Healthy eating can turn into an obsession

SINGAPORE — An avid water-polo player and a fitness pageant finalist, Ms Robin Lim appeared to be the perfect poster girl for glowing good health.

But every time she received compliments for her discipline to eat healthily, her heart sank. “There were so many things I restricted myself from to adhere to my ritual. I ate only plain food — no sauce, oil or salt. I looked healthy but I was really miserable,” she recalled.

For the last two years, Ms Lim, now 20, struggled with what doctors and registered dietitians here describe as an unhealthy desire to eat only pure or “clean” food, which may lead to poor physical, social and emotional health.

Some experts refer to the condition as orthorexia nervosa, a little-researched disorder.

“Orthorexia is present when eating healthy food dominates a person to such an extent that it starts affecting his or her physically, emotionally or socially … there is no formal medical diagnosis at this point,” said Dr Lee Huei Yen, director of Singapore General Hospital’s (SGH) Eating Disorder Programme.

She has seen a handful of cases where her patients are obsessed with healthy eating, such as taking only organic juices or raw vegetables.

Psychiatric consultant Dr Adrian Wang, who founded Dr Adrian Wang Psychiatric & Counselling Care at Gleneagles Medical Centre, said: “There is often a grey area between striving to eat healthily and being unhealthily obsessed with healthy eating.”

For Ms Lim, “healthy eating” at one point meant restricting herself to 30 grams of carbohydrates — just slightly more than one slice of bread — each day, and scrutinising online menus to ensure restaurants serve “healthy” dishes worth her calories before agreeing to attend social outings.

While she did not experience significant weight loss during her “healthy-eating” stint, her social and emotional health took a hit. “Planning my daily meals and workouts began to take over my mind in a way that made me very miserable. I refused dinner gatherings that would disrupt my regime,” Ms Lim said.

Orthorexics may look perfectly normal, and often are not underweight, which can make it difficult to identify them, said Ms Jaclyn Reutens, a clinical and sports dietitian at Aptima Nutrition & Sports Consultants.

“Sometimes, it’s not that they are doing it to get thin, but that they crave control or attention, and take that preoccupation to the extreme,” she added.

While acknowledging that the screening criteria for orthorexia is ambiguous, health experts raised some red flags: Cutting out major food sources such as red meat, gluten, dairy and sugar; spending excessive amounts of time, say three or more hours a day, preparing specific types of food; scrutinising food labels and menus; and being fixated with calorie-counting, such as feeling guilty when they consume five to 10 calories more than their daily quota.

SGH’s Dr Lee said: “People with orthorexia are often resistant to advice because they believe they know what a healthy diet is, and that their diet is healthy.”

Dr Wang said it is important for those with eating disorders to be around a “healthy community”. “By that, I mean family and friends who take a balanced and holistic approach towards food and life.”

Ms Lim found solace in January last year when she co-founded Made Real SG (http://www.madereal.sg), a social initiative which aims to confront youths’ unhealthy preoccupation with body image by creating a community of support for individuals dealing with different forms of disordered eating. Over the last year, Made Real SG has published more than 20 personal accounts from individuals who battled with such problems.

“The more people we spoke to, the more we realised how common the issues we went through were — but they are often shoved under the carpet because they make people feel uncomfortable. As a result, people who are not officially diagnosed (with an eating disorder) often don’t get the support they need,” said co-founder Roslyn Teng, a past patient of anorexia and bulimia.

“Through Made Real, we want to provide a platform for individuals to seek self-improvement and eliminate their image-related insecurities through the pursuit of a healthy and wholesome lifestyle,” the 20-year-old added.