“Can naughty be healthy?”: Healthism and its discontents in news coverage of orthorexia nervosa

doi:10.1016/j.socscimed.2020.112784

Social Science & Medicine

Volume 246, February 2020, 112784

https://doi.org/10.1016/j.socscimed.2020.112784 Get rights and content

Highlights

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News stories overwhelmingly framed orthorexia as a medical problem.
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Primary narratives depicted orthorexia as absurd, obnoxious, paradoxical, and dangerous.
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Shifting explanations of orthorexia's causes differentially allocated blame.
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Narratives about orthorexia can be read as a backlash against healthism.

Abstract

Orthorexia nervosa was first proposed as a diagnosis in 1997, referring to a pathological obsession with healthy food. While not formally accepted by the medical establishment, since its inception, it drew the attention of news outlets around the world. This paper examines almost two decades of news coverage about orthorexia to understand how writers have made sense of the proposed diagnosis. Based on an inductive thematic analysis of 492 articles, I find news stories have overwhelmingly framed orthorexia as a medical problem but relied on narratives that mix moral and medical beliefs to explain what is problematic about it, depicting it as absurd, obnoxious, paradoxical, and dangerous. I also examine how shifting explanations of orthorexia's causes differentially allocate responsibility, presenting it as a matter of personal choice when associating it with diets, while presenting orthorexics as victims in technology-focused explanations. I compare orthorexia coverage with discourses about obesity and eating disorders to show how the label simultaneously draws from and contests preceding health discourse. While narratives about orthorexia demonstrate the pervasiveness of medicalization, I suggest they can also be read as a backlash against healthism, relying on metaphors of mental health, illness, and risk to speak to healthism in its own language.

Section snippets

Orthorexia and the medicalization of eating

Orthorexia first entered the public domain in a 1997 article published in the Yoga Journal by Steven Bratman, a physician specializing in alternative medicine. In the text, he claimed he identified a novel eating disorder (ED), which unlike anorexia and bulimia, centered on an obsession with health. According to Bratman, what made orthorexia a “true eating disorder” was the transference of all of life's value onto the act of eating. The enthusiastic response to the article motivated him to

Data and methods

This study examines 18 years of coverage about orthorexia in print and online news outlets around the world. The analysis is based on a corpus of articles collected through LexisNexis Academic NEWS, a full-text database with content from over 350 newspapers worldwide. The search included articles published between January 1998 and December 2016, in English, containing the word “orthorexia” in the text. Since the term was coined at the end of 1997, the database contained no articles before 1998.

Findings

In total, 492 articles met inclusion criteria, with an average word count of 880. Media attention was scant between 1998 and 2000, with only six articles, total. However, a significant spike of 33 publications occurred in 2001, following the publication of Bratman's book. In the next decade (2002–2011), the number of articles per year fluctuated between 5 and 37; during the last five years (2012–2016), the range varied more, with a low of 18 in 2013 and an all-time high of 102 in 2015. The

Discussion

This study examined how news media have constructed narratives about orthorexia. In line with the findings of the Swedish study (Håman et al., 2016), this analysis finds an overwhelming tendency to address orthorexia as a medical problem. By couching the phenomenon in biomedical terms and relying on medical language and terminology, the news stories advanced the redescription (Kroll-Smith, 2003) of orthorexic behaviors as pathological and, thus, within the medical jurisdiction. While the

Author contributions

I am the sole author of this paper.

Acknowledgements

I would like to thank Dr. Pablo Boczkowski at Northwestern University for his ongoing support and thoughtful comments on previous versions of this manuscript. I am also very grateful to the anonymous reviewers who provided helpful feedback during the review process.

