Orthorexia

Hi Mountaineers! I hope everyone had a great Eating Disorder Awareness week and was able to find some helpful resources for friends, family or for yourself (if needed). This blog post is kicking off a series of discussions around the different eating disorder subtypes to bring awareness to the diversity that exists.

The History of Diet Culture

Dieting across the world can be traced back as early as the 1000s. For example, liquid-based diets, of only alcohol, to lose weight were used by numerous individuals including William the Conqueror ¹. Similarly, Poet Lord Byron proudly spoke of the Apple Cider Vinegar Diet, which resurfaced in the 1950s and early 2000s, for his thin and pale physique ¹.

Since then, we have seen cleanses, celebrity diets (like Beyoncé’s Homecoming diet fad), Atkins, Whole30, Paleo, Veganism, Vegetarianism, diet pills and supplements, Special K cereals, and so many other examples targeted at weight loss or rigorous standards for nutrition consumption. Many of these rigorous standards stem from the legitimate concerns (food processing, food waste and agricultural impacts on global health) and critiques of unhealthy habits (smoking, physical inactivity and imbalance of consumption of certain types of food); however, the spectrum for this has become binary. For example, morality has been attached to foods. So, when you hear binaries such as natural/chemical, organic/GMO, clean/junk, whole/processed, authentic/artificial your dietary choices end up equating to/feeling like moral choices or a judge of character ².

Definition of Orthorexia

In response to the increased interest in obsessive healthy eating habits, researcher Steven Bratman in 1997 ³, signaled a potential existence of a new eating disorder, which described a fixation or obsession on health eating or a healthy lifestyle. Orthorexia is not currently a clinical diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but describes a lifestyle approach of extreme diet and/or exercise intended for health reasons but lead to malnutrition, impairment of daily function and impact overall wellness ⁴.

“Ortho” comes from the Greek word meaning “right”, which indicates an obsession with eating “right” foods. A current review of the literature described a varying prevalence of Orthorexia from 6.9% to 88.7% depending on country and populations. ⁵ These diet-focused beliefs inadvertently harmed psyche and physical health of patients by attaching excessive meaning and power to food and healthy lifestyles. ⁴ Our culture of dieting has led to many short-term diets, mentioned above, which lead to initial weight loss, but rarely a retention of weight loss. This begs the question: why is weight our primary indicator for the health of an individual when current research shows a variety of factors (genetics, social determinants, stress, sleep, etc) contribute to weight fluctuation?

Body Mass Index (BMI) and Weight Stigma

Weight as a measurement for health has a long history in the medical field. The Body Mass Index (BMI) scale was developed by Lambert Adolphe Jacque Quetelet in 1835. BMI was not widely used until the early 1990s, when the World Health Organization used it first to define obesity. ⁶ However, the BMI classification, which is now synonymous with healthy and not actually used as one measurement of a larger holistic picture, has led to extreme weight stigma. People have been stigmatized by their weight from family, friends, medical professionals, teachers, and others.

⁷ Weight stigma contributes to significant physical and mental health effects, such as increased depression, anxiety, lower self-esteem, social isolation, perceived stress, substance use, weight gain overtime, and weight-control behaviors in comparison to those who do not experience weight discrimination. ⁷ We start to see a chronic cycle of dieting attributed to weight stigma brought on by a measurement and diet culture which contributes to an unhealthy obsession with healthy lifestyle.

Health at Every Size (HAES) and Intuitive Eating

The acknowledgement of this cycle has led to the development of the Health at Every Size model (HAES) and intuitive eating. The HEAS model is a weight-centered approach that treats clients and patients of all sizes to promote body-acceptance, end weight stigma and lessen the obsession with weight loss and thinness. ⁸

This health belief model encourages intuitive eating, which inspires the instinct that we all have to eat without stigma, shame, and for nourishment through 10 ordered principles : ⁹

1. Rejecting the diet mentality
2. Honor you hunger
3. Make peace with food
4. Challenge the food police
5. Discover satisfaction
6. Feel fullness
7. Cope with emotions with compassion
8. Body respect
9. Feeling movement
10. Honor your health through gentle nutrition

These frameworks have seen enormous positive success in influencing holistic health of individuals and can encourage a balance between the pendulum of diet and weight culture.

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Resources

1. Wdowik M. The long, strange history of dieting fads. Colorado State University; 2017 2017-11-07.
2. Hanganu-Bresch C. Orthorexia: eating right in the context of healthism. 2020.
3. Bratman S. Health Food Junkie. 1997.
4. TM D, S B. On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eating behaviors. 2016;21.
5. Niedzielski A, Kaźmierczak-Wojtaś N. Prevalence of Orthorexia Nervosa and Its Diagnostic Tools—A Literature Review. International Journal of Environmental Research and Public Health. 2021;18(10):5488.
6. Nuttall FQ. Body Mass Index: Obesity, BMI, and Health: A Critical Review. Nutrition today. 2015;50(3):117-28.
7. Rubino F, Puhl RM, Cummings DE, Eckel RH, Ryan DH, Mechanick JI, et al. Joint international consensus statement for ending stigma of obesity. Nature Medicine. 2020;26(4):485-97.
8. Health AfSDa. The Health at Every Size® (HAES®) Approach 2022 [Available from: https://asdah.org/health-at-every-size-haes-approach/.
9. Tribole ER, Elyse. Intuitive Eating: @ElyseResch; 2022 [Available from: https://www.intuitiveeating.org/about-us/.