Hektoen International

A Journal of Medical Humanities

Clean eating and orthorexia as technologies of the self

Cristina Hanganu-Bresch
Philadelphia, Pennsylvania, USA

 

Photo by Dan Gold from Burst. Licensed under Creative Commons

As numerous social and traditional media outlets and ads constantly remind us, our diets must be “clean”—a vague descriptor whose fuzzy boundaries can fit a plethora of surrogate terms: organic, natural, whole, non-GMO, unprocessed, gluten free, vegan, sugar-free, fat-free, low-carb, raw, unrefined, and so on. The evidence for “clean eating” is often contradictory or cherry-picked, but its dogma is nevertheless viscerally felt to be true, or at least compelling, banking on a series of binaries lopsided in its favor: clean/dirty, organic/synthetic, natural/artificial, whole/incomplete, unprocessed/processed, pure/altered, raw/cooked. The idea that what we eat can not only sustain us but also cleanse, purify, repair, and even transmute our bodies into an enlightened, superior version of ourselves is very old. Hippocrates recommended diet as the first line of prevention of (and defense against) disease. Hunger, eating, ingestion, and the larger semiotic universe of consumption has been largely used to signify the relationship of the body with the universe, and of the ego with the outside world of ideas, feelings, and actions. Food is the symbolic vehicle that travels from the outside in, filling, nurturing, healing, and transforming the body as well as the spirit.

The modern-day obsession with “clean eating” has sprouted from multiple diffuse nodes: healthism (the neoliberal tenet that we are each individually responsible for our own health), clever marketing, alternative medicine and lifestyles, a reaction to western lifestyle diseases (e.g. obesity), food scares (e.g., E-coli contaminations, Mad Cow Disease), as well as a preoccupation with the dietary purity of the populace, which often took nationalistic and racist overtones.1, 2 But what happens when one gets so obsessed with clean eating as to be (ironically) consumed by it? According to recent research, one can acquire a new eating disorder: orthorexia, derived from the Greek orthos=right, and rexia=hunger, appetite.

Orthorexia, in short, is defined as a compulsion for eating “right,” that is pure, healthy food in pursuit of perfect health and control over one’s body.3 The definition of “pure” or “healthy” varies, depending on the vagaries of alternative nutrition “science” seeking to cure modern-day ailments through diet. The overall wellbeing of the orthorexic sufferer may be affected by weight loss, persistent dysphoric states, anxiety toward meal planning and social situations involving food, obsessive behaviors and illusions of control, and nutritional imbalances (stemming, ironically, from the quest for nutritional perfection).4 Orthorexia engenders feelings of control and superiority, which equate nutritional choices with moral prowess.

The concept itself was invented less than twenty years ago by a holistic doctor for the purposes of self-diagnosis. Steve Bratman coined the term “orthorexia nervosa” in an article for the Yoga Journal in 1997; in it, he documented his and others’ increasingly restrictive, ritualistic behaviors regarding food—raw, macrobiotic, vegan, organic, natural, non-GMO, to name just a few, which came from a sincere desire to adhere strictly to naturopathic principles in order to manage his health. “Eventually,” he recalls, “I became such a snob that I disdained to eat any vegetable that had been plucked from the ground more than fifteen minutes. I was a total vegetarian, chewed each mouthful of food fifty times, always ate in a quiet place (which meant alone) . . . .” (He is eventually cured through a series of eye-opening encounters with spiritual leaders, who gradually make him recognize that his habits were neither healthy nor life-affirming).5 Bratman expounded on the concept in a follow-up book, Health Food Junkies (with David Knight, 2000), which was favorably reviewed in JAMA, and whose take-home message was quickly disseminated via a network of wellness websites and magazines.6 The concept was eventually taken up in the medical literature starting roughly in 2004. The first to expand on the definition were an Italian research team led by Donini et al., who also devised an instrument for diagnosing orthorexia—the ORTO-15 questionnaire.7, 8 The instrument was flawed and has never been successfully validated, yielding wildly varying rates of orthorexia in the general population, from 6.9 % to 57.6 % in a follow-up study; however, numerous studies used it to show that a significant number of people in the general population are susceptible to orthorexia, with some populations (e.g., medical or nutrition students) more than others.9, 10, 11, 12 No consistent gender differences have been revealed.

