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The media has always promoted weight-loss and the latest diets, and now social media provides a platform for the health industry to constantly expose us to marketing of diets and “health” products. As strict eating and exercise routines are normalised, body shame and eating disorders are developing.

Orthorexia? Many of us have never heard of it. But Orthorexia Nervosa is an eating disorder that involves an unhealthy obsession with eating healthy, and it is thriving in the age of health, diet culture and social media.

A person who suffers from orthorexia obsesses over defining and maintaining the “perfect diet,” and fixates or avoids particular foods, such as sugar or carbohydrates. The condition involves strict food avoidance, sometimes to the point that a person will consume fewer than 10 foods per day.

Some people with orthorexia avoid many foods, including fat, sugar, salt, animal or dairy products; certain ingredients they deem unhealthy. Alternatively, they may strictly eat only ‘fats’ (keto), paleo, ‘raw or uncooked’ products. If a person with orthorexia believes ‘fat’ is the evil ingredient that must be excluded, they will strictly adhere to this rule. If paleo is the ideal diet, they will follow it religiously. What begins as healthy eating leads to inflexible food planning, studying ingredient lists and rules, and evolves into a serious risk to health.

While going ‘paleo’ or ‘keto’ mightn’t sound so bad, and the more we come to understand orthorexia and associated behaviours, the more concerning it becomes. Most of us want to pursue a healthy, nutritious and balanced diet and everywhere we look there is the promise of a new perfect diet – a solution to attaining perfect health. This captures the two biggest difficulties to prevention and treatment of orthorexia in today’s society: identification and responding to the force of diet culture.

How do we tell when someone is suffering orthorexia?

One problem is differentiating between orthorexia and regular healthy eating. Not only is it difficult to diagnose, but it is difficult for people to notice or negatively perceive it in the first place, as there is no clear “point” at which to identify when healthy eating becomes restrictive.

In our current culture, cutting out certain food groups like sugar or fat is commended. We are encouraging of friends and family making positive changes to their diet and exercise routines. Making healthy changes to diet can be beneficial and even life saving. What’s the harm?

Friends, colleagues or family members are always starting a “great new diet,” they are “fasting until midday,” or have “quit sugar.” This is often followed by, “I’ve never felt better!” Who are we to tell them it’s wrong when cutting out certain foods is the norm? Following a popular diet or being vegan does not mean a person needs orthorexia treatment, but as eating disorder specialist’s Timerline Knolls warn, “if you see common warning signs and symptoms associated with dangerous eating patterns, it may be time to step in.”

Fuelled by diet culture, a person suffering orthorexia’s focus on health is what makes it so dangerous. Orthorexia has the same obsessive quality of other eating disorders but it goes unchecked because a person suffering may not be “thin” as a result of their disordered eating patterns. Comparing anorexia and orthorexia, a person suffering anorexia is likely to adhere to strict rules around weight and how much they eat, and a person with orthorexia has rules about what they can and cannot eat. Melbourne based Accredited Dietitian Lauren Kelly says, “if I sat down with a person with orthorexia and they told me what they have been eating, I would be concerned, as they’re not eating what they usually would.”

It was not until the late 90’s that orthorexia was defined and there is still no official diagnosis. But to help distinguish between healthy eating and orthorexia, Bratman and Dunn recently proposed a two-part diagnostic criteria. Firstly, there is an obsessive focus on healthy eating that involves emotional distress around food choice. This can cause compulsive behaviours, preoccupation with dietary choices, anxiety or even shame when dietary rules are broken. Severe restrictions often escalate over time; a diet might become so strict as to eliminate entire foods groups or a juice cleanse might develop into an addiction to ‘cleanses’ or ‘fasts.’

It is sobering to remember the two planes of thought that might be operating when a friend or family member is on a new diet. We might see the person eating healthy, losing weight and hear them speak positively about their new and improved life. What we might not see is the studying of labels and measuring out of ingredients. And what we cannot see is the mental health struggles, negative thoughts and consuming preoccupation that a person with orthorexia is experiencing inside.

This disruption to daily life is the second aspect of the diagnostic criteria. Not only does orthorexia pose medical risks such as malnutrition and complications like hormonal imbalance and bone health linked to eating disorders, but it intrudes on how a person lives their life. A person suffering orthorexia will not live a freely. They will often be engulfed by personal distress and low self-worth, leading them to become socially isolated.

