Fussy Eating or an Eating Disorder: What's the Difference?

These days it's hard to avoid people who have ‘issues' with food. Sometimes these issues are the effects of genuine allergies and intolerances; more often they masquerade as such. Sometimes they're diets to reduce blood pressure; more often they're diets meant to help get or stay slim. Sometimes they're about not liking certain flavours and textures; more often they involve avoiding, restricting, or augmenting a whole category of macronutrients: low-carb, low-fat, high-protein. And sometimes they're life-threatening eating disorders, or on the way to being; more often they're mildly problematic examples of disordered eating. And just occasionally, they're really not problems at all.

Perhaps the idea of 'disordered eating' needs a bit of justification in this context: most people who do the things described in the last paragraph wouldn't accept the label of ‘disordered eating', and would say, rather, that they exercise sensible choices about the food they eat, that they're doing their best to stay healthy: that they eat ‘carefully', ‘sensibly', or ‘healthily'. To my mind, none of these responses in itself constitutes an argument against the eating being ‘disordered' — those are some of the concepts disordered eating uses to defend itself. And what counts as disordered? Well, I think it must be something about appetite being drowned out by other reasons to eat or not eat certain things at certain times in certain amounts, to the extent that eating according to appetite becomes difficult or impossible (in later stages because appetite has itself been distorted by these habits).

I don't mean to imply that to eat well means to eat according only to the dictates of appetite: we have to go shopping days before we know what we'll want to eat; we feel obliged, and rightly so, to finish a plate of food someone has taken the trouble to make. But if appetite, inclination, what you happen to feel like, and how much you feel like, cannot make a meaningful contribution to making meal choices, there is something clearly wrong — and this is the case for many people.

The quite recently identified disorder ‘orthorexia nervosa' (a term coined in 1997 by Steven Bratman, from the Greek roots orthos, ‘right' or ‘correct', and orexis, ‘longing', ‘appetite') is evidence of how pernicious an illness healthy eating can turn into. The illness needn't manifest as the desire to be slimmer, or lose weight; many people have more constructive goals, and use food to try to achieve them: weight-lifters eat to put on muscle and gain strength, athletes to run faster, boxers to stay and perform within their weight class. All these are valid aims, but the more important they are, the more extreme the equation of progress towards this aim versus the life restrictions required to reach it, and the greater the danger that using food as a means to an end becomes disordered in the sense I just defined.

Source: Adi Prabowo via Flickr, CC Attribution NoDerivs 2.0 Generic

The sprinter who wins the race may well be the one who didn't go out for a beer with friends a couple of nights before; the weight-lifter may not break their personal record if they haven't planned the weekly shop carefully enough to be able to eat the right breakfast. Perhaps the trouble is that for most people, these goals are not articulated clearly enough, nor their importance weighed up explicitly enough, for informed decisions about the unavoidable trade-off to be made. If you ask yourself, do I care more about adding ten kilos to my bench-press weight this week or about showing my friend I'm there for her by going out for a drink, at least you can make a decision on the basis that you know there is a price to be paid for any success bought with dietary strictness, and you are willing, or not, to pay it. That must be better than an unspoken and therefore unchallenged assumption that my health, or fitness, or strength, or slimness matters more than anything — a prevalent assumption, in a society that encourages both individualism in general and one of its most distasteful specific manifestations, vanity.

Alongside the importance placed on self, and especially on physical self, in 'Western' societies, applying rigid rules in the realm of one's diet is one of the more obvious effects of a culture of too much, with too much choice: many people seem to think that because food is now something that can be individually controlled down to the details of type vegetable-oil margarine and total daily calorie count, it therefore should be controlled thus. Even as recently as sixty years ago, WWII food rationing was still in place in Britain, controlling the sale of meat, and scarcity was a fact of life. Since then, food production and distribution methods have improved so much and so fast that we throw away millions of tonnes of food every year, we expect 85 different breakfast cereals to choose from in any decent supermarket, and we won't be surprised to be told by our friends when they come to dinner that they don't/can't eat grains, or dairy products, or whatever else.

This all upsets me a good deal. I try to be pragmatic about it, and resolve not to care what other people decide about their own diets, but I can't quite manage it. It matters to me that so many people are becoming unwilling, and hence unable, to turn up and, without sending instructions in advance, enjoy a meal cooked for them by friends or loved ones. It saddens me that food can seemingly no longer be appreciated for the life-sustaining necessity that it is, nor its easy availability savoured as the very recent privilege it is. It frightens me to think of the current trend towards more and more divergent eating habits creating greater social rifts, both on the large scale the gap between carefully fed rich and badly fed poor widening — and on the personal level: feelings of superiority, inadequacy, and alienation being heightened, as no one just eats, but everyone follows a diet plan or a 'this-isn't-just-a-diet' 'clean' eating philosophy, or whatever. It sickens me that the instinctively ‘normal' eating patterns that I now use as my own yardstick might soon no longer be a social norm at all.

