Is healthy food craze contributing to eating disorder?

Orthorexia nervosa is an obsession with health, wellness and clean eating.

No one who ventures online can escape today’s incarnation of wellness culture. The internet helps amplify every new diet and fitness trend — paleo, keto, detoxing, SoulCycle, infrared spas, celery juice — and so on. Social media is dominated by celebrities and other influencers sharing how they obtained their flawless (read: filtered and Photoshopped) bodies.

Some of the latest diet trends focusing on locally sourced, organic whole foods — which wear the halo of “clean eating” and attract approval in the form of Instagram likes — can seem all-consuming. It’s not surprising, then, that there is growing concern among dietitians about a little-known eating disorder called orthorexia nervosa. “I’ve heard from a lot of clinicians in the field who are seeing more of it,” said Claire Mysko, chief executive of the National Eating Disorders Association.

Mysko describes orthorexia — a term coined in 1998 and not yet an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) — as “an eating disorder concerned with an obsession with health, wellness and clean eating.”

It’s similar to anorexia nervosa, in which the obsession is weight loss. Like anorexia, orthorexia involves food and nutrient restriction; this can lead to lowered metabolism, lowered sex hormones and loss of menstruation, brittle hair and dry skin, bone loss, and cardiovascular issues.

Orthorexia would seem to be a condition uniquely suited to our times, when fats, carbs and processed food are demonized, and even people who don’t have sensitivities to dairy and wheat are eschewing milk and bread. There is research to suggest such

a connection: Most Dutch health professionals who participated in a 2018 study believe orthorexia nervosa is a disorder driven by Western cultural influences such as body ideals and a fixation on healthy living. And research from 2017 found that people who frequently used Instagram had a greater tendency to display increased orthorexia symptoms.

Notably, researchers also found that orthorexia did not carry the stigma of other eating disorders, such as anorexia and binge-eating. That means the condition can hide in plain sight, under the guise of good health. “We’re living in this era of viral misinformation, where it is difficult to discern the evidence base, and even fringe ideas can seem mainstream,” says Rhonda Merwin, an associate professor of psychiatry and behavioral sciences at Duke University. With such a heavy volume of content on social media, it isn’t difficult to find fellow participants in extreme “clean eating” or other dietary regimens meant to control or eliminate foods.

“The commonality between anorexia and orthorexia is perfectionism and anxiety, sometimes obsessive-compulsiveness,” says Linda Hamilton, a clinical psychologist in private practice in New York City, specializing in eating disorders. “There’s also often a desire to be thinner.”

The condition can morph from a healthy intention into a means of control, Merwin says. “Oftentimes, the extreme nature comes in time,” she says. “It starts with, ‘I just want to be healthier,’ but then more and more things become restricted.” Maybe first it’s dairy, then sugar, and then gluten or carbs. “It’s the same with anorexia,” Merwin says. “Nothing is ever enough.”

According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), at least 30 million people suffer from an eating disorder in the United States. But this does not account for all the men and women who are dealing with disordered eating symptoms, Mysko says. She believes the problem is downplayed. “We often hear that eating disorders affect a small number of people compared to obesity,” she says. “But we have a real cultural problem on our hands. We need to talk about how many people are struggling, across all sizes, genders, races and socioeconomic classes.”