Diet Culture and Social Media

Perhaps the biggest concern is how to mitigate against eating disorders like orthorexia operating in a world of diet culture. When we open Instagram, we are saturated by hundreds of accounts and images of celebrities and influencers showing us the new diet they are following. Understanding orthorexia is difficult without a clear diagnosis or wide recognition in society. But if you speak to any dietitian or nutritionist, they probably know all about it.

Lauren Kelly’s biggest concern is social media. Kelly states that the dietetics industry never used to see it as a problem, but have now realised how prevalent diet culture is, “imagine a 16-17 year old watching everything an influencer or celebrity is doing and eating on social media.” With the force of diet culture it is hard to imagine issues with comparison and body image ever go away.

A confronting discovery reveals a higher prevalence of orthorexia in dietitians, nutrition students, exercise science students and yoga instructors. But well-known diet culture expert, and Accredited Dietitian, Christy Harrison is well aware of this problem, saying that the increase in “oppressive diet culture” and “healthism,” provide fertile ground for orthorexia tendencies to form, and it is driven by the health industry, including accredited nutritionists.

The link between social media and negative effects on body image, social comparison and disordered eating is categorical. Instagram is flooded with food sharing, slim waists, big bums and clothes that seem to drape perfectly on figures we are told to envy. Sounds like a perfect storm for impressionable young people, particularly young women. It is no wonder that a 2017 German study found Instagram use is directly linked to symptoms of orthorexia nervosa.

Instagram and the diet industry tell us that if we eat, exercise, look and live a certain way we will be our “best self.” We forget about the selective exposure of images and messages on Instagram, that constantly reinforce the same ideas and images. Influencers are paid to endorse certain clothing and food labels, who further profit from diet culture.

It is easy to feel a little hopeless about the combined impact of the health industry and social media, especially on young women, but there are many positives. The “health at every size” movement is growing among dietitians, nutritionists and celebrities, including models with a lot of Instagram influence. Diet culture remains a force to be reckoned with but powerful movements around body positivity, wellness, self-care, mental health and feminism are fighting back.

We rely on health advice from an industry that simply promotes the latest fad, designed to exploit the vulnerable out of their money. Diet culture wants us to feel bad about our bodies, leading us down a dangerous path of disordered eating behaviours and exercise misuse, inevitably, only profiting those who fool us.

Weight loss TV shows, stick thin celebrities, the ‘obesity epidemic’, Body Mass Index (BMI), bad foods and ‘skinny’ jeans. As a millennial, these were terms and images I was heavily exposed to throughout my childhood and teenage years.

I was a 15 year old girl, eagerly jogging on my treadmill in front of the TV while watching The Biggest Loser. I would dream of living a life like the contestants, exercising for hours on end and following strict eating regimes to ‘transform’ my body.

At school we learnt about BMI, and were required to calculate our own measurements; an activity becoming a petri dish of comparisons and judgment.

The influences that I grew up with were seen as normal, and even healthy, but have resulted in detrimental and dangerous outcomes. I am not alone in my history of disordered eating.

Close to 1 million Australians are living with an eating disorder, with less than one quarter of those receiving treatment or support. A 2012 report commissioned by The Butterfly Foundation, found that females make up 64% of the total.

Eating Disorders

An eating disorder is a mental illness which can be identified as an unhealthy preoccupation with exercise, body weight or shape, and eating habits. Eating disorder behaviours can include restricting, bingeing, compulsive overeating and purging. Purging can extend to vomiting, laxative abuse and excessive exercising.

There are also secondary eating disorder behaviours, which can often fly under the radar due to the influence of diet culture, which creates a sense of normalcy when it comes to obsessing over wellness.

Secondary Eating Disorder Behaviours

Carolyn Costin is a clinician, author and speaker, well-known for her expertise in the eating disorder field. In her book 8 Keys to Recovery from an Eating Disorder, she discusses food rules, food rituals and exercise dependance.

