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New nutrition buzz-words: orthorexia and HAES

Susan Williams is an Accredited Practising Dietitian and body image activist with a private practice in Western Sydney. She sees many clients worn out by the dieting merry-go-round and offers a more positive, weight neutral approach. We asked her about the latest diet buzz-word orthorexia, and the growing HAES movement.

What is orthorexia and how common is it?

The term was introduced in 1997 in the USA by Dr Steven Bratman, MD, who found that in some susceptible people, dietary restrictions intended to promote health can lead to unhealthy consequences such as social isolation, anxiety, loss of ability to eat in a natural, intuitive manner, reduced interest in the full range of other normal activities, and, in rare cases, severe malnutrition or even death. While the media describe orthorexia as an eating disorder characterized by extreme or excessive preoccupation with eating food believed to be healthy, it has not yet been accepted as a clinical diagnosis and as a result research into it and knowledge about the numbers of people affected is limited.

What is HAES?

HAES® is the acronym for The Health At Every Size® approach. Very simply, it acknowledges that good health can best be realized independent from considerations of size. It supports people of all sizes in addressing health directly by adopting healthy behaviours. One of the criticisms of HAES is that it is "giving up". I hope that these principles show very clearly that it isn't that at all. Find out more here.

The HAES® Principles are:

  1. Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
  2. Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
  3. Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
  4. Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
  5. Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.

What is your opinion on the current diet trend to quit sugar?

I'm not a fan of quitting in general. People seem to be bonding over what they don't eat these days rather than enjoying meals and relaxing together. When it comes to food, unless you're allergic to it, or it's gone 'off', then it's probably a food that's ok to include in some way in your diet. I find the whole quitting thing a bit over the top, and when it comes to sugar no one's really quitting it anyway; they're eating honey, maple syrup, rapadura, rice malt syrup, panela and coconut blossom sugar. It's all sugar!

In your opinion, are there any risks of promoting sugar-free diets?

The promotion of a sugar-free diet as necessary for health, and conversely that foods containing sugar are toxic, is potentially risky. Sugar-free diets can result in cutting out fruit, vegetables, dairy, legumes and grains that could lead to nutritional deficiencies. Any restrictive diet, whether it's sugar-free, fat-free, gluten-free (without medical reason), chemical-free, clean, paleo or vegan, has potential risks. Such diets often require unwavering adherence, which can lead to guilt and emotional overeating if the strict rules are broken.

Food is so much more complex than its nutrients or energy value. It is culture, memory, family, celebration and commiseration, which is why strict exclusions are very difficult. 

When you see testimonials of transformation by people who've quit sugar and lost weight, what are your thoughts?

My first thought is: let's see how you're doing in 5 years. There is no weight loss diet that shows long lasting results in more than 3-5% of people. Testimonials are always after a couple of weeks or months, and there's never any follow up. Testimonials are not credible evidence of benefit and health professionals like dietitians, physiotherapists and psychologists aren't allowed to use testimonials to promote their services. There have been several high profile cases recently of bogus claims made by high profile health gurus and this should give celebrities selling diets pause for thought.

For children that are overweight, what approach to you advocate to manage this?

I follow a HAES philosophy, and run a weight neutral practice. With families, I use a model developed by Ellyn Satter called the Division of Responsibility, often paraphrased as, 'parent provides, child decides'. I encourage and support parents to adopt HAES® principles: provide regular meals and snacks; provide opportunities for joyful life enhancing movement; trust their child's appetite; and trust their child's body to grow and develop as it should. I encourage parents need to talk neutrally about foods, and not use language of 'good' and 'bad', or even healthy or unhealthy. Children don't have the cognitive ability to understand these complex ideas.

I wish we could all realize how miraculous our body is; we only get one and it is worthy of care and respect at any size.

What is your opinion of celebrities who promote fad diets and amass armies of loyal followers?

It makes me really angry! Celebrities are often gallingly unaware of their privilege, however I do love the backlash that's happening against this. Celeste Barber and her Instagram photos mimicking celebrities are hilarious and highlight how ridiculous it is for us mere mortals to emulate their lives. Celebrities should stick to what they're good at and leave health to health professionals.

What is the most common mistake you think health professionals make in the area of patients' body weight?

Assuming they know anything about the person because of their weight; assuming weight and health is the same thing; assuming that someone eats and moves a certain way because of their weight; and assuming weight loss is the cure for any condition. I like the weight neutral approach as it helps me to see and hear the person. The question I ask myself is: what would I advise if this person had a BMI of 22? (Thanks to colleague Fiona Willer of Health, Not Diets for that tip). As a dietitian it keeps nutritional quality top of mind, rather than being distracted by energy value.

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