There’s an eating disorder that isn’t well known, can be easily hidden, and often unwittingly gets a lot of praise. Now I know that sounds confusing, but it’s not the disorder that getting the praise, but rather the perceived results of this eating disorder. The eating disorder I’m talking about is orthorexia.
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What Is Orthorexia?
Orthorexia is a common co-occurring eating disorder characterised by a need to only eat healthy foods, to avoid “bad” foods and food groups (Eating Disorder Hope). This need for “clean” and healthy eating can easily escalate into an obsession to eat clean and healthy, causing some overlap with OCD, although it isn’t on the obsessive-compulsive spectrum (Psychology Today).
A study by Bartel, Sherry, Farthing, and Stewart (2020) sort to classify if orthorexia was an eating disorder or on the obsessive-compulsive spectrum using 512 participants. The study concluded that orthorexia was far more connected to an eating disorder than an obsessive-compulsive disorder, thus supporting the idea of orthorexia being classified as a new clinical eating disorder.
A more concise definition of orthorexia nervosa comes from Koven and Abry (2015), who defined orthorexia as a pathological obsession with proper nutrition that often comes with a restrictive diet, avoiding “dirty” unhealthy foods, and ritualised patterns of eating.
However, according to Beat and Koven and Abry (2015), orthorexia isn’t recognised as an eating disorder in a clinical setting, even though it has a name, you won’t find it in the DSM V (National Eating Disorders). Nevertheless, most eating disorder organisations, like Beat, will have information on this eating disorder.
Orthorexia’s Connection To Other Eating Disorders
One way to develop orthorexia could be due to recovering from another eating disorder, whereby someone in recovery might transition from focusing on weight loss and body image to eating healthy foods obsessively instead (Psychology Today).
Support for the recovery causing orthorexia comes from Segura-Garcia et al. (2015), who studied orthorexia in female participants with diagnoses of anorexia and bulimia. The study comprised of two groups, one group’s participants came from an outpatients service for eating disorders and the other group came from high school and college students (control group), with 32 participants coming from each. The results of this study were that orthorexia was highly prevalent among the anorexia and bulimia sample and tended to increase after treatment for their diagnosed eating disorder. This study also backups the claim made by Eating Disorder Hope, that orthorexia commonly co-occurs with other eating disorders.
How Diets And Clean Eating Can Hide Eating Disorders
Because society has tricked us into thinking that being ultra-thin is equated with beauty, dieting has become a common and normalised behaviour in our society. In fact, this has become so normalised, that children between the ages of nine and eleven are dieting at worrying rates (Eating Disorder Hope). The problem is, diets don’t even work, no matter how much time and money you invest into them, diets fail because they’re unsustainable. We don’t need diets, we need lifestyle changes.
Food fads can also play into orthorexia as sufferers try to live a so-called “clean” and healthy lifestyle. Juicing has been a fad that often comes back again and again, but is it actually healthy? No, the fibres found in whole fruits are no longer intact when it’s juiced and the fructose that was once contained in the fruit’s cells are now free and count as regular sugar, speeding up absorption (BBC). Normally, this process of absorbing fructose is slowed down by the presence of the fruit’s fibres. Thus, you’re better off eating fruit than juicing it to drink, although you still need to be careful of your fruit consumption, as fructose is still sugar. Hence, why we’re always told to eat a balanced diet.
Another example of a food fad that could be incorporated into an orthorexia sufferers “clean eating” is giving up gluten. The majority of people have no issues with gluten. Yes, there are people with celiac disease and those people should avoid gluten, but someone out there saw a chance to make a buck and turned this issue into a “clean” eating issue even though there are no proven health benefits from avoiding this protein (HealthPartners).
Calling foods “clean” and “dirty” is just dieting by another name, a trick that has caused so-called “clean eating” to grow in popularity (National Eating Disorders), causing fixations on fad foods and diets that take potentially healthy eating to unhealthy levels.
Someone with orthorexia might start eating “clean” and healthy, but later shift towards weight loss as the obsession with “clean” eating starts to dominate their life (Psychology Today). Thus, if you or someone you know are seeking out new fad foods and diets, then you might be at risk of developing orthorexia because following such food plans can become obsessive, fast.
The problem is, the diet industry is largely unchecked by any scientific regulatory processes, meaning people can make wild and incorrect claims which then get amplified by social media and news companies (Koven and Abry, 2015). And such misleading information puts people’s lives at risk.
The big risk of “clean eating” fads and diets is that it can become pathological, leading to the development of orthorexia. As such, ironically, the person with orthorexia can suffer from nutritional deficiencies, causing medical complications, and a poor quality of life (Koven and Abry, 2015).
My Brush With Orthorexia
I experienced an episode of orthorexia when I tried cutting out carbs and going keto. I became obsessed with cutting out all carbs. Every label was checked, and I only ate antipasti with meat, had soya milkshakes with no carb protein powders, and for a treat, I made keto mug cakes (which just weren’t the same). My life was consumed by making sure I didn’t eat carbs, and it was completely soul-destroying. I lost weight, but I couldn’t live being consumed by my need to avoid carbs. I just couldn’t enjoy myself. Then the pandemic hit and I lost access to the foods I need to maintain a keto diet, so I gave up on it. I have since tried to return to keto several times because I did lose weight, but even though I bought the foods to do it, I couldn’t start it. I just couldn’t bring myself to live through that nightmare again.
