Orthorexia: My Obsession With Eating Healthy Almost Killed Me
The desire to be healthy is great. But for some people, that desire becomes a disease.
Prostock-studio / Shutterstock Obsessing over nutrition, shunning entire food groups — these are just two symptoms of orthorexia, a behavioral disorder that's on the rise among young women. Rachel Levine, 30, reveals to Erin Bried how her fixation on healthy eating almost killed her.
Eight years ago, I nearly died. In fact, at the time, no doctor understood how I hadn't.
My body was so emaciated that my heart rate had slowed to 36 beats a minute, about half of what was considered normal. I was in constant pain, all bones, barely even able to sit. I never wanted to be that thin, so nothing about my body was attractive to me. I'd always wanted to be She-Ra. Or Beyoncé—who, to me, has the ideal body. I'd look in the mirror and ask myself, How did I get here?
This was not supposed to be my story.
I've always been a perfectionist. When I went to the University of Vermont as a premed, my goal was not just to graduate with honors and become a doctor but eventually to cure some major disease. I worked hard. When I wasn't putting in time at the library or in class, I was dealing with all the ordinary stresses every student faces. I drank too much and ate whatever—pizza, wings. Food wasn't good or bad; it was just food.
During my junior year, I studied abroad in Australia, where the sunny beach culture inspired me to get outside. I started running 3 to 5 miles a few times a week. It cleared my mind, and I loved the endorphin high. As I lost a little weight from my 5-foot-11 frame, I also attracted more attention. I remember a guy at a bar said, "I’m in love with your body. You’re so strong and lean." I was, like, Yay, strength!
A new obsession: Orthorexia
After about six months, however, something in me changed. My running had become less of a joy and more of an obligation. I ran through it all—torrential downpours, injury, exhaustion—with no exceptions or excuses because it was less painful to endure the hard workouts than the hell I’d give myself if I skipped them. If I slacked off, my inner dialogue turned hateful: You’re lazy. You’ve failed yourself.
Exercising made me feel like I had control over my life. Putting in 5 miles before anyone was even awake made me feel secretly superior.
That’s when the food changes started, too. I had to make sure every bite I put into my mouth was super healthy: low-fat yogurt and cereal for breakfast (carbs were OK as long as they weren't white), a smoothie for lunch, and brown rice with veggies for dinner. I had an ironclad policy: always the same meals, same time, same chair, same utensils. This rigidity annoyed my friends. "Why can’t you just eat with us?" they’d ask, to which I’d respond, "I like eating this way."
It was a lie. But when you're obsessed, you'll say whatever you can to end a conversation.
When I moved back to Vermont for my senior year, people knew I’d changed. I was 20 pounds lighter and I was no longer my happy, social self. I stopped hanging out with friends because I never wanted to be challenged by my new lifestyle. And I stopped going to parties for fear that if I stayed up late, I’d be too tired to work out the next morning.
I was lean, strong, in control—and also totally alone. For comfort, I relied heavily on my obsessions, which masked my anxieties like a Band-Aid I knew how to apply just right.
A Near-Death Experience
At the end of the year, I graduated from college with a 4.0 GPA (and 0.0 quality of life). I joined AmeriCorps and moved to Santa Rosa, California, to teach at-risk youths—a perfect prelude to my career in pediatrics, I thought.
Really, though, I was just happy to get far away from everyone I knew. I felt horrible about lying to my friends and family all the time. I'd promised them that my weight loss was just from the stress of graduating, though I knew that wasn't true. I was terrified of myself and the way I looked. I remember worrying, When is this going to stop? Never. It never will!
Alone and with zero accountability, I became my sickest. I'd get up every day at 5 a.m. to put in two hours at the gym. Nothing could keep me away. Once, I was so feverish with the flu, I felt like I might pass out on the treadmill. But rather than quit, I staggered over to the recumbent bike and started pedaling. I thought, At least I’ll be seated if I faint.
After the gym, I'd come home to eat half a nonfat yogurt before going to work, then sip organic chicken stock for lunch. Now I avoided anything that wasn't 100 percent natural, which included pesticides and processed food. I never drank anything other than water or coffee, and certainly not alcohol, which I considered toxic. I still ate alone, but when I couldn't avoid joining friends at a restaurant, I'd look up the menu in advance to find something safe.
