The Orthorexia Myth & Paradigms of Shame in Popular Health CultureThere is something I want to get off my chest. No really. Too often, when you talk about food, dieting, obesity, etc., the conversation is too frequently being shut down with catcalls of "food fads", "over restriction" and obsessive eating. I have many friends who are vegan. I've been out to dinner in public with them and noticed how difficult it is for them, and to be honest, way beyond what its like for me as a meat-eating low-carber. Yet nobody, nobody ever describes a vegetarian as faddish or orthorexic.
Last week I booked myself onto my first ever IT roadshow. It’s a hybrid cloud development multiday event for professionals. It will be, unfortunately, probably dominated by largely male developers, designers and founders. Food is provided and they kindly have a checklist of dietary needs. Everything is there: gluten free, vegan, even kosher. There were 8 categories, mostly dominated by religious affiliations and a welcome nod to gluten intolerant attendees. But not 1, not a single category suggested catering for reduced calorie, never mind paleo, low carb never mind, orore!, ketogenic. No.....because ANY kind of non-religious or non-disease related caloric or food group restriction is "faddish", and thus "shameful."
The Shame ParadigmWe keep hearing about projections of "body shame." We make women feel "guilty" about not having perfect bodies, alongside older people, trans folk, people of colour and those with disabilities. But god forbid an obese person dares to try to change anything, suddenly they belong to a whole new wall of shame: the dieter. A few years ago I heard a fancy pant restaurant owner raging about being asked to put nutritional details on his menu. You'd think he'd been asked to print his menu in blood and print a photo of his bare arse on the front, such was his ire. Yet McDonald's, who clearly don't worry all that much really about general health, have no problem sticking detailed calorie counts on menus (and very detailed information on local websites). The message was clear: catering for what Delia Smith delightfully describes in her 1980s cookery classics as "slimmers" is as shameful as actually being one of that shame-ridden group.
Like the lady (alcoholic & overweight) who tried to tell me 10 years ago that I couldn't "deny" myself with the fairly straightforward and not overly restrictive diet I led at the time (basically low to moderate carb, high protein and low fat - on which I lost about 70 pounds and kept it off), many of the origins of these missives are themselves either failed cyclical dieters or those gifted with metabolisms of stern stuff who never had to bother. Imagine telling an alcoholic that they are "denying" themselves by not drinking? Or maybe the recovered heroin addict? For some stuff there is no such thing as moderation – it’s a slippery slope. If you are an ex-smoker you'll know this: you either do it or you don’t. And if you go back, it’s not for one sneaky fag a day, it’s like you never stopped.
So I understand when somebody like Jimmy Moore talks about being entirely unable to tolerate carbs because he ate an entire lifetime consumption of the entire carb group before he was 32. I understand when somebody says X or Y diet didn't work for them. Low calorie/low fat doesn't work for me. I simply cannot get my protein low enough to get keto to work. But I do very well on Dr Maurice Le Roque's Motivation diet or Tim Ferris' Slow carb. I think it’s perfectly ok that Moore has to eat a particular way, just as I do, or just as some other combo might work for somebody else. That’s fine. We are all different. Shoehorning us into methods that are unsuitable will unsurprisingly, have poor results. There is no "fixing" the person who has a low sensitivity to sugar or wheat based products. Just let them eat differently. The problem is that we increasingly have added very high protein intakes to diets that suited people who were largely dependent on very different foodstuffs. Then we added horrendous processing.
Just today I read the label on a product I've loved for years: surimi. This is basically processed Pollock, with added starch to make sticks. Now granted I had a very low quality product from Lidl (and for all the praise you can give Lidl, some of their produce is truly AWFUL). I was quite shocked to realise its huge carbohydrate content, and resolved not to eat it, at least not the Lidl version. This is the problem of misleading labelling, a problem which impacts everybody. I would regard my resolve as prudent, but I am aware that some folk would describe my decision as obsessive.
To be honest, I'm not great at control. I struggle to get out of bed in the morning. I struggle to keep running when I'm out running and have to will myself back into a pace. I cave in easily in the presence of cake, dark chocolate, or shortcake biscuits. I'm not food superheroine. I try to practice mindfulness, gratitude and tolerance, but I often fail. At the same time, I realize that it is all too easy to write something off as too hard, or not worth the effort.
That's the way I was 14 years ago, just as my life fell apart in my hands. I'd made a few decisions and a commitment to a relationship, that turned out not merely damaging, but truly personally destructive. It took a lot to rebuild a life after all that, not least in losing face, something which I had to grit my teeth through. Tell me all about shame because I know it, I did and said things that were wrong, made dumb decisions that turned bad situation into bigger messes, fell into the trap of blaming others and the environment. Digging myself out was hard. Facing the demons was harder.