The concept of orthorexia jumped back and forth between popular and clinical genres and discourse communities. In its first mediatic cycle, orthorexia spread, from Bratman’s article and book, to health websites (which are heavily cited in the 2004 Donini et al. study), and on to clinical journals. In its second uptake cycle, the concept made its way from medical journals back to health magazines, websites and the health sections of newspapers, and into the vast seas of social media. Orthorexia was considered for inclusion in the Diagnostic and Statistical Manual V (DSM-V), an attempt that failed due to lack of sufficient evidence.13 A big boost in the recognition and popularization of orthorexia came in 2014-2015, when Jordan Younger, a popular vegan blogger and Instagrammer, admitted she was suffering from orthorexia and gave up veganism in an attempt to get better. The backlash from her vegan followers was swift, and the media immediately seized on the story—which mixed novelty, shock value, and scandal all in one. Not only was orthorexia a novel term, but a popular (blond, thin, young, pretty, photogenic) health blogger was actually anything but healthy and, on top of that, veganism was revealed to be conducive to an eating disorder. Younger became notorious and was featured on TV and in many newspapers, magazines, and websites. Her 2015 memoir detailing her struggle with orthorexia (Breaking Vegan: One woman’s journey from veganism, extreme dieting, and orthorexia to a more balanced life) was endorsed by Bratman, orthorexia’s inventor and patient zero, who in turn cited her case in a clinical review of orthorexia he co-authored.14 The concept’s reuptake in social media was swift, and numerous confessionals and stories about orthorexia started appearing around this time, accompanied by a sharp rise in the hashtag #orthorexia.15 Meanwhile, the clinical research on the topic has continued apace, with close to 100 hits in PubMed to date and a recent book on the topic.16

Younger, like the many similar self-confessed orthorexics documented in the media, displays an obsessive preoccupation with food, or rather the right food, stemming from her initial desire to cure her own digestive troubles; but given that there is no central authority on clean eating, her ideas of what is “right” are a pastiche of trends that she tries, tweaks, and continually refines in hopes of achieving a feeling of purity and calm in her stomach, and a perfect (healthy, fit) body.17 To this day, she prescribes health advice via her blog, podcast, and app, and devises and sells juice cleanses on her website, “The Balanced Blonde” (formerly “The Blonde Vegan”)—although in her memoir her obsession with juice cleanses is painted as a major manifestation of her disorder. Her complex yoga and dietary regimens, which are illustrative of contingents of wellness bloggers, can be described as a “technology of the self,” defined by Foucault as “permit[ting] individuals to effect by their own means or with the help of others a certain number of operations on their own bodies and souls, thoughts, conduct, and way of being, so as to transform themselves in order to attain a certain state of happiness, purity, wisdom, perfection, or immortality.”18 “Clean eating,” consequently, can be loosely characterized as a neoliberal technology of the self, using composite dietary regimes, often complemented by fitness regimes, to perfect the body and confer both physical and moral superiority to the strict adherents in the context of healthism.

Younger is just one of many similar health, wellness, food, and fitness bloggers and YouTube and Instagram stars. Some examples are Vani Hari “The Food Babe” (a relentless crusader for freeing our foods of “chemicals”); David “Avocado” Wolfe (a raw food guru); Freele “The Banana Girl” (a committed vegan advocating a diet based on raw fruit and in particular bananas); or Belle Gibson (who claimed she cured her multiple cancers through a “clean” diet and alternative treatments, though she was later exposed to have lied about her cancer). In the echo-chambers of the internet their popularity is amplified via “followers” and “likes,” and “monetized” (Hari, for example, has a best-selling book, sells her own natural supplements on her website, and is about to release a second book.) They all are digital entrepreneurs of the self, modeling clean eating as a self-perfecting technology. Their behavior gets modeled and spreads—virally—via social media, allowing orthorexia to proliferate; indeed, a study found that Instagram users have high rates of orthorexia.19

In a recent book, Kravetz made the case that bulimia had also spread via popular media, which picked up on an initial report of a few isolated cases of binging and purging behavior in 1972, causing an eventual epidemic of bulimic behaviors primarily among young women.20 Western societal pressures to be thin mixed with an abundance of food choices were among the vectors contributing to this behavioral contagion. In the case of orthorexia, the abundance of food choices remains but is matched by an abundance of often contradictory dietary and health advice. The internet provides the medium for digital contagion, while our collective preoccupation with clean eating might be the decisive factor in whether one’s healthy dietary behaviors cross the line into pathology. While not an official DSM diagnosis yet, orthorexia is at a minimum a symptom of a cultural pathology, a neoliberal disease emerging from the proliferation of “clean eating” discourses, and a technology-of-the-self gone awry.

