Orthorexia – the unhealthy obsession with healthy food – is a dangerous eating disorder. And it’s on the rise. One MH writer investigates how eating well could be doing you ill
“Go on mate, just one piece. It’s not going to kill you.” The words fill me with anxiety. Without a single spoonful passing my lips, I can already taste the cloying guilt at the back of my throat. While everyone else tucks into their second slice of wedding cake, washed down with yet another glass of champagne, I stay soberingly hungry. Because where they see a soft vanilla-scented sponge layered with fresh-fruit jam and buttery, melt-in-the-mouth icing, all I see is a toxic slice of gluten topped with 50-odd grams of gut-rotting sugar.
I haven’t eaten all night. The starter: too salty. The chicken main: dripping with a butter sauce. The bread rolls: where do I start? I push the cake around on the plate in front of me, and long for the comfort of the Tupperware containers occupying practically every bit of my fridge at home. The initial superiority I felt, while I smugly watched my friends stuff their faces with high-GI carbs and saturated fats, has waned. And the longer the night goes on, the more I feel that maybe the big fat joke is on me after all.
It started with the best intentions – an inter-office fitness challenge – and that had to start with a healthy diet. I cut out the foods I knew to be bad for me, and ate only the good. But three months in, it’s getting out of hand. Going out for a meal with friends is off the menu; the pub is a no-go zone; even weddings, like tonight, simply result in an imperfect marriage of food and stress. My rules were meant to make me feel better; I look good, but feel so much worse. And while I’m getting props in the weights room, I’m one unhappy gym bunny.
Checking the small print
An unhealthy obsession with healthy food: it sounds like a contradiction in terms, the least of our worries in a time of ever-swelling obesity rates. How can cutting out all the stuff that’s bad for you, and eating only what’s good, ever be detrimental to your health? The mere thought repudiates the most basic principles of bro science. And yet psychologists and dietitians are in agreement that this may well be the most wide-reaching, if least well understood, dietary health concern affecting us today.
According to the experts, sufferers are most likely to be in their thirties, well-educated, middle class and health-conscious. For heavily filtered evidence just scroll through your Instagram feed: hashtags like #eatclean and #fitfood abound, through which millions of users unashamedly share their photographs of joyless – borderline inedible – meals, all in the name of health (and validatory likes from strangers). This is but one unappetising, photographic symptom of a most modern eating disorder. Its name is orthorexia, and if you’ve ever felt a pang of guilt after eating a cheese sandwich, or turned down a dinner invitation on account of its impact on your “gains”, the chances are you may well have it.
Doubtful? Ask yourself this: when you’re planning dinner, do you care more about the nutritional makeup of your meal than the taste? Do you have a mental blacklist of bad foods that you refuse to eat, even though you’d like to? Does the thought of going to a friend’s house for dinner and risking their trademark spag bol fill you with unease (for the gluten content of the pasta rather than their famously overzealous seasoning)? Have you ever felt so guilty after tucking into a bowl of ice-cream that you’ve punished yourself – or “made up for it” – with exercise?
If you’re anything like me and answered yes to any of these questions, then what began as a well-intentioned desire to eat only healthy, nutritious food – to look after your body – may have mutated into an insidious threat to your health and happiness. And though our expanding waistlines and the related health concerns steal all the headlines, just as many of us are subject to an unhealthy force of equal and opposite severity.
Deanne Jade, psychologist and principal of the UK’s National Centre for Eating Disorders, says, “I would say that in this country, orthorexia affects hundreds of thousands of people. Maybe even millions. I’ve seen orthorexia in my clients for years, but the problem is getting bigger, because it’s become socially acceptable – cool, even – to eat a quirky diet.” Faddy #eatclean memes, in other words, have become as popular as they are tedious.
This quirkiness takes many guises, but all have one thing at their core: restriction. The paleo diet – no grains, legumes or dairy – is a major culprit. But then so is cutting out gluten or caffeine, sugar, salt, processed foods or alcohol. Removing any of these from your diet on a whim could well prove dangerous. Not just for the impact that it may or may not have on your body, but on your mental health. Because, like all eating disorders, orthorexia nervosa – to give it its proper title – is predominantly a problem of the mind. Case in point: an associate recently attributed his underperformance on the bench to the BPA content of his Tupperware. Not, you know, to the fact he hadn’t eaten a simple carb in three weeks. That doesn’t exactly scream “healthy body, healthy mind”.
Unlike traditional eating disorders, it is exactly people like him, you and me who are most susceptible, according to the experts: men, essentially, but especially those with an interest in health and fitness. Those who are prepared to let their food go cold while they enter their kilojoules into MyFitnessPal, or check the small print on the back of food packaging for its sodium content, or walk up and down their hallway to beat yesterday’s step-count on their fitness tracking wristbands.
“Both sexes are susceptible for different reasons,” says Ursula Philpot, chair of the British Dietetic Association's mental health group, “but men can get hooked into rules and regulations, and kilojoules and numbers, and gadgets and scales going up and down, very easily.”