Given my history of anorexia, and the intense efforts I have recently put into clawing my way out of obsession, it perhaps isn't surprising that I often see more pathological traits in people's fussiness over food than are really there — or more, at least, than they acknowledge to themselves. I've been asking myself of late whether there is a clear boundary which some people overstep and others don't, and which marks the progression of mere fussiness into a fuller disorder. And if there is such a boundary, where precisely does it lie?

The obvious answer is that there is no line that, once crossed, marks the inevitable start of an eating disorder in the majority of people. A more interesting answer is that there are clearly a number of behaviours and thought patterns that signal that considerable psychological, physiological, and/or social damage is being or is likely soon to be done. Being aware of these might make it easier for the disordered eating to be tackled before it becomes a more serious disorder (though see my sceptical discussion of 'early intervention as panacea' here), and also make it easier for people recovering from those more serious eating disorders to see other people's behaviours for what they are: not without risk.

Eating Disorders Essential Reads

Hope and Hesitation in the Journey of Anorexia Recovery

Binge Eating Disorder: Struggling in Silence

So, here is a preliminary attempt at listing some habits that might mark the transition from ‘fussy with food' to ‘obsessed about food'. Some of them are adapted from the ‘Bratman Test for Orthorexia'.

1. All your eating is planned days in advance, and eating unplanned or unpredictable food becomes a source of worry or fear beforehand and possible guilt afterwards.
2. You weigh ingredients when you make food for yourself, and consult nutritional information when deciding what to buy.
3. You have a list of forbidden foods, and suffer from guilt, anxiety, or psychosomatic physical reactions if you do consume any of these.
4. The guilt of eating forbidden foods leads you to tighten up the rules that have been broken, making another transgression all the more traumatic.
5. Eating in such a controlled way induces a sense of superiority over those who don't exercise such control: other people come to seem weak, ignorant, greedy, pitiable, and so on. Conversely, your own self-esteem is dependent on the way in which you eat: your diet allows you to feel good and confident about yourself.
6. You feel pure, light, clean, and/or happy because of the foods you eat, and those you don't.
7. You use moral or ethical convictions, or a self-diagnosis of an ‘intolerance', to justify your food rules to others, whilst being aware that you have other reasons (such as numbers 1, 3, 4, 5, and 6 above) for following these rules.
8. You weigh yourself frequently and adapt your diet to what you see.
9. You read up on the latest food scares, or on the latest scientific research on nutrition, and adapt your diet to what you learn.
10. You spend more than three hours a day thinking about and planning what you eat, and eating matters to you as much as or more than many of the other activities in your day.

The interesting thing about this list is that most of the items on it, taken in isolation, seem rather harmless, and almost too normal, or rather too common, to be worth bothering to write about. But the more of these symptoms of obsession become part of one's life, the further one moves from being able to live with food as it should be lived with: as something that keeps one alive, something that can help bring one closer to those one cares about, something that we are lucky to have in abundance — and may not always. Something that can give visceral pleasure, through its taste alone, in the very act of eating.

Food is fuel, and food is a sensual pleasure and a social bond. It isn't well suited to being a tool for self-improvement, because manipulating food rapidly affects the rest of life, and it becomes difficult, firstly to see clearly all the things that are being altered by one's altered diet, and secondly to move ‘back' from greater control to less. We are taught very early on that self-control is admirable and lack of it despicable, or pitiable. (The famous Stanford marshmallow experiment was for decades taken as evidence that the ability to delay eating a marshmallow was associated with better life outcomes in a range of areas. Only recently did a much larger replication find that economic background accounted for the outcome differences better than 'willpower' or the ability to delay gratification.) We are not taught how easily self-control can spiral into an out-of-control addiction to that feeling of control — perhaps because it's assumed that most people's will power is too weak, or their interest in other things too strong, for that reminder to be needed. And beyond a certain point, of course, it no longer matters whether you think you've reached the original goal which food was helping you achieve or not, because the means is now the end. You are no longer ‘in control', you're controlled by the craving for control — and this happens particularly easily when it comes to food, because the metaphorical associations of thinness with morality, strength, purity, cleanliness, etc., and fatness with their opposites are so strong.

It would do us good to be able to acknowledge that moderation is in fact far harder than fanaticism, even when it comes to food.

That always saying no is much easier than listening to one's whims, or thinking of one's companions, even when it comes to food.

And that complete self-control is the ultimate weakness, even and especially when it comes to food.

We all know these things in other realms, but there's a weird blindspot when it comes to diet and physique. It's fun to look directly at that darkness, and stare it into the light.