Eating disorders. The very phrase sounds awful. What does it take for one of the essential activities of life to become “disordered?”
Doctors, nutritionists, psychiatric and psychological professionals and researchers have been digging in on that very subject for quite a while now. One thing they agree on is that, contrary to the statements of several controversial Instagram “influencers,” there is no such thing as a positive eating disorder. They’re all dangerous, damaging to health and sometimes even fatal.
We’ll take a closer look at the root causes of eating disorders in general in another piece. For today, let’s take a closer look at one in particular – orthorexia nervosa.
Most of us are at least casually familiar with the two most common eating disorders: anorexia nervosa and bulimia nervosa. Anorexia nervosa, or anorexia, as it’s commonly known, is a disorder in which the sufferer has a compulsive, obsessive desire to be thin, skinny or “in shape.”
This obsession leads the anorexic to weigh themselves frequently, eat small, very often insufficient amounts of food, exercise excessively and to fixate on only eating certain types of food. They suffer from low weight and often end up with osteoporosis, heart damage and fertility issues. Forced vomiting is sometimes involved, as well as the use of laxatives to induce weight loss.
Anorexia has been tied to trauma, depression, anxiety and other mood and psychological issues. But as mentioned, we’ll dig in on those more deeply in the near future.
Bulimia nervosa, or bulimia, is characterized by what’s called a binge-purge cycle. The bulimic will eat a large amount of food in a short period of time, then purge that meal by vomiting or the use of laxatives. Other purge methods may include use of diuretics, excessive exercise, stimulants or water fasting.
While most bulimics tend to maintain a normal weight, they often suffer from side effects like breakdown of tooth enamel, skin problems, general weakness, depression, anxiety and even suicidality.
It’s obvious to see the problems and risks associated with anorexia and bulimia. But at first glance, you’d think orthorexia would almost be one of those “positive eating disorders.” But as mentioned earlier, there is no such thing as a “positive disorder.”
So what is orthorexia nervosa, or orthorexia? The term was first proposed in 1997 by an American doctor called Steven Bratman, M.D. While not recognized as an eating disorder yet by the American Psychiatric Association, orthorexia can be a problem for people who otherwise lead a healthy lifestyle and may well be the wrecking ball that brings their whole, heathy world crashing down.
Orthorexia is derived from the Greek root words ortho, meaning correct or right and orexis, meaning appetite. Dr. Bratman described orthorexia as “an unhealthy obsession with eating healthy food.” (1)
His suggestion was that, in some cases, a person’s dietary or food restrictions in pursuit of weight loss, physique change or other healthy goals may lead them down a darker, dangerous path to poor health and a range of physical, psychological and emotional issues. In this regard, orthorexia is akin to it’s more familiar cousins, anorexia and bulimia.
In 2009, Ursula Philpot, then chair of the British Dietetic Association and a senior lecturer at Leeds Metropolitan University, described orthorexics as people who are “solely concerned with the quality of the food they put in their bodies, refining and restricting their diets according to their personal understanding of which foods are truly ‘pure’.” (2)
This fixation on purity and perfection in a person’s diet can lead to some really unhealthy consequences. They include social isolation, as orthorexics often feel superior to those who “don’t eat right.” Isolation can also occur when the sufferer fears that leaving their controlled environment may mean not having the “right” foods available when needed. Relationships with others, including family, become less important than adhering to whatever dietary formula the orthorexic has chosen.
Orthorexics also risk developing a negative and dangerous connection between the “quality” of their diet and their own self-worth or self-esteem. (3)
In a recent Four Pillar Fitness podcast episode, Lyle McDonald, well-known nutrition writer, coach and expert in fat loss and physique change, shared that the consequences of this connection are dangerous. Lyle explained that dieters with rigid approaches to nutrition will project even slight perceived dietary failure as a personal failure. This can combine with other psychological factors like perfectionism to cause significant problems.
One of those problems can be binge eating. If the orthorexic “fails” to adhere to their rigid dietary dogma, even committing the slightest of sins, the value of the rest of the plan is dismissed as a failure. This combines with a massive blow to self-esteem and a feeling of worthlessness and despair. The result is often food binges. Research has shown that rigid dieters show high levels of stress about their nutrition and are more prone to binge eating. (4)
Lyle says ” Due to their all or nothing approach, rigid eating attitudes are often associated with disinhibition and the rigid eater can flip from complete control to a complete lack of control under a variety of conditions. This is especially true if one of the specific dietary rules or goals that they have established is broken in any form or fashion. At the simplest level this may mean exceeding some predetermined daily calorie goal. If the day’s goal is 1600 calories and the rigid eating exceeds that, the day is deemed a complete failure.” (5)
In this example, the content of the rigid eater’s plan may remain intact, but the quantity target is exceeded. The dieter may have eaten 1,601 calories of high quality meats, vegetables, fruits, etc. in perfect proportions of fats, protein and carbohydrates. But that 1 extra calorie? That was the deal-breaker that sent them into a psychological tailspin and a full dive into binge eating.
