You know how this is going to go. There will be water. There will be the most brilliant colors. There will be crunches and snaps. All contained in one bowl, on one plate, and in one menu selection. The salad. Once the ubiquitous starter to every meal. Now a veritable palate of opportunities to engage with fresh food during every course of the meal. A salad can be plain, as in said starter, composed of vibrant green lettuce, sweating cucumber slices, and a ruby red tomato tossed in here and there. A salad can be complex; an entree bursting with the purple of radishes, the orange of carrots, the yellow of a pepper. There is no limit to the number of ingredients in a salad. A salad with steak is carnivorous. A salad with beans is not. You can eat a salad filled with sweet and luscious fruits for breakfast. You can mix in yogurt or cream to create a dessert. You can even eat a “garbage” salad consisting of all the leftovers in your fridge. A salad is perhaps the most flexible food assembly available on the planet.
And there’s more to a salad than the pleasing colors and fresh taste. A salad arrives holding your health in each and every bite. A salad can deliver a full spectrum of vitamins, minerals, and antioxidants in every serving; Vitamin A, Vitamin B, Vitamin C, calcium, zinc, and selenium, to name a few. The same salad can adapt to satiate your hunger for more of one healthy category than another, as directed by your cravings. A salad can also act as Mother Nature’s messenger, delivering nutrients appropriate to the changing seasons: more Vitamin C in the winter and Vitamin A in the summer. A salads health can morph and change to meet the evolving demands of our bodies each and every day: perhaps more folate for the pregnant women among us. A salad delivers more health in one bite than any other item on the menu.
Welcome to PamSalvadore.com and my health and nutrition blog. This blog was established to try and bring a semblance of sanity and reason back into discussions about food and your health. Today, we’re discussing social media’s influence on orthorexia nervosa. As you will see, this new eating disorder is fast becoming widespread and I believe that social media has a role in that. But don’t take my word for it. I’ve analyzed several studies to draw my conclusions. Links to these studies are available here and you should use them to draw your own conclusions. I am merely here to bring the topic to your attention. So, without further adieu, let’s discuss social media’s influence on orthorexia nervosa.
Fully 90% of US adults use the Internet. Furthermore, 72% of those users visit social media websites and 12% of those social media users consider social media their primary resource for health related information. Those are some pretty startling statistics. If you were to apply that to the US population, that means that of the 234.5 million people using social media, 28.1 million people are using social media to find information about health issues. That’s 28.1 million people turning to Facebook, Twitter, Instagram, and YouTube to learn how to treat their bodies in sickness and in health. That’s crazy when you consider the fact that you or I could go onto one of those social media platforms and tell people what is best or worst for their health. You or I!! I am not a certified medical professional. Are you?
Now, let’s whittle down these numbers and apply them to a demographically targeted disease. Approximately 80-90% of social media users are young adults 18-29 years old. Eating disorders, such as anorexia nervosa, bulemia, and binge eating disorder are the most prevalent among young adults 18-29 years old. Hence, it stands to reason that a good number of young adults are using social media to discuss their disorders and/or find further information about their disorders. Think about that. These are impressionable young adults seeking information about a potentially fatal disorder from a platform populated by users with no requirement for licensure or credentials necessary before posting their advice.
So why is that dangerous? Eating disorders in general rely heavily on the concepts of body image and body dissatisfaction to produce disordered eating. Social media provides a one-stop shop to gain both anecdotal and medically proven information and images representative of both categories. For the average young user, social media has become the new group conversation where young adults compare notes about the latest diets and fads. However, instead of a small group of trusted friends giving their input, social media broadens the base of participants exponentially and anyone can chime in.
Orthorexia nervosa is quite literally the newest eating disorder on the block. People suffering from orthorexia nervosa are obsessed with eating food that’s perceived to be healthy and rejecting food that is not…to the point of malnutrition and severe bodily harm.
That leads me to my question: Is there a link between social media use and the rise of the eating disorder, orthorexia nervosa?
FIRST OF ALL, WHAT IS ORTHOREXIA NERVOSA?
