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Health and wellness

Orthorexia: when healthy eating goes too far and you get ill and stop going out with friends in case the food on offer is ‘unclean’

‘Clean’ eating is all the rage, but is it as wholesome as it sounds or a slippery slope from healthy weight-loss practice to serious eating disorder? We take a closer look at this diet trend that’s got many of its followers obsessed

PUBLISHED : Sunday, 26 November, 2017, 7:45pm
UPDATED : Monday, 27 November, 2017, 7:42pm

Elaine Lin began to realise she had an unhealthy relationship with food while studying computer science at Massachusetts Institute of Technology. The 20-year-old food blogger had developed a preoccupation with healthy eating.

“Most of my anxious thoughts stemmed from concerns about food and body image,” says Lin. “My symptoms included making plans entirely based off certain meals, always thinking about food, and being super touchy about unexpected diet changes.”

Lin prepared almost all of the food she ate, and featured many of her meals on Instagram as @foodparsed.

She was strict about portion control, and mostly ate foods that were deemed healthy, such as vegetables, and avoided those deemed unhealthy, such as refined carbohydrates, including pasta and rice, potato chips, pizza, and French fries.

If she ate out, she often ordered salad with the dressing on the side. She also tended to skip social events where unhealthy food was served.

After some online research, Lin surmised that she might be suffering from orthorexia nervosa. Unlike anorexia nervosa or a binge-eating disorder, people with orthorexia are more concerned about the quality of the food they consume than the quantity.

The roots of the term orthorexia are the Greek words ortho, meaning correct or right, and orexis, which means appetite or desire. Coined in 1997 by American doctor Steven Bratman, it is defined as a pathological obsession with “righteous” eating or proper nutrition.

Unlike anorexia or bulimia, orthorexia is not recognised as a clinical condition. In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, orthorexia is categorised under “other specified feeding or eating disorders”.

Orthorexia happens when people take healthy, or “clean” eating, too far.

Most of my anxious thoughts stemmed from concerns about food and body image
Elaine Lin

“In many cases, it begins with adopting simple, ‘clean eating’ habits that eventually spiral out of control as the individual becomes obsessed with becoming ‘purer and healthier’,” says Sally Shi-po Poon, a dietitian at Personal Dietitian in Hong Kong’s Central district.

“People with the condition start off with good intentions and try to eat mostly organic, healthful foods. But in time, the rules tend to get stricter. For instance, they might go from eating the meat only of grass-fed animals to eating no meat at all. Foods just become ‘not good’ or ‘not pure’ enough, and as time goes on the individual is left with very little choice as to what they are even willing to eat.”

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Clean eating is a big trend on Instagram, as a quick search for photos with the hashtag (#cleaneating) shows. They often feature single-ingredient dishes, like a massive bowl of berries; whole, unprocessed meals; and slim and toned gym bodies – shared by followers of the clean-eating trend.

Such photos play a big role in fuelling unhealthy eating habits, as they dictate foods that are “clean” and “unclean” and send the message that if you want to look a certain way, you must eat specific foods and avoid others.

Such rigid diets can lead down a dangerous path, increasing the risk of developing nutrient deficiencies which could result in serious conditions such as osteoporosis and anaemia. They can also trigger feelings of anxiety and guilt when it comes to making food choices and even cause social isolation, as you avoid events where “unclean” food is served.

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Going out of your way to avoid certain foods or entire food groups can also pave the way to life-threatening eating disorders such as anorexia and bulimia.

Some do see value in clean eating, though. Jon Lee, who owns One Personal Training, a private, one-on-one personal training gym in Central, says he eats clean for up to five months when training for body-building competitions.

On this diet, he consumes only eggs, white fish, salmon, chicken, lean red meat, oats, rice, potatoes, and healthy fats in such foods as almonds, nut butters, and olive and coconut oils. “It’s all for body composition and weight gain and not for taste, so my meals are highly regimented,” he says.

