When Your "Health" Obsession Becomes Unhealthy (with Katie Kuhlmann, PLMHP, MS, NCC)

Where is the line between having a balanced, healthy diet and diet culture? I'm joined by my friend Katie Kuhlmann, a licensed counselor from Omaha, Nebraska, as we explore the shifting forms of orthorexia (for more on WHAT orthorexia is, visit my episode from Oct. 11, 2022).

Listen as we address the difficulty in distinguishing a healthy from an unhealthy obsession with health.

Read the article associated with this episode here.

TOPICS COVERED 👇 
[0:48] Katie's story with anorexia and orthorexia
[4:38] When eating disorders (ED) transition to looking a different way
[7:02] The key differences between anorexia and orthorexia, and the #1 sign that your relationship with food is off
[9:52] The similarities between EDs and OCD - why it's so hard to "just stop" struggling with food.
[15:18] When is it orthorexia vs healthy eating?
[23:50] The breaking point for Katie's orthorexia that led her to recovery + some clinical considerations
[28:49] Is "food freedom" realistic?
[29:19] The harm that stressing over food does on our bodies, ultimately being counterproductive

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Transcript

Michelle: 0:02

Welcome to the nourishment free podcast. I'm your host, michelle Yates. I am a registered dietitian and I love talking about the things that most people don't love talking about, which is our relationships with food and our body image, and today I want to talk about when your health obsession has become unhealthy. There's a really fine line between health and actual disorder at eating, and so I want to talk about that with my friend, katie, today. She's a counselor based out of Omaha, nebraska, and we are actually friends in real life, and so I wanted to bring her on to talk about this, because I know we both have similar stories and are both passionate about this subject. Quick reminder to leave a rating or a review if you love this episode and share it with a friend who you think would enjoy it as well. I'm really excited about this conversation. I think it's one of the best episodes of all time, so, without further ado, let's dive in. Katie, how do you say your last name, by the way? Is it Coleman?

Katie: 0:51

It's Kuhlmann, like a cool man, cool man.

Michelle: 0:55

I like that. That's easy to remember. All right, katie, I'm so glad that you're here today, that we got to chat. I love this topic. I'm excited to dive into it with you and I think, just for the listeners that don't know you yet, it'd be great to fill them in on who you are, both from a professional standpoint, and then also your personal story as well, with your relationship with food, would be good.

Katie: 1:18

Yeah, yeah, so I'll start off with the professional and then we can dive into the other stuff. But I am a licensed counselor here in Omaha, nebraska, and my chosen demographic that I love to work with are people with eating disorders, body image struggles or generally disordered eating and chronic dieting universally and just the emotional, spiritual, mental components of that that really drive behaviors. Because I mean, you know as well as I do that our behaviors have a lot of motivations that we might not even be super aware of. So really love to work with that demographic and that group in a field where eating disorders are just like complicated and people don't know a ton about them. They're always complex. No eating disorder or disordering case is the same, and so I've loved learning and been able to, throughout school, focus on that.

Katie: 2:16

And then my year long internship was spent at an outpatient eating disorder clinic here in Nebraska that I gleaned a ton of information from. I worked closely with a nurse practitioner that did a lot of the med management. I worked intimately with a dietitian, as well as being supervised by a counselor that was very well versed in eating disorders as a whole and so really learned how to approach eating disorders holistically from all sorts of different angles so that our clients can be the best served. And yeah, I guess a little bit personally how that really became a passion of mine was, I think typically in eating disorder world it comes from a personal struggle, being able to find freedom yourself and really wanting to be able to help other people get there and really, you know, see through the weeds of all of it.

