Eating hell

We all know someone who's doing it (or we're doing it ourselves): banning bread from the table, ditching dairy, carefully scrutinising product labels for preservatives, colourants and chemicals. Sky-high obesity stats have made us more aware than ever of the need to eat healthily; to cut out fat, cut down on snacks and up our intake of fresh fruit and veg.

But what happens when awareness turns to obsession? When you can't get through a restaurant meal without grilling the waiter, maître d' and chef about what's in the food; when you isolate yourself socially because you don't eat what friends serve at dinner parties; or when grocery shopping takes longer than an appointment at the hairdresser?

This disturbing new trend is called orthorexia nervosa – a pathological fixation with eating righteous or healthy food.

Janet's dance with orthorexia started with cutting out wheat and yeast. Amy can't eat anything with nuts. Susan won't touch anything with fat, and Nadine is into "raw-foodism". Linda is a fruitarian and Joey is a vegan. At what point does righteous eating become just plain wrong?

Allergy or obsession?

Food health and food allergies are big business. Bookshelves are crammed with food allergy titles; in health shops, gluten-, wheat- and lactose-free products stand cheek by jowl. Soya is in, dairy is apparently out. Tofu is in, potatoes are out. With the advent of legislated food labelling, colorants and additives no longer go unnoticed. Food stores claim to stock "only organic". There's a new emphasis on food, nutrition and health. Which is good... until it becomes obsessive.

The causes

The roots of orthorexia are varied. Sometimes it's a desire to improve general health; for some it's about attaining holism or spiritual purity (some of the strongest ideals of alternative medicine), and for others it starts simply as an adjunct to getting over illness.

Jill cut out all dairy products when a friend suggested her post-nasal drip was a symptom of lactose intolerance. But as time went on, she found herself developing increasingly specific food rules. Planning ways to stick to her self-imposed dietary regimen took up more and more of her time. As is common with orthorexia sufferers, what to eat, and the consequences of a dietary indiscretion, began to control her.

Now Jill cannot go anywhere without carrying her own "pure" food supply. Her eating habits have isolated her. She no longer eats out, not only because she can't, but because her friends are tired of being lectured on the evils of refined, processed and junk food, and the dangers of pesticides and artificial fertilisers.

From asthma to isolation

Lynn was a chronic asthmatic. She first cut out milk, then later, wheat and maize. Her asthma improved drastically, thereby also reducing her reliance on medication. She was hooked on her new "food therapy". Next to go were other "allergens", like meat and eggs. The demise of several vegetables and fruits followed, as she discovered additional "sensitivities". Even eating a carrot became an issue, until eventually her diet was a complex rotation of only a couple of foods, with days of fasting to "clear" her system.

Social butterfly Lynn stays at home worrying about what to eat, because while the asthma hasn't come back, headaches, nausea and "strange moods" have taken its place.

From phobia to self-control

Janet, 170cm tall and weighing only 49kg, admits that her ability to participate in normal conversation is impeded by intrusive thoughts of food. After two years, she's no longer able to eat what's readily available, as her phobias have extended to include fat, chemicals, colorants and preservatives. Sticking to this regimen takes tremendous willpower, which allows Janet to feel self-righteous and superior to those who don't have her kind of self-control. It's here that symptoms common in anorexia emerge: limiting foods, feeling superior and in control, and then crashing into a binge.

As with anorexics and bulimics, when Janet breaks her health-food vows and gives in to a craving she feels guilty, and punishes herself with even stricter rules and more restrictions. The difference, though, is that she's concerned only with the quality of food, rather than the quantity. While anorexics want to lose weight, orthorexics want to feel pure or holy, but their relationship with food is equally neurotic.

Dr Steve Bratman, who coined the term "orthorexia" in 1997, says: "The act of eating pure food begins to carry pseudospiritual connotations. As orthorexia progresses, a day filled with sprouts, umeboshi plums (Japanese pickles), and amaranth biscuits comes to feel as holy as one spent serving the poor and homeless. When an orthorexic slips up (which may involve anything from devouring a single raisin to consuming a large pizza), (s)he experiences a fall from grace and must perform numerous acts of penitence. These usually involve ever-stricter diets and fasts. This 'kitchen spirituality' eventually reaches a point where the sufferer spends most of her/his time planning, purchasing, and eating meals."

Information overload?

This is a biology teacher's story: "I've thought about the orthorexia phenomenon for a long time without knowing it had a name. The people I know who have developed eating disorders have all been like that, overly concerned with eating healthily, but taking food far too seriously. None of them was too concerned with body image in terms of fashion, so I've wondered if subjects like those I teach are partly to blame. When I discuss nutrition in class, for example, I try to make pupils aware of reading labels, so that they're aware of additives, etc.

"Also, the media is full of research detailing what you should and shouldn't be eating, and I think young people take it all to heart. They can't just relax and enjoy food without analysing it."

The bottom line

There's never been a better time to eat healthily. Obesity stats are terrifyingly high (children as young as 11 are being diagnosed with type-2 diabetes, and heart attack rates continue to soar). So it's vital that we, and our children, are taught to distinguish good food from bad, and to understand that eating healthily prevents disease and prolongs life.

But obsession is never healthy – whatever form it takes. It is equally important to understand that an obsession with good health can be as harmful as not taking care of your health at all.

Are you health food-obsessed?

Take this test, compiled by Steve Bratman, to find out:

1. Do you spend more than three hours a day thinking about healthy food? (For four hours plus, give yourself two points.)

2. Do you care more about the virtue of what you eat than the pleasure you get from eating it?

3. Have you found that, as the quality of your diet has increased, the quality of your life has correspondingly diminished?

4. Do you keep getting stricter with yourself?

5. Do you sacrifice experiences you once enjoyed to eat the food you believe is right?

6. Do you feel an increased sense of self-esteem when you're eating healthy food? Do you look down on others who don't?

7. Do you feel guilt or self-loathing when you eat foods you like, but which don't comply with your diet?

8. Does your diet socially isolate you?

Your answers

"Yes" to 4—5 of any of these questions means beware. It's time to relax more about what you eat. "Yes" to all of them means a full-blown obsession with eating healthy food.

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