When Does 'Eating Clean' Become an Eating Disorder?
Orthorexia is defined as an obsession with healthy foods. In the age of raw food diets and Instagramming each of your meals as you #eatclean, it's becoming increasingly common—and dangerous.
Illustration by Jessica Olah
For years I have lived asking myself these questions: Have you thought about your food? Have you thought about the virtue of it—how healthy it is and how it will look on Instagram? And since we are on the topic, what does your food say about you? Does it tell the world you are clean and virtuous? Or is that stack of fluffy Sunday morning pancakes a gentle reminder that you know how to have fun, too? I have thought about all of this extensively, and it has been hell.
My only comfort has come from knowing other people have asked themselves these questions, too. Popular Instagram account @youdidnoteatthat—famous for mocking the notion that Instagram models and personalities are actually consuming the food they post meticulously edited photos of—didn't just get a hundred thousand followers because no one is thinking about what we're saying with our food.
The idea of an eating disorder that didn't involve a loss of appetite or the desire to purge began hitting the zeitgeist a year and a half ago. The disease was called orthorexia, a term coined by Dr. Steven Bratman in 1997. "Orthorexia is defined as an unhealthy obsession with healthy food," Dr. Bratman tells Broadly. "It's not the diet that is orthorexia, it's the diet that could lead to it. The more extreme or restrictive the diet, the more likely it could lead to orthorexia."
The more extreme or restrictive the diet, the more likely it could lead to orthorexia.
After coining the term, Dr. Bratman went on to publish several books about orthorexia and healthy living. Today, he has created an official scientific definition for the disease and is working on getting it published and accepted by the medical community. But Dr. Bratman was not the one to bring orthorexia to the mainstream some year and a half ago. Jordan Younger, a 25-year-old lifestyle blogger from California, was.
Younger was a devout raw vegan who had built an online following of tens of thousands by writing about veganism and her virtuous diet on her then-blog The Blonde Vegan. To Younger, veganism was the cure-all she was hoping for—no longer did she suffer from chronic indigestion or feelings of bloating and discomfort. As she preached about the benefits of a plant-based diet alongside photos of bright green smoothies, mason jars brimming with chia seeds, and chopped kale salads, the popularity of her vegan persona grew.
Soon vegan cleanse companies sought her out to try their pricey cleanses for free. Younger started cleansing religiously—for a minimum of three days a week, eventually finding that every time she finished a cleanse and reintroduced solid food, her stomach problems returned, making her feel even worse than before. But Younger was resolute in turning to vegan cleanses as the answer. Soon the cycle of cleansing, getting too hungry, binging on solid food, feeling guilty, and cleansing again became the norm. Instead of looking outside of veganism to feel better, Younger started fearing vegan foods that weren't as healthy as she'd like them to be, and became riddled with anxiety about the food she ate.
Eventually, Younger came to understand that she had a problem. But hers wasn't a classic eating disorder that people were familiar with; hers was a fixation on the virtue of food. She introduced the term orthorexia to her following, saying that she was suffering and was going to get help. The response she got was overwhelming: "Once I started talking about experience with orthorexia on my blog and national news picked up on it, a flood of people came forward saying they identified with me," Younger tells Broadly. "We're talking tens of thousands of messages. It's been a year and a half and I haven't stopped hearing from people. It's not that number anymore; it's a couple people a day now, but it showed me how many people feel inadequate and feel that living a balanced life is not enough."
Once I started talking about experience with orthorexia on my blog, a flood of people came forward saying they identified with me.
Younger has since gone on to become the unofficial poster child for orthorexia. When I spoke to her she had just finished speaking to NBC about her upcoming book Breaking Vegan, which came out on November 1 and documents her struggle with the disorder. "I do feel like I've become the poster child for orthorexia," she says. "At first I was OK with it—more than OK with it because I want people who are suffering from it to know that they aren't alone. Now, on a personal level, I feel like I've already answered every question and then some that could ever be asked about orthorexia. And I feel like, done with the topic as far as my personal interviews go."
Younger was the perfect candidate to bring mass media attention to orthorexia: young, blonde, and unassuming. When she spoke, America listened, and the attention she was able to bring the disease was important and largely overdue.
People have died of orthorexia because they haven't been properly diagnosed. And, as Younger's floodgate of messages can attest, there are an enormous number of people suffering from orthorexic symptoms today. Nutritional therapist Dr. Karin Kratina, who has specialized in treating eating disorders for over 30 years and authored a paper about orthorexia on NationalEatingDisorders.org, tells Broadly: "I have absolutely seen a rise in orthorexic patients as a nutrition therapist. It's almost rising exponentially. Now I get a new client every week with orthorexic symptoms. It is a serious problem."
One of the reasons Dr. Kratina believes orthorexia is rising in popularity is because of our fixation on health. "There is nothing wrong with eating local or being a vegetarian or vegan," she says. "I think a lot of those diets are inherently valuable. The problem is that we have moralized eating, weight, food, and exercise. Food has become presented—more and more—as the answer."