Katie: 3:09

And so I, you know, struggled with dieting. I was put on diets as a child with my family, so like kind of those stereotypical roots there, and early middle school really started restricting my food at that point, restricting food as an athlete really to what I thought was to maximize my performance as an athlete to, you know, build more muscle, and food was always the enemy. So I would restrict food and then end up binging quite a bit. College hits, you know, you get out of your rhythm, I'm no longer an athlete at that point gain some weight and then obsessive dieting kind of through. That restrictive initially was more of an anorexic restriction and then, throughout the process of recovery, really the focus was that orthorexia topic, the then obsession with eating correctly, eating right all the time, and that ultimately that experience for me is what drove me to seek help and go pursue the road of recovery to where I'm at now.

Michelle: 4:18

So, yeah, thanks for sharing that.

Michelle: 4:21

I feel like the the wounded healer phenomenon.

Michelle: 4:23

I just kind of talk a couple episodes go with another dietician who I feel like anybody working in the eating disorder field that's usually the story is like well, I struggled and now I'm passionate about it and want to help people get to the other side because I see how worth it it is. And something that you kind of touched on to is just the transition of going from more anorexic tendencies to orthorexic and I think that's maybe a good place for us to start is just how real that is. I hear that a lot for women who maybe have a history of anorexic tendencies when they were in high school or whatever, maybe even purging and then, as they got older and maybe like the self control quote, unquote side of it, died down, the root problems were still never addressed and so now the symptom is just different and they're more like binging or whatever, and I think that's like good to normalize that if we never solve the underlying issues, it's not like they're going to go away, they're just. They might just look different, you know eating the sort of.

Katie: 5:25

They're sneaky and they can adapt and mold and really just look. However, that season of life wants it to look like, and attacking the root is really what brings you freedom in regards to like balanced relationship of food, because none of them are balanced right. Look different through all of these different seasons of life.

Michelle: 5:45

Yeah.

Katie: 5:46

I think, it's.

Michelle: 5:47

It's extra sneaky, too, when you go like kind of how you did, from anorexia to more of an orthorexic, like unhealthy obsession with healthy eating, because maybe I don't know if this is true for you, but maybe there is a sense of like. Well, it's not that though. So I am healthy, you know right and it's.

Katie: 6:05

I mean diet, culture in and of itself, I mean orthorexia, is praised totally it is oh, you are the one that I want to be you, but you have the self control, you have everything that I want, and it's coached, it's prescribed. It's saying hey, become like me, you can look like me to follow these extremely strict, regimented behaviors and do as well as you can. It's interesting how it shapes and molds into something different that might not have been as bad in the beginning.

Michelle: 6:37

Yeah, that's more of the focus these days too is more of like an obsession on ingredients and sources of food and organic, and whereas in the 90s it was more about like having low fat and it's just. It's just morphs and goes with the times and people pick up on trends and then companies pick up on the trends, then they market to it more and it's tricky. So I'm curious what you feel like for you and then also in the clients that you work with too. What are the key differences between? There's a lot of people who are listening to this and might not even know the difference between anorexia and orthorexia, so what do you think are the key differences there?

Katie: 7:19

Right, right, I mean there's definitely some overlap. There's probably this Venn diagram, right, where there's like very distinct qualities of both that are different and there's those sneaky ways that would overlap in the middle that it could really go either way, depending on um. You know how people feel about it and I think that's a key component too about eating disorders and disordered eating is really paying attention to what stresses you out, like what behaviors are really scary to you, right, is it eating in general or is it eating something that you don't know all the ingredients? Is it eating pasta or is it eating pasta that doesn't have 23 grams of protein in it? Right, like the very the nuance of orthorexia and anorexia.

Katie: 8:15

Both have components of control and, but the source of control or the thing that they're trying to control is really the key difference that I tend to see with my clients is I want to restrict food period. I want to restrict food groups period. I want to restrict, like those fear foods or those things, or over exercise in response and transactionally, whereas orthorexia is very much so like no, I eat pasta, but I only eat this brand. Or no, I eat bread, but I only eat this brand.

Michelle: 8:54

Or no.

