Can we ever be too Healthy?
Orthorexia and the pathological striving for Wellbeing
There is not a wellness blogger or influencer on social media that is not promoting a health product designed to “improve” wellness, that is not complete without a glossed, athletic and toned body, all in the name of health promotion. These days, you can’t view an Instagram feed without being bombarded by services, products and fads that are seeking to capture and capitalise on the “Healthy Image” concept; from “skinny” teas, and appetite suppressing lollipops, to diets based on blood type, and influences prancing around with a green “health” smoothie as meal replacements in hand, promoting “clean” eating as society’s holy grail for health, wellness and the fountain of youth.
Theory of Healthism and Orthorexia
However, we must remember that our current obsession with health, wellness and exercise promotion is rooted in the theory of “Healthism” or the notion established in the early 1970’s, that currently underpins the western socio-cultural view of health. Healthism is the belief that it is the moral obligation of all individuals to maintain their own wellbeing, viewing illness as an individual’s failing to adequately maintain their health through a wellness-promotive lifestyle, that is depicted by external attributes such as body shape, tone and size. Crawford (1980) noted that healthism creates an individual social-moral responsibility to promote wellbeing; individuals who take steps to maintain their health, such as sustaining a slim physique, are socially accepted. However, those who are obese are seen as failing to control their individual health and are condemned, with illness seen as an outcome of their own creation. As a result, the healthism theory creates anxiety within the individual to maintain a “socially accepted” healthy eating behaviour and body shape.
Orthorexia and the Striving for Health Perfection
However, for some individuals, the social responsibility of health is being taken a step too far. There is no denying that a health promotive lifestyle is essential for longevity, physical and mental health, however, in 1997 Dr. Bratman asked the question “Can we take this obsession with health too far?”. It was this question and his further research that led Dr. Bratman to identify individuals with an unhealthy obsession with a healthy lifestyle and coined the term “Orthorexia Nervosa”, meaning “correct diet” to describe the pathological preoccupation with consuming “healthy” and “pure” foods to promote well-being. Dr. Bratman noted that individuals with orthorexia categorise food dichotomously, as ”good” or “bad”; “clean” or “dirty” and follow rigid elimination diets, such as raw food, vegan, vegetable or fruit only diets, often rejecting foods based on their composition, such as containing artificial sweeteners or negligible amounts of sugar, motivated solely by the desire to improve their health. Although a healthy eating regime in itself is not pathological, individuals with orthorexia are obsessed with maintaining the perfect diet; this can lead to health issues such as nutritional deficiencies from the removal of whole food groups, as well as creating issues of anxiety and social isolation, as eating away from home creates a sense of fear due to unknown food preparation methods, leading individuals to avoid social situations.
Orthorexia and Clinical Recognition
Currently, Orthorexia it not clinically recognized as an eating disorder in The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013), however, with the explosion of social media, its prevalence is mounting, and an increasing number of mental health professionals are witnessing presentations in line with Dr. Bratman’s original research findings. Although there is currently no official diagnostic criteria for orthorexia, Dunn and Bratman (2016) have proposed the following unverified diagnostic guidelines to help identify individuals at risk.
A. Obsessive focus on “healthy” eating, as defined by a dietary theory or set beliefs whose specific details may vary; marked by exaggerated emotional distress in relationship to food choices perceived as unhealthy; weight loss may ensure as a result of dietary choices, but this is not the primary goal as evidence by the following:
Compulsive behaviour and/or mental preoccupation regarding affirmative and restrictive dietary practices believed by the individual to promote optimum health;
Violation of self-imposed dietary rules causes exaggerated fear of disease, sense of personal impurity and/or negative physical sensations, accompanied by anxiety and shame;
Dietary restrictions escalate over time and may come to include elimination of entire food groups and involve progressively more frequent and/or severe “cleanses” (partial fasts) regarded as purifying or detoxifying. This escalation commonly leads to weight loss, but the desire to lose weight is absent, hidden or subordinated to ideation about healthy eating
In conjunction with:
B. The compulsive behaviour and mental preoccupation becomes clinically impairing by any of the following:
Malnutrition, severe weight loss or other medical complications from restricted diet
Intrapersonal distress or impairment of social, academic or vocational functioning secondary to beliefs or behaviours about healthy diet;
Positive body image, self-worth, identity and/or satisfaction excessively dependant on compliance with self-defined “healthy” eating behaviour
Unlike clinical eating disorders, such as anorexia, which is found predominately in females, and where the focus is on the quantity of food consumed and the desired outcome is weight loss; In orthorexia, males have been found to be affected to the same degree as females, and the focus is on the quality of the food, with weight loss a by-product of a “healthy lifestyle”, rather than the intent of the individual. After all, who is going to consider a friend or relative as having an eating disorder when their main goal is health and wellbeing promotion? However, we must remember that there is reason for concern if altered eating patterns have the effect of negatively influencing an individual’s behaviour, and adversely impacts one’s health, relationships, and quality of life.