 

References

  1. Bobrow-Strain, Aaron. 2008. “White bread bio-politics: purity, health, and the triumph of industrial baking.” Cultural geographies 15: 19–40.
  2. Bosi, A. Tülay Bagcı, Derya Çamur, Cagatay Güler. 2007. “Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey).” Appetite 49: 661–666.
  3. Bratman, Steven. 1997. “Health Food Junkie.” Yoga Journal (September/October): 42-50.
  4. Bratman, Steven and Knight, David. 2000. Health Food Junkies. New York: Broadway Books.
  5. Chalmers, Vanessa. 2017. “My clean eating obsession became orthorexia nervosa.” https://www.healthista.com/my-clean-eating-obsession-became-orthorexia-nervosa/. Accessed 3 Jun 2018.
  6. Crawford, Richard. 1980. “Healthism and the Medicalization of Everyday Life.” International Journal of Health Services, 10(3): 365-388.
  7. Donini, Lorenzo M., Marsili D., Graziani M.P., Imbriale M, and Cannella C. 2004. “Orthorexia nervosa: A preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon.” Eating and Weight Disorders 9: 151-157.
  8. Donini, Lorenzo M., Marsili D., Graziani M.P., Imbriale M, and Cannella C. 2005. “Orthorexia nervosa: Validation of a diagnosis questionnaire.” Eating and Weight Disorders 9: e28-e32.
  9. Dunn, Thomas M. Dunn and Bratman, Steven. 2016. “On orthorexia nervosa: A review of the literature and proposed diagnostic criteria.” Eating Behaviors 21: 11-17.
  10. Farhoud, Nada. 2016. “Clean eating may be BAD for you and cause ‘orthorexia’, health experts warn as wellness trend faces backlash.” The Mirror. https://www.mirror.co.uk/news/uk-news/clean-eating-bad-you-cause-9105520. Accessed July 13, 2018.
  11. Fasanella, Kaleigh. 2018. “Health blogger says an obsession with “clean eating” led to her battle with orthorexia.” Allure. https://www.allure.com/story/health-blogger-clean-eating-orthorexia-obsession. Accessed June 17, 2018
  12. Foucault, Michel, Luther H. Martin, Huck Gutman, Patrick H. Hutton. 1988. Technologies of the Self. A Seminar with Michel Foucault. Amherst: University of Massachusetts Press.
  13. Grammatikopoulou, Maria G., Gkiouras Konstantinos, Markaki Anastasia, Theodoridis Xenophon, Tsakiri Vasiliki, Mavridis Pantelis, Theodore Dardavessis, Michael Chourdakis. 2018. “Food addiction, orthorexia, and food-related stress among dietetics students.” Eating and Weight Disorders 23: 459. https://doi-org.db.usciences.edu/10.1007/s40519-018-0514-1
  14. Hemshaw, Gena. 2015. “My green recovery story.” The Full Helping. https://www.thefullhelping.com/my-green-recovery-story/. Accessed 12 March 2018.
  15. Hugh-Berman, Adriane. 2001. “Health food junkies: orthorexia nervosa: overcoming the obsession with healthful eating.” JAMA 285(17): 2255-2256.
  16. Koven, Nancy and Abry, Alexandra W. 2015. “The clinical basis of orthorexia nervosa: emerging perspectives.” Neuropsychiatric Disease and Treatment 11: 385-394.
  17. Kravetz, Lee Daniel. 2017. Strange Contagion. Inside the Surprising Science of Infectious Behaviors and Viral Emotions and What They Tell Us About Ourselves. New York: Harper Collins.
  18. Luck‐Sikorski Claudia, Franziska Jung, Katharina Schlosser, and Steffi G. Riedel‐Heller. 2018. “Is orthorexic behavior common in the general public? A large representative study in Germany.” Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity. https://doi.org/10.1007/s40519-018-0502-5
  19. Matthews, Hannah. 2017. “Orthorexia: How my ‘clean eating’ turned into anorexia.” Self Magazine. https://www.self.com/story/orthorexia-how-my-clean-eating-turned-into-anorexia. Accessed 12 March 2018.
  20. McGregor, Renee. 2018. Orthorexia When healthy eating goes bad. London, UK: Watkins.
  21. Oksman, Olga. 2015. “Orthorexia: When healthy eating turns against you.” The Guardian. https://www.theguardian.com/lifeandstyle/2015/sep/26/orthorexia-eating-disorder-clean-eating-dsm-miracle-foods. Accessed June 2, 2018.
  22. Ramacciotti, C.E., P. Perrone, E. Coli, A. Burgalassi, C. Conversano, G. Massimetti, L. Dell’Osso. 2011. “Orthorexia nervosa in the general population: A preliminary screening using a self-administered questionnaire (ORTO-15).” Eating and Weight Disorders 16: e127-e130.
  23. Rochman, Bonnie. 2010. “Orthorexia. Can health eating be a disorder?” Time. http://content.time.com/time/health/article/0,8599,1963297,00.html. Accessed 2 November, 2017.
  24. Segura-García Cristina, M.C. Papaianni, F. Caglioti, L. Procopio, C.G. Nisticò, L. Bombardiere, A. Ammendolia, P. Rizza, P. De Fazio, and L. Capranica. 2012. “Orthorexia nervosa: A frequent eating disordered behavior in athletes.” Eating and Weight Disorders 17: e226-e233.
  25. Treitel, Corinna. 2018. “Triumph of the till: The organic food movement’s Nazi past.” World Policy Journal 35(2): 83-87.
  26. Younger, Jordan. 2015. Breaking Vegan: One woman’s journey from veganism, extreme dieting, and orthorexia to a more balanced life. Beverly, MA: Quarto Publishing.
  27. Younger Jordan. 2018. The Balanced Blonde. http://www.thebalancedblonde.com/. Accessed July 10, 2018.

