Orthorexia and Other Manifestations of Body Shame

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An emerging obsession with “clean eating” may be fueled by a less than healthy fitness culture.

In the first months of 2022, I tried functional training, electric muscular stimulation, interval training, and a few other exercise regimes in the hope of regaining my pre-pandemic-quarantine shape. 

My first personal trainers gave me dumbbells, barbells, and kettlebells. They had me perform battle rope pulls, hang from a TRX suspension trainer, and walk like an accordion with resistance bands tying my legs like a knot, as they were “eager” for me to have variety in my workouts. The electric muscular stimulation novelty only lasted for about three months. My regimen was an expensive, high-intensity interval training program, with a combination of short, high intensity bursts of cardio exercise paired with equal or longer periods of rest or lower-intensity workouts.

Then came my encounter with the most bullish personal trainer I ever met—a self-proclaimed master-of-other-people’s-bodies. Leave it to me! he shouts when I won’t trust my shoulder to bear too much of a load. It has dislocated quite a few times, courtesy of an athletics career at university I swiftly escaped from. My trainer seemed to see my phobia as a matter of misbehavior. Maybe it was. I don’t blame him. He did what he had always known. 

The World Health Organization defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” There is a compulsion toward only embracing the physical element to gym culture that may derail those pursuing this kind of holistic health though, and that single-minded pursuit of the physical may promote insecurities and feed unhealthy obsessions in the process. 

“Thou shalt obey your coach” or “thou shalt win at all costs” or “thou shalt burn all fat.” These are the unholy commandments of competitive sports. And while sports careers often end in the blink of an eye, those who embrace these motivational mantras in their formative years usually carry them to their next post-actively-competing stage of life—which naturally, for many, means becoming a gym rat. I often wonder whether the ultra-bravado, macho-mercenary vibe many gyms give off is one of the reasons why 90 percent of people who are non-athletes quit three months after joining a gym. 

Of course there is always the other end of the spectrum: people who don’t quit. People who, for good or bad, are obsessed with working out and who stay obsessed.

A trillion-dollar industry

In the United States alone, three in every 100 people suffer from obsessive exercise “neurosis” coupled with symptoms of eating disorders. Those numbers skyrocket among gym-goers and athletes. Meanwhile, the fitness and wellness industry has an estimated global value of $3.7 trillion, an expected average annual growth of 9.9 percent, and is expected to be raking in nearly $7 trillion by 2025. What gives?

Prior to the boom of the fitness industry in the 1960s, gyms were grim, sweaty warehouses, full of rusty iron plates and racks and grunting men. It was between the 1960s and 1980s that fitness became all about weight loss and physical appearance, and gyms became clean, well-appointed facilities filled with beautiful people and glistening equipment.

“[Working out] was sold as a way to attract a partner, to be happier, and something that only the wealthy could subscribe to,” says Alexandra Weissner, owner and head coach of Brunch Running, a social running community. But things soon democratized. First came the 1970s running boom, when running stopped being the exclusive activity of athletes and boxers and bubbled out to the masses. In the 1980s, the Jazzercise and aerobics craze (greatly popularized by celebrities like actress Jane Fonda through her workout videos) was completely in sync with the glitzy new wave excesses of the decade. The 1990s loved ellipticals, spinning machines, and Zumba. The 2000s looked eastward, as yoga and Pilates studios popped up like mushrooms on a wet stump, and since 2010 the fitness world has welcomed functional training, circuit training, climbing walls, kettlebells, CrossFit, Spartan courses, and the ascent of the personal trainer. 

Despite the stunning variety, the fundamentals of fitness remain the same since the days of the ancient Greek Olympics, where they were enshrined in various lifting, running, throwing, swimming, and fighting sports. Through the centuries while the cultures that engaged in these sports changed, and while new methods of fitness evolved, the pedigree of ancient Greek wisdom remained the same: Increase your heart rate to a sufficient level for a sufficient length of time and stress the muscular system with resistance of various types. In other words, whether an ancient Athenian or a modern athlete, all you basically need is a bunch of cardio and strength-training exercises.

And that’s where trainers say they are needed. 

“Suppose you go to the pediatrician with your child and get advice about how to feed them. You will get recommendations and a prescription and leave. It’s the same with fitness,” says Claudio Gil Araújo, director of research and education at the Brazilian Exercise Medicine Clinic in Rio de Janeiro. If, for example, you want to take up running, you can consult a fitness instructor about how to monitor your heart rate, position your feet while you run, or select the best shoes to use. And then go out on your own, says Araújo. “You don’t need to be with me every day,” he says.

