Although the Christmas break is a great to chance to relax, it also means we'll all have a lot more time on our hands. And, as the new year approaches, there's a chance you may well be gearing up to spend your evenings cooking healthy new recipes, sweating it out through a HIIT session, or winding down with a yoga class. Which is no bad thing – after all, incorporating new healthy habits into your day-to-day, especially when the whole world feels topsy turvy (three Prime Ministers in one year, anyone?), can feel reassuring and productive.
But what about when healthy habits go too far, consuming your every thought and controlling your every movement? It sounds extreme, but sadly, it's the reality for an increasing number of people.
Take Rhiannon, who is in her twenties, from London. "I first noticed it creep into everyday life in my second year of uni - I became obsessed with the term ‘clean eating'," she shares.
"I cut out entire food groups. Oils, cheese, and butter were a big no-no. So were carbs - pizza, pasta, and bread were all off the cards. Rice cakes became my toast, cauliflower became my rice and I spent ridiculous amounts of money on pastas that had zero carbs and calories (and also zero flavour)," she explains.
So, what is orthorexia?
'Orthorexia' is the term used to explain an obsession with healthy eating, according to leading sports dietician and eating disorder specialist Renee McGregor. "It's often the search for purity, with individuals going to any extent to eat what they perceive as pure or clean," she explains. "Sometimes, this is at the expense of getting key nutrients, means spending huge amounts of money on particular ingredients, and can make you avoid social situations for fear of certain foods."
That's exactly how Rhiannon felt. What started out as a way of increasing the number of healthy foods in her diet soon took over, controlling social events, holidays and ultimately, her life.
"I felt like putting anything into my body that wasn’t ‘healthy’ or ‘nutritious’ was like poisoning myself," she goes on. "Gradually, the food I was eating left me with no energy, miserable and depressed. My relationships with friends and family became strained. People around me had normal relationships with food - food was a part of their life, but not all-consuming. Food was my whole life. It dictated my every thought."
Sadly, Rhiannon's far from alone. There's nowhere near enough research on the condition yet (and eating disorder charity Beat have confirmed that orthorexia is yet to be officially recognised as its own disorder), but the few studies that have been done predict that orthorexia affects between 1% and 7% of the general public. Some studies have also shown there's a link between orthorexia and OCD, too.
Chartered psychologist and eating disorder therapist Rachel Evans explains that the focus on maximising your health by eating the 'perfect' diet often involves cutting out whole food groups and previously enjoyed foods. "What can start as making healthier choices can turn into black-and-white thinking about 'good' and 'bad' foods, with overwhelming guilt and shame when a food rule is broken," she explains.
What are the signs of orthorexia?
According to registered associate nutritionist Isa Robinson, noticing the signs of orthorexia isn't straightforward - eating disorders present in complex and confusing ways and differ from individual to individual.
However, there are a few stand-out warning signs to be aware of if you think you, or someone you know, may be suffering.
1. Obsession with eating healthy food
Someone with orthorexia will likely fixate or obsess over only eating food that they deem healthy, Rachel explains.
"There is stereotypically a sense of judgement or criticism about others who don't follow such a strict diet as them, which can damage close relationships. Often the sufferer will prioritise clean eating, exercise and healthy living over their former hobbies or interests, and can be quite unaware or even defensive about their changes in behaviour," she shares.
2. Focus on only eating pure products
While food 'rules' will vary from person to person, many orthorexia sufferers will only eat pure or organic products, shares Isa.
3. Severely restricting
Often, those suffering from orthorexia will opt for cutting out entire food groups. "They'll sometimes continue to cut things out until their diet is severely restricted and only includes the 'healthiest' foods," she continues.
4. Strict eating rules
A big red flag for orthorexia? Having set rigid eating patterns that dictate your day-to-day life. "People with orthorexia will do pretty much anything to avoid eating any foods they don't consider to be healthy," Isa emphasises.
Rhiannon shares an example: when she was unwell and friends chose to eat out at burger chain Five Guys, she immediately made excuses not to eat with them.
5. Anxiety around breaking their food rules
If you've ever felt guilt, stress or anxiety about breaking a food 'rule', you could be suffering.
"Remember that orthorexia is all about rule-following, so if any rule is broken, the sense of guilt in the sufferer can be overwhelming," Renee shares. Sometimes, the person will then try to right their wrongs, over-exercising or restricting.
6. Avoiding eating out
Tying in with the above, eating out or enjoying social situations can be extremely difficult for people suffering from the condition.
"You'll normally face difficulties eating in restaurants or having a meal prepared by someone else," Isa shares. Why? Because you'll feel a need to control the food, and perhaps the food preparation, too.
"Whether it’s the birthday cake at a family gathering, an ice cream on a trip to the beach or a three-course meal at a dinner party, those who suffer from eating disorders will avoid at all costs social situations that might involve the need to eat outside of their rules," Renee adds.
7. Low mood and health complications
Naturally, if you're limiting what you eat, you're bound to experience low energy, mood swings, anxiety and physical health complications, shares Rachel. "This can include a weakened immune system and hair loss as a result of eating a restrictive and often unbalanced diet," she explains.
8. Creating (or assuming) undiagnosed food allergies
Whether it's gluten-intolerance or dairy-free, regularly omitting certain food groups by creating or assuming undiagnosed food allergies is a big red flag, explains Renee.
"Individuals struggling not just with orthorexia but with any eating disorder may use this as an excuse to limit or control what they eat. If I told you I was gluten-intolerant, you would be far less likely to question why I refuse the bowl of pasta you've served me. Fabricating an allergy or intolerance enables sufferers to persist with the rules of their eating disorder, even when they are with other people," she shares.
Why does orthorexia manifest itself?
As with any mental health disorder, it's different for everyone, and to truly get to the bottom of why you might be suffering, you'll need to visit your GP or a qualified eating disorder specialist.
However, Renee makes an interesting point about any eating disorder being a means to control your life and current situation. "That need for control is a key trigger for any eating disorder. It can manifest in food choices or set rules about food preparation, ingredients, or portions."
In short, the routine of your disorder can evoke a sense of control and calm. However, deviation from these 'rules' can create extreme anxiety and stress. "These routines create a false sense of security. They're a fundamental method of denying your more difficult and uncomfortable emotions that you don't want - or know how - to cope with."
What should you do if you think you have orthorexia?
The most important thing is to speak to someone, say all three professionals. Reach out to someone you can trust, who can help guide you to the right helplines and resources. Beat has an eating disorder hotline that's open every day, and the National Centre for Eating Disorders and the National Eating Disorders association both have guides with lots of handy pointers.
And do know this: you are not alone.
What should you do if you think someone you know has orthorexia?
Again, this can be tricky as with any mental health condition, but one thing that works really well is careful questioning, shares Renee.
She recommends asking the following:
"I have noticed that you never come to coffee with us anymore, is everything ok?"
"You don’t seem yourself, it feels like you are withdrawing a little, I miss your laughter and fun"
Note: When contacted, eating disorder charity Beat was quick to point out that orthorexia is yet to be officially recognised as its own disorder. “While orthorexia can be serious and those affected should seek help, it isn't currently recognised as a separate eating disorder," the experts emphasised.
"Someone who visits a doctor with the symptoms wouldn't be officially diagnosed with 'orthorexia', although the term may be brought up when discussing their illness. Depending on their precise symptoms, they may be diagnosed with anorexia or OSFED [other specified feeding or eating disorder]."
Beat is the UK's leading charity dedicated to helping people with eating disorders. If you or someone you know is struggling and want to seek help, call their helpline on 0808 801 0677 or visit their website for more details.
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