Orthorexia, ‘Clean’ Eating, and Restrictive Diets:

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Food cultures and complex manifestations of eating disorders in young people.

Food culture has a major influence on the way in which we understand our meals, diets, and eating habits. Like most other aspects of our society, food goes through trends; certain international cuisines, styles of eating, or specific foods become popular at certain times. Leafing through an old cookbook from the 50s or 60s will give you some idea of just how much changing cultural norms influence wider food habits. You likely won’t find instructions on making avocado toast or a buddha bowl among their pages!

Although many of these trends are merely the latest example of social food habits, they can occasionally become a dangerous tool for people who are struggling with an eating disorder (ED). Young people with an eating disorder are especially at risk of using food cultures which focus on avoiding certain food items, cutting out entire food groups, or promoting a specific notion of wellness. These can all be used to conceal disordered eating or justify it to those who might otherwise question these behaviours. 

Here we examine some of the complex ways eating disorders can manifest through food cultures, including obsessively collecting cookbooks, watching cooking programmes and following restrictive diets, as well as the more severe obsessions with clean eating, pure foods, and wellness known as orthorexia nervosa.

Collecting Food Experiences

Though many of us enjoy watching television shows focused on food, or leafing through a beautifully designed cookbook, an unhealthy obsession with such food-based experiences can be a sign of an eating disorder. This is because one of the major ways in which eating disorders can manifest as food culture is through an obsession with the idea of food. 

Often this looks like cooking or baking obsessively, or else being obsessed with creating perfect meals and dishes—for example, celebrity chef Lorraine Pascale has admitted to struggling with an eating disorder in the past.[1] 

Eating disorders can also manifest through a fascination with things which are about food, and often, those struggling with an eating disorder collect cookbooks or become obsessed with cooking programmes. In a recent study on eating disorder psychopathology, researchers found that nearly half of individuals intent on avoiding food altogether began collecting cookbooks and recipes.[2] 

Restrictive Diets

Vegetarianism, or the avoidance of meat, has long been a popular diet for those who are concerned about the environment or animal welfare. In fact, some of the earliest references to vegetarianism (at the time called a fleshless diet) are from the 1st millennium BCE in India and the Eastern Mediterranean.[3] Vegetarianism has also long been a tenant of Buddhism, which encourages cultivating harmlessness as a way of life. 

Nowadays, vegetarianism and its more restrictive version known as veganism, which entails avoiding the consumption of all animal byproducts entirely, are extremely popular diets worldwide. However, for many, the emphasis is no longer on the ethical implications of eating meat but instead on how these diets restrict certain foods and thus improve bodily health. In fact, veganism is now associated with what researchers call a lifestyle movement. Harvard scholars have pointed to the ways in which eating vegan is now frequently bound up with the idea of perfecting the body.[4]

For those who are struggling with an eating disorder, restrictive diets, and veganism in particular, have therefore become very common ways of excusing, explaining, or ignoring the symptoms. Young people who are exhibiting disordered eating habits may, for example, insist that it is only because they are in the process of becoming vegan or that they are trying to avoid gluten or meat. 

In addition, veganism and other restrictive diets can act as stepping stones or halfway points to more serious and harmful forms of disordered eating: anecdotal evidence from clinicians in the UK indicates that an increasing number of patients struggling with anorexia nervosa express a desire to follow a vegan diet.[5]

Orthorexia and ‘Clean’ Eating

In recent years some of the major food trends have revolved around the notion of clean or pure eating: generally, this entails eating only foods which are good for the body. Rather than eating processed foods such as bread, pasta, meats, or cheeses, clean eating diets promote such things as smoothies filled with leafy green vegetables, raw fruits, uncooked nuts and legumes, etc. 

The aim of these trends is usually wellness, a generic term referring to vague notions of bodily purity. This hyper-focus on what is put into the body and its perceived value in terms of health or wellness is one of the most potent and dangerous ways in which an eating disorder manifests itself as food culture, known as orthorexia nervosa.

In 1997, alternative medicine practitioner Steven Bratman noticed that many of his clients were assigning “excessive meaning and power” to what they ate. These individuals were avoiding many foods which they believed to be unclean and constructing their diets to contain only clean or pure things. He used the word orthorexia to describe this phenomenon: the name derives from the Greek Ortho, meaning correct.[6] 

Orthorexia nervosa has since been included as an unspecified feeding and eating disorder in the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5). It is defined as an obsession with healthy eating, which nevertheless negatively affects health, relationships, and quality of life.[7] 

Eating Disorder Treatment at The Wave Clinic

If you are concerned about your own eating habits or the eating habits of a loved one and are worried they may be exhibiting the signs and symptoms of an eating disorder, reach out to us at The Wave Clinic. Our website has information on a variety of eating disorders in young people, as well as co-occurring disorders, common symptoms and behaviours, and resources for understanding and providing care as a loved one. 

Our team of highly trained clinicians and psychologists help provide treatment options tailored to the individual’s unique circumstances, and we emphasise working with our young people and their families toward lasting recovery and an active, fulfilling life.

For more information, visit thewaveclinic.com.

Sources

[1] Witcomb, G. (2017) Why people with eating disorders are often obsessed with food. The Conversation. May 15. https://theconversation.com/why-people-with-eating-disorders-are-often-obsessed-with-food-77509

[2] Dalle Grave, R., Sartirana, M., Calugi, S. (2021). Eating Disorder Psychopathology and Its Consequences. In: Complex Cases and Comorbidity in Eating Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-69341-1_2

[3] Britannica, T. Editors of Encyclopaedia (2020, August 11). vegetarianism. Encyclopedia Britannica. https://www.britannica.com/topic/vegetarianism

[4] Nguyen, S. (2017) The Rise of Vegan Culture. Harvard Magazine. July-August. https://www.harvardmagazine.com/2017/07/the-rise-of-vegan-culture

[5] Fuller SJ, Brown A, Rowley J, Elliott-Archer J. Veganism and eating disorders: assessment and management considerations. BJPsych Bull. 2022 Apr;46(2):116-120. doi: 10.1192/bjb.2021.37. PMID: 33928893; PMCID: PMC9074139.

[6] Spinks, R. (2017) Is wellness culture creating a new kind of eating disorder? Quartz. Aug 23. https://qz.com/1059682/is-wellness-culture-creating-a-new-kind-of-eating-disorder/

[7] Scarff, J.R. (2017) Orthorexia Nervosa: An Obsession With Healthy Eating. Federal Practitioners, 34(6): 36-39. PMID: 30766283

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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