Orthorexia: When Healthy Eating Goes Too Far

The celebrity news world lit up in February after David Beckham revealed in a podcast that his wife, Victoria Beckham, had eaten the same dinner for 25 years. That meal? Grilled fish with steamed veggies, a seemingly healthy choice for the former Spice Girl and longtime pescatarian. “Since I met Victoria, she only eats grilled fish, steamed vegetables,” David said in the River Cafe Table 4 podcast. “She will very rarely deviate away from that.” Victoria has spoken openly in the past about her meal choices. The fashion designer and performer discussed her history with eating disorders in her 2001 memoir, Learning to Fly, and in 2021 revealed in a podcast that her favorite comfort food is whole-grain toast sprinkled with a bit of salt. She also admitted to being a “very fussy eater,” preferring her food cooked without any fat or sauces, even when eating out at a restaurant. While there’s nothing wrong with her meal choices, what may ring an alarm bell is the extreme nature of the choices, and how such extreme healthy eating is becoming more commonplace since the pandemic (and not without its hidden burdens).  Behaviors such as this sometimes falls into the realm of an eating disorder called orthorexia. If you’re wondering what orthorexia is, and whether someone in your life may be taking their healthy eating too far, read on. Below, we delve into the definitions of orthorexia, signs of the eating disorder and what to do if you think someone has orthorexia. What is Orthorexia? Orthorexia is when people take healthy eating to an extreme, to the degree where their behaviors paradoxically become unhealthy. Some behavioral examples of active orthorexia include: Being unwilling to eat a meal prepared by someone else Limiting social activities, such as skipping a loved one’s party, in order to maintain a stricter eating regimen Spending exorbitant amounts of time planning meals. There are other signs and symptoms, too, which we’ll discuss further in a moment. The term orthorexia nervosa was first coined by Dr. Steven Bratman in the late 1990s. Similar to anorexia nervosa, which describes a different eating disorder, this new appellation comes from the Greek ortho, meaning correct, and orexi, meaning appetite. While anorexia nervosa, bulimia nervosa and other specified feeding and eating disorders are recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), orthorexia does not have a specific category. But the disorder is captured under the Avoidant/Restrictive Food Intake Disorder (ARFID), which is a broad diagnostic category of eating and feeding disturbances. The difference with orthorexia is that it does not include “a negative evaluation of one’s body influenced by weight, shape or fear of gaining weight,” writes Dr. Susan L. Bennett, PhD, CEDS, a clinical advisor at the Gaudiani Clinic, which focuses on medical care for eating disorders. “In other words, in the case of orthorexia, the individual is losing weight due to food choices, but not due to a drive to be thin.” What Are the Signs of Orthorexia? To gain further insight into orthorexia, Nutritious Life interviewed Victoria Kupiec, RD, LDN, CEDS, the Director of Nutrition and Eating Disorders Services at Timberline Knolls, a residential treatment center for women and girls in the Chicago suburbs. Orthorexia can be a tricky condition to contend with, in part because it’s not yet recognized by all medical professionals as a clinical diagnosis. Moreover, “orthorexia can fly under the radar, because a lot of the symptoms are validated by diet culture,” Kupiec explains. “Symptoms are often minimized by both the individual and their peers. They classify (orthorexia behavior) as a quest for health rather than a disorder.” But for individuals whose commitment to healthy eating becomes extreme, individual choices and behaviors that once signified a positive change in life descend into obsession. In addition to the indications listed above, Kupiec shares a detailed list of further signs that a person might have developed orthorexia, which include: Cutting out specific foods or entire food groups, followed by significant weight loss and/or nutritional deficiencies as a result of that change in diet; Attaching morality to food, which leads to feeling guilty after eating “bad” foods, or a sense of pride after eating “good” or “clean” foods; Judging other people’s eating habits, or attempting to get others to eat the way they do; Struggling to concentrate or handle daily activities, because being a perfect meal planner and eater consumes most of their time and mental energy. What To Do If You Think Someone Has Orthorexia Don’t make assumptions To begin with, don’t make any assumptions about who might struggle with eating in a healthy way, based on their age, sex or race. While research on various kinds of eating disorders has historically focused on women, it appears that teenage boys and men increasingly face these challenges too, driven partly by social media pressures to look a certain way. (It’s also worth noting that among the myriad shock waves unleashed by the COVID-19 pandemic, eating disorders have increased since early 2020.) When it comes to orthorexia specifically, “We need more research to determine any trends in demographics,” Kupiec says. “But it’s important to distinguish that body image is typically not an underlying cause in the development of orthorexia, (compared to) an emphasis on purity to achieve ‘ideal health.’ Given that healthy eating is heavily emphasized and valued in our culture, I am sure we will continue to see an increase in incidence in various demographics.” Lead with compassion Because of the cultural stigma that accompanies eating disorders, if you have concerns about someone’s relationship with food, it’s important to discuss your questions and observations with compassion, not judgment. A gentle approach—thereby “decreasing some of that guilt and shame they carry around struggling with eating disorder behaviors,” as Kupiec says—can be a critical first step for someone to seek professional help. Aim for early intervention when possible Early intervention can be helpful in reducing the severity of the illness, too. “Many variables influence what