Now, let’s be clear. Not all “rigid eaters” are orthorexic. All orthorexics, however, are rigid eaters, and in all likelihood, started out that way. The belief that there is only one proper way to eat, one acceptable way to fuel the human body, is a sign of orthorexic thinking and attitudes. It also flies against the reality of millions of years of human evolution and scientific reality.
Human beings are pretty unique on planet Earth. We are one of the very few species of true omnivores. That means we can survive, and in fact thrive, on a wide variety of food sources. Vegetables, meats, fruit, dairy, grains. Our bodies can adapt to and survive on any or all of these. True, some people have sensitivities to certain food types. Celiacs Disease sufferers and the lactose intolerant come to mind most easily. But for most folks, a wide variety of food sources can provide energy for bodily functions and the activities of daily living.
Our bodies are structurally capable of eating a broad variety of foods and extracting nutrients and energy from all of them. Our DNA has pretty much hard-wired us to seek out a wide variety of food and food sources. Science, industry and pure human ingenuity has led us to a place in history where just about any kind of food we want is readily available. Examples of other humans who have successfully lived healthy lives using a wide variety of dietary plans and structures are readily available all over various media and ubiquitous on social media.
So what would drive a human living in this environment to become so rigid in their beliefs, habits and actions that they would put themselves at risk for social isolation, self-loathing, depression, anxiety and even suicide? (That’s not even mentioning the physical risk that may arise from choosing a food orthodoxy which might exclude essential nutrients.)
Simply put, what drives otherwise normal humans to become orthorexic?
There is no simple answer. Behaviors, trauma, societal pressures, media and social media and environmental factors all likely contribute in some ways. The obvious example of media/social media influence would be repeatedly seeing images of models or actors promoting a specific way of eating. Any person who is attracted to, respects or is a fan of that person is more likely to have that bias influence their behavior. While that may not be a slam dunk cause of orthorexia, it’s likely to move the individual one step closer.
Because the psychological stew surrounding the interaction of behavior, media/social media and other factors is so complex, I’m not going to dive into all of it here. But it is safe to say that in a world where a wealth of examples of successful omnivores exist, it is the dogmatic, often extreme examples of “single stream dieters” that usually make the most noise and get the most attention.
“Influencers” and social media experts rarely get on a soapbox, pull up their shirts to show their abs and preach the life-saving (and often planet-saving) virtues of the omnivorous, flexible eating plan. Vegans, paleo dieters, elimination dieters and ketogenic dieters are just a few examples of folks who often passionately espouse the exclusive righteousness of their way of eating. Those looking for a solution to poor health, overweight, frailty, weakness or some other perceived personal or physical flaw will buy the dogma and become acolytes, espousing the righteousness of their chosen path with similar, if not stronger, zealousness. Add previous emotional trauma to this mix and you may well get the most extreme kind of orthorexic.
Complex, indeed, and equally as frightening in many ways. Perhaps a follow-up to this piece where we dive in on those interactions. But for now, let’s look at two ways in which orthorexia nervosa can overtake an otherwise normal person’s psyche and life.
The first way that orthorexia can rear its ugly head for someone is related to anxiety. Specifically, people who exhibit anxiety about disease, poor health or related issues and disorders are far more likely to seek nutritional solutions for their fear of disease, disorder and death. In some of these cases, this pursuit of proper nutrition to avoid obesity, sickness, etc. can morph into a limited scope, dogmatic approach to eating. This, however, by itself may not yet rise to the level of orthorexia.
When the individual begins making changes in their approach to daily living in order to accommodate their eating habits, orthorexia may well be at hand. An example would be the raw vegan who refuses to eat at any restaurant, even a vegan restaurant, because none are “raw enough” to meet their demands. Another would be the physique enthusiast who can’t eat around other people because of a perception that others with less “pure” or perfect diets are beneath him/her.
For the record, being a raw vegan (or proponent of any other eating or dietary style or system) doesn’t make you orthorexic. Extremely limiting dietary systems such as raw veganism do, however, lend themselves to orthorexia, due in part to the extreme limitations in food selection and availability.
