By Ayelen Hamity, AnyBody Argentina team member
“Joy Bauer's cleanse: Cut out these 4 food groups for a healthier you” (www.today.com)
“Pizza Doesn't Give You Acne—But What About Sugar?” (www.theatlantic.com)
A 28-year-old woman presents with severe malnutrition, marked hypoproteinemia (abnormally low level of protein in the bloodstream), and vitamin B12 deficiency due to restrictive dieting. When she was 14, she was reportedly told by a nutritionist to eliminate fats from her diet to help control severe acne that didn’t respond to traditional treatments. By age 16, she had restricted her eating to an extreme “lacto-ovo-vegetarian” diet*. By age 24, she no longer ate eggs and milk products. With time, the diet became one of only raw vegetables and had resulted in extreme isolation from her friends and family. Despite severe weight loss, this woman did not have the common behaviours of anorexia nervosa: she did not care about being thin nor did she demonstrate body dysmorphia. Her severe malnutrition was a result of the strict belief that certain types of proteins and nutrients are toxic and should be avoided at all costs.
Look at the above headlines in juxtaposition with the case study: a socially-accepted narrative urging its readers to be healthy through the restriction of certain 'bad' food groups stands in sharp contrast with a case study of a woman who did just that. During my research about Instagram in another post, I came across a lot of literature that explored the dark side of 'fitspiration', as well as a somewhat new (as far as we can tell) obsession with being healthy. Many articles and research, such as Strong is the new skinny, have popped up trying to understand this almost ubiquitous obsession with fitness and health. What exactly are we dealing with? At what point does an obsession with health become unhealthy?
Unfortunately, there’s a thin line between behaviours that are considered ‘good for us’, and those that that may be detrimental to our health, as several studies reveal the terrible repercussions associated with lifestyles that hinge on restrictive behaviour. For example, Public Health England's National Diet and Nutrition Survey showed that a growing number of women in the UK are deficient in several vital nutrients as a result of trendy diets and lifestyles propagated on social media. The same lifestyles have further been associated with life-threatening medical conditions related to malnutrition, affective instability, and social isolation. It seems that scrolling through endless feeds of yoga poses, green smoothies, and almond milk lattes can have harmful consequences. It’s time to take this more seriously.
When a healthy lifestyle becomes an unhealthy obsession: Orthorexia Nervosa
It is hardly a surprise that with the boom of social media – particularly narrow-focused applications like Instagram –‘fitness’ and a ‘healthy lifestyle’ has become an end in itself for the 21st century millennial par excellence. Our mobile devices have suddenly given us access to an interminable amount of accounts that encourage (and educate us on) how to attain certain lifestyle goals. And, truth be told, why wouldn’t you want to be healthy and fit? The problem arises when what is considered healthy is misinformed, and when the desire to make positive changes to one’s lifestyle results in psychological distress and physical decline. Kimberly Wick, director of Walden Psychiatric Associates, warns that these new fads may put certain people at risk of developing an eating disorder – more specifically – at risk to develop Orthorexia Nervosa.
Orthorexia Nervosa, commonly referred to as orthorexia or ON, is the term given to an eating disorder in which a person is excessively preoccupied with healthy food and following a healthy lifestyle. The term was coined in 1997 by Steven Bratman, and stems from the words ‘orthos’ meaning ‘accurate’ and ‘orexis’, ‘hunger’. Directly translated, ‘correct appetite’ perfectly captures exactly what the obsession is about: restrictive and controlled nutrition. Even though orthorexia has not yet been formalised as an eating disorder in diagnostic manuals (due to its unclear treatment pathway), healthcare professionals are treating it with the same seriousness as they treat the most well-known eating disorders, bulimia and anorexia.
- the quality of food they are ingesting
- shopping in healthier food stores, and
- appropriating other healthy lifestyle choices (such as more activity, less alcohol intake)
Furthermore, they have a greater tendency to advocate their lifestyle to their friends and family. In other words, it is not uncommon for a person who exhibits the behaviours associated with ON to try to convince the people in their environment that the food they are ingesting is bad for them. This, in turn, comes across as an attitude of superiority and judgement about others. However, the beliefs they hold are deeply interwoven into the way they make sense of their own lives, so much so that transgression of their own dietary rules results in anxiety, shame, and a feeling of guilt followed by more stringent dietary restrictions.