Katie: 8:54

I can do. I can do like a fat, but it has to be a healthy fat, like, very much like where it's like. I can easily justify that. No, I don't have a problem as long as I have complete and utter control over everything. Right, and it's really easy to be sneaky with orthorexia, because if you're a single human that doesn't have kids or you can kind of just like control and dictate your life, like you're probably not going to be all that stressed out because you can pick all your ingredients, cook all your food and like I'm not all that stressed about it. But the moment a friend brings you a latte and you don't know what milk they used, or the moment you're asked to spontaneously go out for ice cream with your friends, you know like those are the moments that freak you out, not necessarily just the type of food you're eating. I don't know if that makes sense or if that's cool, totally makes sense.

Michelle: 9:46

that's crystal clear. So what you alluded to like an orthorexia and orthorexia are both about control. I feel like I've heard you say before like we need to treat this as like almost like OCD, where it's a control issue, not some sort of like addiction or something like that. Can you speak to that?

Katie: 10:04

Yeah, I asked somebody that hadn't eaten a disorder. I think, at least in the mental health field, eating disorders are this really elusive sort of disorder that people don't really dive into and understand and for a very, very long time they've been taught under an addiction model and I think there are some components of addiction within the realm of eating disorders, particularly with bulimia and different sort of purging behaviors that can chemically alter some things. However, I've found that treating an eating disorder as an addiction leads to a lot of really confusing things. Like if you're addicted to alcohol or some sort of substance or even a behavior like sex, right, like these things can be lived without. Like you can go the rest of your life without, you know, alcohol or the substance and arguably I would say sex, you can live without it. Right, like you can live without these things at least for a period of time and you will be okay, whereas with eating disorders you can't, you cannot live without food. It's not like we can just, like black and white, cut something out or black and white, you know, move forward in this new way of living that has no resemblance of a disorder. Like it's not helpful for my clients to teach them about their eating disorder in the language using like addictive sort of Mindset towards it.

Katie: 11:43

Whereas with OCD, right there's this obsession that I feel I need to act on, which is where these compulsions come from, those behaviors where it's like this obsession, my belief that my body is too large or not curvy enough or name it.

Katie: 12:04

I've had countless right where it's like I believe this obsession and I cannot let it go and I need to do something about this urgently. I will start to compulsively create responses that are somehow supposed to reduce my anxiety, my fear in this obsession and we know very clearly with OCD, as I treat that as well, that our compulsions never make us feel better, and I think that's very clear with eating disorders is To compulsively beyond like react to these fears like I never actually feel good about it, I never feel better, I never actually feel better once I hit my goal weight or my Pantsize like there's, there's more, there must be more, I must feel better than how I'm feeling currently. And so using that lingo and really treating an eating disorder under an obsessive, compulsive sort of lens for me I feel like gives my clients more hope and understanding that it's not the food that's the problem, it's not my meal plan, that's the problem. Or even exercise that's the problem. It's my fear and the ways that I've decided to compulsively respond to that fear.

Michelle: 13:13

Yeah, well, with OCD the treatment is usually like exposures right.

Katie: 13:18

Yep, yep, there's exposures, and what's helpful with OCD, too, is that if your brain has really kind of done that, those neuro pathways are there and so kind of enlightening people to be like these fears aren't gonna go away, yeah, like it's. These fears aren't gonna go away and our culture's ideal of beauty and diet culture it's not gonna go away. These fears aren't leaving. And so how do we can, how do we live our life in a healthier response and really work around it, rather than trying to like Never have a fear or problem with it again? Yeah, and.

Katie: 13:54

I feel like that makes it more reasonable for people like to like sit down and like try to recover from this ordered eating. When the expectation is that I'm never gonna have an anxiety or fear or Uncomfortable experience my body again is just unrealistic.

Michelle: 14:10

It is, and I think that makes it even more daunting to face the the hill of recovery.

