My choice to study nutrition at Penn State was solidified by an advisor I spoke to in my first few days on campus. I had applied to study architecture, but was torn between that and a budding interest in food and nutrition science. I had lost weight, become an avid consumer of nutrition and health information and, to be honest, was becoming a little bit obsessive with my own eating patterns. She said I should try the Nutrition 101 class that semester—just to see what I thought of the topics—so I enrolled right there in her office. What she couldn't have known was how this kind of obsession with nutrition, especially at such a young age, is a typical red flag for disordered eating, and potentially a symptom of a condition now widely known as orthorexia.
Orthorexia isn't officially an eating disorder. Unlike anorexia and bulimia nervosa, for example, it doesn't yet have standard diagnostic criteria in the mental health field. However, the term has been around since 1998, when Steven Bratman, M.D., first used it to describe an obsession with healthful eating. I was in college just a few years after that, but it would be more than a decade before I heard about, or related to, this condition.
Until those early days of college, my nutrition knowledge was mostly self-taught—and generally not from reputable sources. In high school, I read countless health magazines geared toward women, making mental notes of every calorie-slashing tip, memorizing nutrition fact labels, and learning to tally my food intake in my head. My Nutrition 101 class provided my mind with a buffet of new information to choose from as I further restricted my total calorie intake, increased my energy output, and continued cutting out "junk" foods and so-called empty calories.
Looking back, I clearly see that during my first two years of college, I struggled with orthorexia, an unhealthy fixation on eating healthy foods. I was intoxicated with my weight loss, my restrictive food intake and the control I felt I had over my body and my health.
I have a lot of food memories from college. I remember restaurants I loved to go to with my parents, Penn State Creamery ice cream cones and late-night pizza slices. To avoid revealing to friends and family that I was intentionally losing (or controlling my) weight, I ate the ice cream and pizza and went to the candy shop with friends to buy sweets by the pound. I diligently restricted otherwise. In retrospect, these glimpses of what could be considered "normal" eating (for a college student) may have been my survival instincts kicking in. I needed that fat, more carbohydrates and those mental and emotional breaks from restricting.
I also remember logging my calories with pen and paper and being proud of how low the numbers got. I remember packing a granola bar and a banana for lunch some days, thinking that was "enough" calories to save me from having to go to the dining hall. I remember eating almost the exact same meals almost every day, because I had the calorie counts memorized. I also remember doing mental math of how many calories I needed to "make up for" if I deviated from the norm. I remember reading food magazines, and constantly looking up recipes online for things I would never cook or bake. As I now know from the hallmark "Starvation Study", which I didn't read until years after my nutrition education, this food obsession is a symptom of extreme restriction.
I remember hunger. I remember drinking a lot of diet cherry soda, and chewing sugar-free gum compulsively. I remember a lot of stomachaches. (See also: sugar alcohols in excess, which are now known to cause gastrointestinal discomfort such as irritable bowel syndrome.) I remember having a hard time concentrating in most of my classes, because I mostly thought about food, and my body was undernourished. I remember physical symptoms too—calf cramps so intense they woke me up almost every night for almost a year, and feeling so cold that I often kept my coat on in classrooms to keep from shivering.
I studied nutrition for four years, and felt both triggered by and justified in my disordered eating patterns. I ignored the fact that I wasn't getting a regular period, and that I didn't sleep well. I distorted my own vision of health, and felt trapped by the behaviors I had turned to for comfort in dealing with anxiety, change and stress.
By the time I graduated with a degree in nutrition science, I had learned enough to know this: I wasn't healthy. I needed to gain some weight back. I needed to get my period back. I needed to let go of calorie counting, restriction and food obsessions. I also think I felt fatigued, mentally, by the disorder. Gradually, I started to realize this wasn't something I wanted to do, or could do, for the rest of my life.
I stopped weighing myself. I stopped logging my food intake, and I stopped myself every time I felt the impulse to calculate my daily calorie intake in my head. In therapy for eating disorder treatment, this is often referred to as learning new behavioral pathways.
I started cooking meals with unknown (to me) calorie counts, using new cookbooks and trying out new food combinations. I gradually stopped looking at nutrition fact labels when I went grocery shopping, and instead bought foods I enjoyed and liked to cook with, and things that didn't have labels (e.g., fresh foods). I used oil while cooking, instead of a "calorie-free" cooking spray. I ate calorie-dense snack bars to bulk up my energy intake.
Throughout this process of changing old behaviors and embracing new foods, I started running more regularly. For some people, this can be a trigger to restrict food intake or feel like you have to "earn" your calories. For me, it was a lesson in fueling my body properly. I thought back to my one sports nutrition class, and remembered that my body can't run on empty. If I wanted to reach my running goals, I had to eat an adequate amount of energy, and a variety of foods. Running felt good to me; running motivated me to change, so I could keep moving my body in new ways.
One of the most important things I learned to do was to separate out my eating disorder thoughts from healthier, logical thoughts. I didn't know how to categorize these thoughts initially—the way I now encourage my clients to—but I did start to recognize which impulses felt disordered and which felt healthy to me. I learned to shut out the inner voice that felt compelled to check a calorie count, or eat "healthier" (or "better") than a friend across the table at a restaurant, or to run more to burn off extra calories. I learned to counter those thoughts with simple mantras: "That's not healthy," or "I don't need to know the calorie counts," or "This is what sounds/feels good to me, so I'm going to stick to it."
By the time I had fully embraced recovery, I was a practicing dietitian working in corporate wellness. But, eventually, I felt really uncomfortable with prescribing weight-loss diets or diet "challenges"—talking constantly about calories and reducing intake and increasing exercise. This is referred to as cognitive dissonance: I felt conflicted in prescribing behaviors to others that had bred my previous obsession with food and health. That's the irony of orthorexia, and other restrictive eating disorder behaviors: some habits we see in eating disorders are the same ones that are prescribed for weight loss. It's really no wonder this obsession is increasingly common, as weight-loss diets seem to be increasingly prevalent.
I now work primarily in private practice, helping individuals let go of rigid food rules, stop restricting their food intake or intentionally chasing extreme weight loss. I teach people—including fellow dietitians—about orthorexia, and see the light bulbs go on. What felt like an effort to eat healthier turned into an obsession and became unhealthy. And unfortunately, it's not uncommon for dietitians to experience symptoms of orthorexia.
I want it to be clear that healthy eating doesn't have to consume your thoughts all day, every day. Health shouldn't be an obsession. Dieting, and restriction, shouldn't be so normalized. Start working to remove some food rules, and eating when you feel hungry, and see how that feels. We can relearn how to eat intuitively—respecting what our bodies need—without constantly being preoccupied by food. And we don't need a set of rules defining how to eat, or what to weigh, but rather an acknowledgment that health is a big picture, and food is just one part of it. (Learn more about Intuitive Eating by reading the book that started it all.)
How to Eat Mindfully