So you might be orthorexic, but the question remains: how can following a diet consisting exclusively of healthy foods be bad for you? How can trying your hardest to avoid becoming a statistic in the obesity crisis be, in itself, a problem? And if eating healthily can become unhealthy, then where is the line?
If you’re trying to pick one out of a crowd, the orthorexic is the one with the rippling six-pack and the guilty conscience. “Personally, given the choice, I’d rather not eat McDonald’s,” says Jade, “but if it was the only thing available, and I was hungry, then I would. Whereas someone with orthorexia would have a great sense of anxiety about it. Mentally, emotionally, they’re horrified at the idea of eating it. They feel toxic or poisoned when it’s inside them.”
This acute food guilt is something I know all too well. During my challenge, every three hours, like clockwork, I would warm up one of my five daily meals, prepped and packed in advance. Combined, the contents of these containers provided the precise daily macronutrient requirements that I’d calculated would help me attain a set of visible abs. (195g of protein, 240g of carbs and 80g of fat, if you’re interested.) Evenings were spent meticulously weighing out every single ingredient for the next day’s meals, from lean protein to low-GI carbs, down to the gram. Outside of the contents of these containers, there was no leeway. Any deviation resulted in panic, guilt-induced insomnia, and more than a little eye-rolling from an understandably unsympathetic girlfriend.
Gluten was out. So too dairy, sugar and booze. In fact, soon the list of restrictions was so long that eating out – be it at restaurants or with friends – became a genuine source of stress. What if they forgot I wasn’t eating cheese? What if this meal would tip me over my daily macros? What if I succumbed to temptation and did something truly deplorable – unforgivable, even – like eat a potato. It was either take my Tupperware with me, or take myself home. Physically, I was in the best shape of my life, but emotionally I was a wreck. I had become so obsessed with micromanaging my diet that I was constantly thinking about food. Fretting over it. Agonising over it. Definitely not enjoying it. In other words, I had become orthorexic.
“Orthorexia begins when healthy eating starts to interfere with ordinary life,” says Philpot. “At Christmas, birthdays, weddings, people will eat certain sorts of food. If you can’t join in with that because you perceive that it’s too unhealthy, because your healthy eating is such that you can’t enjoy normal social occasions, go out for meals or socialise with other people, that is when it becomes problematic. When nutrition starts to become a larger chunk of your life, where you start spending disproportionate amounts of time planning it, thinking about it, researching it, then that’s when we start to worry, because it becomes obsessional.”
I turn to Russell Delderfield, a researcher at the University of Bradford studying eating disorders in men. How could my aspiration to make positive changes to my diet have turned into a burgeoning eating disorder? How can the ability to deadlift most grown men be rooted in an unhealthy mentality? After all, I tell him, it all started as a push to get my body into the best shape of my life. But the damage, he says, started the moment I let my dietary decisions spill over into my relationships. “You begin to withdraw from people because you can’t eat with them; they can’t prepare food the way that you need it preparing; they can’t offer you the kinds of foods that you find acceptable. It even goes to the point of behaviours that you normally associate with anorexia, such as hiding food and disposing of it later, or avoiding any situation where there’s exposure to unacceptable foods. That to me is more than just being on a fitness drive for the summer.”
Delderfield was right. Socially, I was becoming alienated from my friends (and who could blame them; I certainly wouldn’t want to hang out with me). Psychologically, food dominated my thoughts and had a strangle grip on my emotional state. That much I was starting to come to terms with. But nutritionally, it was hard to see why I should stop feeding myself what I had deemed to be a healthy diet. What was the physical harm? Anorexics can starve themselves to death; bulimics can do permanent damage to their internal organs. My diet, neurotic though it might sound, was ultimately healthy. Wasn’t it?
The term orthorexia was coined almost 20 years ago by US doctor Steven Bratman, who was also the first person diagnosed with the condition. Bratman, moved by the scientific literature that was starting to emerge about the effects of certain foods, decided to go on a health kick. To make a concerted effort to let only nutritionally beneficial foods pass his lips. The more he read, the more he cut out, until he realised that his diet had become so restrictive that he was actually – to his own surprise – doing himself physical harm. His healthy diet had started to make him sick.
“People think they’re taking these squeaky-clean roads,” says California-based Alan Aragon, the self-proclaimed Ron Burgundy of nutrition. “But there are things they’re doing in terms of their food choices that are actually less nutritious than if they were being more flexible with what they ate, by which I mean including so-called ‘naughty’ foods.” The problem, says Aragon, who has seen a dramatic rise in cases of orthorexia among gym-going men, stems partly from the bad language we use to talk about food.
“Labels like ‘clean’ and ‘dirty’ automatically make people judge individual foods outside of the context of the rest of their diet. If your diet is rigid and inflexible, where it has a very strict ‘avoid’ list of foods, and a very narrow ‘approved’ list, you could be missing out on good nutrition from the foods you mistakenly feel are ‘bad’.” Single ingredients aren’t in themselves ‘good’ or ‘bad’, he says. The way they fit into your diet, building towards the bigger picture, is what counts. “It doesn’t make sense to look at individual foods in a vacuum. There is such a thing as a dirty diet, but individual foods being dirty? No, because you can’t look at anything in isolation from the wider context.” No, not even a Twix.