Michelle: 14:17

You know when you're like standing at the bottom and looking up and you're thinking like, oh man, I've got to climb that that whole thing, thinking that the top of the mountain is just complete and utter absence of triggers, right, like it's not gonna happen, and it can maybe bring some relief to know that, oh, I don't have to shoot for perfection here. I can actually just like get by with a B grade of Well, it's still coming up, but now I know how to work through it. One of my favorite things actually to hear from clients is when they like Start a maladaptive coping behavior whether it's binging or restricting or whatever it is and they like notice in the middle of it and then they stop it. Yeah, it's not that they like never had the trigger, that they never even started to act on it, it's that you can recognize and change it. I think that's like way more powerful than Than anything else is being able to literally walk away from something in the middle of it right exactly so with orthorexia.

Michelle: 15:20

I think there's like a really blurred line there, because I can even think of like instances in my own story and in myself where I, in my mind, I'm like oh, I feel great, I have zero stress with food, except for the fact that you just made me a sandwich with white bread instead of whole wheat bread and, and so it's so easy to justify like well, I just want the healthier option, though. I'm just trying to take care of my health. If you relate to being very stressed about food and maybe it's all the time, maybe it's just some of the times, such as when things are Not exactly the way you want them to be or you can't be spontaneous with food and it's taking away from your quality of life Then it might be time to get help with your relationship with food so that you really can live your life and you're not constantly having this hanging over your head.

Michelle: 16:17

My signature program, nourished and free, is for any woman who is feeling that food stress or anxiety or all-or-nothing mentality and Feels the weight of guilt and shame and anxiety Bringing them down, and they're ready to be free and to have that weight lifted off of their shoulders and be at peace. Visit the show notes to learn more about my program and if you'd like to apply, you'll get to have a complimentary conversation with me where we can get to know each other and see if this Is a good fit for you. If not, I'll do my best to point you in the direction that best suits you. Means it's time that you get your life back and you become truly nourished and free. At what point is it like an unhealthy and obsessive versus? We are just trying to take care of our health right, right, and that I feel like that.

Katie: 17:06

That's the like. Tricky component right with disordered eating is that is something that can't have a black and white rule for people right, the way that I would Walk one client through that experience and another client would be very, very different, likely because the fears are different and the you know the worst-case scenario is different. However, I really love to empower my clients under the principle of intuitive eating, that is, gentle nutrition, like with Recovery. I am not asking you to throw nutrition out the window.

Katie: 17:44

You don't need to like throw it out and say eat whatever you want whenever you want and You're gonna be fine, like we need to still be mindful and choose balance and I think the the biggest component with that is that you have time to figure it out and you have time After you eat this fear food to really process that and maybe one day you freak out about the white bread and then another day you can eat the whole wheat bread and it's just generally a process. But awareness is key, right where it's like is white bread now something that's on a restricted list? Was today just a really hard day where white bread was hard? Or is this like a? Is this a trend? Is this something that is now becoming an unhelpful rule in my head that I'm now having to obsessively follow? Versus today was hard.

Katie: 18:45

I tried to make a mindful and balanced decision. For me, today and tomorrow is going to be a completely different day. Yeah and like really allowing our nutrition to be gentle, to be fluid, to be adaptable, and anxiety does not like that. We don't like the great area of saying like, well, what? What about today? What about tomorrow? So I don't know if that entirely answers the question. I think so, without kind of going into the nuance in the gray area of the reality of, like the working through that it's going to be different for everyone and awareness is key, like the self awareness is always key and I think that's why, in this sort of profession, it's you really need help.

Michelle: 19:33

Yeah, you really is you just you don't know what you don't know exactly, exactly.

Katie: 19:38

And there are people who've either gone through it on the other side or outside of that fear and outside of that obsession, that can say to you White bread is okay, right, right, right, right. Bread has this, this and this nutrients. You know, and holy bread is going to be there for the next meal or for tomorrow, like this isn't. It doesn't have to be black and white.