According to Dr. Steven Bratman, orthorexia nervosa is an eating disorder described as the “pathological obsession with healthful eating.” Orthorexia nervosa has also been described as the “maniacal obsession in the pursuit of healthy foods.” Formed of the greek words ortho meaning “straight” or “correct” and orexi meaning appetite, orthorexia literally means correct appetite. The formal definition of orthorexia nervosa is “disordered eating driven by the need to follow an obsessively rigid diet designed to promote good health.” Dr. Bratman was the first to describe orthorexia nervosa to the general public, he coined the term orthorexia nervosa, and he wrote a book about it in 2000. Subsequently, no further mention of orthorexia nervosa was made until an Italian study pursued Bratman’s finding and concurred in 2004. The Italian paper lent credibility to Bratman’s description of the condition and the attention the study garnered brought orthorexia nervosa into the medical lexicon.The Italian study goes on to describe orthorexia nervosa as a situation in which “purity of food is valued above all else, including deleterious health effects.” The study proposes that those who suffer from the disease “feel anguish when not eating healthfully, obsessiveness with planning and preparing healthy meals, and a sense of superiority over others regarding diet.” Orthorexia nervosa can be diagnosed by the establishment of certain criteria:
Does the patient show a preoccupation with eating “healthy foods” focusing on concerns regarding the quality and composition of meals, not the mere quantity?
Is this obsessional preoccupation impairing to the patient’s physical health in the form of malnutrition or causing distress in their social, academic, or vocational lives?
Is this disturbed eating pattern an exacerbation of another disorder, such as obsessive compulsive disorder?
Is this behavior accounted for as a tenant of religious beliefs, a requirement of a professionally diagnosed food allergy, or a diet ordered to mediate a specific medical disease?
There are several more in-depth diagnostic tools to measure the occurrence and/or depth of the disease. However, the following case studies show just how severe the disease can be:
28 year-old woman with severe malnutrition including low protein levels and vitamin B12 deficiency, with a body mass index of 10.7, who was not interested in being thin or looking a certain way. She justified her behavior by explaining that certain proteins and nutrients combined in the same meal had a toxic effect in the body and were to be avoided at all costs. This woman ate nothing more than raw vegetables.
30 year-old man who is bedridden after restricting his diet to 3-4 spoons of brown rice and vegetables per day. He did not report a desire to be thin or change the way he looks. He simply believed that the restricted diet would cure him from a facial tic. This man spent 38 days in the hospital to treat metabolic acidosis, subcutaneous emphysema, a collapsed lung, and pancytopenia.
A 33 year-old woman who maintained a diet of only fresh fruits, raw vegetables, and uncooked eggs for eight years primarily because she was concerned that cooking the food would rob it of its nutritional qualities. While she did not express any desire to be thin or alter her looks, she was so obsessed with eating only raw food that she cut ties with her friends and family. At a BMI of 14.5 she required medical intervention. Her bout of orthorexia nervosa eventually gave way to a psychotic break, although her doctors did not feel that the two were related.
A 28 year-old man who presented with a BMI of 12.3 due to the consumption of homemade protein shakes and nothing else. The patient believed that his homemade shakes were superior to store-bought brands in that they did not contain fillers and additives. The patient referred to his body as a temple and designed his diet to give it only the “pure building blocks” that it required to be healthy. Once again, the patient did not express any interest in his body weight or the way he looked.
These are extreme cases, but orthorexia nervosa is an extreme disease. I wish the researchers had a chance to ask these patients where they found the information that led them to such severe restrictions.
It should be noted that, currently, orthorexia nervosa is not classified as it’s own eating disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It falls under the catch all category of Avoidant/Restrictive Food Intake Disorder or ARFID. Bratman and his cohorts believe that orthorexia nervosa should be classified as it’s own disorder because ARFID also includes patients with disorders caused by negative associations between food and adverse events, such as choking, that have nothing to do with the symptoms of orthorexia nervosa. Orthorexia nervosa is much more prevalent in foreign countries such as Spain 86%, Brazil 81.9%, and Austria 69.1%. Perhaps the US just hasn’t caught up and shown enough prevalence to warrant it’s own diagnostic criteria and status in the DSM-5. Regardless, much more research is necessary.