In December 2011 I remember going to an NHS clinic for one of my several times a year asthma induced chest infections. They weighed me and tested my blood pressure. At just 29 I had high blood pressure and was 3 stone overweight. My BMI was well into the obese range. Within 2 years I'd go from 33 on BMI to 38, which was within sight of morbid obesity and all the inherent health problems.
Now in that 2 years I'd left the emotionally abusive relationship I was in, moved back to Ireland, moved to Cork for perm job in a company I was mostly happy in. I do think, regardless of what your state of health or other situation is, if you are in an abusive relationship, even if it's not physically violent, you've got to make it your number 1 to extricate yourself from that relationship and out yourself out of reach of going back. That's why I moved to Cork. For reasons I've long since forgotten, I knew it was one of 2 places my ex wouldn't follow. There are lots of services for domestic violence but really not much for men or gay women leaving female abusers. That's another story, however. You just have to find it in yourself to stop listening to them and listen to yourself. You deserve more. I had bigger things to deal with and my weight continued to drift up.
Thing is, we are bombarded with so many contradictions when it comes to guilt and shame, especially around the body and health, because health is related to consumption. Even exercise has a consumption element – my local shopping centre has no fewer than 3 large sports and leisurewear stores and 2 more big stores with large stocks of sports clothing. Now a lot of it is drawn around what is perceived to be healthy and unhealthy habits. Much of it justified because if you do stuff that's wrong it's correct to feel bad about it, that's why we feel awful even if we inadvertently cause offence or harm in interpersonal relationships (though, interestingly, in the world of work it appears to be a “good” thing to say things that would be considered unacceptable interpersonally). This is where my feelings about the current anti shaming campaigns bristle. If you hurt another person it's only right to be ashamed. If you damage or destroy other people or their possessions, or damage a thing others depend on it's not wrong to feel guilty. Reparations are a healthy, good thing, even if they seem superficial.
I do agree, however, that's it's bad to comment on other people's bodies, food choices or exercise habits, but that's pain rudeness and intrusion, not an attempt to create a culture of shame. Describing it as shameful may be closing down a badly needed debate about misinformation around diet, nutrition and exercise, and creates false dichotomies between well intentioned folk on both sides, between which suffering people are stuck. The misinformation in itself hurts so many people, especially describing perfectly good lifestyle changes as "fads" with demonization of last ditch strategies such as elimination of problematic food groups. This actually creates even more guilt and shame around desperate attempt to stabilise weight among people who really need it.
One of the hardest things, for example, is the pressure to drink alcohol. Anybody who has had any degree of success from low carb approaches will find a special level of vitriol if they live in a country where social drinking is the norm. People sometimes assume you're a recurring alcoholic rather than accept that you don't drink for any other reason. I've had some teetotal friends down through the years who had a lot of questions about their masculinity because they didn't drink. This should be respected as a choice, whether it's for health reasons or any reason. Likewise, the obsession about carb restriction: avoid bread, potato, pasta and rice as well as alcohol and you’ll be a pariah. The anti-gluten movement within the paleo community hasn’t been helpful here, as a lot of people think it’s a wrong self-diagnosis of gluten intolerance rather than other aspects of wheat that might be problematic for some. I even found myself lectured (well-intentioned no doubt) by a nutritionist who told me that weight lost through carb restriction was just “liquid weight.” This I doubt: I suspect the reason that carb restriction works so well is because it removes you entirely from the traditional menu and forces you to build up meals from scratch while simultaneously removing a group that tends to be more calorific than protein. Fat, for example, while high in some foods, is often the main constituent of certain ingredients (such as olive oil or butter) so unless you have an insane palate you won’t simply base your diet around tablespoons of MCT oil. Unless you have a diet based on cheese it’s likely that you’ll find it easier to restrict fat. Furthermore, there is a correct assumption in the perception that many “diet” versions of popular dishes and products simply replaced fat with carbohydrate or sugar, thus offsetting one kind of food type with another.
There is a case to be made, also, in metabolic syndrome, so-called “pre diabetes”. I do hear anecdotes of those who swear, like myself, that the only successful way to lose weight and maintain that loss is through restriction of carbohydrates. The only question for me is not whether it works: it absolutely seems to be the best way for me personally, whether or not accompanied by high protein or high fat variants, the only question is how much I need to restrict. While experimenting with ketogenic (high fat, very low carb) I did test for breath and urine ketones, and on the whole struggled to get above 40%, which is poor. I admit I probably still habitually eat too high a protein level. However, I also run about 30km a week, which requires a fair amount of energy, and I think that may be a factor as glycogenic stores deplete quickly on enduring runs.
