The Scary Way Eating Disorders Hide As Healthy Eating

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It seems like every time you turn around there is a new diet or food trend on the horizon, and a recent report by the International Food Information Council (IFIC) Foundation found that 36% of Americans reported following a specific eating pattern or diet within the past year (2018). This is especially true for young people between the ages of 18 and 34 years old, as this group is most attracted to diets that restrict their access to carbohydrates and sugars while focusing on minimally-processed foods with fresh fruits and vegetables. Although the specific diets themselves have different names, it is all widely recognized as part of the “Clean Eating” movement. 

While on the surface this is a positive and healthy cultural shift that seems to be happening on a global level, many experts warn that an extreme preoccupation with “clean eating” can easily mask the signs of a serious eating disorder. What starts off as a positive move to improve health or lose weight may have the opposite effect for those who have the biological, social and/or psychological precursors for developing an eating disorder. 

While most people are familiar with eating disorders like bulimia and anorexia nervosa, one of the most insidious eating disorders on the rise in recent years is “Orthorexia”. Although it is not officially recognized as a disease by the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), it is a term that was coined in 1997 by California physician, Steven Bratman, MD, MPH. He defines it as “an unhealthy obsession with eating healthy”. 

Unlike with anorexia or bulimia where people focus on weight loss or calorie counting, people with orthorexia focus primarily on the quality of their food and are obsessed with a desire to eat “clean” This can progressively become more rigid over time and develop into an eating style that can have serious emotional consequences and in extreme cases lead to physical harm such as malnutrition.

Another common practice is for people with this condition to eliminate entire food groups including processed foods, sugar, meat, dairy products, carbohydrates and/or gluten. This is often accompanied by persistent and pervasive anxiety related to mealtimes as well as a tendency to label food as “good” versus “bad”. 

Dr. Blake Woodside, Medical Director Emeritus of Toronto General Hospital’s Eating Disorder Program said, “It’s a problem when people are so preoccupied with what they can and can’t eat that they stop normal activities like attending family dinners or going to restaurants. If you spend all your time worrying about what you’re eating or anxious and afraid of food, it reduces your quality of life.” 

It’s no coincidence that the rise of orthorexia; particularly in westernized countries, significantly correlates with the increased popularity of the “clean eating” movement as it is endorsed by YouTube celebrities, bloggers, social media influencers and online magazines. In 2017 the Eating and Weight Disorders Journal linked Instagram use and orthorexia finding “no other social-media channel having this effect”. There are currently more than 41 million #clean eating hashtags on Instagram along with an endless sea of clean eating “food porn” consisting of smoothies and sprouted salads posted by self-made “Insta-gurus” who openly share their obsession to millions of devoted followers. 

While there is nothing inherently wrong with this behavior, the problem is that many are taking advice from people who are sharing their personal stories, and who are restricting their diets without the benefit of scientific evidence, research or medical advice. 

It’s quite common to have the desire to take control of your nutrition and advocate for a healthy lifestyle, but things can get tricky when clean eating becomes an ”unrealistic quest for perfect health”. Below are a few signs and symptoms of orthorexia as outlined by Psycom.net and the National Eating Disorders Association that you may want to be aware of. 

1. Compulsive checking of ingredient lists and nutritional labels.
2. Overly concerned about the health of ingredients.
3. Cutting out an increasing number of food groups (sugar, carbs, dairy, meat, all animal products, etc).
4. An inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’.
5. Spending hours per day thinking about what food might be served at upcoming events.
6. Showing high levels of distress when ‘safe’ or ‘healthy’ foods aren’t available.
7. Obsessive following of food and ‘healthy lifestyle’ blogs on Twitter and Instagram.
8. Have obsessive thoughts over the effects of the food you eat on medical conditions, such as asthma, anxiety, allergies, or digestive disorders and including conditions that have not been diagnosed.
9. Use significant amounts of probiotics, herbal remedies, and other supplements thought to have healthy effects on the body.
10. Irrational concerns about the preparation of foods, relating to food washing techniques and sterilization of utensils.
11. Avoidance of eating food away from home or not prepared in your home kitchen.
12. Experience strong emotional reactions to food.
13. Having critical, judgmental thoughts of others who do not follow healthy, pure eating plans.
14. Unusual interest in the health of what others are eating.
15. Avoiding food bought or prepared by others.
16. Creating distance between friends and family who do not share the same beliefs you have about food.
17. Previous diagnosis or feelings of Depression.
18. Previous diagnosis of feelings of Anxiety.
19. Experience frequent and unpredictable mood swings.
20. Riddles with feelings of shame, guilt and self-loathing.
21. Increased social isolation and avoidance of a situation where you have to eat food publically or share food with friends or family. 

“Orthorexia is healthy eating taken to the extreme,” stated Jennifer Mills, an Associate Professor of Health at York University in Toronto. “It’s where it’s starting to cause problems for people in their lives and starting to feel quite out of control.”  If you feel that you or someone you care about may be struggling with Orthorexia, or any other avoidant restrictive food intake disorder such as anorexia nervosa, bulimia nervosa or binge eating then please contact the professionals at The River Rehab for a free assessment to explore what treatment options are available.