Is wellness culture creating a new kind of eating disorder?

Orthorexia is a moral or righteous fixation on consuming “pure” and “clean” foods.
Orthorexia is a moral or righteous fixation on consuming “pure” and “clean” foods.
Image: Reuters/Eddie Keogh
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If you’ve ever ordered a turmeric matcha latte, you probably know someone like Daniella Isaacs. The 20-something British actress and playwright was once entrenched in the world of wellness, with the attendant blogging career, paid appearances, and budding gluten-free granola brand. But all that changed when she realized that “wellness” might actually be making her sick.

Isaacs had orthorexia, an eating disorder not about thinness, but rather a moral or righteous fixation on consuming “pure” and “clean” foods. Her new autobiographical play—Hear Me Raw, running at the Edinburgh Fringe Festival through the end of August—viscerally documents Isaacs’ journey from smoothie-gulping goddess to messy, complex, but ultimately happier human being. In doing so, the play begs an obvious yet unexamined question: Is wellness culture causing orthorexia?

As a condition, orthorexia has a somewhat zig-zagged history. The term was coined by Steven Bratman, then an alternative medicine practitioner, in a 1997 article for Yoga Journal after he noticed that some of his clients, “had reduced the dimensionality of their human lives by assigning excessive meaning and power to what they put in their mouths.” The first mention of orthorexia in a peer-reviewed journal came in 2004, but it took another decade for the term to enter the popular lexicon. In 2014, Instagram star and blogger The Blonde Vegan (now called The Balanced Blonde, naturally) admitted to her 70,000 followers that the condition caused her to “[live] in a bubble of restriction.”

Despite recent media attention, orthorexia is not listed in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5), largely because there is no singular diagnostic criteria that clinicians agree on. Worse, the condition is often conflated with mere healthy eating. As Bratman noted in a paper last month (pdf), the crucial distinction separating the two is a pathological mental component—including “obsessive thinking, compulsive behavior, self-punishment, and escalating restriction”—that can often be concealed from the outside world.

Throughout Isaacs’ comic and tender play—which begins as mock wellness book launch, complete with a pelvic floor-strengthening exercise and gluten- and dairy-free date balls passed around the audience—the cracks of her dizzyingly positive wellness veneer begin to show. She says the performative nature of the theatre setting mirrors how she saw the wellness industry operate.

“Working in this industry [as a ghostwriter for a wellness brand], I saw it up close and personal,” Isaacs says. “These people that are running wellness brands are just as messed up as the people following them. They’re actors in a play and their play is Instagram or Snapchat. What I want to do in this play is expose the mess and celebrate it.”

Isaacs believes that a considerable number of people in the wellness world share her condition, whether they admit it or not. But saying that wellness—and, more specifically, the social media platforms it thrives on—actually causes orthorexia? That’s another claim entirely.

Pixie Turner is a biochemist and nutritionist who also used to suffer from orthorexia. In a June paper published in the journal Eating and Weight Disorders, Turner directly examines the link between social media and orthorexia. Using a survey based on 680 female respondents, she found “higher Instagram use being linked to increased symptoms” of the disorder, “with no other social media channel having this effect.” Turner’s paper cites the rabbit hole-like nature of wellness on Instagram, where the emphasis on imagery and the lack of expert oversight make it easy to distort reality for people who may be susceptible to eating disorders.

It’s believed that less than 1% of the US population has orthorexia, but the documented rates for those heavily involved in the wellness world—including yoga instructors, dieticians, and nutrition students—are, in some studies, as high as 86%. Turner says that more research is needed before we can point to a causal link there, but her anecdotal and personal experience suggests that “wellness really is just a socially acceptable eating disorder.”

Dr. Lauren Muhlheim, a Los Angeles-based clinical psychologist and eating disorder therapist, isn’t quite that emphatic: Although she noted a marked uptick in the number of clients with orthorexia in 2010—interestingly, the same year that Instagram was founded—Muhlheim believes many of her clients with orthorexia would, in the absence of wellness culture, still suffer from other forms of eating disorders due to their underlying susceptibility.

“Wellness definitely contributes to it presenting this way. But we don’t know if, in the absence of wellness culture, these people would have developed anorexia or something else,” she says. “There were cases of what we might now consider anorexia as early as the 1200s, but reasons for the fasting in that case was for holy or spiritual reasons. So it may be that an eating disorder takes on the sociocultural context.”

Isaacs’ story seems to jibe with this assessment. In writing Hear Me Raw, she explored various traumas and mental health issues she experienced as a teen, and says that her underlying mental health was undoubtedly a risk factor.

“For me orthorexia is just another version of OCD or anxiety; it’s a way of controlling all the other uncontrollables in your life,” Isaacs says. “But because we’re constantly surrounded by food and marketing that tells us we need to look a certain way, it’s an easy thing to become obsessed with. If you can make a smoothie and control exactly how much chia and almond milk goes into it, isn’t that a much more manageable than dealing with all those unanswerable questions?”

There is another unique caveat to orthorexia, one that perhaps strengthens its linkage to wellness. With anorexia, there’s a limit to the cultural reward for getting thin (for proof of that, note how quickly tabloid coverage of a Hollywood actress can go from “best she’s ever looked” to “skin and bones”). But since orthorexia is not about getting thin, sufferers can not only appear normal out the outside, but laudable in the current cultural context. They can continue to reap financial rewards from the $3.7 trillion wellness industry—including six-figure book deals, free clothes and food, and the sponsorship and endorsement opportunities that come with increased Instagram reach—without betraying the fact that they’re actually quite unwell on the inside. As the character version of Isaacs knowingly intones in the play: “The world will congratulate you if you get well.”

Indeed, for Turner, whose Instagram following had swelled to 115,000 by the time she publicly turned away from veganism, giving up on wellness to get better also meant giving up on business opportunities.

“Instagram, for me, was the main trigger for my illness. And as soon as I was eating a limited number of things, my following went up massively and I got free stuff, invitations, etc,” she says. “When I started eating more liberally, there was quite a shift in what I started posting, and my following just stopped growing for about a year.”

In general, eating disorders are notoriously misunderstood, and can be devastatingly hard to recover from. While we can’t yet say that wellness is causing orthorexia, Turner believes that the scale of Instagram (700 million-plus users), coupled with the intensity of interest around food there (42% of social media users seek advice about food) has created an urgent need for more research in this area.

For now, Isaacs hopes her play will encourage a deeper conversation about what’s beneath the “candy-colored phrases of empowerment” that wellness culture promotes.

“When I was forced to give up on orthorexia, it did feel like I was giving in,” she says. “Your stupid brain says ‘You’re not being strong enough.’ But I hope people watch the play and say ‘Wow that girl enjoys life to a much higher degree than she ever used to.’”