THE RISE OF Or­thorexia Ner­vosa

When the ‘right food’ be­comes an ob­ses­sion, it can lead to mal­nour­ish­ment, anorexia and dis­abling anx­i­ety. Kate Birch looks at the lat­est eat­ing dis­or­der

Friday - - Society -

When a friend, Sarah*, comes over for din­ner, she usu­ally brings a dish of food. Not out of gen­eros­ity, or a de­sire to be help­ful, but be­cause she sim­ply wouldn’t eat if she didn’t. You see, Sarah doesn’t eat meat, fish, dairy, gluten, or any foods that are non-or­ganic, pro­cessed or canned.

She’s a tough din­ner guest and, to be hon­est, a bit of a health nut, but she in­sists her life­style – that of black­list­ing not just in­di­vid­ual in­gre­di­ents, but en­tire food groups – is both healthy and nat­u­ral. And with the lat­est data re­veal­ing that the num­ber of over­weight peo­ple in the de­vel­op­ing world more than tripled from 1980 to 2008, with a third of adults world­wide now over­weight, along­side ris­ing cases of can­cer, heart disease and di­a­betes, it’s lit­tle sur­prise that peo­ple such as Sarah are cut­ting out, rather than just cut­ting back.

As the list of foods to fear and erad­i­cate con­tin­ues to grow, eat­ing dis­or­der ex­perts are in­creas­ingly con­fronted with women like Sarah. Not be­cause they’re eat­ing healthily, but be­cause they’ve be­come ob­sessed with do­ing so and their rigid re­stric­tions are lead­ing to ev­ery­thing

from mal­nour­ish­ment and in­fer­til­ity, to de­pres­sion and so­cial iso­la­tion. En­ter or­thorexia ner­vosa, a fairly new kid on the block of eat­ing dis­or­ders, which though recog­nised by the med­i­cal pro­fes­sion is not yet of­fi­cially clas­si­fied.

First coined by Cal­i­for­nian doc­tor Steven Brat­man in his book Health Food Junkies in 1997, or­thorexia is a “fix­a­tion on eat­ing proper food”, an un­healthy ob­ses­sion with, well, eat­ing healthily. It sounds in­cred­i­ble but be­cause or­thorexia mas­quer­ades as a quest for healthy liv­ing – re­strict­ing bad in­gre­di­ents and striv­ing only for clean, pure foods – it can eas­ily spi­ral out of con­trol and be­come ob­ses­sional. While

‘The per­son who is able to re­strict food is seen as suc­cess­ful’

the con­stant strug­gle to stick to an in­creas­ingly re­stricted diet can af­fect men­tal health and self-es­teem – as orthorex­ics blame them­selves rather than their in­ad­e­quate di­ets for their hunger and sub­se­quent crav­ing for ‘un­healthy’ food – in rare cases this fo­cus may turn into a fix­a­tion so ex­treme that it can lead to se­vere mal­nu­tri­tion or even death.

Most of the time, or­thorexia be­gins in­no­cently enough, as a de­sire to over­come chronic ill­ness or to im­prove one’s gen­eral health, ex­plains Dr Brat­man. A per­son may start off fol­low­ing a nor­mal diet, re­strict­ing, say, carbs or eat­ing only pro­tein, but it soon starts to spi­ral.

“Over time, th­ese peo­ple start to black­list cer­tain foods. What to eat and how much, and the con­se­quences of di­etary im­pru­dence, come to oc­cupy a greater pro­por­tion of their day,” Dr Brat­man says.

This is ex­actly what hap­pened to Lucy, 33, who be­gan by cut­ting out dairy and whose diet is now so re­stric­tive that she sub­sists on just veg­eta­bles. And raw, or­ganic-only ones, at that. At 165cm, she weighs less than 40kg and has now been di­ag­nosed with anorexia.

Lucy didn’t set out to lose weight. She set out, like orthorex­ics do, to get healthy. Her path to this most deadly of eat­ing dis­or­ders was grad­ual, sub­tle, hid­den. She be­gan cut­ting out foods three years ago af­ter a bout of ir­ri­ta­ble bowel syn­drome (IBS) and an in­tol­er­ance test that deemed her lac­tose-in­tol­er­ant.

“I cut out dairy, which made me feel healthier. But then I started to worry about what gluten was do­ing to my body, so ban­ished that too. And so it went on,” she says.

Lucy’s so-called healthy eat­ing de­vel­oped into eat­ing-dis­or­dered think­ing, lead­ing to the very dan­ger­ous con­di­tion of anorexia. She found that when­ever she slipped up (most orthorex­ics man­age to keep up a rigid diet only 80 per cent of the time) she’d ex­pe­ri­ence feel­ings of guilt and self-loathing – feel­ings as­so­ci­ated with anorexia and bu­limia – and would sub­se­quently pun­ish her­self, usu­ally with fur­ther di­etary re­stric­tions.