Michelle: 20:03

Right. I remember talking to a client about ice cream in particular. She was like I feel really good about most foods, but there's still something about ice cream and I think that that can totally happen where there's just like one or two like leftover fears that we haven't really addressed and knocked out yet. And I was like well, let me give you all the reasons why it's healthy for you. And I was just like calcium, like fat, that you probably need that day, calories, you probably need energy, like all these things, and just like that. And she was like that's actually really helpful.

Michelle: 20:33

And I was like you just had a dietitian tell you that ice cream is healthy, so, and it's like again, it's all about like obviously there's great there because it might be healthy for you in one moment, it might not be in another moment, it might be in some quantities and not another quantities. Like it's it is great. And I think that's that is such a hard part of recovery is being okay with that and knowing that every day is going to be different when, especially when you're coming from a place of wanting control.

Katie: 21:00

Exactly exactly. My clients are the most frustrated when I tell them like there is actually there's no rules, like there's, there's really no rules anymore, right, and I can't give you a concreting answer on that.

Michelle: 21:11

Yeah, yeah. But I think you you did explain it well in terms of like, what stresses you out? And are you? I think another way to put that is like are you able to be spontaneous? I came up with the white bread and whole wheat bread example because my husband, he got us Jimmy John's yesterday and I wanted like a tuna on wheat. Their wheat bread is so good, so crunchy, it's delicious, it's so grainy, and they, he did order it right. I, you know we had that conversation and he's like no, I ordered it right, I swear. But they just like made the wrong one, totally fine.

Michelle: 21:47

And I had a moment where I was like that little thing up, like because it doesn't totally go away, like you still have disordered eating somewhere, or that that ED voice still exists, it's just quieter and it's less often right, and you learn how to like silence it. But I did like I had to come up for a minute where it was like, oh, this isn't what we thought we would have. And then I was like it's okay, but I didn't know what to do. Michelle, like you can still have the sandwich.

Michelle: 22:14

And then I was like, wow, what a blessing that is that I'm able to have a sandwich that was made wrong, but I'm still able to give it to my body because I know my body deserves fuel and my body will be able to handle it. You know, like, and that's like that spontaneity, right, that's being able to go with the flow, and I think that's that's what we need to look for. If we're not sure if we're really healthy or not, is are you able to go with the flow or not, can you have your plan thrown off and be okay, right, right, that's the key to work with you because it can work in real quick and people can praise you for yourself.

Katie: 22:53

Control and discipline and all of that versus like, if I can't actually have that component under control, I don't feel great about it anymore.

Michelle: 23:03

Yeah, and it is. You know, you mentioned this earlier. It is really glorified and I like I remember going to the grocery store maybe a month ago and I was getting annoyed because this woman was like she spent. She had to spend like 20 minutes just pulling things off, looking at the label, putting it back with like a Just dissatisfied look on her face, grabbing something else, looking at the label, like never really put anything in her cart because nothing was good enough for her, and I was like annoyed because I was like you need to just live your life. But I also was like I understand, right in there.

Katie: 23:43

Yeah, yeah, absolutely.

Michelle: 23:47

So for you, what was like, what was the turning point with your orthorexia?

Katie: 23:55

It was man. That was a process. It was so fluid and I think it turned into something that I didn't recognize without me really even knowing it. I think, as always, it really started with the desire to lose weight. I joined a weight loss company and lost the weight that I wanted to lose. I think for a while there wasn't that distress. There wasn't all that stress. I was able to be a lot more flexible. I don't think the disordered aspect of it really crept in in that season. It was after I had lost the weight that I had wanted to lose. I was in a stage of having to maintain that weight for the membership to this company.

Michelle: 24:59

I already know which company this is.

Katie: 25:02

Yes, I had to maintain that weight for the membership of that company. I had decided this was in my undergrad. I had decided to go for a summer internship in Florida. I didn't know where a way in location was. I was living on the school campus for my internship and I had to eat dining hall food. You don't have as much control. I didn't know what types of cheeses were being used or whether or not there was butter in those potatoes. All of those questions came up.

