Source: Nadine Primeau/Unsplash, Creative Commons
Co-authored with Fatmah Jahim and Robert T. Muller, Ph.D.
With the rise of diabetes, cancer, and high blood pressure in North America, it’s no surprise that doctors and dietitians encourage dietary changes, including eliminating processed foods, reducing fats and sugars, and eating more vegetables. There is even a current trend of social media influencers sharing their cleansed diets using the hashtag #CleanEating.
On the surface, it seems that there is nothing wrong with having a strong desire to eat healthy. However, desires can lead to obsessions, and obsessions can be unhealthy, sometimes even deadly.
Orthorexia nervosa is an eating disorder defined by a maladaptive obsession with eating healthy. People with this disorder are obsessed with purity of your food and obsess over the ingredients. They can restrict the type of food they eat by cutting out food groups, such as strictly adhering to vegan, gluten-free, dairy-free, or all-organic diets. These concerns can be extreme, as some people with orthorexia spend hours preparing, categorizing, weighing, and ruminating on food.
What sets it apart from other eating disorders is an intense focus on the quality of the food consumed rather than the quantity. However, as with other eating disorders, these behaviors can lead to malnutrition, psychological decline, and social isolation.
Since orthorexia has not yet been added to the DSM-5, the dominant American psychiatric diagnostic system, there is an ongoing debate about diagnostic criteria. The most frequently asked question is: Where is the hard line that separates healthy from pathological eating? Jessica Setnick is a registered dietitian, author, and member of the expert task force working toward a unified definition of the diagnosis. Setnick says it’s the same hard line that separates use of abuse with any substance or behavior, which focuses on whether it is causing problems in your life. A person can enjoy going to five farmers markets, spending their disposable income on gourmet foods, or spending hours every day preparing new recipes. If they are healthy and have a happy life that supports those behaviors, who are we to judge them?
But a person who does the exact same thing and gets depressed when they don’t, or can’t eat a meal prepared by a loved one because they’re afraid of food, or can’t go to work anymore because of the time they’re forced to spend food preparation, these are the problems. Not the food itself, but the way the obsession with food is hurting her life.
Social reinforcement and idealization of healthy diets make orthorexia more difficult to detect. Jennifer Mills, a professor of clinical psychology and an expert on eating disorders, explains that people with orthorexia are much less likely to present for treatment because eating healthy is socially reinforced as a virtue. “They may get all kinds of positive social reinforcement for it, so they may not see it as a problem.”
The disorder can also be difficult to detect medically. One clinical concern is that GPs do not know enough about orthorexia to ask patients about their eating habits. Someone may be severely struggling with this, but not medically underweight, and loved ones may not notice or say anything about the person’s weight. Even a primary care physician or family doctor might miss it at an annual checkup, because the person presents as if they are in a healthy weight range. Adds Mills: “You would only know through a specific blood test. That’s the worrying part. It can go unnoticed.”
In recent years, the wellness culture on social media platforms has created a toxic environment for those most vulnerable to eating disorders. A recent study revealed a link between orthorexia and Instagram use. One possible reason for this link is that Instagram celebrities create the impression that you need to eat in a specific way to be successful.
23-year-old Instagram blogger Jordan Younger was known for her “gluten-free, sugar-free, oil-free, legume-free, plant-based, raw vegan diet.” She sold over 40,000 copies of her clean up Program. Many fans did not see their matches behind the screen. She stopped menstruating. He lost his hair. Her skin had turned orange from consuming an excessive amount of sweet potatoes. After seeking help and recovering from the orthorexia, she announced that he would go off his clean diet and eat foods that he had previously restricted.
As he began his recovery, he lost thousands of followers. People insulted her, accused her of a lack of self-discipline, and even demanded that she pay them back. Society seems to reward clean eating and shame those who stray.
However, social media platforms are not the only culprits. Mills says the diet and exercise industry bears much of the blame. He promotes the idea that if you eat a certain way, you’ll not only look better, but you’ll be happier. This idea is internalized by young people, men and women, from a very early age that what you eat is in some way a reflection of your value as a person.
What can we do to ensure that eating disorders are not promoted, which contributes to the exaltation of clean eating and the idealization of thinness? Setnick says the main thing is to stop judging and commenting on other people’s bodies. Accept that everyone will look different, even if we all ate the same way. Also, we need to adjust the belief that weight change is the solution to problems. Instead, we can direct our efforts to help people with the real issues they are struggling with and not just recommend weight change as a way to feel better.
Whether it’s with weight or food, obsession is unhealthy. Many people seek control through the magic of a clean diet. Unfortunately, their diet may soon end up controlling them.
Copyright Robert T. Muller, Ph.D.