Weekends were always the hardest, with no fixed schedule. I'd stay busy to avoid anything I didn't want to do, like going out for drinks.
Instead, I'd drive to the local Safeway, where I'd wander the aisles for hours, just browsing. It was like window-shopping on Rodeo Drive—the food was all so beautiful, but I couldn't "afford" any of it. I'd stare at bags of Chex Mix or boxes of Lucky Charms and recall all the good childhood memories I had of eating that food. Just being around it reconnected me with all I'd lost, and I'd fantasize about a happy, carefree life I no longer had.
By winter, my parents, frightened by my weight loss, insisted I start therapy. It didn't help. My BMI eventually fell to 12.5, a full six points below the official "underweight" classification. My hair was falling out, and my body was covered in lanugo, fuzz to help me conserve heat. At night, I'd routinely have heart arrhythmias and run to the kitchen to crisis-eat an apple with peanut butter to get me through until morning.
A desperate intervention
My increasingly worried friends eventually contacted my mom, a nurse. We'd always been close, and she was flying out from Vermont to visit me every four weeks. For her, it was probably like watching someone you love slowly jump off a bridge. I remember waking up in the middle of one night to find her fingers pressed against my neck, taking my pulse. When I asked her what she was doing, she told me she was worried I was going to die if I didn't stop eating this way.
One day in May, while I was standing in front of my class of 5-year-olds, my heart suddenly started racing. Panicked, I called 911, and a friend drove me to the hospital. They ran labs, but other than being emaciated and having electrolytes out of balance, I seemed fine.
Not long after I was discharged, my mom flew out again and asked me to walk with her near a creek by my house. She pulled out her cell phone and said, "Rachel, I have our lawyer's number on this phone. You've become a danger to yourself. So, you can either go to a treatment center, where you'll get help and be respected, or I'll put an involuntary hold on you right now, and you'll go to a psych ward and get a feeding tube. Which would you prefer?"
You always hear that when you hit rock bottom, you're going to want to change, but I didn't. Instead, I felt angry. But I also had a moment of clarity: My masquerade was over. That thought seized me with fear so debilitating that for a split second, I thought about just running. But when I saw the look in my mom's eyes and how deeply my disease was affecting her, I stayed.
Filled with deeper sadness than I'd ever known for the loss of my meticulously curated lifestyle, I chose the treatment center.
A plan for recovery
Two days later, I checked in to the Center for Hope of the Sierras, in Reno, Nevada. There are no locks on the doors, but leaving without permission will trigger a police alert. I learned I was suffering from severe orthorexia, which is an obsession with healthy or "correct" eating. At first, you might be able to live with your healthy addictions and even appear to be strong and vibrant. But in reality, you're constantly battling your own thoughts, and your behavior becomes overly restrictive.
Though orthorexia is not yet classified in the Diagnostic and Statistical Manual of Mental Disorders, some experts think it's related to obsessive-compulsive disorder, because you become fixated on controlling every little aspect of your eating. Others think it should be classified as a new eating disorder, alongside anorexia. Ultimately, I was diagnosed with both.
Here's how I picture the disorders: Orthorexia is my left hand, and anorexia is my right. Once one clasps the other, everything gets intertwined and it becomes difficult to know which behavior stems from which disorder.
At the center, going from a highly structured world, where I made every decision, to one where I could make none, I was gripped with terror. I had to eat everything on my plate and attend therapy. I wasn't allowed to work out. I wasn't even allowed to stand up, except when I was walking to the dining room or bathroom. Just to keep my heart beating, I needed to eat three times as many calories as the average person.
But although I was crazy, I didn’t want to act crazy—to completely freak out about a piece of pizza. So I forced down whatever they served. It was only when I called my parents that I let that mask slip. "These people are awful. You need to get me out of here!" I’d scream. Calmly, my mom would respond, "If you leave, you're not welcome home. You need that care to stay alive."