NOW, LET’S LOOK AT SOCIAL MEDIA:
According to a recent Pew Research survey,the typical social media user is 18-29 years old, makes good money, is not married, and lives in their own home. The average social media user spends their time among the most popular social media sites as follows:
Furthermore, social media users are young. According to the same Pew Research survey, social media is most popular among Adults 18-29, however it is also gaining popularity with older demographics.
These same users are frequent. 74% of Facebook users and 60% of Instagram users visit their respective sites at least once daily.
In a recent study of health related users on Twitter, 53% of the 700 Twitter posts analyzed contained a testable claim (supported by medical evidence) and 61% made testable statements. That means that of health related posts curated from Twitter, 61% made testable statements that may or may not contain verifiable facts and/or peer reviewed scientific studies that back that claim. Furthermore, the study found that 56% of users with no formal profile posted health-related content, whereas 61% of health providers (such as doctors and nurses) primarily shared testable claims and news with verifiable links to click on. That’s a broad spectrum of information being presented by a very diverse group of people.
So social media is real. It’s here to stay, and it is perceived as a safe space in which to discover information and provide feedback regarding that information, with no requirement regarding the quality or veracity of said information.
CURRENT DIET TRENDS ON SOCIAL MEDIA
Here’s a quick snapshot of the number of posts specific to a particular highly restrictive diet trend on Instagram, as of April 5, 2018:
The Whole 30 – 3,517,417 posts
ketogenic diet – 1,277,555 posts
nom nom paleo – 12,199, 398 posts
gluten free – 19,931,783 posts
Remember, these are all posts by users that are not verified and/or credentialed in their assertions. Is it possible that some of these posts informed orthorexic behavior?
ARE SOCIAL MEDIA USE AND EATING DISORDERS, SUCH AS ORTHOREXIA NERVOSA, CONNECTED?
According to a recent study of 1765 young adults aged 19-34 years old, those who fell within the highest quartiles for social media usage, both in volume and frequency, had significantly greater odds of having an eating disorder. Furthermore, the study suggests that certain social media platforms may be more attractive to the younger generation. Sites such as Instagram, Pinterest, and Snapchat pride themselves on visual content such as picture and infographics. These pictures may expose users to influential visual material, such as those images used to establish body image and self perception, major factors in eating disorders. The social media sites are cognizant of these problems. Instagram even went so far as to ban certain hashtags, such as #thinspiration and #thinspo in an effort to combat images that jeopardize body image and self perception. The study concluded that “a strong and consistent association between social media and eating concerns was found in a nationally representative sample of young adults.”
In another recent online survey of 680 social media users that follow health accounts, study authors, Turner and Lefevre, found a significant relationship between the symptoms of orthorexia nervosa and Instagram use. Additionally, the study revealed a somewhat protective effect against orthorexia nervosa generated by posts on Twitter. After careful consideration of the questions and the manner in which they were presented, the authors concluded that three factors were the most likely contributors to these results:
The authors found that the image focused nature of Instagram lent itself well to the browsing activities of food-focused users. It is the authors belief that the ability to see images is particularly motivating, whereas the text focused, character limited nature of Twitter is thought not to compliment food-focused browsing in the same way.
The authors found that the fact that social media allows the user to control what feeds they see, creating a form of tunnel vision in which the user only sees the information they want to and excludes contrary points of view.
The authors also noted the prevalence of “eminence-based practices” on social media, wherein users with large followings are perceived to be authorities, regardless of their credentials or the validity of their recommendations.
This is the first study I’ve seen that definitively claims that social media (Instagram specifically) has an effect on the rising occurrence of orthorexia nervosa symptoms. Of course, further studies need to be conducted, however this is groundbreaking work when you consider that orthorexia nervosa has not yet been validated as an eating disorder via inclusion in the Diagnostic and Statistical Manual of Mental Disorders.
ANSWERING THE QUESTION
Orthorexia nervosa is one of the newest eating disorders to be discovered. It’s prevalence has only increased while, at the same time, social media use has grown exponentially among younger adults. Given these burgeoning studies, I find it fair to say that social media absolutely impacts the instance of all eating disorders and we will likely find that it has a major influence on orthorexia nervosa alone, as we take the time to conduct more research on the growth and prevalence of that new eating disorder. What do you think? Check out the following images. Do they communicate information that could provoke orthorexia nervosa? If someone were to blindly follow the advice being offered, would their nutritional status become compromised?