Another way is related to the pursuit of physique improvements. For many who pursue the “perfect” physique, there are underlying issues of self-esteem and self-worth. Their self-perceived value to the world can be connected to the way they look. Their dietary habits, then, may become extremely rigid and fixated on how to “eat clean” or eat only those foods which support their pursuit of the perfect physique.
It’s easy to see the connection between this thinking and orthorexia. It shouldn’t be hard to imagine, then, that these folks are often those who binge eat as a result of a perceived dietary failure. The blow to self-esteem leads to actions which deal more blows to the self-esteem. This often results in a redoubling of the militant, dogmatic eating approach which led to the meltdown in the first place.
For the record (again,) being a disciplined eater does not make you orthorexic. The secret there is in your attitude about others eating habits, how you treat yourself when you make a mistake and the variety of foods you are willing to consume (to a degree.)
What are the signs of orthorexia? Good question! Let’s look:
- Obsession over the quality of food – The quantity of food is usually less important than the quality or purity of food. Orthorexics will often limit their acceptable foods to those which fit a specific category of purity or application. Physique-related orthorexics often must have specific kinds of proteins, carbs and fats, sometimes only from specific sources or suppliers. Others may limit their foods to those that are organic, vegan, raw or whole.
- Extremely rigid eating patterns – Anything considered impure, unhealthy, bad, negative or unacceptable will be rigidly avoided. Given the choice between starving and eating an unhealthy food, the orthorexic would likely choose starvation.
- Eliminating entire food groups – Carbohydrates, meats, dairy, sugar, gluten, processed foods, etc. Anything deemed inappropriate or unacceptable.
- Constant worry and anxiety over disease or sickness – For the orthorexic, failing to eat pure, whole or clean foods is connected to a belief that, at some level, these foods are poison. There is a risk, for them, that these foods will cause sickness and disease.
- Depression, anxiety, guilt and emotional turmoil and disorder when their rules are broken – “Falling off the wagon,” either in food selection and consumption or in their exercise program, can lead to self-imposed shame and guilt and/or feelings of worthlessness and failure. The anxiety and depression related to this can be profound, sometimes including suicidal thoughts.
- Anxiety from just being around some foods – There is often an intense drive to remain separated from specific foods or food groups. Orthorexics may skip family or social events because of the fear that a “bad” food will be present. They may leave a room if one of these foods appears. This avoidance technique can instigate intense emotional disturbance, create social isolation and contribute to depression. (6, 7)
In a few cases, food allergies may lead people to become orthorexic. The avoidance of a specific allergy trigger food can lead to the avoidance of the entire class of foods or food group to which the trigger food belongs. Some people may find themselves headed down the orthorexic road via a desire to treat asthma, allergies or other conditions naturally.
In these cases, the use of an elimination diet is often recommended, too often by people who have no business doing so. Personal trainers and even the medical professionals know as your sister-in-law or the guy 3 cubicles over at work will tout the miracles of the elimination diet or other plan in “curing” allergies, asthma and even diseases like arthritis, Alzheimers and cancer. From there, it’s a slippery slope of limitation and elimination of foods and groups before orthorexia is a problem.
Let’s be clear. I’m not advocating either for or against any diet or nutrition plan. Except for one. I can tell you with 100% certainty from experience that the people who succeed nutritionally in the most sustainable ways use some form of flexible eating plan. Even if they’ve chosen a ketogenic, paleo, vegan or other “exclusive” plan, allowing for some flexibility, cheat days or meals or just the understanding that you won’t always be perfect is a far better way to go.
While orthorexia is not an official psychiatric eating disorder yet, it is a frightening one. Orthorexia has a close connection with anxiety, self-loathing and depression. All of those are connected to poor levels of emotional, mental and even spiritual fitness. Anxiety and self-loathing can be especially damaging to your emotional and spiritual well-being, leaving gaps to be filled by vices and activities that just make things worse.
You were born an omnivore, really pretty unique in nature. Enjoy it, and all the bounty nature has to offer. If you choose a specific nutritional path, be aware of the values of flexible dieting. Not sure how to do that? I recommend Lyle McDonald’s Guide to Flexible Dieting. You can find it at Lyle’s online store right here. If you find yourself starting to limit foods or groups, or get anxious about specific foods, talk to someone who can help. It’s not just your diet at stake. It may be your life.
Keep the faith and keep after it!
- 7. https://www.timberlineknolls.com/eating-disorder/orthorexia/signs-effects/