The long game of the short workout

The five elements of fitness are body composition, flexibility, muscular strength, muscular endurance, and cardiorespiratory endurance. Gyms and fitness centers are indispensable allies to each fitness journeyer aspiring to tick all five boxes, says Ashley Dannelly, a certified personal trainer and owner of a site that compares health insurance. She is quick to agree with Araújo that frequent interactions with trainers should only happen on a short-term basis, though. 

Dannelly believes the fitness industry preys on people’s doubts and insecurities to keep them glued to their memberships. “During the free one-on-one sessions they offer to new or prospective members, most gyms highlight areas that people are told they need to work on,” she says. In most cases these are areas of excessive fat. “Once a gym or fitness facility convinces a person they are unhealthy and have a lot to do to ‘get better,’ they then suggest a way to help, which typically manifests in either group fitness classes or personal training sessions, both of which require more money,” Dannelly says.

Half of fitness influencers take some form of performance-enhancing drug.

Consider the experience of 30-year-old Florida-based Tim Connon. When he was 20, some old high school friends and gym buddies offered him steroids, telling him “There are plenty of people in the gym taking them and selling them.” He declined because he was aware of the health risks involved and because he did not want an unnatural physique. “Being 180 lbs of muscle with 5 percent body fat is not sustainable or healthy, and it is a telltale sign of performance enhancer abuse,” Connon says. He openly accuses fitness influencers of perpetuating a false body image that can only be achieved through steroids—all while claiming to their followers on Instagram or YouTube that it was plain hard work and supposedly innocent supplements like protein that gave them their musculature. Connon might be right: People in the industry report that half of fitness influencers take some form of performance-enhancing drug, whether it’s steroids, human growth hormone, or even insulin to burn fat. Generally speaking, the culture of fitspiration (or fitspo), a growing social media phenomenon motivating people to “evolve” toward the “perfect” body through rigorous exercise and diet, has a lot to account for, according to some experts. Perhaps it’s one of the reasons why gym facilities make the perfect breeding grounds for orthorexia.

“The most common occurrence is typically understood as disordered eating, and it’s a way that people tend to punish their bodies based on the perceptions of others,” Dannelly says. So maybe an individual eats a diet consisting mainly of fruits, vegetables, and lean protein during the week, but they binge on the weekend and then feel acute pangs of guilt, which send them straight back to the gym to get back on track, Dannelly continues. Over the last 10 years, the number of people suffering from what is known as orthorexia nervosa has been alarmingly on the rise. The condition is amany centuries-younger sister of anorexia and bulimia (which actually date back to Hellenistic times). The term orthorexia was only coined in 1997 to describe the excessive preoccupation with clean eating. Perhaps as many as seven in every 100 people in the United States are living with orthorexia right now and they don’t even know it. 

The extent to which the fitness industry contributes to a growing problem of orthorexia in the United States by playing upon our self-obsessions is unclear. Experts like yoga teacher, author, and body liberation guide Laura Burns are quite vocal. In an interview she gave to Self, she said it is incredibly troublesome that teachers force students toward unrealistic goals that don’t take into account their injuries, age, or weight. In the same article, professor of kinesiology at the University of Wisconsin–Milwaukee Christy Greenleaf openly discussed weight stigma, and how it is served by the fitness industry as something that exists for “people’s own good.” 

People who suffer eating disorders are often advised to join a gym so they can ramp up their physical activity or bulk up. A great irony takes place right at that moment. In their search for recovery, people transition over to the orthorexic way of living, internalizing the idea that “it’s all about strict control” and calorie counting and acquiring steely discipline. But it is exactly this need for fierce control and deep-seated anxiety that triggers eating disorders in the first place. And, because orthorexia is not yet officially classified as a medical condition in the Diagnostic and Statistical Manual of Mental Disorders, it can go easily unnoticed—it may be even going downright mainstream nowadays.

A couple of studies have reported that between 1–7 percent of the general population suffer from orthorexia, and the number is rising. Justified to a great extent by the global epidemic of obesity, which has tripled since 1975, a panicked society is taking an all-or-nothing approach: Eat clean or get fat. That said, genetics, gender, environment, stress and trauma—the predictors of every other eating disorder—can also favor the development of orthorexia. There is no clinical treatment tailored to orthorexia, but according to the National Eating Disorders Association, mental health professionals usually adopt anorexia or obsessive-compulsive disorder therapeutic protocols to treat it. People with orthorexia are advised to also work with a registered dietitian to redefine “healthy,” do away with the magical food mentality that some foods can save our lives and others destroy it, and increase exposure to all types of foods. No, your life will not go to tatters if you eat cake on Friday, and you don’t have to do two hours’ cardio to burn the “bad” fat you put in your body if you “sinned.”

