Episode 25: When healthy habits become unhealthy

Definition: https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia

What is orthorexia?

A fixation/preoccupation with so-called ‘healthy eating’ or ‘clean eating to a point where it becomes obsessional and begins in infiltrate their life - causing anxiety, stress and impacting in relationships. More common with the rise of the #cleaneating #sugarfree #dairyfree, etc.. phenomenon on social media. 

It is an eating disorder, however  there are no diagnostic criteria at present. There is a lot of work happening at the moment to help characterise it. Hopefully it will be able to be incorporated in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition)in the future. This makes it increasingly difficult for doctors or dietitians to characterise this condition, particularly those who work within a weight centric paradigm.

It’s difficult to pick up because there are so many food and nutrition fads. Orthorexia can be quite easy to hide behind because a person can appear as if they are focused on ‘health’ and ‘wellbeing’ where as they’re battling a mental illness people may not know about. A person may often be at a healthy weight and not have any nutrient deficiencies (others will) - everyone is different depending on their restrictions. 

There can be many ways which orthorexia can develop e.g. previously mental illness or ED (many clients can transition from anorexia to orthorexia - meaning they may restore weight and start eating but the obsessions thoughts continue to infiltrate) or a health condition (e.g. autoimmune disease or bowel issues) or it may be a desire to just feel better and because we are inundated with health messages everywhere we go, it can be difficult to escape.

Warning signs and symptoms

• Compulsive checking of ingredient lists and nutritional labels
• An increase in concern about the health of ingredients
• Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
• An inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
• Unusual interest in the health of what others are eating
• Spending hours per day thinking about what food might be served at upcoming events
• Showing high levels of distress when ‘safe’ or ‘healthy’ foods aren’t available
• Obsessive following of food and ‘healthy lifestyle’ blogs on Twitter and Instagram
• Body image concerns may or may not be present

Ref: https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia

Common theme of when it becomes a problem:

• It’s impacting your mood
• Impacting your social life
• Compulsive checking of ingredient lists and nutritional labels
• You’re cutting out food groups or consistently skipping meals
• You feel guilty if you miss a training session or eat out of plan
• You fear losing control.
• You feel stressed or anxious about straying from your plan/usual actions
• It becomes too high on your ‘priority list’. Absorbs too much of your brain time. E.g. choose between brother’s bday dinner and gym / eating your planned meal and you choose the latter
• You skip work, school, or social events to exercise or to avoid particular foods/eating behaviours
• You feel the need to hide your behaviour - eating / training in secret
• You continue to exercise when injured or sick
• Friends, family, or your provider are worried about your eating or exercise habits.
• Food and exercise are no longer fun
• You are overly critical of friend and family food choices + exercise habits
• Obsessively checking food labels

 

Bottom line: If food is causing anxiety/stress- alarm bells. If you can’t eat a slice of cake on your boyfriend's birthday because it’s ‘unhealthy’, then there is a problem. Being healthy means being flexible and eating intuitively.

Treatment

At present there are no clinical treatments developed for orthorexia. We are reliant on the skills/experience from eating disorder clinicians to manage this condition - strong links with AN and OCD. Treatment team usually involved a psychologist (psychotherapy & anxiety/stress mx) and dietitian (aim to increase the variety of foods and manage anxiety relating to foods). Weight restoration may be required if the patient is underweight.

At the core it is an inability to deviate and a sense of feeling ‘out of control’ if the rules and restrictions set can not be adhered to. One of my favourite lines that I heard from Dr. Stefanie Reinold (who also has her own brilliant podcast which we will link in the show notes) is “It’s not about the food”, there is a lot more going on underneath that we need to uncover to get to the core of the obsessive need to control food. 

 

Strategies:

• Understand what is at the root of the obsession, as we know it’s not about the food so what is it about? Is it feeling out of control in your life and therefore feeling the need to control food? Are you having a stressful time with a loved one? Did something happen in your past?
• Adoption of a balanced mindset (which is easier said than done) - it would be important to seek professional help and work to increase flexibility with eating. Develop strategies to help manage anxiety or stress around food.
• Rules = guilt/shame - be more liberal with rules you put on yourself
• Acknowledge everyone is different, what works for one doesn’t work for another - social media detox and following positive people.
• Knowing recovery is challenging, because rigidity and rules have been created and you need support to help break those down and remodel. Sticking to a particular diet can make you feel safe (even though it is not safe or ‘healthy’).

 

Further information and support

https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia

https://thebutterflyfoundation.org.au/

https://headspace.org.au/

https://daa.asn.au/