THE ANTI-ORTHOREXIA MOVEMENT ON SOCIAL MEDIA
Social media’s influence is not only felt in the development of orthorexia nervosa, but in the battle to discredit it as well. A few Instagram users have created accounts that claim that orthorexia nervosa is merely the politically correct way to accept obesity. Here’s what the con side has to say:
Obviously, social media has enough of an influence on orthorexia nervosa that contrarians are using Instagram to tout their anti-orthorexia messages.
WHAT CAN WE DO ABOUT IT?
First of all, we should all identify social media posts for what they are: conversation. When recommendations are made in the course of that conversation, always look for credibility. Ask yourself: Is this information credible? Does this statement point to solid scientific research that backs it up? Don’t fall for the old “according to scientific research” disclaimer. Always insist on seeing a link to the exact research supporting that claim and reading it yourself.
Be skeptical of all the social media posts that call for you to take some action without telling you why. Would you jump off the Brooklyn bridge just because someone told you to? No! You would want to know why that person wanted you to jump and what was to be gained by your jumping. Advice on social media is no different.
Reject bogus claims. Unfollow users who post inaccurate information. Refuse to join groups that have their foundations in “light” information. Always insist on seeing the science. No science = No joining.
Did you know that you don’t need any formal training to call yourself a nutritionist? You can go to a weekend lecture then hang out your shingle and start selling nutrition advice. The only people trained and certified to dispense nutrition advice and eating plans are Registered Dietitians and Registered Dietitian Nutritionists. Make sure that you are dealing with a well trained practitioner before you accept what they say as fact. Even with credentials, always expect to see the science. No science = No credibility.
Be wary of advice coming from celebrity doctors. They are not your physician. They don’t know whether your body is healthy or sick. They have no idea if you are overweight, underweight, or nutritionally compromised. These are all important pieces of information that any healthcare professional needs in order to recommend any kind of eating plan. Assess the authors motivation by asking yourself why they are offering this information. Is it because they truly care about the health of the human race? Is it because they want each and every person out there to be living their best lives? Or is it because they’re selling a book and they want you to go out and buy it? Chances are there’s a less than altruistic motivation behind that inspiring post. Be skeptical. It may be the best way to stay safe.
Most importantly, do what’s right for you! Make informed decisions from credible information and share your choices with your doctor or medical specialist. Always consider how the information can both help or harm you, were you to put it into practice. Pay special attention to the young people in your life. Are your kids easily swayed by information found on social media? Are you seeing drastic changes in their behavior? You have to remember that social media has become your child’s new “group of friends.” Where parents once met their children’s friends to make sure they were good kids, they now have no way to vet the broader group of people their kids hang out with online. Have open and honest conversations with your children. Teach them to think critically about the information they read on social media. Show them how to be as skeptical and wise as you are.
Exercising rational thought and critical thinking will not only help you maintain your general health, but it will contribute to an overall improvement of our social media environment as well. The less we, as social media users, patronize less-than-credible sources and the more we reject bogus claims the better the standard for information on these sites will be. It takes a mass movement to elevate the status of what we see, but together we can make that happen.
I have worn many hats over the past twenty odd years. First, as a single woman with a successful career in radio. Then, as a married mom to a now-grown man. And currently, as a part-time college student, full-time wife, and primary caregiver to aging parents. Throughout the many incarnations of my life I have found one constant that I not only enjoy, but I am told I am reasonably good at…writing. So here is a collection of the pieces I have written to date. I intend to add more as time goes on and vow to include some of my ideas and thoughts that delve into the way the human body really works, unfiltered by publishers who don’t have the space for the depth that I plan to provide. While I encourage feedback on my style and structure, please keep in mind that the stories, opinions, and facts I present are exactly that…mine. If you don’t like the topics or points of view, please cease reading and go on about your day. If you are interested in an evolving body of work, spanning many topics, and providing a glimpse into a near middle-aged woman’s sometimes frantic mind, then I hope you enjoy reading these pieces as much as I enjoyed writing them.