When he’s not competing, Lee makes it a point to eat the same foods, but allows himself to indulge the odd craving.

“I think that’s the main difference between healthy eating and clean eating,” explains the 26-year-old.

I’d say that clean foods make up about 80 to 90 per cent of what I eat now. It’s important to have balance and to enjoy everything
Jon Lee

“With healthy eating you focus on foods that are good for you, whereas clean eating is focused on avoidance.”

Lee also understands a restrictive clean-eating diet can cause problems, having experienced them before.

“It can lead to an unhealthy relationship with food, causing problems like binge eating,” he says. “I’ve had post-show days where I took the diet and my training to the extreme, and ended up bingeing on ice-cream and burgers.

“Now, eating well is a lifestyle for me; eating extremely clean 24/7 is not an approach I take because I’m not looking to compete again any time soon. The main difference between now and my clean-eating days is that I’m not mentally exhausted from thinking about food all the time, so I don’t have that desire to binge-eat.

“I’d say that clean foods make up about 80 to 90 per cent of what I eat now. It’s important to have balance and to enjoy everything.”

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There’s a fine line between the extreme and non-extreme versions of eating healthily. So how can you tell if you might be suffering from orthorexia? There are a few indicators, according to Poon.

“A healthy eater consistently chooses the healthiest items on a menu when eating out, whereas someone with orthorexia doesn’t eat out due to an inability to control every ingredient on the menu.

“A healthy eater also avoids unhealthy items containing trans fat or sugar, whereas someone with orthorexia avoids certain foods to the point where he or she barely eats or doesn’t eat at all.

“And then there’s the guilt factor – so while a healthy eater might feel bad about making an unhealthy food choice, a person with orthorexia might express emotional turmoil due to an unhealthy food choice and find it hard to forgive him or herself for it.

“Another difference is that a healthy eater contemplates making healthful food choices but still socialises with friends and enjoys life. On the other hand, someone with orthorexia might withdraw from the social scene altogether and, as a result, experience a decreased quality of life.”

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Poon warns that healthy eaters must be able to recognise when they have crossed the line. The Bratman Orthorexia Self-Test, named after Dr Bratman, was developed to help healthy diet enthusiasts tell if they have the condition.

Answering yes to any statement on the list suggests you might have a problem. Such statements include:

“I spend so much of my life thinking about, choosing and preparing healthy food that it interferes with other dimensions of my life, such as love, creativity, family, friendship, work and school”;

“When I eat any food I regard to be unhealthy, I feel anxious, guilty, impure, unclean and/or defiled; even to be near such foods disturbs me, and I feel judgmental of others who eat such foods”;

While a healthy eater might feel bad about making an unhealthy food choice, a person with orthorexia might express emotional turmoil
Sally Poon

“My personal sense of peace, happiness, joy, safety and self-esteem is excessively dependent on the purity and rightness of what I eat”; and

“Following my theory of healthy eating has caused me to lose more weight than most people would say is good for me, or has caused other signs of malnutrition such as hair loss, loss of menstruation or skin problems.”

Lin, now a software engineer in San Francisco, believes only you can tell if your healthy eating habits have become a concern.

“The key distinction between an eating disorder and healthy eating is that the former gets in the way of your day-to-day life,” she points out. “For me, orthorexia resulted in awful mental health, but few external effects. I was still productive, except for the occasional day spent crying about how fat I was. I only cried in private to a friend, so most people didn’t see the problem.”

When Lin realised that she had taken her healthy diet too far, she began adding “unhealthy” foods to her diet, so that she could discover her true food preferences. And before following any diet advice, she would ask herself, ‘Is this sensible advice or just my orthorexia talking?’.

At social gatherings, she tried to focus more on the people she was with rather than on the food. She says that these small changes helped in her recovery.

“I’ve grown more mindful of my appetite and kinder when talking to myself about my body. For example, I used to beat myself up for overeating, but now, it’s not that big of a deal.”