Katie: 25:40

I think that was the turning point when it got bad, because after I got home from the internship I had my control back and it wasn't all that bad. I was working at a church and I was in charge of the women's group in college. I had to take these girls out for ice cream. I could not hide my distress about the fact that I had to choose between being present with these girls that I was leading and eating the ice cream or not do it with them and then risk being exposed for my problem. I chose the ice cream and had a panic attack later that night and fell asleep crying. It was one of those moments where I was like, do I really want my life to be marked by these sorts of moments when I choose to be present in the moment and I can't mentally recover from the fact that I just did that when 15 other women just had ice cream and had no problem with it Maybe a couple of them did, but universally, in general, people were probably not falling asleep crying because they had a cup of ice cream.

Katie: 27:02

I was still in denial at that point, but I had a good mentor pull me over and say, hey, I think this is probably a problem. I was like no, it's not a problem. She kept pressing and I was convinced shortly after that moment where I was like, yeah, I truly at one point was I would rather have my life end than gain any of the weight back that I had lost. It was a foundational core value of mine that I felt as though if I were to let go of this quote unquote progress that I had made, I would rather not live. And I think if people are honest with themselves, that's where some people get right, where it's like I'd really truly rather not continue life than go back or lose my progress or gain weight. And so that was the kind of the turning point for me and I had to quit my job and go through treatment for a bit to really kind of get my bearings back.

Michelle: 28:13

Yeah, I think that's really powerful that you brought that up. I think there's a lot of people that don't even realize they're feeling that way, but they are.

Katie: 28:22

It's a hard thing to admit.

Michelle: 28:25

Yeah, which is probably why they don't realize it, because they're suppressing it and don't want to admit it. That's why, like man, body image, work and your mental health and getting professional help there is so incredibly important and why I'm such a big advocate for that. Well, I love this. This was such a good episode. I'm excited for people to hear this. I think it's definitely a great area.

Michelle: 28:49

I love that you brought up the gentle nutrition piece of intuitive eating, because I do think a lot of times, what we see on social media or whatever is the food freedom side, which is important. You need liberation in order to combat that control. But also we do care about healthy eating too. We're not just saying don't ever care about treating your body with respect in terms of nutrition, but there's that fine line between am I actually doing something healthy for my body because I want to and I enjoy it and it's an easy choice and it sounds great or is it because I am so stressed at the thought of not doing that, not doing that, I'm literally unable to not do that Right, which at that point, it's an unhealthy obsession that can actually do more harm than good.

Katie: 29:45

Of course, I like to tell my clients often I'm like the stress hormones and the chaos going on in your brain and your body due to your fears around food is doing far more harm than a brownie will ever do to you 100%. It's important to do that work and really come to the realization that stress and distress and fear to those levels are truly unhealthy. Chemically with our body You're actually doing harm Putting those on the same level, the same pedestal, so that we're gentle with ourselves in all of these different areas.

Michelle: 30:28

Yeah, it's not just some random excuse to be lazy or eat what you want and justify it. It's like no, actually, if you're stressed this much, the chronic levels of epinephrine and cortisol that you've got coursing through your body on a regular basis is not good for you and it's completely counterproductive.

Katie: 30:49

Those are probably the source of all your gut issues, not the food.

Michelle: 30:53

Yes, Right, yes, oh my gosh, the gut health stuff. Don't even get me started. Yes, yeah, it's tough.

Katie: 31:03

It is. I appreciate the work that you do, so I love being able to collaborate on the other end and have somebody that I trust to send all my clients to.

Michelle: 31:13

Oh, it's mutual. You're awesome. I appreciate you for coming on and I'm excited to hear some thoughts on this episode from listeners. I know this was super helpful.

Katie: 31:21

Yeah Thanks for your time, yeah thanks.