" Eat in this Order"
Recently Julie Abraham finished her graduation project at the Design Academy Eindhoven. Presenting her results, she advocates for more awareness around our relationship with food nowadays. During her research she asked herself: “When does our strive for health become unhealthy?
”. To answer this question and to prevent the development of eating disorders, she developed a self-reflective test.
In a world where there is a continuous attention on social media, cookbooks, cooking shows and all sorts of conflicting diets, people can develop their own eating rules. It is a complex issue to know what really is healthy. The way to deal with food depends therefore on personal beliefs. We develop our own definition of what is healthy. Food choices based on these beliefs can become rules, and rules can become strict and rigid. In this way eating disorders, such as orthorexia nervosa, can develop.
In 1997 orthorexia nervosa was first defined by the American doctor Steven Bratman. The phrase is used to describe an obsession with healthy food, together with specific beliefs and strict food rules. In science eating healthy is defined as having a sufficient and diversified diet. On internet the definition of eating healthy is doubtful. An enormous quantity of information can be found, which is often contradictory and not scientifically based. For that reason, what patients with orthorexia see as healthy depends on their own beliefs.
Formally orthorexia nervosa is not (yet) acknowledged as an eating disorder, and it is therefore not included in the classification of psychiatric disorders, the DSM-5. This is mainly due to big controversy surrounding the diagnostic criteria. Furthermore, there are no adequate measuring devices and there is not enough understanding of disease mechanisms to formally classify orthorexia nervosa as an eating disorder at the moment.
“I had a friend with anorexia nervosa. At some point, her eating disorder turned into something else which they didn’t have any knowledge about back then. On social media, she posted lots of photographs playing sports and also the amount of kilometers she ran and the healthy food she ate. Knowing her background, for me this didn’t feel right. For that reason, I started to do some research five years ago. Eventually, I discovered the term orthorexia nervosa. This is when I not only realised that my friend probably suffered from this eating disorder, but also that numerous people in my surroundings possibly find themselves on the border of having orthorexia. Nowadays, many people are intensely focused on health, are very concerned about the food they eat and are obsessed with playing sports. Of course, the strive for a healthy lifestyle is a good development, but it also easily leads to an obsession.”
Orthorexia often starts with the innocent aim to improve ones general health. Food is used as a remedy in this strive for health. This initially innocent aim for health can turn in an obsession wherein one is fully convinced of the self-established food rules. This goes further and further, until entire food categories are omitted from ones diet, which can result in severe health consequences. Some examples are shortage of certain nutrients, fatigue, loss of hair, and absence of menstruation in women. Just like with other eating disorders food becomes an obsession. Orthorexia differs from anorexia as the aim of the patient is not to lose weight, but to eat as healthy as possible.
“Succeeding in eating healthy makes people feel proud. Initially, they will feel more healthy and often lose weight, they experience control over what they do and what they eat, and they will receive positive feedback from their surroundings. It feels good. Meanwhile, a person starts eating based on nutritional values, instead of making choices based on tastes. This way the joy which can be attached to food disappears. The relationship with food changes, which has a negative impact on several aspects of the person’s well-being. In particular the quality of social life, body image, physical health and emotional health declines.”
During her study at the Design Academy, Julie became friends with Luca, who suffers from orthorexia. Due to the acquaintance with Luca she was triggered again and decided to make it her graduation project. A lot of her current research is based on him.
After further research on the topic it appeared to Julie that there particularly is a lack of awareness and knowledge. “Many people have an obsession with food, but do not see this as a problem. After all, nowadays everybody is to a certain extent focused on their diet and physical exercise. Furthermore, an unhealthy relationship with food is often seen as an individual problem. Therefore, people are often not aware of having an eating disorder. For these reasons, I developed a test. This test cannot be seen as a diagnostic instrument, but it gives people insight in their individual relationship with food and healthy living. This way it gives them the opportunity to reflect on themselves.”
During the Dutch Design Week 2019, which took place last autumn, Julie presented her graduation project and people were invited to fill in the test. Until now, 300 individuals did the test and the first results are available. In 83,7% of all cases respondents seemed to chose the food they assume to be healthy.
At the same time, Luca administered the test repeatedly. Julie compared his results with the obtained average of results. This way it became clear that Luca’s diet exists mainly of food categories which are generally assumed as being healthy. Remarkably, Luca’s diet seems to contain far less variation than the diet of other respondents and in 96,6% of all cases Luca eats what he thinks he should eat. Due to this way of dealing with food, Luca suffers from several negative consequences. He has a strongly negative body image, his social life is confined and he copes with physical health issues. However, his emotional health seems to be more positive.
The feeling people experience when eating food they don’t think they should eat, appeared mainly determinative in whether someone has a healthy or unhealthy relationship towards food. As Julie says: “Our aim for a healthy lifestyle becomes unhealthy when we experience strong feelings of guilt.” On average people seem to feel guilty now and then when they eat something they consider unhealthy, Luca turned out to feel guilty almost every time he does not meet up his eating rules.
During her presentation the test appeared to be possibly a useful tool for dieticians and other caretakers. It can give an impression of the relationship with food and how the client’s life is affected by it the most. “I hope the test can contribute to early detection and prevention of the development of eating disorders. Having a good relationship with food and being able to reflect on one’s own choices concerning food is what can prevent eating disorders.”
Are you interested? The test is available at www.eatinthisorder.com. More information about Julie Abraham is available at www.abrahamjulie.com. "