At this point, it is important to raise that ON does not manifest in the same way cross-culturally. For example, in a study published in Psychiatry, the authors exposed a marked difference in the manifestation of symptomatology between patients in Hungary and Turkey, which were attributed to religious differences of the two contexts (as well as other factors such as cultural understandings of food). The symptomatology of the disorder is therefore influenced by the specific culture to the extent that a person in Argentina will not display the same behaviours as someone who is from, for example, Australia. That said, there is a transcultural belief that results in the fomentation, encouragement, and difficulty in the treatment of the disorder: a social tendency to congratulate stringent self-deprivation. The fad of cutting out entire food groups has not only become socially acceptable and tolerated, but it is praised as a desirable quality in people across cultures. For this reason, orthorexia has been described as “a disease disguised as a virtue”. The issue with orthorexia is that malnutrition or debilitating psychological rigidity gets misconstrued as ‘normal’ or hidden under praise such as being ‘health conscious’ or ‘healthy’. Kimberly Wick explains that food has been given ambiguous labels such as ‘bad’ and ‘good’ which obscure the actual nutritional value of different food groups. The idea is that if you ingest ‘bad’ food, you are being inconsiderate towards yourself and your health and are therefore a bad person, and vice versa.
A restrictive eating disorder like orthorexia is further encouraged by a culture that erroneously appraises the human body and its appearance as an indicator of health. Disappointingly, during my investigation, multiple authors revealed personal biases when attempting to understand this disordered behaviour, primarily by misconstruing a person’s weight as an accurate indicator of a person’s health (a topic I will engage with a little later). When this occurs, a treatment pathway becomes further obscured as thinness continues to be problematically congratulated.
A step towards ourselves
It is hard, at this point, to give suggestions on how to move forward – given that professionals are struggling with treatment of a disorder that goes under the guise of a ‘healthy lifestyle’. It seems counterintuitive to tell someone to stop trying to be healthy. But, that’s the point: this is not healthy. It is for this reason that we must adopt a critical lens when understanding health. The question arises: what constitutes health? Examination of what this means in today’s society reveals many ways in which social understandings of health are misguided, and paradoxically, terrible for us. For example, the false idea that there’s a direct correlation between a person’s appearance and their health. This is an important point to challenge for people suffering from ON, as part of the structure of the disorder relies on judging a person’s intrinsic worth on their dietary behaviour and appearance. The truth is, it is close to impossible to appraise a person’s health based on what the eye can see. Books such as Health at Every Size by Linda Bacon serve to disrupt the misinformed idea that a person’s fat, body shape or size is the problem.
Health professionals are the only ones apt to make an appraisal of a person’s health, and even then, they may carry prejudices as they are not objective observers of bodies and are not immune to the discursive paradigms of our time. Ageism, homophobia, sizeism, sexism, ableism, and other forms of systemic oppression, often spill into medical discourse in disconcerting ways. Disconcerting because it is the one profession meant to operationalise the idea of care, and if this very profession is tainted by harmful discourse, the onus is on us to be vigilant and to inform ourselves.
Another important point to disrupt is fat-shaming and concern-trolling – and the other side of the coin - congratulating restrictive behaviour and self-deprivation. Although certain restrictions are good (in the case of alcohol consumption or a necessary dietary change in the face of a physical ailment such as diabetes), others may be causing a person a lot of psychological distress and physical harm. With these points in mind, it is important to reframe how we understand health.
I have a vivid memory that shocked me to my core when I attended a house party a few years ago. A lot of people congratulated a friend for losing weight – only to later learn that the weight loss was as a result of an aggressive cancer. The body and its health is a complicated space: Can we view our bodies in an informed and compassionate way, without it becoming a restrictive nutritional orthodoxy devoid of real wellness or self-care? By challenging our misguided views around weight and health, we may begin to move towards a healthier form of health.
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*Veganism and vegetarianism are not to be equated with orthorexia.