And, ac­cord­ing to ex­perts, Lucy is not alone. Founder and pres­i­dent of the Le­banon-based Mid­dle East Eat­ing Dis­or­ders As­so­ci­a­tion (MEEDA) Dr Jeremy Al­ford says he is see­ing more and more peo­ple with or­thorexic be­hav­iours. “Diet re­stric­tion, such as those fol­lowed by ve­g­ans and raw food­ists, have been iden­ti­fied as po­ten­tial start­ing points for de­vel­op­ing an eat­ing dis­or­der if the per­son is not prop­erly in­formed,” he ex­plains.

For No­rah, 37 – who be­came or­thorexic af­ter a pos­i­tive gluten in­tol­er­ance test – it was the com­pli­ments she re­ceived on be­ing so dis­ci­plined that en­cour­aged her to re­strict her diet fur­ther. “All I ever got was pos­i­tive feed­back for what peo­ple saw as my healthy be­hav­iour,” says No­rah.

Be­cause for so­ci­ety, re­stric­tion of food, in what­ever shape or form, is seen as so­cially ac­cept­able, while eat­ing nor­mally or abun­dantly is as­so­ci­ated with loss of self-con­trol. The prime in­di­ca­tion of or­thorexia is the elim­i­na­tion of en­tire food groups and ex­perts warn that many of to­day’s new-age food move­ments or celebrity-en­dorsed di­ets are fuel for the fire that is ob­ses­sive eat­ing.

“Th­ese days, the per­son who is able to re­strict food­wise with suc­cess is of­ten viewed as a ‘dis­ci­plined, suc­cess­ful per­son’,” ex­plains Dubai-based Ger­man Neu­ro­science Center psy­chother­a­pist, Dr Jared Alden.

Aside from the slip­pery slope into more se­ri­ous eat­ing dis­or­ders an ex­clu­sion­ary diet can – rather iron­i­cally, given that its mo­ti­va­tion is to achieve good health – ac­tu­ally lead to poor health, both phys­i­cally and psy­cho­log­i­cally.

Dr Alden says he is see­ing more and more young peo­ple, in par­tic­u­lar, with ex­treme fears of eat­ing foods from cer­tain cat­e­gories, like fat, and warns that such rigid re­stric­tions can greatly af­fect our phys­i­cal func­tion­al­ity.

“Our brain is still de­vel­op­ing up to the age of 25 and we need fat for healthy brain func­tion,” he says, ex­plain­ing how elim­i­nat­ing whole food cat­e­gories can de­prive the body of es­sen­tial nu­tri­ents. Re­strict your fat in­take and you miss out on cru­cial fat­sol­u­ble vi­ta­mins A, D and K; cut out carbs and you may find your mem­ory slow­ing.

“Nutritional de­fi­ciency can oc­cur if food groups are ex­cluded to­tally, lead­ing to con­se­quences af­fect­ing the me­tab­o­lism and fer­til­ity, among other con­di­tions,” ex­plains Dr Tara Wyne, clin­i­cal psy­chol­o­gist, The Light­house Ara­bia, Dubai.

For­bid­ding food does more than deny your body the nu­tri­ents it needs to thrive. It can also af­fect you psy­cho­log­i­cally: an ab­nor­mal need for clean­li­ness and or­der re­places the pas­sion once felt for life as orthorex­ics plan their lives around food.

An or­thorexic in fact will typ­i­cally spend at least three hours each day pre­par­ing menus, cook­ing, shop­ping, read­ing about, and dis­cussing diet, as well as procur­ing the purest in­gre­di­ents. This sort of ob­ses­sive be­hav­iour can be­gin to hin­der ev­ery­day ac­tiv­i­ties, lead­ing an or­thorexic to be­come so­cially iso­lated and sub­ject to mood swings, anx­i­ety and de­pres­sion. No­rah’s re­stric­tions, she says, have ru­ined many a good friend­ship. “I learnt to skil­fully avoid any sit­u­a­tion that would force me to de­vi­ate from my food regime.”

The mush­room­ing of or­thorexia in so­ci­ety to­day is not just down to fad di­ets, though. Ex­perts

in­sist that a com­bi­na­tion of obe­sity and dis­easere­lated scare sto­ries by the me­dia and a del­uge of in­for­ma­tion on nu­tri­tion is re­spon­si­ble for push­ing peo­ple from sen­si­ble eaters to ex­treme ob­ses­sives.

“While we all now get so much in­for­ma­tion about food, it’s sim­ply not com­mu­ni­cated in con­text,” says Dr Alden. “One day, we are told to eat toma­toes, the next day, to avoid them. One month, or­ganic is the only way to go, the next month, it’s not worth the ex­tra money.”

So who is likely to be­come an or­thorexic? “Any­one who has a job or hobby based on their phys­i­cal per­for­mance can be prone to it,” says Dr Alden. As well as those whose phys­i­cal ap­pear­ance is al­ways un­der scru­tiny, like mod­els; and those, like Lucy, who are re­cov­er­ing from an ill­ness.

Be­cause or­thorexia, un­like anorexia and bu­limia, starts from a place of health, not weight loss, the mo­ti­va­tion for food re­stric­tion is dif­fer­ent. Orthorex­ics are more con­cerned about the chem­i­cals in food, rather than the calo­ries.