Do You Suffer From Disordered Eating?

  Do you think about the consequence of a meal far after it’s over?  Do you weigh yourself at least once a day, thrown off by the slightest change in the number? Do you restrict foods or entire food groups that limit the amount of food you consume? Do you skip meals, use laxatives, or attempt to fast? If any of this sounds familiar, you may be suffering from what’s known as disordered eating. Disordered eating includes a wide range of thoughts and behaviors that, according to the DSM-IV (a fancy diagnostic classification tool used by the medical community) don’t warrant a diagnosis of a specific eating disorder, like anorexia nervosa or bulimia. However, it should in no way be minimized or thought of as less destructive or mentally invasive. Both eating disorders and disordered eating carry harmful consequences. Because disordered eating is less “extreme” than anorexia or bulimia in terms of endangerment to life, many people, including those suffering, don’t realize the impact it has on their mental and physical health. People may begin to socially withdraw, often saying no to dinners/dates. Sometimes the suffering can manifest itself in anxiety or depression. Often, constant denial that there’s anything wrong exists. The symptoms are harder to detect than a traditional eating disorder. Because this condition is more “silent” than a traditional eating disorder, it’s less likely to picked up by family and friends. Many people suffer for far too long before realizing that the inner pain and conflict they feel isn’t “normal”. Others consider their feelings of guilt and shame to be completely normal, and live their entire lives without getting the help that is available. The Signs and Symptoms of Disordered Eating Rigidity around food and exercise regimen Feelings of guilt and shame when making what’s considered to be “poor” eating decisions Emotionally driven eating Preoccupation with food, body, and working that causes stress and negatively impacts other areas of life Dieting Misusing laxatives/diuretics/colon cleansers Denial of physical hunger and satiety, usually for the sake of losing weight How Did Disordered Eating Happen? In my opinion, disordered eating is the result of the messages we see and hear in magazines, commercials, and television that have left men and women suffering. 1200 calorie diets have been drilled into our head for years.  Home economics, health class, and the science courses have failed to fully teach the science of food and relay the importance of individualized needs. We live in an “Eat this food, don’t eat that food” society, which frequently contradicts itself. Ever been told avocados are healthy, but then told they make you fat? We make 200-300 food choices per day. Without a clear understanding of what a food will do to our bodies, our perplexity intensifies. How to Recover From Disordered Eating First, you must identify that you’re living in pain, and that the pain isn’t normal. Whether that be negative self worth, obsession with food, binging, or a refusal to eat in restaurants or outside of your home. Second, accept that you’re not to blame. This is 100% not your fault. These feelings are so abundant that they can pass as the norm for many people. Social media has become a part of our routine, and with millions of messages flooding our brains daily, we’ve become more susceptible to eating disorders and disordered eating. Third, understand that it’s possible for you to improve your relationship with food and your body.  If you want to get out of the messed up relationship you have with food, the power is yours. Fourth, seek help. Whether from a psychologist or a Registered Dietitian, make a plan with a health professional who can steer you in the right direction. The process of recovery may take anywhere from a month to a few years. Be patient with yourself and the process and know that you’ll soon be able to focus on the important things in life. About Lisa: Lisa Hayim, MS, RD is a Registered Dietitian and Mindful Eating Expert in New York. She holds her Master’s in Nutrition and Exercise Physiology from Columbia University. She works in private practice, helping clients and patients learn to eat real food and make choices mindfully. Lisa believes that healthy is a complete state of physical, mental, and social well being. When we nourish our bodies with whole foods and learn to be mindful, we are not only preventing and combating disease, but effortlessly learning to appreciate our bodies. Follow Lisa on Instagram @TheWellNecessities, or head to TheWellNecessities.com  or plant based recipes that are 5 or less ingredients!