Is Orthorexia the Eating Disorder for the Digital Age?

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In the quest for virtuous eating, there can be a risk in taking it to extremes.Photographed by Eric Boman, Vogue, 2016.

After Emily Fonnesbeck had her first child, she was eager to get her body back. As a registered dietitian, she knew what she had to do: She started with at least an hour of cardio six days a week, and cut out processed foods. (Gluten, dairy, and sugar soon followed.)

The weight slipped off. But Fonnesbeck, a 36-year-old Utah native with a creamy complexion and a chestnut bob, was plagued by fatigue and headaches. “I didn’t see that as a result of overexercise and under-eating,” she says. “I saw it as a sign of ‘inflammation’ from something I was eating. If I could just find the culprit, I would feel better.”

A clean diet was the ideal, and hers would be immaculate. Fonnesbeck eliminated all animal products and nuts, then most fruits, until she was down to a random handful of foods she deemed “pure” enough: purple cabbage, corn tortillas, brown rice, lentils, kale, and tahini.

Her obsession intensified until, while preparing for a vacation, she sat down and informed her husband that she wasn’t going. “I would have needed to pack all of my own food, and it just felt easier to stay home,” she recalls. Her husband, who had grown increasingly worried about her, produced an article on a little-known eating disorder called orthorexia nervosa. Fonnesbeck was flooded with relief. Her behavior not only followed a recognizable pattern, it had a name.

Coined by Colorado physician Steven Bratman, M.D., in 1997, orthorexia (Greek for “correct appetite”) nervosa (Latin for “nervous”) is an unhealthy obsession with healthy eating. Unlike most other eating disorders, it focuses on the quality of food rather than the quantity. Often it starts innocently with the desire to eat “clean,” a ubiquitous term to describe the act of mindfully ingesting only whole foods in their most natural state. But it progressively hardens into a rigid eating style that can crowd out other activities and relationships.

As of now, orthorexia is not formally recognized in the *Diagnostic and Statistical Manual of Mental Disorders *(DSM), the handbook used by doctors, so it’s difficult to get precise numbers of those affected. But as clean eating becomes an aspirational, highly Instagrammable, and celebrity-endorsed lifestyle, this will likely change, suggests Paula Quatromoni, D.Sc., an associate professor of nutrition and epidemiology at Boston University, and one of the country’s leading experts on sports nutrition and eating disorders. “It’s probably just a matter of time,” she says. “This is affecting a huge segment of the population.”

The desire for rules and rituals surrounding food is understandable—a reasonable reaction against genetically modified crops; scary additives; contradictory and confusing food studies; pesticide residues; and lax FDA regulations. But things get problematic when clean eating becomes an unrealistic quest for perfect health. According to the National Eating Disorders Association, orthorexia symptoms range from the compulsive checking of ingredients and meal planning to cutting out entire food groups with little rationale, to distress when unalloyed foods aren’t available. Some orthorexics begin taking large amounts of supplements, powders, and probiotics to make their food even more nutrient-dense; others stop going out socially. Rachael Steil, 27, a former All-American runner from Grand Rapids, Michigan, ate so many fruits and vegetables while struggling with orthorexia six years ago that her skin turned orange. “My sister asked if I had gotten a spray tan,” says Steil, who is now an advocate for athletes with eating disorders.

Another widespread symptom is a fixation with the diets of others—made infinitely easier with social media. A 2017 study published in the journal Eating and Weight Disorders found a link between Instagram use and orthorexia, “with no other social-media channel having this effect.” There are more than 41 million #cleaneating hashtags on the photo-sharing app, a vast sea of smoothies and sprouted salads, where 37,000 people are moved to “like” blogger and wellness entrepreneur Ella Mills’s post of her chickpea-and-mushroom lunch. Now everyone can compare: Whose chia-pudding bowl is more virtuous? “Social media has almost normalized orthorexia,” says Quatromoni. “People who aren’t making those healthy choices 24/7 are the ones who are judged.”

This normalizing sheen may partly be the reason some orthorexia is not taken seriously. Which is unfortunate, says Jennifer Thomas, Ph.D., codirector of the Eating Disorders Clinical and Research Program at Massachusetts General Hospital. “We have so little empathy for people who are affected by mental illness, particularly eating disorders, which have one of the highest mortality rates of any mental illness,” she says. Understanding treatment options is crucial, with many experts recommending exposure and response prevention (ERP), a common prescription for obsessive compulsive disorders, as well as cognitive behavioral therapy (CBT) combined with an eating regimen overseen by a nutrition professional. Medication may also be prescribed for any underlying conditions, such as anxiety or depression.

After two years of therapy, Fonnesbeck is now fully recovered. One of the hardest issues to overcome, she admits, was “the sense of superiority, that healthy eating is disciplined and morally right.” But there is righteousness in flexibility and variety. “Now my day doesn’t revolve around food,” she says. “I feel free to travel, to dine out, to be fully present with my children. Now I feel free to live.”