DIY fitness

Not everybody agrees that the fitness industry is the modern Lucifer. 

On the contrary, Ivory Howard, a yoga and pilates instructor and public health professional believes gyms foster a sense of community. “You’re more likely to succeed when you surround yourself with like-minded people who are also working toward similar health goals,” Howard says.  “As humans, we are wired to crave community and belonging,” she continues. Neuroscience supports that: Mirror neurons in our brains fire when we’re interacting with other people. Also, this sense of community is a part of the theory of self-determination, continues Howard. The self-determination theory in psychology is a framework that explains human motivation, and it says that all people have three core psychological needs: autonomy, competence, and relatedness that determine their motivation to grow and develop. 

“Lots of research has supported the importance of the sense of community in public health programs,” Howard adds. And for Caroline Grainger, a kinesiologist and certified personal trainer at FitnessTrainer, the fitness industry bestows upon us the precious gift of time. “If you wanted to build a society from the ground up with a major focus on making sure everyone in it stays healthy, society would look very different; we would have more time to work out, more opportunities to walk to our destinations, and be more active,” Grainger says. Time is in short supply for most of us, and things are even worse for categories like parents who work full-time. “There simply aren’t enough hours in the day to get a good workout done without some help, and this is where gyms and personal trainers come in handy,” says Grainger.

But where there is lack of time, consistency might help. One of the simplest ways to pursue fitness outside of a gym setting is to set a four-day-a-week schedule for at-home workouts, advises Dannelly. The onset of COVID-19 triggered the global launch of over 71,000 health and fitness apps, which have continued to enhance the lives of people pursuing fitness in the comfort of their home. In 2021, fitness apps like Fitbit, MyFitnessPal, Strava, and Peloton were downloaded over 400 million times. But even if you don’t have the wherewithal to comb through the thousands of tracking apps, fitness streaming platforms, audio-only workouts, personal training apps and the like that make up today’s fitness app ecosystem, you can start simple, according to Dannelly.

It’s a little more complicated for individuals who have medical conditions like myocardial ischemia (lack of blood flow getting to the heart muscle) though. They should seek out a supervised exercise program, advises Araújo. And therein lies another paradox of the modern fitness ecosystem. “Go to a 2,000-square-feet mega-gym in New York. Who do you find on the treadmill and in the weights room?” asks Araújo. “Those that run well and those that lift heavy,” he answers. People try to reinforce what they have in spades. That said, you’ll certainly not see many members perfecting things like their balance and flexibility.

An inability to stand on one leg for 10 seconds in later life is linked to nearly double the risk of death from any cause within the next decade.

 “Things like balance, you can do at home. Balance is hard to sell,” says Araújo. Yet research he published in the British Journal of Sports Medicine in June 2022 found that an inability to stand on one leg for 10 seconds in later life is linked to nearly double the risk of death from any cause within the next decade. Balance is important. Try it at home: Stand on each leg for 10 seconds while you brush your teeth—you did your balance training for the day, says Araújo.

Perhaps we need a reset of the fitness industry—one that incorporates the physical changes we see in our bodies as an added bonus and not the final destination. If we change the definition of fitness, we could move it away from its current dimensions as a grueling, gym-only, guilt-ridden activity driven by the fear of becoming a less-than-a-perfect-body-pariah if we don’t. Instead, fitness could come to be defined by its positive aspects: We do it everywhere whenever we get the opportunity, and love it because we embrace the holistic definition of health. 

Redefining fitness that way could fill our lives with a newfound psychological euphoria and save people (who can afford it) from the plagues of orthorexia and obsessive exercising, says Weissner. “Fitness should be about having fun and finding joy. It can be as simple as a daily 30-minute walk,” she says. It would be a noble pursuit, but one can only hope, given the corrosive influence of #fitspo culture, particularly on young minds. Or you could endure working with a fitness instructor for a limited amount of time, absorb as much as you can, and then fly out on your own, like I did.

Whatever you do, don’t forget to stand on each leg for 10 seconds each morning while you brush your teeth.

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