Having an excessive preoccupation with the quality of your food can be harmful to your health. This behaviour has a name, orthorexia. It primarily affects young people, and social media only makes it worse.
“My self-worth was determined exclusively by what I would eat.” Mathilde Blancal, author of the book Confidences d'une ex-accro des régimes (Confidences of a former diet addict)1, uses humour to tell the story of her long battle with eating disorders and orthorexic behaviour. “Being conscious about nutritional quality is highly valued in our Western societies. Without realising it, some people who would compliment me were actually encouraging my behaviour. There’s also a certain degree of pride in sticking to a healthy diet. I felt as though I was doing the right thing and sometimes even a bit superior to others.”
From the Greek “orthos” (correct, proper) and “orexia” (appetite), orthorexia refers to an excessive desire to eat only foods considered healthy.
Orthorexics tend to become fixated on the quality of their food, which they classify into binary categories: good or bad.
“I would spend hours at the supermarket choosing my food and also cooked everything myself to avoid ingesting anything bad for my body,” Mathilde Blancal says. This black-and-white attitude can cause orthorexics to set strict rules for their diet. “However, categorising things in this way is based on subjective dichotomous thinking, which is not reality. No food is intrinsically healthy or unhealthy,” says Maaike Kruseman, a dietician in private practice and lecturer at the University of Lausanne.
It is difficult to draw the line where a person crosses from a simple desire to choose healthy food into excessive preoccupation. Orthorexia is not yet recognised as a mental disorder and is not included in official classifications. “It’s a new phenomenon. As yet there is no formal definition or standardised criteria for diagnosis.
That complicates research to determine its causes. For example, orthorexia can be used as a means to control anxiety or boost self-esteem. Experts also believe that there are ties between orthorexia, perfectionism, rigid thinking and compulsion,” says Carolin Janetschek, clinic head of the special unit for eating disorders at Lausanne University Hospital (CHUV).
In Switzerland, nearly three-quarters of young women aged 16 to 20 want to lose weight, estimates the Swiss Multicenter Adolescent Survey on Health (SMASH). The Swiss Federal Statistics Office (FSO) reports that while anorexia nervosa generally occurs in early and late adolescence, bulimia nervosa often occurs later, between the ages of 18 and 21. Social media are omnipresent in their lives: 98% of young Swiss people use at least one social media website, and more than half of them use Instagram several times a day, the Swiss 2022 JAMES study found. “During adolescence, young people naturally seek out models beyond the family unit. Today, internet plays an increasingly important role as an influence. For example, unscientific nutritional advice can be dangerous for young people,” says Christin Hornung, child psychiatrist with the CHUV.
While claiming to promote a healthy lifestyle, some accounts convey harmful instructions if consulted excessively and without putting things into perspective. “Content with the hashtag ‘What I eat in a day’, where amazingly beautiful girls eat 1,000 calories a day, drinking smoothies and eating spinach, can be very appealing. I remember regularly subscribing and unsubscribing to accounts that interested me but were actually doing me a lot of harm,” Mathilde Blancal says. Dietician Maaike Kruseman believes that this is a genuine public health problem. “However, due to the lack of statistics and data, we cannot yet measure the phenomenon.”
The lack of scientific criteria to identify orthorexia means no proper diagnosis can be made. Online questionnaires are sometimes used to screen for orthorexia. But their validity is widely regarded as deficient. “Prevalence of the disorder varies in different countries and populations, as does the tool used to measure it. Results can range from 6.9% to 75.5%,” Christin Hornung says. Treatment may be necessary in some cases. “If eating behaviour hinders a teenager’s normal physical and mental development – either due to nutritional deficiencies or social withdrawal – or if the teen and their loved ones are having trouble coping, it may be worth seeing someone about it,” Carolin Janetschek says. Certain population groups, such as athletes, are at a higher risk of developing this type of disorder (see also inset).
Getting treatment by a professional team can be a challenge. “People with no training in the area need to learn about nutrition,” Maaike Kruseman says.
“Some nutritionists – a profession that is not regulated in Switzerland – offer advice that can be overly simplistic and sometimes harmful. It’s better to consult a dietician for example, who will monitor and design a programme customised to your needs.” /
Controlling your diet can improve athletic performance and prevent injury. But caloric intake must also be sufficient to cover energy expenditure and facilitate recovery. “In aesthetic or gravitational sports, staying lean can sometimes improve performance.
However, it can also keep the body from functioning properly if the athlete is energy deficient,” says Nathalie Wenger, sports physician and clinic head of CHUV’s Centre SportAdo.
Formerly known as the “female athlete triad”, Relative Energy Deficiency in Sports (RED-S) affects many female athletes. However, in Switzerland the syndrome is relatively unknown to sports doctors, coaches and athletes alike. Some symptoms such as disrupted menstruation, remain taboo. “Prevention is essential due to the potentially irreversible consequences on bodies, bones and mental health. We recommend an annual health exam for young people who train more than three times a week.”
Swiss Olympic, the umbrella organisation of Swiss sports federations, launched the Women and Elite Sport project in 2019 to address this issue. It aims to lift the veil on certain taboo subjects such as RED-S.
Orthorexia was first described by the American physician Steve Bratman in 1997. Rather than turn it into a pathology, he aimed to start the conversation about a growing trend he was seeing in his patients.
Social norms such as self-discipline and attaching value to healthy eating seem to play a role in developing orthorexia. The disorder remains largely unexplored, and only future research will confirm any connection.
The Swiss Federal Statistical Office estimates that 3.5% of the Swiss population struggles with an eating disorder at some point in their lives. Women are four times more prone to these disorders than men (5.3% versus 1.5% of the population).
Aggravated by the pandemic, eating disorders are harder to diagnose in men than in women. However, a recent British study reported a 128% increase between 2016 and 2021.
Orthorexia can lead to somatic symptoms such as a lack of certain substances in the blood, vitamins, iron, calcium, and cause growth deficiency or even amenorrhoea (disrupted menstrual cycle).
