What is orthorexia?

When does 'clean eating' become an unhealthy obsession? Dietitian Emer Delaney explains the symptoms and dangers of orthorexia and how to get help...

What is orthorexia?

Clean eating has recently hit headlines for all the wrong reasons, with some claiming that labelling foods as 'clean' or 'dirty' encourages restrictive eating behaviours and imposes moral values onto food. We spoke to Emer Delaney, a Registered Dietician, about how orthorexia manifests, why it can be problematic, and when to seek help.

What is meant by 'orthorexia'?

Orthorexia was first described by the Californian doctor Steven Bratman in 1997. Although it has not yet received a formal medical diagnosis, it is described as a ‘fixation on righteous eating’. The term is increasingly being used to describe strict and inflexible eating behaviours. It appears to be on the increase due to social media and the popularity and obsession with ‘clean eating’.

How does it start?

It tends to start out as a true intention to eat healthy foods, but is then taken to the extreme. A defining characteristic includes missing out or not participating in social occasions because of the food being served. It also includes underlying motivations, such as the compulsion for complete control, the desire to be thin, improving self-esteem and using food to create an identity.  Many with orthorexia are also exercise enthusiasts, where exercise is equally as important in their lives as eating.

What are the symptoms?

People develop rules about how much to eat, the timing and location of eating meals, avoiding specific foods due to misguided beliefs on what they perceive as healthy. It’s a behaviour that can have insidious and far-reaching effects beyond the physical. What starts as a genuine intention to become healthier, develops into a diet that becomes so restrictive in both calories and variety that health suffers. People slowly begin to eliminate entire food groups such as diary, grains and meat and food choices become extremely limited. Maintaining this rigid eating style requires self-discipline and an extremely strong will. Every day is a chance to exude dietary prowess by eating the ‘right’ food and if temptation wins, then punishing through stricter food choices and exercise is common.

Who can help?

Seeking help at an early stage is key, although recognising these symptoms can be a challenge. Discussing the situation with a GP or contacting a specialist dietitian is the first step in getting help. As a dietitian, my key role is to re-educate people about the nutritional value of all foods, highlighting that there are everyday foods which should be included in our diets such as rice, pasta, breads and dairy and extra ‘treat’ foods that can be enjoyed occasionally. Discouraging foods from being labelled as ‘good’ or ‘bad’ is essential, as this can help eliminate any guilt associated with ‘treat’ foods, allowing room for inclusion as part of a healthy, balanced diet. I encourage people to enjoy a range of foods from all of the food groups including wholegrain breads, cereals, pulses, vegetables, lean meat, fish and eggs. A handful of nuts and seeds are great snack foods and should be encouraged in the diet. Modelling your plate on the Eatwell guide is ideal which shows there is a little room for ‘treat’ foods occasionally.

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Emer Delaney BSc (Hons), RD has an honours degree in Human Nutrition and Dietetics from the University of Ulster. She has worked as a dietitian in some of London's top teaching hospitals and is currently based in Chelsea.

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