“Or­thorexia is fo­cused only on what they con­sider healthy foods, with the aim of be­com­ing su­per healthy, whereas anorexia is pri­mar­ily fo­cused on a fear of gain­ing weight and an ob­ses­sive de­sire to be thin­ner,” ex­plains Dr Al­ford.

But while the cov­et­ing of good health ap­pears to be the trig­ger for such black­list­ing of foods, there is, more of­ten than not, a more wor­ry­ing psy­cho­log­i­cal trig­ger at work. “A com­mon trig­ger is

‘Watch­ing peo­ple gorge on rub­bish made me feel vir­tu­ous’

when some­one is ex­pe­ri­enc­ing a loss of con­trol in their life, such as in re­la­tion­ships or at work,” says Dr Wyne. “They feel they need to re­gain a sense of con­trol and do so through re­stric­tive eat­ing.”

Which is why, when it comes to per­son­al­i­ties, those who are per­fec­tion­ists and high achiev­ers are more prone. They are also more likely to be in their thir­ties; more likely to be women (women are more in­clined than men to fall into the or­thorexic trap as they’re con­di­tioned to ob­sess about food in a way that men are not) and more likely to be work­ing pro­fes­sion­als – the lat­ter, ex­plains Dr Alden, be­cause they have the eco­nomic abil­ity to be so choosy about food.

So, when ex­actly does healthy eat­ing be­come un­healthy?

“If it’s im­pair­ing the per­son’s func­tion­ing in ar­eas such as work, so­cial life or psy­cho­log­i­cally, then it’s re­garded as ob­ses­sive healthy eat­ing,” says Dr Wyne.

If you can’t visit a friend for the weekend with­out pan­ick­ing, can’t travel over­seas, or avoid eat­ing food pre­pared by oth­ers then, says Dr Alden, you have a prob­lem.

If you start mea­sur­ing your self-worth on the pu­rity of your diet, ad­mon­ish cer­tain foods as dan­ger­ous or dis­gust­ing or feel crit­i­cal of the way oth­ers eat, then that healthy eat­ing be­comes sus­pect, says Dr Al­ford.

Be­cause orthorex­ics be­lieve that the food choices they make po­si­tions them on a higher moral scale, they are of­ten guilty of judg­ing oth­ers, feel­ing a sense of su­pe­ri­or­ity to­wards peo­ple whose di­ets are less dis­ci­plined.

“Watch­ing peo­ple gorge on sodium-rich, sug­ar­coated rub­bish made me feel vir­tu­ous and clean, as I nib­bled on an or­ganic ap­ple,” says No­rah.

And the more ex­treme the diet for health rea­sons, the more vir­tu­ous, clean – even spir­i­tual – they’ll feel about them­selves. And it’s this so­ci­etal norm of ap­plaud­ing, even cel­e­brat­ing, those who are able to con­trol what they eat, that makes recog­nis­ing and treat­ing those with or­thorexia dif­fi­cult.

“When a ther­a­pist pointed out to me that this ex­treme way of think­ing was un­healthy, I scoffed,” says Lucy. “How could ad­her­ing to my healthy diet pos­si­bly be bad for me?”

Re­cov­ery from or­thorexia is ul­ti­mately about get­ting be­yond la­belling foods as good or bad, un­der­stand­ing that carbs or fats, for ex­am­ple, are not in­trin­si­cally bad for you. “It’s true that some food is bet­ter for you, but when a per­son starts to think of foods as dirty or clean, it’s too sim­plis­tic and can be dan­ger­ous,” ex­plains Dr Alden.

“Orthorex­ics eval­u­ate their self-worth ac­cord­ing to their eat­ing prac­tices, much like anorex­ics, and so ther­apy must in­clude set­ting re­al­is­tic ex­pec­ta­tions for them­selves, im­prov­ing their self-es­teem and ed­u­cat­ing them about proper nu­tri­tion,” says Dr Al­ford.

No­rah says, “I’m still a gluten-free veg­e­tar­ian but I have since dropped most of my other for­mer diet re­stric­tions. It’s about be­ing gen­tler with my­self. I don’t judge oth­ers on their food choices any­more.”

Lucy, too, has re­laxed her re­stric­tions but is not quite ‘cured’. “Those feel­ings are still with me but food is no longer the first thing I think about when I wake up in the morn­ing. How­ever, I do think that some bad health news could mo­ti­vate me to do ex­treme things again.”

Or­thorexia will no doubt con­tinue to draw more at­ten­tion as in­creas­ing num­bers of ob­sessed eaters are se­duced by its siren song. Hope­fully, this in­creas­ing num­ber of suf­fer­ers will mean the con­di­tion be­comes of­fi­cially recog­nised as the de­bil­i­tat­ing and very real eat­ing dis­or­der that it is.

“I don’t con­sider or­thorexia to be as dan­ger­ous as anorexia or bu­limia, but it is cer­tainly no less real,” con­cludes Dr Brat­man.

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