But it wasn't really the food I hated so much. It was what it represented. Although my need for control was literally killing me, it was also what had made me so successful. It was what earned me a 4.0 and drove me to work 60-hour weeks as a teacher. It made me perfect.
And now I was imperfect. That thought petrified me to the point of tears every day. I cried not only for the life I faced but for everything I'd lost. I was 23, sitting in a treatment center in Nevada, while my friends were out there living their lives.
RELATED: 7 People Who Lost 100+ Pounds Share Their Best Weight Loss Secrets
Four months after I'd checked in, my parents came to visit. I was still extremely underweight, but to celebrate their arrival, I got a pass to join them for lunch in town, where my counselors advised me on what to eat: a club sandwich (with cheese and ranch dressing) and fries. After I'd ordered, the waitress turned to my dad. "I’ll have a salad," he said, "no dressing, grilled chicken on the side." Upon hearing his healthier-than-mine order, I burst into tears and ran outside.
When I was growing up, food and exercise had always been a major deal in my house.
Both of my parents were always physically active. My mom would often follow fad diets—with little success. And my dad, perhaps because he's a doctor, viewed everything he put into his mouth in terms of its health impact, as in "Eating too much of this could one day give you a heart attack."
He was always concerned with his diet. So when my dad ordered, something in me clicked. Countless hours of family therapy would eventually reveal that I wasn't the only one in my family who had orthorexia. He ultimately got help, too, and our shared struggle has brought us closer.
Of course, having a parent with an eating disorder doesn't automatically put you in danger.
But researchers believe that genes do play a role—and may account for up to 60 percent of your chances of developing a disorder. Most people with low genetic risk might feel fat and skip dinner, but the next morning they'll be hungry and eat breakfast again. Though some experts may disagree, I think that when you have a genetic predisposition, it's not so easy. Your biology kicks in, and your brain just tells you to keep going.
Relearning to eat was a struggle since I hadn't fed myself appropriately in more than three years. I didn't even know what "appropriate" meant. I started by eating pre-selected meals, then progressed to practicing how to handle certain situations: "You're at a restaurant with a friend who eats only half her order. What do you do?" my advisor would ask.
After a few months, we started going out to restaurants.
If I didn't eat enough, my advisor would get on my case. If I complained about being served white rice, not brown, she'd say, "I don’t care—you should've eaten it all." At first, I ate to avoid confrontation. Eventually, I stopped eating for her sake and started eating for my own.
By December, I'd regained enough weight that I was allowed to go home for a few days.
It was the first time in seven months I'd been more than 5 miles from my doctors, and it felt amazing. I went out for Mexican—margaritas, and enchiladas—with friends, like any normal 23-year-old. I got this beautiful taste of life that I thought I'd lost forever, and that night, I told myself, I'll be damned if I don't get better. On my return flight to Reno, I listened to "Survivor" by Destiny’s Child on repeat. It became my recovery anthem.
An appetite for life
On April 5, after 11 grueling months, I graduated from the program, and the staff sent me off with a huge party. (There was chocolate cake and, yes, I ate some.)
I'd be lying if I said the first year out was easy. At first, I'd go through the motions of healthy eating, but my disordered thoughts lingered. Even now, seven years later, there are days when I'll have a doughnut in the teacher's lounge and find myself thinking about it at night. In my old mind, that playback reel would've kept spinning. But now I can have the thought and move on.
I don't plan out my eating anymore, but I do have one nonnegotiable—I eat three meals.
I can have pizza for lunch and not feel bad about it. I can cook dinner for friends—with butter because it tastes good. I have not stepped on a scale—other than facing backward at the doctor's office—since I left the center.
I exercise about four times a week, depending on my schedule and energy. I don't run much, because, it turns out, I don't love to run at all. Instead, I usually hike or do yoga with friends. If I'd rather sleep in, I do. And I no longer hide my feelings behind a treadmill or a 60-calorie yogurt. I actually feel them more.
I've learned that when I feed, care for, and listen to myself, my body just knows what to do.
Erin Bried is a senior staff writer at SELF magazine, founder of Kazoo Magazine, and author of How to Sew a Button.