As the prevalence of disordered eating rises, particularly among people managing chronic diseases, it’s essential to understand the fine line between healthy eating and unhealthy restriction. Here’s why eating with balance, not obsession, is key to long-term health.
Managing chronic diseases often involves making significant dietary changes, but when the pursuit of health becomes an obsession, it can lead to unhealthy behaviours. Orthorexia, a term used to describe an extreme preoccupation with eating healthy foods, is on the rise, particularly among those managing conditions like irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD).
But when does a healthy diet become an unhealthy obsession? And how can we tell when symptom management leads to disordered eating?
Understanding orthorexia
Orthorexia is an intense, sometimes damaging, focus on pure or clean eating. This obsession may begin with a desire to avoid foods that trigger symptoms of chronic diseases like IBS or IBD. However, the constant fear of eating certain foods can turn into extreme restriction, often leading to nutritional deficiencies and other health issues.
“When a person avoids foods to manage their symptoms, they may initially experience relief. But the more they restrict, the more likely they are to develop a distorted relationship with food, which could lead to a clinical eating disorder,” says Nessmah Sultan, dietician and PhD Candidate, Monash University, Australia.
ARFID vs. orthorexia
Orthorexia focuses on the obsession with clean eating, whereas avoidant restrictive food intake disorder (ARFID) is marked by a fear of eating specific foods, often because of sensory issues or the perceived negative effects of food on health. ARFID, unlike orthorexia, is linked to short-term fears such as choking, whereas orthorexia often involves long-term concerns about chronic disease. “While orthorexia has yet to be fully recognised as a formal eating disorder, ARFID is now in the DSM-5. The blurred lines between these two disorders reflect how complex eating behaviours can be when managing chronic conditions,” adds Sultan.
Risk of disordered eating in symptom management:
Many people living with gastrointestinal diseases like IBS find that avoiding certain foods helps control symptoms. “However, this avoidance can go too far. According to research, up to 43 percent of young people with IBS refrain from eating when they’re hungry to prevent symptom flare-ups” says Sultan.
In some cases, these restrictions can lead to disordered eating behaviours. “Disordered eating often begins as a way to manage symptoms, but over time, it can become a cycle that worsens health. The key is moderation and guidance from a dietitian,” Sultan advises.
Orthorexia and ARFID
Studies have shown that between 13-23 percent of people with gastrointestinal diseases exhibit disordered eating behaviours. “Though this can be seen as a way to manage disease symptoms, the line between healthy symptom management and unhealthy restriction can blur, particularly when those who self-manage without professional support,” shares Sultan, adding, “Research has consistently shown that people who self-manage their diets are at a higher risk of developing disordered eating behaviours. It’s crucial to involve a dietitian early on in the treatment process.”
Risks of extreme dieting:
Over time, extreme dietary restrictions can result in serious health problems, including nutritional deficiencies that contribute to conditions such as anemia, osteoporosis, and malnutrition. In fact, people with ARFID are at a 60 percent risk of malnutrition, which can further complicate their disease management. “When you restrict your diet too much, you’re not just preventing disease flare-ups; you’re also increasing your risk of developing new health issues,” Sultan warns.