Shame & the Dieter
It's implicit that dieting is in itself a shameful activity. Food restriction is perceived as giving in to societal pressures, rather than real efforts to reject the awful norms of the standard western diet. Even efforts from ostensibly ethical food producers are criticised for pandering to guilt and shame, and usual complaints about the horrible gendering despite the fact that so much food information caters badly for anybody not male and 5 foot 10 with a strong metabolism. For example, check the “Safe Food” website run by the Irish government and try to figure out what calorific count is right for you. If you can’t, don’t feel foolish, for years I had no idea what I required, in fact until this year I only recorded my food intake on paper without working out the nutritional content. It took the advent of smartwear and a boom in related applications to realise that I really only needed 1400 calories a day on sedentary days – a frightening though when the “recommended” intake is 2000 a day. On the basis that it takes an additional 3000 calories to gain 1 pound, for somebody like me who averages around 122 pounds, the kinds of weight swing I saw in the past were unsurprising. If I consumed just an additional 300 calories per day, that would add 1 pound every 10 days or 30 pounds a year! That explains how my weight easily ballooned up to 12 stone – all I had to do was eat “normally” and within 5 months I’d be there. Within a year I’d be a frightening 15 stone.
Bear in mind that most restaurants, canteens, packaged processed foods, all base their calorific needs on this ideal of 2000 calories per day, and that’s before snacking, and other poor habits.A lot of folk have made a lot of progress adopting low carb/high protein or low carb/high fat approaches. These include a lot of people who suffered for years as I did, with a rake of health problems, who never even did anything about them because they were "normal." Tell anybody you eat this way and you'll be barraged with accusations of faddism, shame, unhealthy restriction and the latest imaginary mental condition of orthorexia. This is basically a suggestion that highly disciplined dieters are suffering from an eating disorder.
Ok, if you cannot bear a lack of control around food and/or exercise to the point of obsession I don't deny it’s not a problem, but we already have diagnoses such as OCD for these conditions. We don't need to start labelling folk who work hard to get their diets and exercises right any more than the existing stigma that exists around food and exercise.
The core issue is the obsession with stigmatizing everything outside of the perceived norm, even though there are patently huge problems with that norm. Western countries are on roller coaster rides to huge levels of obesity, with English speaking countries leading the way. So why the denial, and obsession with marginalizing those who try to fix the problem?
It's tied into the fact that much of the biggest efforts come from women, who are hit hardest by bad dietary advice and a sporting culture from childhood that excludes many girls and women from participation. The worst thing we can do is to keep creating imaginary mental health conditions for folk who are doing nothing more than trying to improve their own lives. We need to start supporting those who cannot follow typical lifestyles instead of stigmatizing their efforts. If standard advice doesn't work for some at least assist people with proper monitoring systems to check things are ok.
In 2004 I found a diet (low carb, high protein, which I cycle now with ketogenic to ease my liver) and exercise regime (alternating cardio/running and weights/bodyweight) that works for me. For most of the past 11 years I've kept most of the 5 stone I lost off, in the last year slightly more. Eating out can be difficult: there is a real resistance to catering for even reduced calorie diets, as I mentioned in the opening paragraphs. How can it be that we continue to ignore the needs of a huge number with weight problems?
Then there is the exercise problem. Many schools in Ireland offer only GAA sports or other team games to students. GAA is notorious for gender elitism, the men's game enjoying massive support and funding while the women's games are relegated to second fiddle. That doesn't even tackle the problem of individual exclusion or the horrible culture of social privilege afforded to GAA players off the field (even poor performers!) One of the biggest problems I've seen with well intentioned "team building" efforts at corporate level is they really privilege fit young men who are used to team sports, perpetuating already discriminatory structures. In fact, one thing I ask now in interviews is if there is a soccer team. It gets me strange looks, but what it often indicates is that there is a boy’s club culture in the workplace where men bond at football after hours, excluding women and non-conforming men. In contrast, if the favoured sport is running, Pilates or tag rugby, it means there are deliberate efforts not to exclude women from extra-curricular activities. This often indicates a more inclusive workplace.
In Defence of Willpower, cooking and shopping
Attacking individual discipline is deeply misplaced in environments where other structural problems do far more harm. Resisting temptation is increasingly difficult in a consumer society where choices for commodities like food tend to place poorer quality of food at cheaper prices, even more, than, for example, entirely unprocessed items like fruit and vegetables or raw meat, fish and poultry. At the height of my impoverishment in 2001, I recall being down to being unable to afford more than 2 meals a day, and at one stage, that meant an evening meal of a half tin of baked beans or Tesco tinned baby potatoes. These cost a mere 10p and could be heated on the hob. Of course, I couldn’t cook at all – I only learned to cook in Cork the following year thanks to the English market and the example of http://chrispiebicycle.blogspot.ie/ who not only largely taught me how to eat by example, but very thoughtfully fed me regularly while I was getting back on my feet.
