By Erin Phelan
If you work in the fitness industry, you are familiar with the shades of grey surrounding healthy eating. Food is a complex issue, and highly emotional for many of our clients – not simply those who are overweight, or are living with obesity. For a percentage of our clients, healthy food becomes a restrictive way of life – and the perils behind this hide a darker, more insidious problem within our industry.
What is Orthorexia Nervosa?
Orthrorexia Nervosa is an obsession with “proper” nutrition or “clean eating” and is normally characterised by the food restrictions, ritualised eating, and rigid avoidance of foods that are seen as unhealthy. The term “orthorexia nervosa” was coined by Dr. Steven Bratman, MD in 1997 but is still not officially recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), in spite of the rise and the prevalence of “healthy eating” fixations all over the world. Bratman, who himself recovered from orthorexia, used the term to describe people whose extreme diets – intended for health reasons – end up going too far and lead to malnutrition and an inability to function in daily life.
Healthy Eating Gone Too Far?
If you Google “healthy eating” you get more than four billion results; the hashtag #cleaneating on Instagram has more than 48 million posts and is a sea of pictures of avocado toast and green smoothies. We have clients experimenting with Keto and going gluten free and looking for the next answer that will help them lose belly fat for good or trim down.
Here is the dilemma: our industry thrives on this. We work in the business of habit change, and that includes food and exercise. Surely, we want our clients to eat healthier, don’t we? The juxtaposition is evident – with clients coming to us who want to lose weight, and a rising obesity problem in our society, with the flipside of an unhealthy obsession with healthy food. How do we know when healthy eating has gone too far?
“Orthorexia is one of the hardest disorders to diagnose, because it can easily be hidden under the guise of ‘healthy eating’ in the fitness and wellness world,” says Renee McGregor, MCC, RD, a leading sports and eating disorder specialist in the United Kingdom and author of Orthorexia: When Healthy Eating Goes Bad (2017). “Individuals truly believe that their quest to eat clean will ensure they are purifying their bodies. It is this obsession that creates orthorexia. Individuals believe that following a particular method of eating, which usually involves removing food groups, is the best way to allow for everlasting health.”
Rise of Eating Disorders in the Pandemic
According to various reports, eating disorders are increasing in our society- with a large rise in eating disorders reported during the pandemic. From province to province, there has been a big jump in hospitalizations, admissions to eating disorder outpatient programs, and calls to hotlines have increased by 100 per cent in some areas. Given that isolation and stress can trigger an eating disorder, this is not altogether surprising. Rates of orthorexia nervosa, as a stand-alone condition, are also increasing though experts say it is difficult to measure as orthorexia often overlaps with other eating disorders. One small study found that peri-menopausal, menopausal, and post-menopausal women were particularly vulnerable to disordered eating, linked to orthorexia.
We should be aware of orthorexia nervosa and exercise addiction as our members come back to our facilities.
“For a percentage of our clients, healthy food becomes a restrictive way of life – and the perils behind this hide a darker, more insidious problem within our industry.”
How We Can Help
We are coaches and trainers, not therapists. If you suspect your client might have orthorexia nervosa, how do you address it? The National Eating Disorder Centre uses these questions as a guideline. They are a good starting point for a tough conversation, but remember – any input into disordered eating or exercise patterns should be handled by professionals. That said, if you are genuinely concerned you can ask the following:
- Do you wish that occasionally you could just eat and not worry about food quality?
- Do you ever wish you could spend less time on food and more time living and loving?
- Does it seem beyond your ability to eat a meal prepared with love by someone else – one single meal – and not try to control what is served?
- Are you constantly looking for ways foods are unhealthy for you?
- Do love, joy, play, and creativity take a back seat to following the perfect diet?
- Do you feel guilt or self-loathing when you stray from your diet?
- Do you feel in control when you stick to the “correct” diet?
- Have you put yourself on a nutritional pedestal and wonder how others can eat the foods they eat?
If your client answers yes to several of these questions, advise them to seek help by contacting their physician.
What About Us?
Undeniably, there are leaders in our industry who have orthorexia nervosa – whether they have been diagnosed, or are completely unaware. It is a slippery slope in a field where our focus is health and wellness. One quick survey of fitness influencers on social media shows us that orthorexia nervosa needs to be talked about more – and if you are restricting your own foods, or answering yes to any screening questions, think about your own relationship with food. According to the National Eating Disorder Information Centre (NEDIC), the preoccupation with “healthy” or “clean” eating needs to be monitored. For trainers and coaches, it is imperative we check our own language – not simply in person but on social media. Are we promoting restrictive eating? Do we use words like “good” or “bad” to describe food? Do we discourage dieting as a practice? Are we encouraging balanced and healthy lifestyles, including eating a wide range of food?
We need to build safe spaces where everyone feels supported and remind ourselves of our most vital role: leading Canadians to a healthier way of life.