When “healthy eating” is not what it seems

The New Year often brings renewed and vigorous commitment to healthful eating. Most people unflinchingly commend such dedication. 

There’s increasing recognition, though, that healthy can become unhealthy at certain extremes. With eating, this interest in nutritious diets can slide into a preoccupation with the quality and purity of foods at the expense of mental, emotional, social and even physical health. 

It may start with an understandable desire to consume primarily organic produce, or a need to avoid an ingredient that triggers a food sensitivity. Perhaps it begins with reading nutrition labels to reduce exposure to chemical additives. But for some, passionate pursuit of health devolves into rigid adherence to food restrictions that categorizes foods as good or bad, clean or unclean. As this pattern continues, planning for and preparing foods consumes an inordinate amount of time and energy. 

People experiencing this may develop significant anxiety around eating where food sources or preparation methods are unknown, such as restaurants or at the home of a loved one. They can become isolated as the drive to eat right crowds out other interests. Food becomes targeted solely toward nutrition, while joy and pleasure in eating withers away. 

Understanding orthorexia

If this sounds to you like a description of an eating disorder, you’re in good company. Orthorexia is the clinical term that describes this disordered eating pattern, lending necessary gravity to what may otherwise appear innocuous, or even laudable at first. The term was first coined in 1997. It is not yet incorporated as an official diagnosis in the DSM-V, the handbook used by medical professionals that classifies mental disorders, but it is becoming more commonly studied in peer-reviewed medical journals and understood as a distinct phenomenon. Orthorexia is similar to the more well-known eating disorders, anorexia and bulimia, in that individuals severely restrict food intake. In orthorexia, however, food restriction is based on the perceived quality of food, not the quantity. 

Recognizing orthorexia can be complicated. In the beginning stages of orthorexia, it may seem as though an individual’s health is improving. They may receive accolades for changes in lifestyle and discipline that reinforce their food choices and eating patterns. So where do you draw the line between healthy passion and detrimental fixation? 

Without specialized training, it is sometimes difficult even for health care providers to correctly assess eating disorder symptoms. In a 2006 study, 91 clinicians were asked to read a passage describing the disturbed eating patterns of a fictional character named Mary. They were then asked whether they thought Mary had a problem and to rate her anxiety, depression and eating disorder symptoms. Less than half of the clinicians in the study correctly identified that Mary had an eating disorder. What’s even more alarming is that the rate of diagnosis dropped drastically (from 44% to 17%) if Mary was portrayed as Black instead of white, even though all other details were kept constant. 

Beyond the stereotype

This study highlights the dangerous trend of underdiagnosis of eating disorders among people of color and in other historically marginalized groups. This is due, in part, to the historical association of eating disorders with affluent, young, cis-gender, white females. This stereotype stands strong today (do a Google image search for “anorexia”), even though research consistently shows that anorexia occurs at similar rates among all demographic groups and genders, and that bulimia and binge eating disorders occur at higher rates among ethnic minorities. 

Furthermore, the impact of eating disorders is generally greater for people in traditionally marginalized groups. BIPOC and LGBTQ+ people, males and people in larger bodies are less likely to be diagnosed or even asked about their eating disorder symptoms by a doctor than cis-gender white females. The presentation of eating disorder symptoms and patterns of seeking help among these groups may differ, further delaying diagnosis. This means disordered eating patterns become more deeply rooted and continue for a longer time, leading to worse health outcomes and decreasing the likelihood of long-term recovery without lifetime health consequences. 

Even when individuals who do not fit the stereotypical profile are diagnosed, treatment may not be accessible or even desirable. Programs built around the white female experience may not be culturally sensitive or relevant to others. Those who are not comfortable confiding in a white therapist may struggle to find a non-white therapist who treats eating disorders. Because eating disorders are often still perceived as a disorder of vanity among a well-resourced demographic, there is little funding for research compared with similar illnesses, treatment options are expensive, and often treatment is not covered within public health insurance plans. These factors compound the barriers for accessing help and healing among marginalized groups. 

Marginalization itself magnifies the impact of eating disorders. Marginalization is the experience of being pushed out, excluded, and told you’re worth less than others. For those in minority communities, marginalization happens repeatedly in big and small ways, and can lead to deeply internalized shame and self-loathing. Messages such as “I don’t deserve to take up space” and “I’m not worthy” can take root, reinforced by daily experiences of racism and stigmatization. This puts people from minority communities at higher risk for the development of eating disorders, because eating disorders are not simply patterns of disordered eating, but are disorders of anxiety, disconnection and shame. An eating disorder is not about wanting to look better, but about wanting to be better. 

Orthorexia challenges our preconceptions of disordered eating and even our perception of health. Discussion around orthorexia can provoke us to reshape our understanding of eating disorders and propel movement toward more equitable health practices. Every person, across all communities, is worthy of care—rooted in belonging—that nourishes mental, emotional and physical wellbeing. 

Erin Cazel is pursuing a Master’s in Nutrition at Bastyr University. Radical hospitality is Erin’s life passion—she loves gathering community around a table filled with food and conversation, and cares deeply about using foods to nurture the body, heart and mind. 

A pioneer in natural medicine, Bastyr University is a nonprofit, private university that is at the forefront of developing leaders in natural health arts and sciences for the 21st century. Bastyr offers graduate and undergraduate degrees in science-based natural medicine that integrates mind, body, spirit and nature. The University is also a leader in conducting cutting-edge research in complementary and alternative medicine and in offering affordable natural health care services in its local communities.