To the orthorexic mind, the notions of ‘healthy food’ and ‘healthy diet’ have become conflated. Dangerously so. No-one can argue that kale, for example, is not good for you, but try to survive on a kale-only diet and you’ll live a miserable and emaciated existence. (The key to happiness simply does not lie in the leaves of a cruciferous vegetable.) This, on a wider scale, is where the obsession with healthy food – rather than a healthy diet – becomes physically destructive. As the list of foods you <i>can<i> eat gets shorter, as your diet becomes more restricted and your rules more devoutly observed, you miss out on essential nutrients your body requires in order to be truly healthy.
It’s something psychologist Jade sees all too often in her clinics. “When I work with people who have orthorexia,” she says, “part of my job is to try and get them to start eating some of the foods that they forbid themselves, and the terror is just enormous.” Don’t believe her? Try telling someone on the paleo diet that they need to eat a lasagne for their own good. “But they need to do so because some of them are deeply malnourished. They’re restricting their diets, they’re not getting enough nutrients, their body is under stress, and that, clearly, isn’t healthy.”
Routine health check
At the root of the problem is the constant message that it’s our unhealthy food choices that are killing us, let alone our healthy ones. Obesity is on the rise, as are diabetes and heart disease – all of which have their roots in our deleterious diets. Everyone insists that in order to protect ourselves from these risks we need to think more carefully about our food choices. To eat more healthily. (After all, goji berries may be expensive, but the cost is negligible compared with the untold billions that overweight and obesity is estimated to cost society each year.) In this context, it’s not surprising that orthorexia is reportedly growing at such an alarming pace (it’s impossible to know the exact figures, as so few people know how to recognise the symptoms, and even fewer actively seek help).
Isn’t it only natural – inevitable, even – that people will begin to obsess over what goes into their shopping baskets? “We, as a society, have lost our balance,” says Jade. “Orthorexia has become normalised. The message that permeates is that if you’re eating ‘normally’, then you’re not taking care of yourself. People wear their quirky eating habits – paleo, ayurvedic, clean – like a badge of pride. And anxious people who don’t feel in control, who swallow it whole, so to speak, become orthorexic by stealth.” Anxious people with a #fitspo- and #fitfam-dominated timeline like me.
For months, I obsessed over the minutest detail of my diet; every gram of food that entered my body. After that, I couldn’t just go back to “normal”. Not only did I not want to – I’d worked too hard for my newly carved out abs – but I’d forgotten what normal was. This is typical of people who micromanage their nutrition, says Aragon. “Once you’ve been lean, and you have everything in your mind associated with what was necessary to achieve that, then it can be very difficult to think of doing anything else. So even though you are physically healthy, it can be traumatising,” he says.
In other words, I had overhauled my unhealthy habits, but replaced them with a set of psychologically, and potentially physically damaging, new ones. By the end, I knew that my relationship with food wasn’t healthy. That it was disordered. But still, if I “slipped up” by having a couple of beers with friends, or “cheated” by ordering dessert, I was racked with guilt.
The thing is, I still want to be healthy. I don’t just want to stuff my face with all the buttery, sugary cakes that come my way. I was only just getting to know my abs – it seems a shame to wave them goodbye, with a mouthful of crisps and empty chocolate wrapper in hand. So how can I commit to a wholesome diet without compounding my unhealthy obsession with sticking to it? I ask Aragon for his advice. “Don’t try to micromanage your diet,” he tells me. “You can never track everything down to the most minute detail, and by trying to do so, you lose the big picture. You can’t see the forest for the trees. Try to eat predominantly whole and processed food, but build in a margin of flexibility. Realise that if 10, or even 20 per cent of your diet comes from ‘junk’, you can still live a long and healthy life”.
The challenge now, then, is to learn to enjoy food for what it is, rather than the nutritional value it provides. And not to set rules, but create a more relaxed framework of guidelines. “Getting into a routine is fine,” says Aragon. “Just get into a routine that you like.”
So I’ve developed a new routine. It involves eating an apple in the afternoon, despite its high sugar content. Drinking a beer, or four, on a Friday night. Saturday too, maybe. And only posting pictures of food on social media that tastes as good as it looks. Because that’s healthy. And it’s the kind of behaviour I’m looking forward to obsessing over.
ARE YOU ORTHOREXIC?
If you’re worried about what you eat, take the Bratman Test for orthorexia. Answer yes to four or more of the below and it might be time to relax your thinking around food. If you answer yes to all of them, talk to a mental health professional
Do you spend more than three hours a day thinking about your diet?
Do you plan your meals several days ahead?
Is the nutritional value of your meal more important than the pleasure of eating it?
Has the quality of your life decreased as the quality of your diet has increased?
Have you become stricter with yourself lately?
Does your self-esteem get a boost from eating healthily?
Have you given up foods you used to enjoy in order to eat the “right” foods?
Does your diet make it difficult for you to eat out, distancing you from family and friends?
Do you feel guilty when you stray from your diet?
Do you feel at peace with yourself and in total control when you eat healthily?