 

Endnotes

  1. Cf. Richard Crawford. 1980. “Healthism and the Medicalization of Everyday Life.” International Journal of Health Services, 10(3): 365-388.
  2. Bobrow-Strain, Aaron. 2008. “White bread bio-politics: purity, health, and the triumph of industrial baking.” Cultural geographies 15: 19–40; Treitel, Corinna. 2018. “Triumph of the till: The organic food movement’s Nazi past.” World Policy Journal 35(2): 83-87.
  3. Bratman, Steven. 1997. Health Food Junkie. Yoga Journal (September/October): 42-50.
  4. See: Donini, Lorenzo M., Marsili D., Graziani M.P., Imbriale M, and Cannella C. 2004. “Orthorexia nervosa: A preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon.” Eating and Weight Disorders 9: 151-157; Koven, Nancy and Abry, Alexandra W. 2015. “The clinical basis of orthorexia nervosa: emerging perspectives.” Neuropsychiatric Disease and Treatment 11: 385-394; Dunn, Thomas M. Dunn and Bratman, Steven. 2016. “On orthorexia nervosa: A review of the literature and proposed diagnostic criteria.” Eating Behaviors 21: 11-17.
  5. Bratman, ibid.
  6.  Hugh-Berman, Adriane. 2001. Health food junkies: orthorexia nervosa: overcoming the obsession with healthful eating. JAMA 285(17): 2255-2256.
  7. Donini, et al., 2004.
  8. Donini, Lorenzo M., Marsili D., Graziani M.P., Imbriale M, and Cannella C. 2005. “Orthorexia nervosa: Validation of a diagnosis questionnaire.” Eating and Weight Disorders 9: e28-e32.
  9. Ibid.
  10. Ramacciotti, C.E., P. Perrone, E. Coli, A. Burgalassi, C. Conversano, G. Massimetti, L. Dell’Osso. 2011. “Orthorexia nervosa in the general population: A preliminary screening using a self-administered questionnaire (ORTO-15).” Eating and Weight Disorders 16: e127-e130.
  11. Luck‐Sikorski Claudia, Franziska Jung, Katharina Schlosser, and Steffi G. Riedel‐Heller. 2018. “Is orthorexic behavior common in the general public? A large representative study in Germany.” Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity. https://doi.org/10.1007/s40519-018-0502-5
  12. Bosi, A. Tülay Bagcı, Derya Çamur, Cagatay Güler. 2007. “Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey).” Appetite 49: 661–666; Segura-García Cristina, M.C. Papaianni, F. Caglioti, L. Procopio, C.G. Nisticò, L. Bombardiere, A. Ammendolia, P. Rizza, P. De Fazio, and L. Capranica. 2012. “Orthorexia nervosa: A frequent eating disordered behavior in athletes.” Eating and Weight Disorders 17: e226-e233; Grammatikopoulou, Maria G., Gkiouras Konstantinos, Markaki Anastasia, Theodoridis Xenophon, Tsakiri Vasiliki, Mavridis Pantelis, Theodore Dardavessis, Michael Chourdakis. 2018. “Food addiction, orthorexia, and food-related stress among dietetics students.” Eating and Weight Disorders 23: 459;
  13. Rochman, Bonnie. 2010. “Orthorexia. Can healthy eating be a disorder?” Time. http://content.time.com/time/health/article/0,8599,1963297,00.html. Accessed 2 November, 2017.
  14. Dunn and Bratman, 2016