Orthorexia and Social Media
But what has caused the sudden influx and interest in orthorexia? Central to the development of our current health obsession is the engagement in social media. Body ideals are now defined by social media platforms, in particular Instagram and the #fitspiration movement. Research by Bratman (2016) highlights that Orthorexic behaviour is shaped by the socially accepted mantra that an extreme healthy lifestyle is acceptable, with social media normalising extreme dietary behaviour through the lens that diet discipline and self-control, all in the name of health, is acceptable.
In a recent study conducted by Turner and Lefevre (2017) they concluded that social media, in particular, Instagram, was a significant influence in how we approached eating and wellness. As Instagram is image based, and imagery recognition is superior to words, images of toned, healthy men and women, and healthy food related content, can create a drive for physique perfection, promoting the pursuit of clean eating. Turner and LeFevre (2017) further argued that Instagram creates an environment of selective exposure and encourages users to follow feeds based on their interest, creating an “echo chamber” effect or an amplification of beliefs in an environment free from rebuttal, which encourages self-perpetuating views on eating and lifestyle.
As Bratman concludes, orthorexia is a disease that is disguised as a virtue. Although we are all on a quest for wellness and to undertake measures to improve our health, we must remember that any behaviour changes that negatively impacts an individual’s wellbeing requires attention. Despite orthorexia not currently considered a medically recognized disorder within the literature, numerous health professional agree that it is a serious condition that is no less debilitating than other current recognized disorders, and one that requires immediate professional intervention.
ᴮʳᵃᵗᵐᵃⁿ, ˢ. ⁽²⁰¹⁷⁾. ᴼʳᵗʰᵒʳᵉˣᶦᵃ ᵛˢ. ᵗʰᵉᵒʳᶦᵉˢ ᵒᶠ ʰᵉᵃˡᵗʰʸ ᵉᵃᵗᶦⁿᵍ. ᴱᵃᵗᶦⁿᵍ ᵃⁿᵈ ᵂᵉᶦᵍʰᵗ ᴰᶦˢᵒʳᵈᵉʳˢ, ²², ³⁸¹⁻³⁸⁵. ᵈᵒᶦ: ¹⁰.¹⁰⁰⁷/ˢ⁴⁰⁵¹⁹⁻⁰¹⁷⁻⁰⁴¹⁷⁻⁶
ᶜʳᵃʷᶠᵒʳᵈ, ᴿ. ⁽¹⁹⁸⁰⁾. ᴴᵉᵃˡᵗʰᶦˢᵐ ᵃⁿᵈ ᵗʰᵉ ᵐᵉᵈᶦᶜᵃˡᶦᶻᵃᵗᶦᵒⁿ ᵒᶠ ᵉᵛᵉʳʸᵈᵃʸ ˡᶦᶠᵉ. ᴵⁿᵗᵉʳⁿᵃᵗᶦᵒⁿᵃˡ ᴶᵒᵘʳⁿᵃˡ ᵒᶠ ᴴᵉᵃˡᵗʰ ˢᵉʳᵛᶦᶜᵉˢ, ¹⁰⁽³⁾, ³⁶⁵⁻³⁸⁸. ᵈᵒᶦ: ¹⁰.²¹⁹⁰/³ʰ²ʰ⁻³ˣʲⁿ⁻³ᵏᵃʸ⁻ᵍ⁹ⁿʸ
ᴰᵘⁿⁿ, ᵀ.ᴹ., & ᴮʳᵃᵗᵐᵃⁿ, ˢ. ⁽²⁰¹⁶⁾. ᴼⁿ ᵒʳᵗʰᵒʳᵉˣᶦᵃ ⁿᵉʳᵛᵒˢᵃ: ᵃ ʳᵉᵛᶦᵉʷ ᵒᶠ ᵗʰᵉ ˡᶦᵗᵉʳᵃᵗᵘʳᵉ ᵃⁿᵈ ᵖʳᵒᵖᵒˢᵉᵈ ᵈᶦᵃᵍⁿᵒˢᵗᶦᶜ ᶜʳᶦᵗᵉʳᶦᵃ. ᴱᵃᵗᶦⁿᵍ ᴮᵉʰᵃᵛᶦᵒᵘʳˢ, ²¹, ¹¹⁻¹⁷. ᵈᵒᶦ: ¹⁰.¹⁰¹⁶/ʲ.ᵉᵃᵗᵇᵉʰ. ²⁰¹⁵.¹².⁰⁰⁶