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Eating healthily is widely understood as a key way for individuals to achieve and maintain good health, but how people make sense of what healthy eating involves is more complex. In a context characterised by shifts in authority around health and knowledge, and neoliberal and healthist discourses, we ask how the task of ‘eating healthily’ is made sense of in the everyday. We examined constructs around healthy eating in Aotearoa New Zealand, using 118 stories collected using the story completion method. Participants wrote stories in response to a story prompt about a person who was about to start eating healthily. Using a constructionist version of reflexive thematic analysis, we developed four key themes: healthy eating is constantly under threat; to separate fact from fiction; can you afford not to (eat healthily)?; and, healthy eating takes a particular type of person. These four themes told an overarching story of the impossible rightness of healthy eating – healthy eating was simultaneously what one should do, but difficult, if not impossible, to do. This novel method generated a nuanced understanding of some of the representational or sociocultural tensions that may limit engagement with healthy eating.
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Perhaps it is time to consider that identification of orthorexic motivations for restrictive eating need to be considered as a viable part of the syndrome of AN. Although yet to be recognized as a formal psychiatric diagnosis, ON has captured the interest of researchers and news media alike (Ross Arguedas, 2020). Research to date has struggled to demarcate the neuropsychological profile of those at-risk for ON traits from those with eating disorders, in particular AN (McComb & Mills, 2019).
Orthorexia Nervosa (ON) is a term describing a fixation on food purity, involving ritualized eating patterns and a rigid avoidance of “unhealthy foods.” Those self-identified as having ON tend to focus on food composition and feel immense guilt after eating food deemed “unhealthy.” Although not formally recognized as a psychiatric disorder by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), ON has received increasing attention since its identification in 1997. There is ongoing work to establish diagnostic and empirical tools for measuring ON; embedded in this is the question as to whether or not ON is a new eating disorder. In this paper, we argue ON is not a new psychiatric disorder but rather a new cultural manifestation of anorexia nervosa (AN). We begin by providing an overview of historical representations and classification of eating disorders, with a specific focus on AN. This is followed by discussion of the rise in diet culture and healthism since the 19th century. We conclude by examining the diagnostic validity and utility of ON through a discussion of empirical evidence. Classifying ON under the diagnostic umbrella of AN may improve our understanding of factors underlying restrictive eating behaviors.
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Depuis une dizaine d’années, le concept d’orthorexie connaît un intérêt de plus en plus important auprès des professionnels et de la presse généraliste. Paradoxalement, l’orthorexie reste un objet de recherche encore peu travaillé, particulièrement en France. De plus, le concept d’orthorexie est loin de faire consensus. L’objet du présent travail consiste en une exploration des différentes connaissances et positions de recherches connues à ce jour à propos de l’orthorexie. Depuis la création du concept, trois positions se sont développées : la reconnaissance de l’orthorexie comme un nouveau trouble du comportement alimentaire, l’orthorexie comme une forme atypique d’un trouble déjà existant ou la non-reconnaissance de l’orthorexie comme une pathologie. Pour cela nous avons exploré les publications scientifiques internationales, mais également les ouvrages de référence ou encore les interventions de colloques. Il apparaît que malgré les difficultés d’appréhension actuelle de l’orthorexie, cette dernière constitue une réalité clinique indéniable rencontrée par les différents professionnels de terrain.
For the past decade, the concept of orthorexia has steadily increasingly interested healthcare professionals and general press. Remarkably, orthorexia still is a research field seldom explored, especially in France, and has shown to be a controversial topic since its rise in general interest. The present report entails an exploration of the diverse knowledge acquired about orthorexia through research. Ever since the identification of orthorexia, three stances have been observed: the recognition of orthorexia as a new eating disorder, orthorexia as an atypical presentation of a pre-existing eating disorder or the non-recognition of orthorexia as a pathology. With a view to researching the concept, we have studied worldwide scientific publications as well as reference work or interventions during symposiums. It suggests that, today, although there still is a difficulty in understanding orthorexia, it nevertheless is a clinical reality that cannot be ignored when encountered by healthcare professionals.
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View all citing articles on Scopus

View full text

“Can naughty be healthy?”: Healthism and its discontents in news coverage of orthorexia nervosa

Highlights

Abstract

Section snippets

Orthorexia and the medicalization of eating

Data and methods

Findings

Discussion

Author contributions

Acknowledgements

Soc. Sci. Med.

Patient Educ. Couns.

Diagnostic and Statistical Manual of Mental Disorders: DSM-5

Communication or spin? Source-media relations in science journalism

Moralities in food and health research

J. Mark. Manag.

Obesity frames and counter-frames in British and German online newspapers

Health

Down the Rabbit Hole

Taboos and excesses: lay health moralities in middle class families

Sociol. Health Illn.

Lay evaluation of health and healthy lifestyles: evidence from three studies

Br. J. Gen. Pract. : J. R. Coll. Gen. Pract.

The Low-Fat Health-Food Junkies

Clean Eating Can Become a Dirty Prospect

Orthorexia Stalks Perfectionists

All the news that's fat to print: the American “obesity epidemic” and the media

Qual. Sociol.

Obesity in the US media, 1990-2011: broad strokes, broad consequences

Health Food Junkie

Health Food Junkies

Using thematic analysis in psychology

Qual. Res. Psychol.

‘Tidy, Toned and Fit’: Locating Healthism within Elite Athlete Programmes

Diagnosis and medicalization

The Best Food Is like the Best Sex: Anything but Pure the Independent

You Are what You Won't Eat

Let's Enjoy the Sauce of Life, Wisely

Biomedicalization: technoscientific transformations of health, illness, and U.S. Biomedicine

Am. Sociol. Rev.

Up, down, and sideways

Society

Deviance and Medicalization: from Badness to Sickness

Food, Morals and Meaning: the Pleasure and Anxiety of Eating

Healthism and the medicalization of everyday life

Int. J. Health Serv.: Plan., Adm., Eval.

Health as a meaningful social practice

Health

Introduction: Obesity, Eating Disorders and the Media

The New Food Fights: U.S. Public Divides over Food Science

My Name Is Bridget and I Am Not an Orthorexic

The framing of orthorexia nervosa in Swedish daily newspapers: a longitudinal qualitative content analysis

Scand. Sport Stud. Forum

Holier-than-thou eaters, you need some help

Making Mental Health News: Australian journalists' views on news values, sources and reporting challenges

Journal. Stud.

Daily Star

Too Much of the Good Stuff Could Spell 'Orthorexia'

The Real Skinny

‘It's disgusting how much salt you eat!’:Television discourses of obesity, health and morality

Int. J. Cult. Stud.

Meet the Food Faddists

Ten Portions of Veg a Day? They’ll Tell Us to Eat Pie in the Sky Next

Foodies: Democracy and Distinction in the Gourmet Foodscape

Food faddism: yellow is not the only color

The Observer

It's a Trap with No Warning, and So Tough to Get Out

Putting A Name to it: Diagnosis in Contemporary Society