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When does 'healthy eating' become an eating disorder?

Woman walking two dogs in snow
Ashley Marion walks her dogs Lili and Georgia in her Fairport neighborhood after work.

Ashley Marion is 33 and has struggled with eating for much of her life.

"There've been little red flags that should have alerted me from at least high school age,” said the Fairport resident.

Marion didn’t consult a dietitian until a few years ago, when she was struggling to lose weight.  

She couldn't figure out why, because she was eating wholesome food like eggs, fruits, and vegetables and working out twice a day.

"I thought I was being the most healthy person,” she said, but registered dietician Marie Beiber told her otherwise.

“She said, 'You know, Ashley, what you're describing to me are really disordered eating habits.'"  

Beiber said Marion’s diet and lifestyle were associated with a specific type of eating disorder sometimes called orthorexia.    

The term refers to a fixation with proper or "healthful" eating. 

"It becomes so obsessive that it actually becomes anxiety-provoking for that individual if they're in a situation where they're not able to eat in accordance with the 'rules' they're supposed to be following,” Beiber explained.  

Orthorexia is not recognized as a formal diagnosis, according to Dr. Richard Kreipe, a pediatrician and professor emeritus at the University of Rochester Medical Center who has treated eating disorder patients for decades. 

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Ashley Marion walks her dogs Lili and Georgia in her Fairport neighborhood after work.

"It's not a matter that it's not something important, it's that we don't have the scientific evidence yet to support that,” he said.

And Kreipe isn’t saying that he thinks the disorder doesn't exist. 

In fact, he said rigid diets like the kind that recently retired football star Tom Brady reportedly followed during his career can serve as a dangerous example for people. 

Brady is said to have placed several major food groups — dairy, sugar, refined carbohydrates, and even some fruits and vegetables — off-limits. 

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photo provided
Dr. Richard Kreipe, Professor Emeritus, Division of Adolescent Medicine, Department of Pediatrics, Golisano Children’s Hospital, University of Rochester Medical Center

"I don't think anybody can say anything bad about Tom Brady as far as his performance as a quarterback,” Kreipe said. “I think the difficulty is that someone who lacks a lot of skills says, 'Well, maybe if I follow his diet, maybe I'll be able to make it.'"  

So how do you know if your "healthy" diet has drifted into disordered eating?   

One clue is when activities like meal prep and the need to avoid certain places and activities begin interfering with life.   

A simple question a person can ask themselves is: Do they have an emotional reaction to food?  

"The only thing that should change from before eating to after eating is that before eating, you feel hungry, and after eating, you feel satisfied,” Beiber said.

“If you have a shift in your emotion due to the foods that you're eating, then that indicates there's a problem with your relationship with that food." 

When Beiber first suggested that Marion introduce more fat into her diet, she was scared.

"I was like, 'What do you mean? Fats are horrendous,’” she recalled. 

Marion also was diagnosed with anxiety and depression, which Beiber said is quite common among people with eating disorders.  The last two years, with its periods of isolation and stress, have been a particularly challenging time for many of them.   

Since the start of the COVID-19 pandemic, calls to the National Eating Disorders Association helpline soared by more than 100%.  

But Marion was already in treatment and making progress by early 2020.  She said there were actually some benefits for her during the shutdown.  

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Ashley Marion gets a kiss from her dog Lili while finishing her walk with her two dogs in her Fairport neighborhood after work.

Her gym was closed, so her twice-a-day workouts ended.

"So that stopped that anxiety right there,” she said, “since it was outside my forces to try to keep that up."  

She worked with Beiber on ending some unhealthy habits and opening herself up to new healthy ones.   

Now, she tries to eat fats, proteins, and carbohydrates in every meal.     

She’s learned to not see food as "good" or "bad" and gives herself permission to have a treat now and then. 

"Whereas before, I would say 'Well, if I'm going to have a chocolate bar, I just better not, 'cause people are going to judge me for eating chocolate.'"  

One thing she's still working on is self-acceptance.  She said she's at a seven out of 10 on that.

"I think it's going to be a lifelong journey,” Marion said. “I don't think it's something that one day I say, 'I accept myself. I'm perfect.'" 

If you or someone you know needs help with an eating disorder, you can call or text the National Eating Disorders Association helpline at (800) 931-2237.

Beth Adams joined WXXI as host of Morning Edition in 2012 after a more than two-decade radio career. She was the longtime host of the WHAM Morning News in Rochester. Her career also took her from radio stations in Elmira, New York, to Miami, Florida.