Over Christmas (which feels like a lifetime ago), I had the pleasure of reading Renee McGregor’s book Orthorexia. Even greater a pleasure is that Renee was willing to be part of this juicy series sharing her expertise on some contentious issues and the growing phenomenon of orthorexia.

Renee is a leading Performance and eating disorder specialist dietitian with over 15 years’ experience working in nutrition. She works with elite athletes, coaches and sport science teams to provide nutritional strategies to enhance sport performance and manage eating disorders. She has delivered nutrition support to athletes over the last 2 Olympic and Paralympic cycles and other major international competitions. She is presently working with British Wheelchair Fencing, Scottish Gymnastics, pro endurance athletes, and is Nutrition Lead @TrainAsOne Team.

Renee is also the Nutrition Lead for Anorexia and Bulimia Care, a national Eating disorder charity who offer training, on-line learning and advice via their helpline to those struggling with or caring for someone with an Eating disorder.

She is the best-selling author of Training Food, Fast Fuel books. and Orthorexia, When Healthy Eating Goes Bad.

Renee has been invited to speak at several high profile events including Cheltenham Literature Festival, The Stylist Show and Google. She writes for many national publications and is often asked to comment in the national press. She regularly contributes to radio and TV, including News night.

Without further ado……

So Renee, I always start off with this question, you can invite 4 other people to dinner and they can be real, fictional, dead or alive, who would they be?

This was a really difficult one because there are so many people I want to say but I think in this particular case, these are the 4 that have been hugely influential and inspirational both professionally and personally but I also know share my passion for enjoying food without guilt or judgement:

Bee Wilson

Holly Rush

Emma Woolf

Edith Bowman

 

I’m sorry to start off with the blindingly obvious but please can you briefly explain what Orthorexia is and who’s at risk?

The term Orthorexia, when broken down into its meaning is “the obsession with eating correctly”; simply put it is the obsession with purity.

While it is a term that is becoming more widely used, technically it has not been recognized as a diagnosable eating disorder; the main problem being the difficulty in developing a tool to encompass and collect valid information for specific diagnosis.

Indeed, Orthorexia is one of the hardest disorders to diagnose as it can easily be hidden under the guise of “healthy eating”; more so since the increase interest in fitness, wellness and the rise of social media “health” influencers.

Individuals truly believe that their “quest to eat clean” will result in a “pure” body and ever lasting health. However, the truth of the matter many individuals are more likely to be doing more harm than good due to the fact that many of the eating practices encouraged and followed, usually involve the removal of food groups that are indeed vital for health.

For someone who is already low in self confidence and self-worth, the need to please and be “good enough” is a relentless battle. They will go to any lengths in order to achieve what they perceive is “perfection”. The problem being that what ever they do, is never sufficient and the pursuit for happiness continues. The real answer of course is being able to accept oneself for who we are, faults and all.

While these problems maybe internal, they will use methods such as “clean eating” to project this dissatisfaction with themselves. They will often evangelize how healthy they feel on this particular path, without fully appreciating the negative impact removing food groups will be having on their health. With the rise of social media as a mode of communication, #cleaneating has become something of a “badge of honor” with more and more people adopting the phrase and striving towards it in order to feel validated and accepted.

With all eating disorders, including Orthorexia, it has been determined that individuals who are most susceptible to developing one are of a particular personality type. They are often perfectionists, very driven but also sensitive. Thus they may interpret criticism or experience certain situations in a negative manner. So there is no specific reason or a particular comment someone has made that causes an eating disorder. It is the accumulation of their experiences, their interpretation and perceptions, accompanied by their personality type that creates the perfect storm for an ED to develop. No-one chooses to have an ED and indeed, it is usually a gradual decline. What starts out as a way of “trying to improve” themselves through eating more nutritionally can soon turn into a dangerous and harmful illness.

