Eating Disorder Dietician

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When healthy eating becomes an eating disorder

In the beginning, Melanie Murphy simply followed the doctor's instructions.

Murphy, then 19, had gained weight during a period of depression, and her doctor told her she needed to lose some weight. She lost 81.5 to 56.5 pounds in 18 months - and even when she knew it was time to stop losing weight, she just couldn't shake the need to pursue a goal. Without losing weight, she needed a new goal. This has turned into finding the "perfect" diet that is clean and will keep you healthy for years to come.

At least that's how he thinks about it then. Today, she uses a different description: "orthorexia" or an unhealthy obsession with eating healthy food. "I was just obsessed with perfection and I was very afraid of food," says Murphy, now 30, a successful lifestyle vlogger and author based in Ireland. That's all I've been thinking about all day.

Encouraged by influential people who undergo extreme diets on social media, Murphy embarks on a raw diet consisting mostly of fruits and vegetables, and moves away from any situation in which he cannot control what he eats, even if it meant is socially isolated. Eating "good" foods made her feel chaste, while "bad" foods filled her with anxiety and made her think brightly about how eating would make her way through her body and cause her illness. "I watched my friends eat nachos and I just couldn't figure out how good they felt about it," she recalls. "I couldn't imagine ever being that person again."

With such strict dietary rules, Murphy says she found herself desperately craving "forbidden" foods like steak, so much so that thirst eventually displaced the eating disorder. This finally prompted Murphy to seek help. Guided by cognitive-behavioral therapy and intuitive nutrition - (a system that teaches followers to use physical and mental cues, not dietary rules to determine eating patterns) - she now believes she has recovered, although sometimes she still needs to to soothe the voice in her head that tells her that certain things are out of bounds. She says it helps that she is not alone.

Reaching a diagnosis of orthorexia

Dr. Stephen Bratman comes to the definition of "orthorexia", which includes: extreme obsession with the purity and health of food, from which all other aspects of human life suffer. McGregor adds that another potential feature of orthorexia is that many sufferers formulate dietary advice into strict rules. "They take the instruction [like: 'You need to reduce your sugar intake' and make it a fact: 'You shouldn't eat sugar,'" she explains. "This is becoming their truth." The condition also appears to be linked to perfectionism and obsessive-compulsive disorder and is common among professional athletes and those who follow a vegan diet, she said.

"It's never about food," says McGregor. Eating disorders are usually an expression of another problem, she says, whether it's anxiety, a desire to accept, a need for control or something else.

Illinois-based nutritionist Ashley Thomas was once among the people suffering from eating disorders. She says she struggled with orthorexia as a food science student when she followed a strict vegetarian diet and firmly avoided sugar and carbohydrates for fear of developing diabetes. It wasn't until years later, after abandoning her vegetarian diet and seeing numerous clients behave orthorexically, that Thomas realized she had a problem. "It was a little embarrassing because as a nutritionist I want to make sure I'm promoting the right type of healthy behavior," she says. "I probably didn't do it then."

Today, Thomas claims that most of the clients he sees show signs of orthorexia, and McGregor agrees. It seems that eating disorders are also becoming more common. An international survey of research in 2019 (which does not analyze orthorexia) found that about 8% of respondents from 2013-2018 reported having struggled with eating disorders in their lifetime, compared to 3.5% of 2000-2006

Are "wellness" movements harmful?

The predominance of the influence of  wellness influencers   and "clean food" profiles on Instagram - which may perpetuate the notion that food is inherently good or bad - does not help. A December 2019 study found that frequent use of social media, especially platforms with heavy images, is linked to eating disorders among adolescents. McGregor says that the use of social media rarely causes eating disorders per se, but can contribute to problematic thinking by throwing misinformation and confusing the wellness view (what is healthy) of one's identity.

It also normalizes behavior that may not be as healthy as it seems. "There are a lot of people who hide malnutrition behind wellness trends," says McGregor. As a result, some people, such as Thomas, may not even realize that their relationship to food has become abnormal - another obstacle that can prevent the diagnosis of a person with orthorexia.

The treatment of orthorexia is difficult because it requires the dismantling and restoration of a person's entire thought process around eating and requires the correction of food beliefs, which in most cases are not based on science. (Believing that consuming any sugar, for example, will lead to diabetes.) Anorexia is incredibly challenging to treat, but experts can at least gradually show patients that a normal diet does not lead to abnormal weight gain - fear of many sufferers, says registered nutritionist and eating disorder specialist Jessica Setnik. "For someone with orthorexia, we don't have that," she says. "You can't cure thoughts with facts."

Looking back on her experience with orthorexia, Murphy says that diagnosing could help her realize her behavior and could help others realize that they need help. "Understanding where it comes from and what caused it," she says, "can really inform recovery."