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Ron Chapple studios

The question

I count every calorie that I consume. I don't think there's anything wrong with that - I just don't ever want to be overweight. My parents/friends think it's unhealthy and could lead to an eating disorder. What's your stance?

The answer

Issues around shape, weight and eating behaviours exist on a continuum. On one end, people may be completely unconcerned about their shape or weight, and eat with little concern or worry for what they are eating or how many calories they are consuming.

On the other extreme, individuals may meet criteria for a bona fide eating disorder.

The two most common types of eating disorders are:

- Anorexia nervosa, which has the hallmark features of lower than average body weight (lower than 85 per cent of expected body weight) and an intense fear of weight gain. There is often significant restriction of food intake and excessive exercise. Misuse of laxatives, diuretics or enemas may occur. There may occasionally be elements of binge-eating or purging.

- Bulimia nervosa, which has the hallmark features of recurrent binge-eating behaviours (i.e., eating a markedly high quantity of food during discrete periods of time, with an associated lack of control during the binge) as well as purging behaviours to prevent weight gain (e.g., self-induced vomiting, fasting, excessive exercise, or use of diuretics, laxatives or enemas).

Calorie counting can be a feature of both of these types of eating disorders, but is often more characteristic of anorexia.

In my opinion, excessive focus on calorie counting could certainly be a possible (but not necessary) precursor to more significant problems.

That being said, being mindful of what you are eating, staying within recommended health guidelines for caloric intake, and wanting to maintain a healthy body weight are all positive health behaviours.

There are a few things that I would wonder about: first, you say that you count "every calorie" that you consume. This sounds a bit worrisome if only for the rigidity around it. If you were forced to not count every calorie (but rather just approximate intake) would this create distress?

Could you, rather than focusing on calorie counting, simply focus on ensuring that you are eating in moderation and eating healthy foods?

Perhaps allow a change in your weight (e.g., more than a 5 pound gain) to serve as an indicator that you may need to slightly modify your eating behaviours (rather than excessively focusing on every calorie)?

If any of these things sound difficult to do, I would wonder if there is perhaps an over-focus on calories, and if shape/weight plays a more significant role for you beyond just a normal, healthy focus on weight.

I also wonder what leads your friends and family to be concerned: are there indications of other behaviours (extreme fluctuations in weight, emotional distress, over focus on food, shape or weight, excessive exercise, etc.) that they are concerned about?

If the answer is yes I would suggest you think about at least having an initial consultation with a trained mental health professional with expertise in eating disorders that could help you to identify whether there is anything to be concerned about.

Send psychologist Joti Samra your questions at She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

Read more Q&As from Dr. Samra.

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The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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