Allyson Pesta felt like she had ‘some kind of super-power’. She was exercising five hours a day. Her diet was ‘clean’, with the emphasis on what she describes as ‘good’ foods. Everyone around her was telling her how admirable her discipline was. She admits that she somewhat looked down on those who weren’t so committed to a similar lifestyle. That was, until she almost had a heart attack at the age of 17, and doctors told her she had a week to live.
‘Of course, what I had considered healthy – getting by on celery, sweet potato and protein bars – wasn’t healthy at all,’ says Allyson, author of Beyond My Body: Recovering from a Complex Eating Disorder. ‘I was cutting out certain food groups, as many people do with different diets, but then wasn’t letting them back in. Those that I didn’t consider to be clean I thought of as being actual poison. Looking back at photos of myself I looked like a ghost – a ghost with abs’.
Orthorexia Nervosa Unrecognised
It wouldn’t be until a year into her treatment that Allyson finally found a label for her condition: orthorexia nervosa. Even though it was first identified in 1997, orthorexia is still not officially recognised though it’s likely it will be in the next edition of the Diagnostic and Statistical Manual, the healthcare professionals’ authoritative guide to mental disorders. An international Orthorexia Nervosa Task Force was established a couple of years ago to push for and collate more definitive research.
Studies suggest orthorexia is prevalent among people who are anxious by nature, or who have some other mental health issue, but also among athletes, those working in the performing arts and in medicine, as well as those who are middle class and well educated
What is it? If anorexia, which has been recognised for 150 years, is a debilitating obsession with the quantity of food eaten, orthorexia is a debilitating obsession with the quality of food eaten.
That can result in such behaviours as sufferers avoiding food prepared by anyone other than themselves, a preoccupation with food supplements and vitamins, and endless hours of food and fitness research. When such preoccupations don’t bring the desired results, sufferers typically double-down on their diet and exercise behaviours to disastrous effect.
Studies to date suggest orthorexia is prevalent among people who are anxious by nature, or who have some other mental health issue, but also among athletes, those working in the performing arts and in medicine, as well as those who are middle-class and well-educated. Another study last year concluded that three in 10 participants showed signs of orthorexia.
‘Healthy’ Eating Disorder
The bigger problem is achieving more clarity about this ‘unspecified eating disorder’ – as the pathological condition is currently often diagnosed – is that it’s hiding in plain sight.
Sufferers often don’t realise they have a problem – quite the contrary. It often takes the action of partners or family for treatment to be sought, typically a mix of cognitive behavioural therapy with, importantly, says Allyson, both an eating and ‘movement plan’ that plays positively to the sufferer’s concerns but puts them on a track that’s genuinely healthy.
As with other eating disorders, treatment may also involve various forms of relaxation training that helps sufferers feel more at ease with more typical food and exercise choices. Part of treatment is often helping sufferers find more a positive replacement for the sense of control in their lives that their rigid rules around food provided. The goods news is that, like any eating disorder, orthorexia can be successfully treated if it is addressed soon enough. The challenge with orthorexia is that, in contrast with anorexia, the signs are not so highly visible.
‘People with orthorexia nervosa often don’t understand that their behaviour is problematic, and is the cause of their emotional distress. In fact, it’s something they’re often proud of’
‘In pathological eating there is a preoccupation with one activity – with “healthy” eating in this case,’ explains Professor Anna Brytek-Matera, head of the nutritional psychology unit of the Eating Behaviour Lab at the University of Wroclaw, Poland.
‘This is about the individual’s own criteria too. They believe that their eating habits are healthy but objectively they’re not. You may believe that bananas are good because they’re rich in vitamins, but if you only eat bananas that’s a problem. That’s why people with orthorexia nervosa often don’t understand that their behaviour is problematic, and is the cause of their emotional distress. In fact, it’s something they’re often proud of.’
That’s perhaps no surprise given how the discussion of fitness and nutrition is so much part of our culture, and so often comes with more than a tinge of moralising to it, too. Orthorexia seems deeply counter-intuitive: how can a super-healthy lifestyle actually be a driver of serious illness? So many of us also get sucked into eating and exercise fads that sufferers of orthorexia take to extremes. Those that do tend to be seen as figures of fun, rather than requiring serious intervention.
Indeed, researchers are asking whether orthorexia has long been with us in some form. Dr Louise Morgan, of the University of Warwick, in the UK, an historian specialising in eating disorders, argues that we have an instinctive concern about the safety of the food we eat, which the industrialisation of food production – where it is made away from our oversight – has only exacerbated.
Deadly Influence?
Or is it, actually, in some sense a product of mass media’s emphasis on a “healthy” lifestyle? According to a 2023 study, people with orthorexia traits are also more likely to obsessively follow nutrition influencers on social media.
‘An additional problem to all of the “health” information out there now is that there’s no stability as to what is recommended or as to how it is interpreted,’ says Dr. Elena Syurina, assistant professor of trans-disciplinary mental health at Vrije University Amsterdam.
‘Given the tendency of society now to reduce information to very brief explanations and for us to consume those very quickly, there’s not much room for nuance either. Orthorexia nervosa is a real and very relatable problem – it’s very likely we all know somebody [who has these behaviours]. But we need to get to the primary causes, whether that’s society, trauma, genetics, perfectionism [or some combination]’.
Sometimes the wake up call comes very abruptly. Jason Wood, now director of community engagement for the National Association of Anorexia Nervosa and Associated Disorders, in Chicago, is recovering from orthorexia nervosa. Four years ago he was out to dinner when the restaurant was unable to swap parts of his meal for ones he preferred. ‘Because I couldn’t get what I wanted I broke down,’ he says. ‘I had certain rules about food and was just so afraid of breaking them. All I could ever think about was food and exercise. It was then that I realised I needed to get help. And it’s still hard. But I’m getting there.’
As for Allyson. The 29-year-old is now a qualified yoga teacher, Eating Disorder Recovery Coach and is ten years into her recovery. As well as writing her book, she goes into colleges, universities, and high schools and partners with organisations to deliver impactful events, talks and workshops on ‘finding purpose beyond our bodies as we continue to heal our full selves.’
‘In a world obsessed with “health,” “fitness,” and “ideal bodies,” it is extremely challenging to go against the messages you are constantly receiving and to create your own path of healing and definition of wellness,’ she says. ‘Recovery is possible, but I wish people took the time to understand the complexity of eating disorders in order to develop more empathy for this illness.’