It is hence then not surprising why the incidence of ED, including Orthorexia, is such a common problem within athletes and high achievers. In order to be successful you do need to have that drive and determination but if you do not have the emotional resilience to deal with the failures and criticisms on the way, then this can become problematic and potentially detrimental to health.

 

When did you first see Orthorexia appear in your clinics and what made you realise this was quite a serious condition?

Its hard to pin point exactly as if I’m honest it has probably been a slow build up over the last 3-5 years; definitely with the rise of social media and also aspects such as “wellness” and “fitinspiro”

From my point of view, any method of eating, regardless of weight loss or not, that evokes anxiety if deviated from, has to be taken as a serious condition.

 

Orthorexia isn’t currently a recognosed Eating Disorder by the DSM V (Diagnostic and Statistical Manual of Mental Disorders (DSM). Do you think it should be and why?

Absolutely but as we know one of the real difficulties is producing a tool that can be used to encompass and collect valid information for specific diagnosis. As there is no consistent physical characteristics such as weight loss in Anorexia or vomiting in Bulimia, it makes it difficult to find something objective to make a diagnosis against. And as stated earlier, its harder still as Orthorexia really is very easy to disguise behind “healthy eating” with the rise of “wellness” bloggers, books and TV programmes.

I absolutely do believe there needs to be a tool and I am aware that this is being looked into.

 

Gluten and dairy free diets are very trendy at the moment? What are your views on this and how do you think they relate to our relationship with food.

Many so called healthy eating trends often encourage the removal of food groups which can then leave the individual deficient in key nutrients. One common example, as you have pointed out is that of dairy – in some food trends it has been deemed as a food group that should be avoided as it causes inflammation within the body. Firstly, there is absolutely no evidence for this what so ever but more importantly, by removing an entire food group, you are severely restricting your intake of calcium, an incredibly important nutrient for bones, teeth and muscle contraction.

Many will say but I have replaced dairy with almonds or oranges but in reality these are very poor replacements of calcium. A handful of almonds only provides 52mg of calcium whereas a glass of milk provides 250mg. the body requires a minimum of 400mg of calcium a day through the diet and for most people, ideally it should be 700-1000mg a day. When intake is low, the body will release calcium from the bones to ensure correct levels are maintained within the blood to allow for muscle contraction. If this calcium is then not replaced through the diet, then bones become fragile and weak.

When it comes to gluten, it has been reported time and time again that following a gluten free diet is only beneficial in those that clinically have been diagnosed with Coeliac Disease as we know that consuming gluten has a detrimental affect to their health.

Whether someone chooses to include gluten or not is obviously entirely down to choice; often they will feel better and while they mistake this association with avoiding gluten, in majority of cases it actually relates to the fact that they have to be more mindful about choices and so this helps them to make better decisions.

The danger with following any extreme food rule when it is not required is that it then evokes anxiety when it cannot be avoided. I have a client I have been working with who has a huge aversion to dairy –she associates it with causing inflammation and weight gain because of comments and information put out by a non-qualified but very popular and successful food blogger. Consequently my client has severe bone health issues at age 20.

 

Apologies for making assumptions but I’m sure the prevalence of false nutritional information out there makes you extremely frustrated. Given the chance, what would you say to bloggers, celebrities or magazines that promote fad diets or cutting out food groups.

You are indeed correct by your assumption. My thoughts on this are as follows:

While I believe that Social media has definitely contributed to the rise in incidence of Orthorexia, we cannot go around and blame it as the main cause. It is important to highlight that Orthorexia is a mental illness, like all other Eating disorders. It is a method of controlling negative emotions and low self worth. Any individual who has a poor perception of themselves will go in search of ways to help themselves feel better -the images on social media feed into this by selling stories and lifestyles of those that who claim that their method of eating has helped them to be successful and feel fantastic. These claims are what vulnerable people want but what they do not understand that the pursuit of happiness is not entangled in food but actually it is about working on themselves and learning to accept who they are as they are. Only then will they be able to be truly comfortable in their skin =not through trying to restrict or control their eating. While this gives temporary relief, it also creates a whole lot of negative health issues.

