For there is nothing either good or bad, but thinking makes it so. To me it is a prison.
- Hamlet Act 2, Scene 2
I love that line. Is it entirely true? Of course not. Charity is good. Terrorism is bad. But for the vast number of things that can be either, this quote is very useful!
I regularly encounter people who are stuck in the prison of black-and-white thinking. They valiantly try to stick to their list of good foods and avoid the bad ones. They have a host of absolutist rules, such as:
Exercise is good.
Weight gain is bad.
Eating good foods makes me good.
Skipping exercise is bad.
It’s a harsh way to live, and ironically, also an unhealthy one. Is exercise good? It can be fantastic. But perhaps not when you have a sprained ankle or when it comes at the cost missing a special family event. Is weight gain bad? Not when gaining weight is health-promoting for you. Context is everything. When you lose sight of the forest because of the trees, you are liable to make some pretty poor choices and may just find yourself imprisoned by your own thinking.
You might be someone who loves to have rules because it makes you feel safe. If you experience other aspects of life as being out of control, it can be very soothing to have one area in which there’s a promise that if you do everything right, things will turn out well.
As long as I stay away from white flour and sugar, I will be able to control my eating. I’ll lose weight. I’ll feel great. Things will be good.
It is very, very tempting to believe this. Unfortunately, avoiding certain foods does not guarantee health. Can making changes to your diet help you feel better? Yup. Will doing so transform your entire life? Not likely. If you are allergic or have a diagnosed intolerance to a certain food, or if it is moldy or poisoned, then it is bad for you. Otherwise, all foods can be included as part of a balanced diet. If someone eats nothing but jelly beans, that’s unhealthy. But if someone eats nothing but spinach, that’s unhealthy too. It’s a person's eating behaviors that have the biggest impact on health, not one specific food or food group. Being able to enjoy fun foods in moderation is much healthier than having to avoid social situations in which “bad” foods will be served. An unhealthy relationship with food is far worse for you than any one particular food can ever be.
Sounds far-fetched? You may have heard of orthorexia, an eating disorder in which “healthy eating”, rather than achieving thinness, is the motivation for restriction of intake. The term orthorexia was coined by Dr. Steven Bratman in 1997. In his original article introducing this term, he wrote,
“Many of the most unbalanced people I have ever met are those have devoted themselves to healthy eating. In fact, I believe many of them have contracted a novel eating disorder, for which I have coined the name “orthorexia nervosa.” The term uses “ortho,” in its meaning as straight, correct and true, to modify “anorexia nervosa.” Orthorexia nervosa refers to a fixation on eating proper food.”
It can be hard to identify orthorexia when we live in a culture so preoccupied with healthy eating, but when you come face-to-face with this disorder, it becomes clear that it is anything but healthy. Individuals suffering from orthorexia feel compelled to make changes to their eating that go far beyond what is necessary for health, and they are terrified of eating any food they have labeled as “bad”. Life is viewed through the narrow lens of safe and unsafe foods. Characteristics of orthorexia include obsessive thoughts, ritualistic behaviors, isolation, and eventually, malnutrition. Like anorexia, orthorexia is a mental illness that can be life-threatening, but it is unique in that it starts out as a quest for better health. As in with weight loss, someone with orthorexia may initially receive a lot of praise and social support for his or her eating habits. When we live in a culture that lauds “making healthy choices”, it can be very challenging for someone to recover from orthorexia when that requires purposefully eating “bad” foods. In reality, eating that bad food is a healthy choice for that individual! Context is everything.
Not labeling foods as good or bad does not mean paying no attention to nutrition. If that were the case, there wouldn’t be much need for my profession. Being especially interested in nutrition isn’t a problem. If I weren’t especially interested in nutrition, I’d find my job quite boring. A strong interest in healthy eating isn’t a disorder. The problem is that in susceptible individuals, it can become disordered. One risk factor is possessing perfectionistic, black-and-white thinking. As Dr. Bratman describes, when certain foods are demonized and others are considered almost magical, when restrictions escalate and variety of intake decreases, when entire food groups are cut out, when violation of rules results in a fear of disease, a sense of impurity, and anxiety or shame, when others are viewed as weak or inferior due to their more relaxed eating habits, and when eating right becomes the primary source of self-worth, happiness, and meaning, then that’s no longer a strong interest in nutrition; that’s a disorder. A focus on eating well can bring greater balance and joy to your life, but a preoccupation with eating perfectly can make your life constrained and highly stressful.
My brilliant colleague Jessica Setnick, MS, RD, CEDRD-S, who also published the first proposed criteria for orthorexia in The Eating Disorders Clinical Pocket Guide, Second Edition in 2013, developed the very helpful chart below:
Did you recognize yourself or someone you know in the description of Pathological Nutrition? Is the way you eat enhancing your life, or is making it worse? Does the approach you follow take you into consideration as a whole person, including psychological and social factors and not just your physical body? Such an approach would be called “holistic”, and Dr. Bratman points out that ironically, many practitioners who call themselves holistic often do just the opposite. In his words,
“It would be more holistic to take time to understand the whole person before making dietary recommendations, and occasionally temper those recommendation with an acknowledgment of other elements in that person’s life. But too often patient and alternative practitioner work together to create an exaggerated focus on food.”
Moving away from black-and-white thinking can be scary. It means letting go of a sense of security, and it also means realizing that the promises of safety were false all along. It requires internalizing that you have inherent value regardless of how you ate today. Some people use the term “grey” to describe a way of thinking that is more nuanced and balanced, but I don’t think that does it justice. It’s more like going from seeing the world in black-and-white to seeing it in full color. When you aren’t trapped in rigid thoughts about food, you open up a rainbow of opportunity. There’s room for every shade, and you don’t have to choose only one color all the time. (There are other colors besides green!) It is vibrant, inclusive, balanced…and beautiful. It’s the way it should be.
 Bratman, Steven. Health Food Junkie. Yoga Journal 1997; September/October:42-50.