When healthy eating becomes unhealthy. By Li Yuling
Photo: stokkete / www.123rf.com
Move over #foodporn. There are new hashtags in town – and they are trending like wildfire. Presently, there are more than 19 million posts with #eatclean and over 14 million with #cleaneating on Instagram alone. Is this a sign of more people being concerned about their health? Perhaps, but experts also think social media could be feeding a lesser known monster: orthorexia nervosa.
Described as an unhealthy obsession with healthy eating, orthorexia nervosa literally means “fixation on righteous eating”. According to the US National Eating Disorders Association, the eating disorder often starts out as an innocent attempt to eat more healthfully, but orthorexics tend to become so fanatical about eating clean, pure and good food that their growing off-limits list leaves them with fewer and fewer choices.
The term orthorexia nervosa was first coined in 1997 by American physician Dr Steven Bratman. Initially, he used it to tease his diet- obsessed patients. But over time, it has assumed “a more significant place as a description for a type of obsession with healthy food that is psychologically or even physically unhealthy,” he writes on his website.
So when does healthy eating cross the line?
“It becomes unhealthy when it dominates your thoughts all day,” says Dr Adrian Wang, consultant psychiatrist at Gleneagles Medical Centre, who adds that orthorexics feel stressed when they’re not able to eat the way they want, or the type of food they like.
Another red flag is when the need to eat healthily even affects one’s social life. “Many people showing signs of orthorexia do not allow themselves to eat out or socialise with friends as it may mean they have very little control over their intake,” says Vanessa McNamara, founder of Singapore-based nutrition consultancy The Travelling Dietitian.
Alarm bells should also go off if you find that you no longer enjoy food. For people struggling with the disorder, there is a lot of guilt, stress and anxiety associated with food, adds Vanessa. “Those with orthorexic attitudes tend to focus on either including or excluding specific foods and ingredients from their diet.”
More shockingly, orthorexia nervosa can be fatal. Dr Bratman mentions one woman, Kate Finn, who died of heart failure brought on by orthorexia- induced starvation. He cautions: “Emaciation is common among followers of certain health food diets, such as raw foodism, and this can at times reach the extremes seen in anorexia nervosa.”
Recently, orthorexia made the headlines again when social media sensation Jordan Younger, better known by her Instagram monikers, The Blonde Vegan (then) and The Balanced Blonde (now), opened up about her struggle with the eating disorder. While Jordan sought help earlier than Kate did, she suffered multiple nutrient deficiencies as well as hormonal imbalances that stopped her period for several months. Read her story here.
Unlike other eating disorders, orthorexia is harder to diagnose. “There is no clear diagnostic criteria and often, sufferers look normal,” says Dr Wang. Indeed, cases similar to Kate’s are rare, and women like Jordan can appear to be in good health.
Among Dr Wang’s patients who qualify for a borderline diagnosis, some similarities stand out: They are usually more affluent and better educated, with obsessional personality traits. Jaclyn Reutens, clinical dietitian at Aptima Nutrition & Sports Consultants, adds that for those who need to be in total control of themselves, diet restriction is an easy way to do so.
Healthcare experts like Dr Wang and Jaclyn believe social media and the Internet also play a big part in facilitating – and even promoting – disordered eating behaviours, which is why younger people might be more at risk of developing orthorexia nervosa.
Of course, social media is not the sole catalyst. Disordered eating patterns can also develop after traumatic events like a health scare or losing a loved one to disease. “Seeing a family member suffer from an illness can trigger the desire to prevent that from happening to oneself. Cancer, heart disease or diabetes are some common diseases often mentioned by patients,” says Jaclyn.
Therapy, such as counselling, is tricky terrain to navigate. “It involves challenging some of the core beliefs of orthorexics, and helping them to understand how their behaviour causes more harm than good,” explains Dr Wang.
“You have to tell them to do things in moderation. Unfortunately, dispensing conventional healthy eating advice seldom works because they often think they know better – or that their body types are different from others and need a specific diet.”
Perhaps this is where dietitians and nutritional therapists might play a bigger role in helping orthorexics adopt balanced eating patterns. For those who believe they are well-informed of all nutritional pitfalls and what is the best for them, Jaclyn encourages them to question their information sources: “Are they credible? Do they present unbiased facts? Or are they blogs and books written by extreme dieters?”
A change of mindset is also needed. “It’s important to remove the labels of good and bad foods,” says Vanessa. “I encourage mindful eating and help patients to make sensible decisions about their diet based on evidence-based science rather than what they read on the Internet.”