We see this moral fixation on the virtues of food thrown back into our faces on a daily basis. Instagram can often seem like ground zero for a grotesque display of morally just food choices. Food bloggers like Deliciously Ella—whose vegan food blog has attracted hundreds of thousands of Instagram followers and multiple books deals—are attractive to us because they provide a clear answer: eating healthy will make you good. This answer, regularly served in the convenient form of an easily digestible #eatclean picture, feels so nice on our eyes.
"I think the images of all the really beautiful food—the joke for me is the kale smoothie—the endless kale smoothies are very pretty," says Dr. Bratman. "A lot of it is wonderful food photography. I think this type of media is definitely causing orthorexia to reach a larger audience and a younger audience."
But despite the increase in orthorexic patients and our constant fetishization of healthy food, doctors can't officially diagnose orthorexia as a disease. This is because orthorexia hasn't been accepted into the DSM (Diagnostic and Statistical Manual of Mental Disorders), the official manual that doctors use to diagnose patients with mental disorders. Because of this, it isn't uncommon for orthorexic patients to go years without being diagnosed as having an eating disorder. And while the media has made orthorexia look like it's on the verge of being accepted into the DSM, the truth is the disease is nowhere near that point.
The problem is that we have moralized eating, weight, food, and exercise.
"There's at least ten years more to go before talking about it being in the DSM at all," says Dr. Bratman. "There is only a small amount of research being done on orthorexia today. There's a lot of media articles being written, but all they're doing is repeating the same stuff, or sometimes telling very good personal stories, or they're all more-or-less stupid rehashes of other stuff that's out there. Most of the articles that I look at are really, really not very thought through."
Because orthorexia isn't well understood outside of certain circles, those who suffer from it can have difficulty realizing that their condition is valid and finding resources to get help. "One of the things that worries me is that, after years of struggling with orthorexia, I didn't get help," Kaila Prins, a health and wellness coach in San Jose who struggled with orthorexia for 10 years, tells Broadly. "Nobody thought I needed help. Even when I asked for help people said, 'Well you're going to have to pay for your own recovery.' Insurance companies wouldn't help me because I didn't have the same behaviors that an anorexic does. I didn't look like an anorexic until I finally stopped getting my period. I was not not eating. I was just eating so healthfully and so restrictively that I was very sick." Prins was left to deal with multiple bouts of depression and suicidal thoughts on her own. Help didn't come until ten years later, when she found Dr. Bratman's breakthrough book Health Food Junkies, which explained orthorexia and helped Prins diagnose herself.
Instead of getting help when she was struggling with orthorexia, she got compliments: "I started getting thinner and thinner and got compliments and my first boyfriend. People in my family who had never approved of me before were telling me that I looked amazing."
I was not not eating. I was just eating so healthfully and so restrictively that I was very sick.
I know that Prins' experience isn't an isolated incident. In early 2013—after undertaking a strict Paleo diet—something similar happened to me. What started as a mission to unnecessarily shed ten pounds and reap the alleged health benefits of a Paleo lifestyle soon spiraled into an obsession with the virtues of my food. Since I was eating only vegetables, coconut oil, and lean meat, the ten pounds came off quickly. Soon, people who hadn't spoken to me in years started praising me for how great I looked. The compliments were addicting—they would become my justification for enduring what evolved into a fear of half the food groups. Soon I started making excuses about why I couldn't go out for Chinese food or beers with my roommates.
"You're being crazy," my roommate would tell me. "Just get a wonton soup, you'll be fine." What they didn't understand is that wontons were wrapped in the devil that was wheat, and I was looking forward to staying up late reading fear-mongering articles about the risks and benefits of different types of nut butters. Eventually, exhausted by the weight of my own "craziness," I had an anxiety attack in frozen foods section of the grocery store and signed myself up for therapy shortly after that. This should have been the beginning of my recovery. But instead, my therapist diagnosed me with OCD. Taking my OCD diagnosis in stride, I continued carefully monitoring my Paleo diet, basking in the compliments I was receiving, and having anxiety attacks in the grocery store.
This is the side of orthorexia that demands attention: If we are applauding eating disorders without realizing, then it's clear that the way we talk about food needs to change. While institutions like the DSM can move slowly—let's not forget that the term "anorexia" was first used a full 80 years before it was included in the DSM—we cannot continue ignoring an eating disorder because we refuse to understand what it is.
Orthorexics are not "crazy" and othorexia is not about blaming healthy food. It is about when the desire to eat healthy takes away from the other aspects of a person's life. As Jordan Younger writes on her blog, orthorexia occurs when someone believes that a diet is the answer: "It breaks my heart to see and hear beautiful, motivated, capable young women being sucked in to an extreme diet and way of life because it has been branded to them as 'THE HEALTHIEST WAY TO LIVE' above all else," she notes. "If anything is claiming to be the #1 healthiest, or the ONLY way to live, then you know you've found a problem."