Orthorexia: is an obsession with ‘healthy food’ the new eating disorder?

In a world that is increasingly dominated by eating clean, green foods and posting pictures of meals on Instagram, it appears that eating healthily can have its limits. Orthorexia nervosa, a condition characterised by an obsession with healthy eating, was first coined by Californian doctor Steven Bratman in 1997, but as yet has not received a formal medical classification.

Doubtless, some people will hear the definition of orthorexia and dispute that there are any negative side-effects of eating “too healthily”. But orthorexia is indeed a condition – recognised by Bodywhys, the Eating Disorder Association of Ireland – and one that can have insidious and far-reaching effects beyond the physical.

“While obviously being conscious of what we are eating and trying to follow a healthy, balanced diet is a positive thing, I think the key word here is ‘obsession’,” says clinical dietician Patrice McNamara. “Orthorexia is essentially an extreme fixation with ‘healthy eating’ and can lead to an unhealthy relationship with food and ultimately an unbalanced diet.”

Orthorexia can become deeply rooted in a person of any body type, and the repercussions can be mental as well as physical.

“Individuals with orthorexia may spend hours daily reading food labels, worrying about what they are eating, restricting whole food groups, and may exhibit symptoms of depression, anxiety and social isolation,” says McNamara. “It can take over all aspects of their life. The food pyramid is a model for a healthy, well-balanced varied diet, and this does not ban any food. It allows all foods in moderation and without guilt, and recognises that, although some foods have no nutritional value or health-giving properties, they are pleasurable – and delicious – to eat.”

Unlike with anorexia or bulimia, the orthorexia sufferer’s goal is not necessarily to be thin; negative body image might not even be a factor. But, like most eating disorders, orthorexia is about obsession and control of food intake. It is about conforming to a perceived healthy ideal, but often the perception of what is beneficial for a person’s health can be warped beyond recognition. This can lead to extremely unhealthy choices that are often normalised by pseudoscientific justifications, constant media coverage and celebrity endorsements.

The paleo diet

The dairy and grain-free paleo diet, which has been championed by Miley Cyrus and Matthew McConaughey among others, is an elimination diet based on foodstuffs possibly consumed by our Paleolithic ancestors. This means fruit, non-starchy vegetables and lots of red meat.

“As a dietitian, I would never recommend this diet,” says McNamara. “Studies of the paleo-type diet are small, and more long-term research is needed to show conclusively whether or not it is as effective as claimed. This diet is largely based on educated guesses, as there are no accurate records of our ancestors’ dietary intake. Its health claims lack good-quality scientific evidence.

“Some versions of the paleo diet actually encourage large amounts of meat, which contradicts current recommendations on meat consumption and could increase your risk for some conditions such as colon cancer.

“Indeed, any diet which recommends exclusion of whole groups in the long term will ultimately increase one’s risk of nutritional deficiencies. Unfortunately most of these diets are recommended by individuals who have no real qualification in nutrition.”

Paleo and elimination-based diet adherents labour under the assumption that what they are eating is healthier than anything else on offer, and the large amount of noise and nutritional doublespeak around such diets appear to confirm the validity of their choices.

Ethical code

“The term ‘nutritionist’ is not a protected title, which means ultimately that anyone can call themselves a nutritionist and potentially offer inaccurate, inappropriate, and dangerous dietary advice,” says McNamara. “It’s difficult to differentiate between those who have a nutrition degree and those who don’t. Dietitians are the only nutrition professionals to be regulated by law and governed by an ethical code, to ensure that they always work to the highest standard and provide accurate, evidenced-based advice.”

It’s emblematic of the changing face of eating disorders that, while fad diets used to be about losing weight, they are now about gaining health. But, with the majority of fad diets, the probable outcome is also the least welcome one. Those who engage in deprivation diets may gain weight in the long term, and those who partake in elimination diets such as the paleo diet could be setting themselves up for future nutritional deficiencies.

Aside from the physical effects of such eating habits, orthorexia can also have a serious impact on mental health. “Ultimately, orthorexia can lead to nutritional deficiencies just as bulimia and anorexia do; the potential to cause malnutrition is just as serious. But it could have a devastating effect on someone’s day-to-day life, leading to anxiety, depression and social isolation,” McNamara says.

Compounding this sense of social isolation is the plethora of bad science available online, conveniently packaged by an ever-increasing amount of often misinformed “health gurus” and food bloggers. Some of these food bloggers command a sizeable online readership of devoted followers; their rhetoric is often based on bad science and, in some cases, outright lies.

Australian food blogger Belle Gibson is a case in point. She claimed to have cured herself of five different kinds of cancer through clean eating. She based her business, The Whole Pantry, on this premise, and expanded into phone apps and a book. But when she admitted in a recent interview that she fabricated her cancer story, her many followers felt betrayed.

Orthorexia is indeed marked by obsession and control, but the word “disorder” is also important to remember. The food pyramid, often regarded as the proper model for balanced eating, has order in its triangular form, with carbohydrates forming a steady base, and rich, fatty foods at the sharp pinnacle.

“Even a healthy diet allows treats in small quantities,” says McNamara.

Remove a slice – any slice – from the pyramid, and the order is disrupted and thrown into disarray.