Antonia Eriksson, an Instagram-famous fitness expert who suffered from orthorexia. Photo courtesy @eatmoveimprove on Instagram.
In a society where obesity is attacked and six-pack abs are praised, at first glance the world of health and fitness seems pretty black and white. Growing up, children are forced to participate in gym and told to always eat their vegetables. With adulthood comes freedom to choose what we put in our bodies, and many choose to indulge in processed foods, leading to a percentage of overweight individuals that some call an epidemic. But while obesity can be dangerous and even fatal, so can the other side of the spectrum: being healthy.
Swedish fitness guru and blogger Antonia Eriksson struggled with anorexia in 2012. After a bout in the hospital and a continued fight at home, she reached her healthy goal weight in a year and was allowed to start exercising again. Though she technically had beat her eating disorder, the fight for her well-being wasn’t over just yet.
“I just decided that I wanted to be the perfect ‘healthy ideal,’ Eriksson says. “I didn’t see it as being sick then, since I didn’t want to lose weight or end up under my goal weight. But I didn’t want to gain weight either and couldn’t imagine polluting my body with sugar or unhealthy, processed foods. I didn’t understand that there was such a thing as being too healthy. I over-exercised and only ate healthy foods. Eventually I realized that I had just switched from one addiction to another.”
After literally wearing herself out, and being diagnosed with depression, Eriksson couldn’t do anything but rest for three months.
“I couldn’t handle any stress or pressure during this time, and was just an emotional wreck. I had pushed myself to the absolute limit, and eventually my body said ‘no.’”
Though it wasn’t entirely clear to her then, Eriksson now knows that she was suffering from orthorexia nervosa, a term used to describe people who have an unhealthy obsession with otherwise healthy eating. Though it is not currently recognized as a clinical diagnosis in the DSM-5 (the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders), many people struggle with symptoms associated. What may start out as an innocent attempt to eat healthy, turns into being fixated on food quality and purity, according to Sondra Kronberg, MS, RD, CEDRD, executive director of Eating Disorder Treatment Collaborative and FEED programs and spokesperson for the National Eating Disorders Association.
“It’s about the degree to which your thoughts are about food,” Kronberg says.
“Orthorexics want to know if the food is chemically clean. This could be fatal. Traditional eating disorders are more about weight and body size, but in orthorexia the mindset is how pure your body is due to the food you’re eating.”
The disorder was first coined by Steven Bratman, MD in 1996, after he had suffered from the symptoms himself. For a few years he lived in a commune and managed an organic farm, giving him constant access to high-quality produce. He often lectured his friends on the foods they ate, and completely gave up eating out at restaurants. For two years Bratman’s world revolved entirely around food.
“Eventually, I became such a snob that I disdained to eat any vegetable that had been plucked from the ground more than fifteen minutes,” Bratman writes in an online essay. “I was a total vegetarian, chewed each mouthful of food fifty times, always ate in a quiet place (which meant alone), and left my stomach partially empty at the end of each meal. Gradually, however, I began to sense that something was wrong. But even when I became aware that my scrabbling in the dirt after raw vegetables and wild plants had become an obsession, I found it terribly difficult to free myself. I had been seduced by righteous eating. The problem of my life’s meaning had been transferred inexorably to food, and I could not reclaim it.”
In 2005, Italian researchers created the ORTO-15 questionnaire to determine if a patient is suffering from orthorexia. They reported a prevalence of orthorexia nervosa of 57.6 percent with a female ratio of two-to-one. In a different study in Turkey, researchers found a 45.5 percent prevalence in medical doctors, and a 56.4 percent in performing artists, according to The Conversation.
Finally back in my happy-place! 🙏 2 weeks in bed, 3 doctors visits, penicillin, aspirin and cortisone spray and I am back in the game! 👊 My first workout was shoulders+abs and it was hard work to say the least! But it was also amazing to sweat and challenge my mind and body again. I love my workouts! 😍💪 •••••••••••••••••••••••••••••••••••••••••••••••••••••••• • http://eatmoveimprove.fitnessguru.com • Direct link in my profile @eatmoveimprove ••••••••••••••••••••••••••••••••••••••••••••••••••••••••
In his essay, Bratman goes on to say that his recovery from orthorexia was only possible after people he looked up to encouraged him to lay off his strict eating regimen. Finally, he broke.
