Australian actress Teresa Palmer revealed that she previously had an eating disorder called orthorexia, and that becoming a mother had “liberated” her. According to the National Eating Disorders Association, orthorexia is “an obsession with proper or ‘healthful’ eating.”
Palmer, known for her roles in the films “Bedtime Stories,” “The Sorcerer’s Apprentice,” “The Ever After,” and “Hacksaw Ridge,” spoke about her struggles on the podcast “Mama Mia: Me After You“: “I was incredibly clean with my eating, so I didn’t have anorexia or bulimia, but I had something different, which is when you become so obsessed with the amount of calories you’re putting into your body; everything had to be of the highest quality. I wouldn’t eat anything stripped of its nutritional value.”
Palmer says her eating disorder started in 2008, when an agent, after seeing a paparazzi picture of her in a bikini, told her that she needed to work out more: “She said, ‘Do you know what? You should start working out, because that’s a part of your job. You need to make sure that you look really good.’ And I was like, ‘Oh, I thought I did look good.'”
But Palmer said that having orthorexia took a toll on her: “It was exhausting, utterly exhausting, to log every calorie and to just be so overly conscious of the food I was putting into my body.”
Now, being the mother of three children, ages 1, 3, and 6, she says pregnancy made her see her body in a different light. “My body just blossomed and I had this big belly and I could feel life within me, and it was just incredible seeing what my body could do.”
“I was finally liberated from these judgments that I had surrounding my body, which I realized had existed since I was … a teenager,” she said. “Since being a mum, I’ve embraced it all. The lumps and the bumps and the stretch marks … it’s a map of my journey of bringing my babies into the world.”
What is Orthorexia?
The term “orthorexia,” or orthorexia nervosa, was coined in 1997 as an eating disorder associated with an obsession with proper or “healthful” eating. Those with the disorder become so fixated on healthy eating that they can damage their own well-being.
Currently, orthorexia is not formally recognized in the DSM-5. It is sometimes put into the “unspecified eating disorder” category. This makes it difficult to get precise numbers of how many people are affected with the disorder, but several studies estimate the prevalence at about 1%.
Moroze et al. suggested the following diagnostic criteria for orthorexia nervosa:
Criterion A: Obsessional preoccupation with eating “healthy foods,” focusing on concerns regarding the quality and composition of meals. A patient should have two or more of the following:
- Consuming a nutritionally unbalanced diet due to preoccupying beliefs about food “purity”
- Preoccupation and worries about eating impure or unhealthy foods and of the effect of food quality and composition on physical or emotional health or both
- Rigid avoidance of foods believed by the patient to be “unhealthy,” which may include foods containing any fat, preservatives, food additives, animal products, or other ingredients considered by the subject to be unhealthy
- Excessive amounts of time (more than 3 hrs/day) spent reading about, acquiring, and preparing specific types of foods based on their perceived quality and composition
- Guilty feelings and worries after transgressions in which “unhealthy” or “impure” foods are consumed
- Intolerance to other’s food beliefs
- Spending excessive amounts of money relative to one’s income on foods because of their perceived quality and composition
Criterion B: The obsessional preoccupation causes impairment by either of the following:
- Impairment of physical health due to nutritional imbalances (i.e. developing malnutrition because of an unbalanced diet)
- Severe distress or impairment of social, academic, or vocational functioning owing to obsessional thoughts and behaviors focusing on the patient’s beliefs about “healthy” eating
Criterion C: The disturbance is not merely an exacerbation of the symptoms of another disorder such as obsessive-compulsive disorder or of schizophrenia or another psychotic disorder.
Criterion D: The behavior is not accounted for by orthodox religious food observance or with concerns with special dietary requirements due to medical diagnoses, such as food allergies or medical conditions with dietary restrictions.
Because of the overlapping symptoms, some have questioned whether orthorexia is a unique disorder or a subset of anorexia nervosa or obsessive-compulsive disorder. However, Koven and Abry pointed out that there are “notable points of departure between orthorexia and these other conditions.”
For example, there are currently no medical treatments designed specifically for orthorexia. Experts recommend a multifaceted approach that includes physicians, psychotherapists, and dietitians. As there is an overlap in symptoms with anorexia nervosa and obsessive-compulsive disorder, serotonin reuptake inhibitors may help with anxiety and obsessive-compulsive traits. However, there are no reported studies on the efficacy of psychotherapies or psychotropic drugs for orthorexia.
Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country, including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.