When a friend, Sarah*, comes over for dinner, she usually brings a dish of food. Not out of generosity, or a desire to be helpful, but because she simply wouldn’t eat if she didn’t. You see, Sarah doesn’t eat meat, fish, dairy, gluten, or any foods that are non-organic, processed or canned.
She’s a tough dinner guest and, to be honest, a bit of a health nut, but she insists her lifestyle – that of blacklisting not just individual ingredients, but entire food groups – is both healthy and natural. And with the latest data revealing that the number of overweight people in the developing world more than tripled from 1980 to 2008, with a third of adults worldwide now overweight, alongside rising cases of cancer, heart disease and diabetes, it’s little surprise that people such as Sarah are cutting out, rather than just cutting back.
As the list of foods to fear and eradicate continues to grow, eating disorder experts are increasingly confronted with women like Sarah. Not because they’re eating healthily, but because they’ve become obsessed with doing so and their rigid restrictions are leading to everything from malnourishment and infertility, to depression and social isolation. Enter orthorexia nervosa, a fairly new kid on the block of eating disorders, which though recognised by the medical profession is not yet officially classified.
First coined by Californian doctor Steven Bratman in his book Health Food Junkies in 1997, orthorexia is a “fixation on eating proper food”, an unhealthy obsession with, well, eating healthily. It sounds incredible but because orthorexia masquerades as a quest for healthy living – restricting bad ingredients and striving only for clean, pure foods – it can easily spiral out of control and become obsessional.
While the constant struggle to stick to an increasingly restricted diet can affect mental health and self-esteem – as orthorexics blame themselves rather than their inadequate diets for their hunger and subsequent craving for ‘unhealthy’ food – in rare cases this focus may turn into a fixation so extreme that it can lead to severe malnutrition or even death.
Most of the time, orthorexia begins innocently enough, as a desire to overcome chronic illness or to improve one’s general health, explains Dr Bratman. A person may start off following a normal diet, restricting, say, carbs or eating only protein, but it soon starts to spiral.
“Over time, these people start to blacklist certain foods. What to eat and how much, and the consequences of dietary imprudence, come to occupy a greater proportion of their day,” Dr Bratman says.
This is exactly what happened to Lucy, 33, who began by cutting out dairy and whose diet is now so restrictive that she subsists on just vegetables. And raw, organic-only ones, at that. At 165cm, she weighs less than 40kg and has now been diagnosed with anorexia.
Lucy didn’t set out to lose weight. She set out, like orthorexics do, to get healthy. Her path to this most deadly of eating disorders was gradual, subtle, hidden. She began cutting out foods three years ago after a bout of irritable bowel syndrome (IBS) and an intolerance test that deemed her lactose-intolerant.
“I cut out dairy, which made me feel healthier. But then I started to worry about what gluten was doing to my body, so banished that too. And so it went on,” she says.
Lucy’s so-called healthy eating developed into eating-disordered thinking, leading to the very dangerous condition of anorexia. She found that whenever she slipped up (most orthorexics manage to keep up a rigid diet only 80 per cent of the time) she’d experience feelings of guilt and self-loathing – feelings associated with anorexia and bulimia – and would subsequently punish herself, usually with further dietary restrictions.
And, according to experts, Lucy is not alone. Founder and president of the Lebanon-based Middle East Eating Disorders Association (MEEDA) Dr Jeremy Alford says he is seeing more and more people with orthorexic behaviours. “Diet restriction, such as those followed by vegans and raw foodists, have been identified as potential starting points for developing an eating disorder if the person is not properly informed,” he explains.
For Norah, 37 – who became orthorexic after a positive gluten intolerance test – it was the compliments she received on being so disciplined that encouraged her to restrict her diet further. “All I ever got was positive feedback for what people saw as my healthy behaviour,” says Norah.
Because for society, restriction of food, in whatever shape or form, is seen as socially acceptable, while eating normally or abundantly is associated with loss of self-control. The prime indication of orthorexia is the elimination of entire food groups and experts warn that many of today’s new-age food movements or celebrity-endorsed diets are fuel for the fire that is obsessive eating.
“These days, the person who is able to restrict foodwise with success is often viewed as a ‘disciplined, successful person’,” explains Dubai-based German Neuroscience Center psychotherapist, Dr Jared Alden.
Aside from the slippery slope into more serious eating disorders an exclusionary diet can – rather ironically, given that its motivation is to achieve good health – actually lead to poor health, both physically and psychologically.
Dr Alden says he is seeing more and more young people, in particular, with extreme fears of eating foods from certain categories, like fat, and warns that such rigid restrictions can greatly affect our physical functionality.
“Our brain is still developing up to the age of 25 and we need fat for healthy brain function,” he says, explaining how eliminating whole food categories can deprive the body of essential nutrients. Restrict your fat intake and you miss out on crucial fat-soluble vitamins A, D and K; cut out carbs and you may find your memory slowing.