“On the twenty minute drive into town, I planned and replanned my junk food menu. Within ten minutes of arriving, I had eaten three tacos, a medium pizza, and a large milkshake. I brought the ice cream sandwich and banana split home, for I was too stuffed to violate my former vows further. The next morning I felt guilty and defiled. It took me at least two more years to attain the ability to follow a middle way in eating easily, without rigid calculation or wild swings.”
According to Bratman, the patterns of anorexia and bulimia are similar to that of orthorexia: the cyclic extremes, the obsession and the separation from others. Orthorexics can have some of the elements associated with OCD, and may even have a touch of anorexia, like Eriksson did. Though the problem is usually only psychological, rare cases can be more severe and result in death from malnutrition.
“Being healthy is a balance between physical and mental health, and orthorexia is a fixation with the physical health, forgetting the psychological parts,” Eriksson says. “Rules, regulations, control and anxiety around food and exercise are not healthy. Never resting is harmful to the body and breaks it down.
Orthorexia can be just as dangerous as any other eating disorder. It just doesn’t show as much and is seen as something positive from society.”
Sondra Kronberg agrees that society is a part of the problem, when the cultural message is overwhelmingly more about controlling food, weight, and exercise. If a person’s brain chemistry is naturally controlling, it’s easy for that person to fall into orthorexia if society’s focus is on the dangers of processed food.
“The message is changing,” Kronberg says. “Ten years ago you wouldn’t have heard about gluten-free. I’m a nutritionist, so of course that I recommend organic, natural food. But it still requires an amount of balance and flexibility. If you have a cookie with some chemicals in it, you’re going to be okay. The adolescents that I’m treating with the more traditional eating disorders like bulimia and anorexia, have another layer of orthorexia on top of it. Some of our former patients would want fat-free jello, but the new generation of eating disorders don’t want fat-free jello. They want coconut water.
They’re not only concerned from a perspective of weight, but have another non-organic filter. We don’t see it that much of just orthorexia, that’s more rare. We live in a society where the messages themselves aren’t bad, but we need to be flexible in our eating and thinking. When we get extreme we break.”
Cecilie Lind, personal trainer, lifestyle coach and founder of the The Protein Kitchen, says that that people with orthorexia try to label their habits as a lifestyle, and the expanse of the fitness industry has led to people wanting more “hardcore” goals.
“Our ideal has changed from size-zero to six-pack,” Lind says. “Because of the extreme usage and opportunity with the social medias, we are being exposed to so many ‘fitspo’ photos, and tons of fitness models and athletes. The problem with this is, that it does not show and tell the truth of the work, time and sacrifices there is behind that given shape.
The new body ideal has become more hardcore.”
Though Lind promotes a healthier lifestyle on her blog, she says it crosses the line when you get caught up in meal-prep, macro and calorie counting. Focusing on the numbers, and feeling panic when you can’t control them, is orthorexia. All the experts used as a resource in this article agreed that balance is the absolute key to keeping from falling into this dangerous disorder.
“It is important not to ban yourself from unhealthy foods; as soon as you do that, your mind will start craving the things you are not allowing yourself to eat,” Lind says. “Instead you should think ‘I may eat candy, cake, and unhealthy foods, but I choose not to, because I want to reward my body with health.’ It is also important not to think of eating healthy, and working out as being a punishment. There is also room for eating unhealthy and drinking alcohol once a while, but it is important to not feeling guilt afterwards. Then it is not worth it. It is a balance and a lifestyle for the rest of your life.”
Eriksson says that therapy really saved her life. Getting her mental health in check, and learning how her thoughts were hurting her, was the key to her own personal recovery.
“I think the best thing to do is to stop everything for a while and give yourself some space and time to work on your thoughts,” she says. “I think taking a step back and forcing yourself you do the opposite to what the eating disorder is telling you is really important. Practicing skipping the gym, practicing eating unhealthy foods and so on. It has become such a fixation and ideal in society to be healthy and happy and fit, but mental health is forgotten and it is just as important. I think the best thing we can do is talk about it. Eating disorders come from mental illness. It has nothing to do with food or weight or anything else really, it is just a way of controlling uncomfortable feelings. If we were more open in speaking about mental illness, stress, depression, anxiety and so on, people would understand how common it is and perhaps dare to ask for help.”
Anyone who is struggling with an eating disorder, and is looking for support should visit www.nationaleatingdisorders.org.