Opinion | We need to talk about orthorexia

Dieting isn’t always healthy. Sometimes it’s an eating disorder, and probably not one you’ve heard of.

Orthorexia, a term coined in 1998, is fixation on healthy eating to the point where it damages the person’s well-being. It typically starts with a desire to eat more wholesome foods but evolves into symptoms that include obsessively checking nutrition labels and an inability to eat anything unless it is considered healthy or pure. Those suffering also often show an unusual interest in what others are eating, as well as high levels of distress when foods without preservatives, sugar and fat are not available.

Orthorexia is not officially recognized as an eating disorder by the American Psychiatric Association. Unlike anorexia, bulimia and binge eating disorder, orthorexia isn’t a term that is widely recognized. Since orthorexia’s symptoms can be difficult to recognize, opening a conversation about it is vital to helping adults, teenagers and health care providers recognize it at an early stage.

It often manifests through actions that can look like an innocent attempt to improve dietary choices. But it is an all-consuming mental illness — its long term effects are similar to those of bulimia and anorexia, including, but not limited to, decreased cognition, osteoporosis, infertility, heart disease, anxiety, depression and malnutrition. Since it’s not officially recognized, the only way to help others understand is to have open conversation about it.

Professionals often argue that orthorexia should be classified as a subtype of anorexia, but there are two profound differences that would prevent those with the orthorexia from being diagnosed.

According to the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders, for one to be diagnosed with anorexia they must have either an intense fear of gaining weight or display persistent behaviour that interferes with weight gain. They also must display dissatisfaction with their body weight or shape, undue influence of body shape and weight on self-evaluation or persistent lack of recognition of the seriousness of the current low body weight.

Orthorexia, on the contrary, may or may not be associated with dissatisfaction with body image. Unlike anorexia, a person can engage in the compulsive healthy eating, without a desire to lose weight, fear of becoming overweight or dissatisfaction with their body. Since the desire to lose weight and body dissatisfaction are not always part of orthorexia, the eating disorder also does not require someone to be clinically underweight for official diagnosis.

Many people who show anorexic-like behaviors are already excluded from the anorexia diagnosis because they are not underweight. Because many of the required symptoms for anorexia diagnosis may not be present in a person suffering from orthorexia, naming orthorexia a cluster of symptoms would be detrimental to those who are suffering.

Though it’s understood in the eating disorder community, many people outside of the community and the mental health profession are unaware of its existence. The eating disorder community is a community of those who are affiliated with the mental illness in some way. Members may be dietitians, therapists and doctors who specialize in treating the illness, family members and friends of someone who has been experienced the illness or, of course, people who are going through or have survived eating disorders themselves. People often do not learn about orthorexia until after they, or someone they love, has been diagnosed with anorexia, bulimia or binge eating disorder.

Dialogue within the community is vital, but dialogue outside of the community is even more important, since eating disorders can often go undiagnosed. Research shows that orthorexia has great potential to evolve into anorexia. Christy Harrison, a registered dietitian who runs a podcast and Instagram blog on eating disorders, expresses her concern about the transition from orthorexia to anorexia.

“I’ve seen many clients who get so afraid of foods they see as ‘processed’ and ‘unclean’ that they end up eating hardly anything,” Harrison told the women’s magazine SELF. “Then, even if the orthorexia didn’t have anything to do with weight at the beginning, they end up extremely fearful of, and resistant to, gaining weight.”

Eating disorders have a mortality rate of approximately 20 percent — the highest of any mental illness. They are the number one cause of death for women between the ages of 15 and 24. If orthorexia is discussed more openly, there will be a greater chance of health care providers, adults and teenagers being able to notice the abnormal eating patterns being displayed by those around them.

Research shows that the earlier an eating disorder is treated, the better the chance person has of full recovery. Awareness will not only help curb the cases of orthorexia that evolve into anorexia, but also help those showing symptoms to access treatment at an earlier stage, when the illness is easier to combat.