Vegetarian, vegan, low-carb, raw, paleo — all claim to be the "ideal" diet, and adherents preach the benefits with the conviction of religious converts. But the current obsession with "clean" or "healthy" eating can have very unhealthy consequences. Mirasol clinicians gathered to talk about the roots of orthorexia, how it differs from anorexia, and the red flags that help health professionals and family members distinguish between selective or "picky eating" and an eating disorder.
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Diane Ryan: "Orthorexia is not exactly the same as anorexia. The strict translation is 'righteous eating'. So it has a few different components than anorexia although some of the components are the same. The thing that characterizes orthorexia, in addition to the restrictiveness that's created by the narrowing down of food choices, is the fact that there's this 'virtuous' component to it. It often comes from peoples' desires to eat healthy, and it just gets out of hand and becomes extreme. And I think the general consensus is that 'it becomes a problem when it becomes a problem,' when your decision to eat healthy prevents you from interacting socially, when it prevents you from normal relationships or normal ways of eating or normal places to go and ways of participating. And it also seems to impact the person's self-perception, so you can't feel really good about yourself unless you eat in a certain way that's very very clean and pure, and foods have to come from certain sources. There's always a component of, 'my self-esteem comes from the fact that I eat a certain way, and therefore if I don't, I have a lot of harsh self-judgment.'"
Anne Ganje: "Orthorexics won't often say 'I want to lose weight.' It can start with these diets that become very popular, and all of these books that promote health and cleansing and purity are very attractive, but once orthorexics or anorexics start diving into this, they realize that the consequences are weight loss. Then they get affirmed by their peers and culture, and that can be very addicting. There's also a high from fasting in and of itself. So the desire to cleanse or to be pure will promote a physiological response of feeling high, and then the culture and peers really promote that. It's often correlated with trauma, so that cleansing is a symbol of 'I'm cleansing my body from what I feel shame about.'"
Moderator: "When somebody comes into treatment with a long list of food preferences or food allergies, how can you identify which ones are legitimate?"
I think the general consensus is that 'it becomes a problem when it becomes a problem,' when your decision to eat healthy prevents you from interacting socially, when it prevents you from normal relationships or normal ways of eating or normal places to go and ways of participating.
Anne Ganje: "It's something that we have to deal with every day, and I think the level of attachment and what it brings up for the client when they're given guidelines, and told what we do and don't allow. We do allow three dislikes and we certainly honor legitimate allergies and intolerances. But when there's a lot of fear and anxiety, and behaviors escalate, that's always a sign for me as a dietitian that's there something much more than nutrition going on, that there are layers of trauma and anxiety that they're trying to cover up through the use of food. An orthorexic might start by becoming a vegan or a raw foodist, but it becomes more rigid and stricter, and then malnutrition starts to set in."
Diane Ryan: "And when you have malnutrition, you're going to have fairly quickly symptoms of cognitive failure of one sort or another, so the person's ability to make good choices is decreased."
Moderator: "It must be very difficult to persuade them that something they have been conditioned to believe is healthy eating is now a health problem for them. How do you go about disabusing them of that notion that what they're doing is healthy and 'cool'?"
Anne Ganje: "I think it's spending part of my time as a dietitian engaging in conversation with the clients about faulty belief systems around healthy eating and what it means to be a healthy individual, and then also working with the shame and the fear that come up around food."
Maeve Shaughnessy: "When somebody goes to their doctor and says, 'This is what I'm eating and I seem to be underweight,' if they're working with a doctor who doesn't have any sort of eating disorder specialty, it's going to be ... applauded!"
Moderator: "Are there things that you would want school counselors, and doctors to know to look for to help them identify when picky eating is actually becoming problematic?"
Kira Vredenburg: "I would look at the importance of balance, keeping an eye on whether that person is cutting out whole food groups, and then seeing if that's affecting the individual's life. Is making those food choices taking away from their lives? Is it making it hard for them to go out with friends? Is it making it hard for them to do well in school?"
Anne Ganje: "I think there's a real difference between picky eating and orthorexia. Children, in the absence of any kind of trauma or serious dysfunction, typically would not have the ability to understand or indulge in orthorexic behaviors. But when it becomes something that is cutting you out of life and social activities and connection with others — when it becomes a way to spirituality and peace and decreased anxiety — that addictive use is when it becomes a problem."
Maeve Shaughnessy: "One other component of orthorexia that I don't think we've highlighted quite enough is the exercise component. That's another red flag to look for, that quest to optimize a healthy lifestyle, when an individual focuses in on exercise, and 'How do I perform the best, and feed my body the best so that I can perform the best?' I think that's really common in athletes, and we have quite a few athletes that come [to Mirasol]. You asked the question earlier, 'How do we tease apart this healthy mindset versus an eating disorder when it's so ingrained into their identities,' and that can be a really challenging thing to pick apart."
It's very similar to PTSD or trauma, where we talk about their lives slowly becoming more narrowly focused. It's very gradual, so by the time they get there they don't realize how much they've given up and how much they've changed.
Katie Klein: "I was doing a little googling prior to the discussion, and the word that kept coming up was 'obsession': an obsession with eating healthy, an obsession with purity."
Ann Twilley: "When it interferes with peoples' lives, and they can't do the things they want to do, that's how I approach it. 'Okay, you say you want this lifestyle, you say this is really important to you, and yet it has limited what you can do in your life. It's limiting you from engaging socially or with family members.' And that's the biggest thing I see. We had a client who ate only raw food, and she couldn't go to any family functions, she bowed out of pretty much anything involving food, and that's just about everything socially. So I think that's a huge piece of it, the obsession piece for sure, and also how it limits their lives."
Jamelynn Evans: "It's not only the limitations on freedom, but also the limitations on how much of their day — and their life — becomes about buying the food, planning the food, going to the farmers' market, making the food .... So, not only they are missing out engagements with people who are eating other things, but also how free are they to live a life that revolves around anything but food?"
Ann Twilley: "It's very similar to PTSD or trauma, where we talk about their lives slowly becoming more narrowly focused. It's very gradual, so by the time they get there they don't realize how much they've given up and how much they've changed."Subscribe to Our Newsletter