It seems like everyone is health-conscious these days. People love recipe videos and food pictures. There are weight loss incentive programs at work. People join online fitness challenges. Eating clean is all the rage and for some reason we have all done away with gluten whether we have an allergy to it or not. Whether it is a passing fad or something that is here to stay, it is hard to deny, at least from anecdotal observation, that there is a recent trend toward people getting excited about health and fitness. With over one third of Americans dealing with obesity and at risk for the chronic diseases that are associated, it is a good thing to be healthy, right? It is. But the question is when does what we consider “healthy” actually become harmful?

Many people do not realize it, but a preoccupation with healthy eating can actually be a form of disordered eating. What starts as a sincere attempt to eat clean and organic, limiting processed foods, can actually become an obsession for some. The term is called orthorexia. Although it is not a formal clinical diagnosis in the psychiatric community, it is a way of describing an increasingly common problem. According to the National Eating Disorder Association, orthorexia is not about thinness or body image concerns, necessarily. But rather, there is an over-emphasis on “righteous eating” that can cause significant impairment in daily living. Here are some reflection questions to determine if you might struggle with this disordered eating pattern (retrieved from NationalEatingDisorders.org, April 3, 2016)

• Do you wish that occasionally you could just eat and not worry about food quality?
• Do you ever wish you could spend less time on food and more time living and loving?
• Does it seem beyond your ability to eat a meal prepared with love by someone else – one single meal – and not try to control what is served?
• Are you constantly looking for ways foods are unhealthy for you?
• Do love, joy, play and creativity take a back seat to following the perfect diet?
• Do you feel guilt or self-loathing when you stray from your diet?
• Do you feel in control when you stick to the “correct” diet?
• Have you put yourself on a nutritional pedestal and wonder how others can possibly eat the foods they eat?

One’s relationship to food is just one part of the puzzle though. When evaluating how healthy your lifestyle is, you also have to assess your relationship to exercise. Believe it or not, you can have too much of a good thing in exercise as well. This is called compulsive exercise or exercise bulimia. Exercise bulimia is another colloquialism and not a formal diagnosis. However, it is a way of describing a phenomenon that has the potential to be very dangerous.

Compulsive exercise is when a person uses exercise in excess. It might be used to purge the calories consumed, but instead of self-induced vomiting, the individual works out really hard. Or, like orthorexia, it might start out as a reasonable desire to be fit. But when the workouts become daily and longer and harder without allowing for adequate rest and recovery, it becomes a problem. Here are some reflection questions if you are concerned about someone’s relationship to exercise (retrieved from NationalEatingDisorders.com, April 3, 2016:

• Do you feel guilty if you miss your workout?
• Do you still exercise when you are sick or hurt?
• Would you miss going out with friends or spending time with family, just to ensure you got your workout in?
• Do you freak out if you miss a workout?
• Do you calculate how much to exercise based on how much you eat?
• Do you have trouble sitting still because you’re not burning calories?
• If you’re unable to exercise, do you feel compelled to cutback what you eat that day?

It is critical to evaluate the health of your healthy lifestyle because it often does not take much to go from disordered eating and exercise habits to an actual eating disorder. For instance, many who are overly preoccupied with maintaining their rigid diet rules might restrict their food intake if their preferred options are unavailable to them. Or, if they feel they have messed up by not eating perfectly, they are vulnerable to developing compensatory behaviors to manage the guilt, including but not limited to various forms of purging behavior. The same negative spiral can happen if they do not complete their ritualistic exercise pattern. They might restrict their food intake or develop a vicious binge/purge cycle of some form or another. At that point, they would meet criteria for a diagnosable eating disorder, be it anorexia nervosa, bulimia nervosa, binge eating disorder, or unspecified eating disorder.

It is worth noting that there is usually a tremendous amount of emotional pain for people who have an imbalanced relationship to eating and exercise. It cannot be said enough that although it usually starts with good intentions, if the warning signs are not caught early, things can quickly get out of control. Imagine life where you no longer eat and enjoy food because you are so preoccupied with its calorie count, nutritional make-up, and how it was prepared. What if moving lost its joy because it is no longer moving for moving’s sake, but is now a forced way to push yourself harder and further than last time? Do not forget the sadness. People that develop obsessions often disconnect from others in order to make more time for their behaviors. In the short term, this might feel safer to the person who struggles. They do not have to make excuses anymore or answer to anyone. They can focus on themselves and fully give in to their habits. It seems easier that way. In the long run, however, it can feel very lonely.

If reading this has brought someone to mind and you want to know how to address it, the National Eating Disorder Association(NEDA) offers some tips.

• Set a time to talk. Set aside a time for a private, respectful meeting with your friend to discuss your concerns openly and honestly in a caring, supportive way. Make sure you will be some place away from distractions.
• Communicate your concerns. Share your memories of specific times when you felt concerned about your friend’s eating or exercise behaviors. Explain that you think these things may indicate that there could be a problem that needs professional attention.
• Ask your friend to seek professional help. If you feel comfortable doing so, offer to help your friend make an appointment or accompany your friend on their first visit.
• Avoid conflicts with your friend. If your friend refuses to acknowledge that there is a problem, or any reason for you to be concerned, restate your feelings and the reasons for them and leave yourself open and available as a supportive listener.
• Avoid shaming. Do not use accusatory “you” statements such as, “You just need to eat.” Or, “You are acting irresponsibly.” Instead, use “I” statements. For example: “I’m concerned about you because you refuse to eat breakfast or lunch.” Or, “It makes me afraid to hear you vomiting.”
• Avoid simple solutions. For example, “If you’d just stop, then everything would be fine!”
• Express your continued support. Remind your friend that you care and want your friend to be healthy and happy.

Let us be clear. A healthy lifestyle of proper nutrition and regular exercise is very important. It is a good thing that so many people are finally prioritizing it. The key is remembering a healthy lifestyle is one of balance. You nourish your body by giving it what it needs. You can also be appropriately flexible knowing that if you make enough positive choices, your body will work for you. So, as you consider yours or someone else’s relationship to eating and exercise, is it truly healthy or is it harmful?