by Christopher Trennepohl, MPH

The holiday season can be a stressful time for those triggered by changes in eating patterns that often accompany the holidays, concerns with body image, or fear gaining weight. In addition, for many people depression often worsens in the fall and winter, making emotion regulation strategies (i.e., effectively managing uncomfortable emotions) more difficult to implement (Donofry, Roecklein, Rohan, Wildes, & Kamarck, 2014; Ghadirian, Marini, Jabalpurwala, & Steiger, 1999), which can amplify worries about eating, weight, and shape.

An excessive preoccupation with “healthy” or “clean” eating can significantly impair one’s life and can be a first step toward an eating disorder.  Unhealthy preoccupation with eating can manifest as cutting out entire food groups, compulsively checking ingredient lists, and obsessing about foods that may be served at upcoming events. Some studies have shown this type of preoccupation with eating to be more common in men than women (Donini, Marsili, Graziani, Imbriale, & Cannella, 2004; Fidan, Ertekin, Işikay, & Kirpinar, 2010), while others have found no gender difference (Dunn, Gibbs, Whitney, & Starosta, 2017). It may be related to high stress, low mood, and lower life satisfaction (Strahler, 2018) or perfectionism (Parra-Fernández et al., 2018).

A study recently published in Eating Behaviors (Stutts, 2020) took a closer look at these types of behaviors. They use the term orthorexia, which we choose not to use because it is not an official diagnosis, and is unlikely to ever become one. The authors assessed different symptoms and their severity as they relate to weight/shape concerns, routine restraint (consistently limiting food intake), compensatory restraint (limiting intake after a large meal), eating behaviors, and mood in 217 adults. The sample was 46% men, predominantly white and college educated, and had an average BMI of 27.8 kg/m² and average age of 35 years old. The symptoms of food preoccupation were not associated with education level or age, but were associated with gender, with men having higher symptom burden than women. Results also suggested that factors that predicted food preoccupation differed by gender. For example, in men it was predicted by routine restraint, emotional eating, stress, and well-being, while the overall model for women included weight/shape concerns, routine restraint, stress, and negative emotion. When all participants were included, symptoms of preoccupation were associated with routine restraint, compensatory restraint, and well-being.

What do we do with this information? As clinicians, it is important to recognize the holidays as a stressful time for everyone, and they can be particularly stressful for individuals who experience distress related to eating.  A person’s reasons for preoccupation with eating can vary and might differ by gender. We should acknowledge that a small amount of weight gain (an average of 0.7 kg from November to January) is normal and to be expected (Zorbas et al., 2020). What is most important is to stay safe and have a happy holiday season!

References

Donini, L. M., Marsili, D., Graziani, M. P., Imbriale, M., & Cannella, C. (2004). Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eat Weight Disord, 9(2), 151-157. doi:10.1007/BF03325060

Donofry, S. D., Roecklein, K. A., Rohan, K. J., Wildes, J. E., & Kamarck, M. L. (2014). Prevalence and correlates of binge eating in seasonal affective disorder. Psychiatry Res, 217(1-2), 47-53. doi:10.1016/j.psychres.2014.03.012

Dunn, T. M., Gibbs, J., Whitney, N., & Starosta, A. (2017). Prevalence of orthorexia nervosa is less than 1 %: data from a US sample. Eat Weight Disord, 22(1), 185-192. doi:10.1007/s40519-016-0258-8

Fidan, T., Ertekin, V., Işikay, S., & Kirpinar, I. (2010). Prevalence of orthorexia among medical students in Erzurum, Turkey. Compr Psychiatry, 51(1), 49-54. doi:10.1016/j.comppsych.2009.03.001

Ghadirian, A. M., Marini, N., Jabalpurwala, S., & Steiger, H. (1999). Seasonal mood patterns in eating disorders. Gen Hosp Psychiatry, 21(5), 354-359. doi:10.1016/s0163-8343(99)00028-6

Parra-Fernández, M. L., Rodríguez-Cano, T., Onieva-Zafra, M. D., Perez-Haro, M. J., Casero-Alonso, V., Fernández-Martinez, E., & Notario-Pacheco, B. (2018). Prevalence of orthorexia nervosa in university students and its relationship with psychopathological aspects of eating behaviour disorders. BMC Psychiatry, 18(1), 364. doi:10.1186/s12888-018-1943-0

Stutts, L. A. (2020). It’s complicated: The relationship between orthorexia and weight/shape concerns, eating behaviors, and mood. Eat Behav, 39, 101444. doi:10.1016/j.eatbeh.2020.101444

Zorbas, C., Reeve, E., Naughton, S., Batis, C., Whelan, J., Waqa, G., & Bell, C. (2020). The Relationship Between Feasting Periods and Weight Gain: a Systematic Scoping Review. Curr Obes Rep, 9(1), 39-62. doi:10.1007/s13679-020-00370-5