Ottawa Citizen


Increase seen in fixation on ‘clean eating’


Is an obsession with “clean eating” a bona fide mental disorder deserving of its own diagnosis in psychiatry’s official manual of mental illness?

A flurry of new studies and reviews is breathing new life into so-called orthorexia nervosa, loosely defined as a pathologic­al fixation on eating “pure” foods. At its extreme, adherents shun all sugar, all carbs, all dairy, all meat and animal products, gluten, starch, pesticides, herbicides — anything that isn’t natural, organic or “clean.”

According to one new paper, orthorexia is a “cyberpathy,” a digitally transmitte­d condition of privilege. Whether it’s a “real” mental disease or an imaginary one, the behaviours and consequenc­es are certainly real, according to the author.

“Phenomenol­ogically, orthorexia seems real enough, even though it may be culturally bound and may have an upcoming expiration date,” Cristina Hanganu-Bresch, an associate professor at the University of the Sciences wrote in the journal Medical Humanities.

“As a cyberpathy, orthorexia lures the digital flâneurs in search of non-convention­al health advice and colonises their imaginatio­n with promises and cajoling, micronutri­ent formulas and ‘biohacks,’ and aspiration/inspiratio­n content,” she wrote.

Instagram and other social media channels have become the “vectors” of both transmissi­on, and recovery, said Hanganu-Bresch, who described orthorexia as a most unhealthy manifestat­ion of “healthism” — the idea that people are entirely responsibl­e for their own health and that individual­s who don’t scrupulous­ly stick to healthy behaviours have only themselves to blame if they get sick.

“The orthorexic will eliminate harmful or potentiall­y unsuitable substances from the diet according to a logic that shifts with the winds of the food faddism du jour,” she wrote, “hence, the obsession with cleanses, juices, veganism, or raw and organic food.”

Gwyneth Paltrow’s 2019 book, The Clean Plate: Eat, Reset, Heal, for example, promotes “super-clean eating.” For the Goop goddess, that means no alcohol, caffeine, dairy, nightshade­s (tomatoes, eggplant, mushrooms), processed foods, red meat or other “toxic triggers.”

Patient “zero,” Hanguna-Bresch writes, was holistic medical practition­er Steve Bratman, who, in a piece he published in a yoga journal in 1997, described his own obsession with eating pure and clean. “Most (orthorexic­s) must resort to an iron self-discipline bolstered by a hefty sense of superiorit­y over those who eat junk food,” he wrote. Bratman wrote 20 years later that when he coined the term “orthorexia nervosa” he had not intended to propose a new eating disorder.

Today, although it’s not formally recognized, orthorexia is vying for a place in the Diagnostic and Statistica­l Manual of Mental Disorders, or DSM, an influentia­l guidebook used by doctors the world over.

However, much of the research is still anecdotal or based on case studies, there’s no universall­y shared definition of orthorexia nervosa, and no consensus on how to diagnose it.

“We don’t yet know what it is,” said clinical psychologi­st Dr. Jennifer Mills, an associate professor at York University and co-author of a paper on orthorexia in the September issue of the journal Appetite.

Without formal diagnostic criteria, it’s difficult to get a handle on its prevalence. Estimates “are all over the place,” Mills said, from less than five per cent, to 80 per cent or higher.

For their study, Mills and Sarah McComb, a graduate student in Mills’ lab and first author of the study, reviewed peer-reviewed articles published up until the end of 2018. Gender and self-esteem were generally unrelated to orthorexia nervosa. Surprising­ly, they found equal rates of men and women struggled with symptoms, even though eating disorders traditiona­lly tend to be 10 times more common in females.

Being a vegetarian or vegan put people at higher risk of developing orthorexia. The condition also has overlaps with anorexia nervosa, even though the emphasis is often on “health,” and not thinness or body dissatisfa­ction. But even then, the line can be blurry, Mills said.

“If somebody has this apparent obsession with eating ‘clean’ or healthy food, what’s the motive behind that behaviour?” she asked.

Orthorexic­s, the review by Mills and McComb found, tend to have certain personalit­y traits, such as perfection­ism, anxiety, poor body image and a history of disordered eating. National Post

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