Besides the weight loss, there was also another benefit of me going keto. While on the keto diet, just before I was forced to give it up by world events, I’d stopped getting my hypo symptoms, which was nice. For the longest time, the starving issues caused by my eating disorder were dealt with by my hypos, because my symptoms are so unbearable that I’d have to eat. However, without those hypo symptoms, I returned to starving myself and was only eating once every three days by the time the pandemic hit.
This one diet, which was recommended to me by my doctors even though I told them I have an eating disorder, in a relatively short time, turbocharged my eating disorder. And although it was nice not having my hypo symptoms for the first time in years, having my eating disorder go out of control like that just isn’t a price I’m willing to pay.
Signs And Symptoms Of Orthorexia
- Self-esteem comes from healthy eating.
- You compulsively and obsessively check ingredient lists and nutritional labels.
- You avoid eating out due to fear of not being able to find the food you can eat.
- You have a growing concern about what ingredients are in food.
- Feeling of guilt and/or shame bombard you when you don’t meet your dietary standards.
- An inability to eat foods outside of your accepted healthy and “clean” foods group.
- Being consumed with thoughts about what food options will be available at events.
- Getting stressed out when your sanctioned foods aren’t available.
- Cutting out a growing list of food groups, such as carbs, meat, and gluten.
- An unhealthy interest in what others eat.
- Experience anxiety around your meal times and food planning.
- Becoming obsessed with joining healthy lifestyle groups and following healthy lifestyle blogs and social media accounts.
- Developing less than favourable opinions of others who don’t follow your kind of “clean eating”.
Interestingly, body image may not be present as a symptom of orthorexia.
The Bratman Orthorexia Self-Test
The self-test is made up of a few statement questions that Steven Bratman outlines on his website for exploring if you have orthorexia, so you can seek support and make adjustments. If you’re keen on healthy living and diet fads, this small test might be useful to you to avoid health complications further down the line. Thus, if you answer yes to any of the following six statements, then you may be at risk of developing orthorexia.
- I spend too much of my life thinking about, choosing, and preparing healthy food that it interferes with other aspects of my life, such as work, school, social activities, and relationships.
- I feel anxious, guilty, impure, unclean, and/or defiled when I eat any food I regard to be unhealthy; even being near such foods disturbs me, and I feel judgmental of others who eat such foods.
- My sense of happiness, joy, peace, safety, and self-esteem is excessively dependent on the purity and rightness of what I eat.
- Sometimes I would like to relax my self-imposed “good food” rules for a special occasion like a wedding or a meal with my loved ones, but I’m unable to bring myself to do so. (Note: If you have a medical condition in which it is unsafe for you to make ANY exception to your diet, then this item does not apply).
- Over time, I’ve steadily eliminated more foods and expanded my list of food rules in an attempt to maintain or enhance health benefits; sometimes, I may take an existing food theory and add to it with beliefs of my own.
- Following my theory of healthy eating has resulted in me losing more weight than most people would say is good for me, or has caused other signs of malnutrition such as hair loss, loss of menstruation, or skin problems.
According to Koven and Abry (2015), no studies currently confirm any effective treatments for orthorexia. So currently there is no peer-reviewed clinical treatment for orthorexia. However, that doesn’t stop eating disorder organisations like Beat from offering you advice and support. Thus, please reach out to your GP or an eating disorder service if you think you may have orthorexia or any eating disorder.
As always, leave your feedback in the comments section below. Also, feel free to share your experiences with orthorexia and eating disorders in the comments section below as well. Don’t forget to bookmark my site and if you want to stay up-to-date with my blog, then sign up for my newsletter below. Alternatively, get push notifications for new articles by clicking the red bell icon in the bottom right corner.
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Unwanted Life readers.
Bartel, S. J., Sherry, S. B., Farthing, G. R., & Stewart, S. H. (2020). Classification of Orthorexia Nervosa: Further evidence for placement within the eating disorders spectrum. Eating Behaviors, 38, 101406. Retrieved from https://doi.org/10.1016/j.eatbeh.2020.101406.
Koven, N. S., & Abry, A. W. (2015). The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatric Disease and Treatment, 11, 385–394. Retrieved from https://doi.org/10.2147/NDT.S61665.
Segura-Garcia, C., Ramacciotti, C., Rania, M., Aloi, M., Caroleo, M., Bruni, A., Gazzarrini, D., Sinopoli, F., & De Fazio, P. (2015). The prevalence of orthorexia nervosa among eating disorder patients after treatment. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 20(2), 161-166. Retrieved from https://www.researchgate.net/profile/Cristina-Segura-Garcia/publication/270220344_The_prevalence_of_orthorexia_nervosa_among_eating_disorder_patients_after_treatment/links/5ac4fab9aca27239edb8d959/The-prevalence-of-orthorexia-nervosa-among-eating-disorder-patients-after-treatment.pdf, https://pubmed.ncbi.nlm.nih.gov/25543324, and https://doi.org/10.1007/s40519-014-0171-y.