Food rules:
  • Being unable to trust internal hunger and fullness cues without a ‘rule’ or ‘guide’.
  • Limiting choices of foods or food groups based on rules.
  • Measuring foods based on numbers such as calories or time.
  • Feeling a sense of control over food, and therefore out of control when food rules cannot be followed.
Food rituals:
  • Participating in food behaviours that create a sense of ‘safety’ around food.
  • Preparing food in a specific way.
  • Consuming foods at the same time every day.
  • Eating foods in a particular order.
  • A feeling of anxiety if the food ritual cannot be followed.
Exercise misuse:
  • Compulsive exercise is a commonly justified behaviour.
  • Exercise is no longer a choice, but an obligation.
  • Exercise is linked to self worth.
  • Exercise is continued through injury and illness.
  • Social engagements are cancelled for exercise.
  • Exercise is used to compensate for eating.

Diet Culture

Diet culture has a long history, and its roots are embedded in the media, science, medicine, religion and racism today. The anti-diet movement has been established to fight back against an industry that we are conditioned to believe has our best interests at heart.

Christy Harrison is an intuitive eating coach, anti-diet dietitian, and author of Anti-Diet: Reclaim Your Time, Money, Well-Being and Happiness Through Intuitive Eating.

She describes diet culture as a system that:

  • “Worships thinness and equates it to health and moral virtue, which means you can spend your whole life thinking you’re irreparably broken just because you don’t look like the impossibly thin “ideal”.
  • Promotes weight loss as a means of attaining higher status, which means you feel compelled to spend a massive amount of time, energy, and money trying to shrink your body, even though the research is very clear that almost no one can sustain intentional weight loss for more than a few years.
  • Demonizes certain foods while elevating others, which means you’re forced to be hyper-vigilant about your eating, ashamed of your food choices, and distracted from your pleasure, your purpose, and your power.
  • And oppresses people who don’t match up with its supposed picture of “health,” which means you experience internalized stigma and shame—and perhaps external stigma and discrimination as well—for all the ways in which you don’t meet diet culture’s impossible standards.”

Diet culture is cunning and clever, we may not even realise when it is meddling with our lives. The identifying trends and behaviours are so normalised in society today, that it sneaks up on us in workplace lunch rooms, at social events, even through our internal voice, which may echo the food rules from our dieting pasts. Diet culture is inescapable.

“The implication is clear: eating anything other than the correct diaita made people less than fully human. The term diet, then, was bound up from the start with ideas about morality, restriction, the renunciation of pleasure, and the superiority of certain races.”

The Anti-Diet Approach

Anti-diet is anti-diet culture. The approach has a focus on overall wellbeing, rather than weight loss, and it shows us how the foods we eat and what our bodies look like, are not tied to moral virtue or social status.

Diet culture makes us believe that we have to ‘beat’ our hunger and change our bodies in order to find happiness and self worth.

Christy says, “Diet culture is a form of oppression, and dismantling it is essential for creating a world that’s just and peaceful for people in ALL bodies.”

Research supports this notion and confirms that diet’s don’t work. A 2019 study concludes: “The increases in BMI and WC were greater in dieters than in non‐dieters, suggesting dieting attempts to be non‐functional in the long term in the general population.”

To adopt the anti-diet approach, we need to keep our wits about us. Organisations know that diets don’t work, and have been moving away from language such as ‘diet’ and ‘weight loss’, instead, changing their language to terms like ‘wellness’. The diets have not ceased, they have just changed forms.

Diets are often disguised through buzz words such as ‘protocol’, ‘clean eating’, ‘health reset’, ‘nutrition challenge’ or ’lifestyle change’.

How can we adopt the anti-diet approach and fight back against diet culture? We can keep an eye out for diet culture red flags.

Diet Culture Red Flags

  • Wellness programs with a weight loss focus.
  • The use of before and after photos.
  • A program that gives food a moral value such as ‘good’ or ‘bad’, including ‘traffic light’ systems and the like, that categorise foods.
  • Eliminating foods or food groups, without a medical reason.
  • Focusing on numbers such as calories, percentages, or time.
  • Buzz words like ‘cleansing’ or ‘detoxing’.
  • Tracking of calories, exercise or steps.

What can we do now to start adopting the anti-diet approach? We can identify diet culture through it’s red flags, notice our own internal dialogue when it comes to food, say no to fad and perfectionistic diets, and unfollow social media accounts that make us feel bad about our bodies or food choices. When we stop engaging in diet culture, diet culture loses its power.

“Weight loss doesn’t heal people from their internalised weight stigma. Bad body image is not cured by weight loss.” – Lisa DuBreuil in Anti-Diet.