  15. See, for example, Gena Hemshaw. 2015. “My green recovery story.” The Full Helping. https://www.thefullhelping.com/my-green-recovery-story/. Accessed 12 March 2018; Olga Oksman. 2015. “Orthorexia: When healthy eating turns against you.” The Guardian. https://www.theguardian.com/lifeandstyle/2015/sep/26/orthorexia-eating-disorder-clean-eating-dsm-miracle-foods. Accessed June 2, 2018; Nada Farhoud. 2016. “Clean eating may be BAD for you and cause ‘orthorexia’, health experts warn as wellness trend faces backlash.” The Mirror. https://www.mirror.co.uk/news/uk-news/clean-eating-bad-you-cause-9105520. Accessed July 13, 2018; Kaleigh. Fasanella. 2018. “Health blogger says an obsession with “clean eating” led to her battle with orthorexia.” Allure. https://www.allure.com/story/health-blogger-clean-eating-orthorexia-obsession. Accessed June 17, 2018; Vanessa Chalmers. 2017. “My clean eating obsession became orthorexia nervosa.” https://www.healthista.com/my-clean-eating-obsession-became-orthorexia-nervosa/. Accessed 3 Jun 2018; Hannah Matthews. 2017. “Orthorexia: How my ‘clean eating’ turned into anorexia.” Self Magazine. https://www.self.com/story/orthorexia-how-my-clean-eating-turned-into-anorexia. Accessed 12 March 2018.
  16. Renee McGregor. 2018. Orthorexia When healthy eating goes bad. London, UK: Watkins.
  17. Younger, Jordan. 2015. Breaking Vegan: One woman’s journey from veganism, extreme dieting, and orthorexia to a more balanced life. Beverly, MA: Quarto Publishing.
  18. Foucault, Michel, Luther H. Martin, Huck Gutman, Patrick H. Hutton. 1988. Technologies of the Self. A Seminar with Michel Foucault. Amherst: University of Massachusetts Press, p. 18.
  19. Turner, Pixie G. and Carmen E. Lefevre. 2017. “Instagram use is linked to increased symptoms of orthorexia nervosa.” Eating and Weight Disorders 22: 277–284.
  20. Lee Daniel Kravetz. 2017. Strange Contagion. Inside the Surprising Science of Infectious Behaviors and Viral Emotions and What They Tell Us About Ourselves. New York: Harper Collins.

 

 

CRISTINA HANGANU-BRESCH is an Associate Professor of Writing and Rhetoric at the University of the Sciences (Philadelphia), where she teaches primarily writing and scientific writing in addition to multidisciplinary courses in the history of medicine and animal studies. Her research has focused primarily on medical rhetoric, in particular the rhetoric of psychiatry. Her work was published in Written Communication, Literature and Medicine, and several edited collections. Her upcoming book with Carol Berkenkotter, Diagnosing Madness: The Discursive Construction of the Psychiatric Patient, 1850-1920 (South Carolina University Press) is scheduled to be published in 2019. Work on this paper has been made possible by a residential fellowship with the Brocher Foundation, Switzerland, July-August 2018.

 

Highlighted in Frontispiece Volume 11, Issue 1– Winter 2019

Summer 2018  |  Sections  |  Food

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