Also there was a friend whose floor I crashed on in London, who taught me, literally, how to shop. This turned out to be a useful skill when I moved to Cork, because I could pick out fresh meat and produce from the market, and then whatever additional items I needed from the city supermarkets. Being able to walk to all of the major players in the city was great, although I do remember once putting my bag on the side of Brian Boru bridge and losing my shopping into the Lee with the next gust of wind! It helped me a lot when myself and the ex went on the successful diets a couple of years later. By then we were living in Midleton, which really is Foodie paradise, with Darina Allen’s legendary weekend Farmers Market, and a range of wonderful food shops, including a good fishmonger (Ballycotton Seafood). We experimented with every vegetable and fruit we could find in Lidl and Aldi, as well as local grocers. I’d never cooked aubergine, butternut squash or done much with a courgette aside from sauté in butter.
It seems incredible, in an age of endless TV programmes about food, and books galore, that so many people are nutritionally ignorant, unable to cook, or both. I have a sibling who “doesn’t believe” in cooking and lives entirely off M&S convenience foods. (In all honesty, M&S have always been one of the better players in the healthy convenience market, but at a price).
The second issue is that of exercise. As Krista Scott-Dixon in her wonderful website has long since lamented, the discouragement shown towards women interested in strength training is one problem. The second problem, as others have occasionally pointed out, is the societal perception of women as delicate flowers who shouldn’t do anything “too strenuous” which appears to include doing anything at all. I’m frequently berated by family members for “doing too much.” (I work out at most, 6 hours a week). I work over a “Curves” gym which is an education. Sometimes while walking past I glimpse older women barely moving at all. Yet it’s always busy. In fairness, most of the regulars seem trim enough but I suspect it attracts a clientele who don’t fundamentally have difficulty with eating and weight control.
Those worried about post partum exercise or exercising while pregnant should read Ruth Field, the hilarious “Grit Doctor” and author of several books including “Run Fat Bitch, Run”. While I don’t agree with everything Field says, she does boil down the situation to two things: you either do something about your situation, or you don’t. Her motivation is largely based on reverse psychology which may suit some of the more, well, hesitant. Running, is, of course, a good start for some. It’s free and just requires a pair of runners and an open road. For me, in 2004, unfortunately, that wasn’t enough – I was simply too overweight to even run for more than a minute. I used to sneak into the work gym at 1am on night shifts and could only run for 1 minute at first, on a pace as slow as 4km per hour. In fact, my total workout was just 10 minutes, 3-4 times a week. With this and the simple food plan, I knocked off 2 stone in 3 months.
It seems heart-breaking to me now that I would only crawl into the gym when I was sure nobody was looking, and I didn’t have a gym induction because I was afraid of what an instructor would think of somebody as FAT as me going there. I had tried walking but after a few weeks of walking up to one hour a day and seeing no results I called it quits and snook into the gym. It was terrifying. We had really good equipment and intuitive too, so I was able to do something straight away. A lot of people are cynical about weights machines but honestly, they stop you hurting yourself. What scares me now was that I think I was actually more embarrassed to be a fat person in the gym or on a diet than I was about being overweight per se.
It also strikes me that of the 4 or 5 doctors I saw regularly thanks to my avalanche of chest infections from 2001 to 2005 (they tapered rapidly as I got fitter) none explicitly told me to lose weight, nevermind how, suggested exercise, or suggested anything that would have helped. My mother, a diabetic, sees a dietician once a year, who for only the first time in about 10 years has started to come out in favour of cutting sugar and carbohydrate levels. This proves an enabling system for those who want to blame societal finger pointing and mockery of the obese as well as the shamed overweight folk who really just don’t know what to do.
Sadly, I don’t think this is ending with a happy ending. As I write this, the South African high fat, low carb advocate Dr Tim Noakes is facing an unprofessional conduct hearing in South Africa, for giving unconventional breast feeding advice over social media. I repeatedly find that much of the shame and blame advocates who attack non traditional diet and exercise advice as faddish are pretty bolshy about unconventional practitioners such as Noakes, Westman, the late Robert Aktins and others. There is almost a determination to discredit them, even for small items. Yet as I pointed out above, average GPs are allowed to ignore dreadful weight related conditions like mine and get away with it. (In fairness, the one exception was my late GP from home, Michael Cox, who used to repeatedly lecture me and the rest of the family to “keep the weight down.”) Instead of trying to justify bad eating, lack of exercise and demonising “body shame” while vilifying those who try to help themselves as fanatics, fad dieters and “orthorexic” obsessives we need a culture of reassurance and support, one where those who fail and helped up to try again.