Vegetarianism, rawism, orthorexia nervosa?

10.07.2020

My article "Nervous Food" has become highly discussable: there were many questions, both openly and in private messages. This means that the topic is interesting and important to readers. Taking into consideration that eating disorders have the highest mortality among all mental disorders, I want to continue this discussion.

Today we will do a deep dive into the problem of orthorexia nervosa. What is it, why does it arise, what is it characterized by and how is it connected with a raw food diet, and vegetarianism?

 

From the history of the problem

     The term "orthorexia" consists of a combination of two Greek words. Orthos means "true, faithful"; orexis – “appetite”. Orthorexia, or orthorexia nervosa, is an eating disorder that involves an extreme fixation on healthy eating. At the same time, a person can ritualize the choice of products, buying them with an extreme precision, expressly excluding dirty or unhealthy foods, and follows a strict diet.

   The research of the problem began with the publication of an essay by Steven Bratman. It was called "Health food junkie" (1997). In this work, the author has argued the negative side effects of dietary medicine. He also has named a new form of ED - orthorexia nervosa.

   Researchers began to talk about the need to include this problem in the official classifiers of diseases. Many experts have studied it. I was one of these experts, researching various aspects of orthorexia. This type of ED was made viral by the world media. The general portrait of a person with orthorexia looked like this: an individual above 30 years old, strict dietary regulations, an obsession with a healthy lifestyle, dedicating all his thoughts and time to it. At the same time, he does not take into account his taste preferences and focuses solely on the benefits of products carefully checking their quality. He also ignores the calorie content of the daily diet, the balance between energy intake and expenditure. People with orthorexia are characterized by powerful self-discipline, a taboo on regular restaurants, and a sense of superiority over people who eat "absolutely everything."

 

The root of the matter

The main need for a person with orthorexia is self-affirmation (Lozova, O., Fatieieva, M., 2017). The taboos on unhealthy food and such dietary restrictions are the tools to achieve their own superiority. Such eating behavior is usually associated with pseudo-spirituality. This means that, when a person with orthorexia nervosa fills himself with "clean" food, he feels better, superior, cleaner. It comes to a sense of holiness and arises a need to teach relatives and friends, promoting orthorexic eating style, true and healthy principles. Other people, in return, see this as a cult, a sacred rite instead of the usual meal. There starts condemnation, mockery, and sarcasm. Or polite distancing.

Usually, it is difficult to understand that such eating behavior must be viewed in an overall context, that there is always a certain idea behind such a cult. As a fictional Russian author, Kozma Prutkov said, one must get to the root of the matter. Why did a person change his usual dietary guidelines for new, not typical ones? Only an expert can figure this out.

It is the same as a therapist identifies the causes of a headache. It can be a sign of sleep disorder or meteorological dependence; heatstroke or hypertension; cervical osteochondrosis or an effect of a concussion ... In a word, a symptom of many different health problems. Therefore, the doctor conducts a comprehensive examination of the patient and only then makes the final diagnosis. And only when a person himself asked for help.

Same thing with orthorexia. Without having the full picture, you can’t make the right conclusion. Any behavior is important to consider in context, what is the idea behind such a restriction? The same naked person in the shower and on the city street are different contexts.

Undoubtedly, rawism and vegetarianism are restrictive eating behaviors. However, this can be a sign of ED, or a manifestation of schizophrenia, or an experiment. For example, vegetarianism for someone could be following a fashion trend or the influence of an authoritative person. For girls, it can be a spring challenge to lose some weight and gain a healthy complexion. Cases are very different.

     Researches have shown that representatives of both genders are amenable to orthorexia nervosa. Vegetarians, strict vegans, and perfectionists are at risk.

 

Let’s differentiate correctly

    Where is the line between healthy eating and an eating disorder? The criteria for orthorexia were identified by F. Barthels (Barthels, F., Meyer, F., & Pietrowsky, R., 2015), and were specified in 2016 by S. Bratman and T. Dunn. There are:

1. Long-term, strong passion for health products and healthy eating;

2. The taboo on unhealthy foods, anxiety about them;

3. Rituals of buying, preparing and eating food, due to overvalued ideas;

4. Concentration on healthy eating provokes difficulties in professional, social and other spheres of human life;

5. Weight loss may be present, but it is not dominant.

   To diagnose orthorexia, it is necessary to have points 1, 2, 3, 5, and partially 4. When point 5 is not clearly met, the authors advise diagnosing with atypical anorexia nervosa.

 

Let’s be respectful!

     In 2017 S. Bratman wrote about the incorrect interpretation of the term in the media. He urged not to stick labels on eating disorders and to maintain empathy for those who have become an adherent of an alternative diet. This attitude is also axiomatic in the codes of ethics of nutritionists in many countries.

   To be completely fair, I should admit that orthorexia can have such side-effects as a decrease in immunity, osteoporosis, hormonal disruptions, exhaustion of the nervous system, diseases of the cardiovascular system, and social isolation. Less commonly, death from cachexia (exhaustion), as, for example, in recent cases of vegan families Shakur from Atlanta, O'Leary from Florida, etc. Nevertheless, every adult is the owner of his body, he or she has the right to do whatever he or she wants with it. Of course, children and adolescents are an exception. Parents are responsible for them, they must step in and seek help from a specialist. The specialist, in his turn, does not have the right to force help on adults, even when they cause notable harm to themselves. Professor A. Bryukhin (Peoples' Friendship University of Russia, Moscow) told in details about the voluntary and involuntary assistance in such situations in the journal Eating Disorders: Modern Experience (A. Bryukhin, T. Lineva, 2019).

 

No one has the right to condemn those who have changed their nutritional principles and, in fact, are promoting orthorexia. An adult can do whatever he sees good for himself according to the principle “MY BODY IS MY OWN BUSINESS”. If a person wants to sort out his doubts and searches together with a specialist and understand how to satisfy his own needs without strict restrictions on food - it's great! The main thing is that the approach should be professional.

   I wish you all health and energy!

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