“Nutritional deficiency can occur if food groups are excluded totally, leading to consequences affecting the metabolism and fertility, among other conditions,” explains Dr Tara Wyne, clinical psychologist, The Lighthouse Arabia, Dubai.
Forbidding food does more than deny your body the nutrients it needs to thrive. It can also affect you psychologically: an abnormal need for cleanliness and order replaces the passion once felt for life as orthorexics plan their lives around food.
An orthorexic in fact will typically spend at least three hours each day preparing menus, cooking, shopping, reading about, and discussing diet, as well as procuring the purest ingredients. This sort of obsessive behaviour can begin to hinder everyday activities, leading an orthorexic to become socially isolated and subject to mood swings, anxiety and depression. Norah’s restrictions, she says, have ruined many a good friendship. “I learnt to skilfully avoid any situation that would force me to deviate from my food regime.”
The mushrooming of orthorexia in society today is not just down to fad diets, though. Experts insist that a combination of obesity and disease-related scare stories by the media and a deluge of information on nutrition is responsible for pushing people from sensible eaters to extreme obsessives.
“While we all now get so much information about food, it’s simply not communicated in context,” says Dr Alden. “One day, we are told to eat tomatoes, the next day, to avoid them. One month, organic is the only way to go, the next month, it’s not worth the extra money.”<#comment>#comment>
So who is likely to become an orthorexic? “Anyone who has a job or hobby based on their physical performance can be prone to it,” says Dr Alden. As well as those whose physical appearance is always under scrutiny, like models; and those, like Lucy, who are recovering from an illness.
Because orthorexia, unlike anorexia and bulimia, starts from a place of health, not weight loss, the motivation for food restriction is different. Orthorexics are more concerned about the chemicals in food, rather than the calories.
“Orthorexia is focused only on what they consider healthy foods, with the aim of becoming super healthy, whereas anorexia is primarily focused on a fear of gaining weight and an obsessive desire to be thinner,” explains Dr Alford.
But while the coveting of good health appears to be the trigger for such blacklisting of foods, there is, more often than not, a more worrying psychological trigger at work. “A common trigger is when someone is experiencing a loss of control in their life, such as in relationships or at work,” says Dr Wyne. “They feel they need to regain a sense of control and do so through restrictive eating.”
Which is why, when it comes to personalities, those who are perfectionists and high achievers are more prone. They are also more likely to be in their thirties; more likely to be women (women are more inclined than men to fall into the orthorexic trap as they’re conditioned to obsess about food in a way that men are not) and more likely to be working professionals – the latter, explains Dr Alden, because they have the economic ability to be so choosy about food.
So, when exactly does healthy eating become unhealthy?
“If it’s impairing the person’s functioning in areas such as work, social life or psychologically, then it’s regarded as obsessive healthy eating,” says Dr Wyne.
If you can’t visit a friend for the weekend without panicking, can’t travel overseas, or avoid eating food prepared by others then, says Dr Alden, you have a problem.
If you start measuring your self-worth on the purity of your diet, admonish certain foods as dangerous or disgusting or feel critical of the way others eat, then that healthy eating becomes suspect, says Dr Alford.
Because orthorexics believe that the food choices they make positions them on a higher moral scale, they are often guilty of judging others, feeling a sense of superiority towards people whose diets are less disciplined.
“Watching people gorge on sodium-rich, sugar-coated rubbish made me feel virtuous and clean, as I nibbled on an organic apple,” says Norah.
And the more extreme the diet for health reasons, the more virtuous, clean – even spiritual – they’ll feel about themselves. And it’s this societal norm of applauding, even celebrating, those who are able to control what they eat, that makes recognising and treating those with orthorexia difficult.
“When a therapist pointed out to me that this extreme way of thinking was unhealthy, I scoffed,” says Lucy. “How could adhering to my healthy diet possibly be bad for me?”
Recovery from orthorexia is ultimately about getting beyond labelling foods as good or bad, understanding that carbs or fats, for example, are not intrinsically bad for you. “It’s true that some food is better for you, but when a person starts to think of foods as dirty or clean, it’s too simplistic and can be dangerous,” explains Dr Alden.
“Orthorexics evaluate their self-worth according to their eating practices, much like anorexics, and so therapy must include setting realistic expectations for themselves, improving their self-esteem and educating them about proper nutrition,” says Dr Alford.
Norah says, “I’m still a gluten-free vegetarian but I have since dropped most of my other former diet restrictions. It’s about being gentler with myself. I don’t judge others on their food choices anymore.”
Lucy, too, has relaxed her restrictions but is not quite ‘cured’. “Those feelings are still with me but food is no longer the first thing I think about when I wake up in the morning. However, I do think that some bad health news could motivate me to do extreme things again.”
Orthorexia will no doubt continue to draw more attention as increasing numbers of obsessed eaters are seduced by its siren song. Hopefully, this increasing number of sufferers will mean the condition becomes officially recognised as the debilitating and very real eating disorder that it is.
“I don’t consider orthorexia to be as dangerous as anorexia or bulimia, but it is certainly no less real,” concludes Dr Bratman.