Orthorexia: Is your attitude to food healthy?
If your attitude to eating ‘pure’ is borderline obsessive, take care of your mental health and beware of this obsessive healthy lifestyle
Text: Dr Tsin Uin Foong
As a general practitioner doctor in a busy clinic, I see my share of patients struggling with eating disorders. They are male and female, young and old, of every race and culture. You are probably familiar with terms like bulimia and anorexia nervosa or even body image or binge disorders? Eating disorders come in various forms and can be complex to identify. The sooner a potential issue is recognised, the sooner we (and other supporting professionals like dietitians, psychologists or counsellors) can help.
In recent years there has been an increase in various types of ‘clean’ eating trends. These come in various guises — perhaps fat-free, no carb diets, or cutting out certain food groups and eating only specific food as they are the “super-foods”. There is nothing wrong with good intentions for a healthy lifestyle, but when the behaviour becomes obsessive, and life and thoughts revolve strictly around this regime and schedule associated with the food trend, and you start to feel anxious and unsettled if this lifestyle is not always met, you may be looking at a condition known as orthorexia.
Masking a more significant illness
Orthorexia is a condition where a person is motivated to eat in a way they see as “perfect” or “pure”, often involving very strict and inflexible eating behaviours. (The Greek origin of the word orthorexia is ‘orthos’ meaning ‘correct or right’). While orthorexia is yet to be officially recognised as an eating disorder, health professionals are seeing an increasing trend of this condition.
Unfortunately, there is little data on the development of orthorexia in Singapore, but we know that other developed countries are experiencing a marked increase. Alexia Dempsey, an eating disorders specialist and Dietician at The Priory Hospital Roehampton in the UK say, says: "I have experienced a worrying trend of patients telling me they don't have anorexia nervosa but have 'orthorexia' when I see them in clinic. For healthcare professionals, this is a growing concern which often appears to be buried in gym culture and 'clean eating'. The term 'orthorexia' appears to be at times bandied around as a socially acceptable label, implying that someone is just very much invested in being healthy. The picture I see as a professional is that this label is often masking a more significant illness."
Increasingly, experts are recognising orthorexia as being part of the eating disorder spectrum alongside the more widely known conditions like anorexia nervosa and bulimia. In orthorexia, there is no obsession with body weight and shape, but with food.
As such, a person with orthorexia may experience nutritional deficiencies due to eating a limited range of foods. This can make them feel tired and low in energy and may cause them to avoid social events for the fear of having to eat foods outside of their comfort range. Over time, this can cause anxiety and affect social interactions and relationships with family and friends.
How to know if you’ve crossed the line
With so many different ‘eating trends’ around, and an increased overall knowledge of health and nutrition, how do we know if we are just a ‘health nut’ or we have crossed the line? The Bratman Test for Orthorexia is a 10-question checklist developed by Dr Steve Bratman, who first coined the term ‘orthorexia’ in 1996.
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?
If you answer ‘yes’ to four or more of the questions, you may benefit from seeking support around your eating behaviours. A good place to start is your trusted GP, who will ask questions and try to understand your relationship with food. The best approach to your care will be holistic — where your doctor will work in conjunction with other specialists, as and when needed. These specialists may include a dietician, counsellor or a psychologist. As a GP I have relationships with trusted practitioners and we would collaborate with to reach the best health outcomes.
Lastly, if you think you may know someone who is teetering from ‘healthy eating’ to worryingly ‘health obsessed’, please use this guide which may help you approach this sensitive topic:
Choose a place to talk to them where you both feel safe and won’t be disturbed. Make it a time when neither of you feels angry or upset. Avoid any time just before or after meals
Have some information with you that you can refer to. Show them a copy of this feature. No-one likes to feel dictated to so let trusted websites share the data (see below for further thinks)
Try not to centre the conversation around food and/or weight. I know this is hard, but while it may be necessary to bring this up to explain why you’re worried, these may be things they’re particularly sensitive about. Remember that at their roots, eating disorders are about what the person is feeling rather than how they’re treating food
Mention things that have concerned you but try to avoid listing too many things as they may feel like they have been ‘watched’
Try to avoid language that could feel accusatory. ‘I wondered if you’d like to talk about how you’re feeling’ is a gentler approach than ‘You need to get help’, for example
They may be angry and defensive. Try not to get angry in response, and don’t be disheartened or put off. Reassure them that you’re there for them, and that your concern is their wellbeing
Don’t wait too long before approaching them again. It might feel even harder than the first conversation, especially if they didn’t react well, but if you’re still worried, keeping quiet won’t help. Remember, eating disorders thrive on secrecy
If they accept that they need help, encourage them to seek it as quickly as possible. Offer to go with them to the GP
If they tell you there’s nothing wrong, even if they seem convincing, keep an eye on them and keep in mind that they may be ill even if they don’t realise it. You were worried for a reason, so trust your judgement
For further reliable information on orthorexia, read here and here. Dr Tsin Uin Foong is a friendly, family doctor with over 20 years of experience based at Osler Health International.
