as purifying or detoxifying. This escalation commonly leads to weight loss, but the desire to lose weight is absent, hidden, or subordinated to ideation about healthy eating.

Criterion B

The compulsive behavior and mental preoccupation becomes clinically impairing by any of the following:

• Malnutrition, severe weight loss, or other medical complications from restricted diet;
• Intrapersonal distress or impairment of social, academic, or vocational functioning secondary to beliefs or behaviors about healthy diet;
• Positive body image, self-worth, identity and/or satisfaction excessively dependent on compliance with self-defined healthy eating behavior.

Common Symptoms of Orthorexia Nervosa

According to one review, many agree on the following characteristics of ON:

(a) obsessional or pathological preoccupation with healthy nutrition;

(b) emotional consequences (e.g. distress, anxieties) of non-adherence to self-imposed nutritional rules;

(c) psychosocial impairments in relevant areas of life as well as malnutrition and weight loss.

The Dangers of ON Being Construed as Healthy

This type of behavior could easily get more and more restrictive. As society praises health and food morality, this could lead to dangerous outcomes such as another eating disorder or malnutrition and malabsorption.

Summary and Conclusion on the “Other” Eating Disorders

We are at a point in our society and healthcare where the value of food has gone beyond its use in a protocol to assist with healing, and it has become a moral decision and a socioeconomic status signal.

This can lead to restrictive eating habits that can be perceived as “healthy” due to the normalization of dieting and the acceptance of weight stigma.

It is dangerous and needs to be brought to light.

We deserve to pursue health and enjoy food choices based on our own reasons and personal needs. We are entitled to a healthy relationship to our bodies and food, to live life in a more peaceful and serene manner, and to embrace a truly wholistic way of being.

Obsessing about food and body size won’t get us there.

In the conclusion of this series, I will finally wrap up this discussion. I will provide a brief description of the other types of eating disorders and what I feel is a more balanced solution to disordered eating.

Please help me spread the word by sharing this post widely.

Eating Disorder Resources:

• National Association of Eating Disorders (NAED): Resources
• ANAD (National Association of Anorexia Nervosa and Associated Disorders)
• Eating Disorders Anonymous
• Resources on How to Be Healthy Without Obsessing About Weight

*Important Note:

If you struggle with mental health or an eating disorder, please reach out for professional support.

You may also wish to consider implementing holistic resources and partnering with a naturopathic doctor.

For example, I offer mind-body support for general mood issues using a functional medicine and wellness-oriented approach. I also practice using a non-diet, HAES approach to nutrition.

Click here to learn more about my approach to whole-person, mind-body care.

Free resources and more education are also available to you here.

Please stay tuned for an upcoming opportunity that can support you in holistic mind-body-heart-soul healing. (Join my newsletter below to learn more.)

Many blessings.