My biggest frustration wit individuals who post on social media and have a huge influence and following, while I do not for one minute belief that they are sending out these message with intent to harm people, they also have no awareness about how their messages can become so dangerous to those that are vulnerable and susceptible to developing an ED. It is important to highlight that the majority of these social media influencers have absolutely no qualification in nutrition but have used their own personal story -while something may have worked for them, this is not evidence based and so is not necessarily going to help someone else in the same way. I feel they have a responsibility to understand how their actions can have severe consequences for many who look up them.

 

In my experience, lots of people know that things like carbohydrates are essential or that sugar is the same inside the body as maple syrup. Yet, because of how much these foods have been demonised the belief is so entrenched it’s hard to actually change behaviours. How do you think we might be able to help people actually change their behaviours?

The only way you can change behaviour is to challenge it and this is always my message whether I’m working with an individual or a whole population group. I think for every non-qualified health blogger, there is now an equal number of us working against them and blogs like yours; individuals like myself and The Angry chef and projects such as The rooted project are starting to make headway but I believe in success by numbers so actually, doing this, working collaboratively is probably the strongest means of getting our message out there.

 

In your book you say “in an ideal world I would have all literature relating to “healthy eating guidelines” redefines as “healthy attitudes to eating”. I loved this statement. How do you think we can better practice a healthy approach to eating?

One of my key messages always is about self care and self acceptance; I know form the work I do that this is often what is missing in those who struggle with a dysfunctional relationship with food. This is why I talk a lot about a healthy attitude towards eating which actually helps individuals to appreciate that there is no one size all that fits. Even down to national guidelines, they are guidelines so they are not going to be relevant to every single member of the population. So one of the challenges is that individuals who struggle with their sense of self continually compare themselves to others and basically set themselves up to fail. You cannot compare yourself to anyone as we are all unique –what we really need to be promoting is being true to ourselves. Trying to work out what being healthy means to us as an individual. This is also one of the reasons I rarely put up pictures of what I eat as I know for a fact that many of my clients and followers will the compare and judge their own intake based on what is on my plate. However their body is very different to mine and their circumstances will be very different to mine. Remember that individuals with ED will also look for validation to maintain their ED and so if they see that I’ve had porridge and walnuts for breakfast but they’ve been told to have cereal and toast as they need to restore weight, this will actually hold them in an ED mind set.

My advice about a healthy approach to eating is very much that no foods are off limits –I often use the 80:20 philosophy is that for 80% of the day I’ll eat really well with lost of fresh and whole foods and then 20% of the time I’ll enjoy those foods that should be eaten less often –not never, just less often. In this way then nothing becomes taboo –I’m allowed everything and then I don’t actually want it all the time, but more importantly, there is no anxiety or guilt associated with eating it as its part of a healthy lifestyle.

 

What advice would you give someone who suffers or who is worried they may suffer from Orthorexia?

Admitting that you have a problem, or identifying a dysfunctional relationship with food in someone you care about or work with, if you are a coach, is the first step.

For those of you who are worried about someone, a further conversation will be required; it is important to consider how you approach the individual you are concerned about. Keep the conversation factual but show compassion.

For Example, “ I’ve noticed that you never want to come out with us anymore and you seem really anxious when we talk about going for a pizza, is everything ok with you?”

In this way, you can open the door for a discussion to be had and taken up at any point, when the individual is ready.

For those of you who have accepted that you do have an issue with food, the next step is looking for appropriate support; this will likely need to be psychological and potentially nutritional. In each case, research the practitioner to ensure they do have the relevant qualifications and experience to support you.

 

Lastly, what would be your last meal on earth?

My last meal on earth would have to be my Mum’s cooking –in particular her chickpea curry; aubergine curry, chapattis and yoghurt and pepper dip.

 

 

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