On the surface, Florence Gillet, 39, looks like a happy-go-lucky mother of two beautiful kids. Naturally slim and a champion of feminism and body positivity, you’d never guess that she’s lived though more than a decade of disordered eating that stemmed from something as simple as increasing her intake of fruit and vegetables. What she didn’t know back then, as a 25-year-old whose plan was to lose a few pounds to “look better” in her wedding dress, was that this initial and basic level of controlled eating would develop into years of a full-blown eating disorder that would halt her periods, leave her battling with temporary infertility and continue to control her every nutritional decision throughout her thirties. She would not even know that her obsession with healthy eating was in fact a psychological illness that had a name: orthorexia nervosa.
“Although not formally recognized in the Diagnostic and Statistical Manual of Mental Illness, the term ‘orthorexia’ was coined back in 1998 and is an eating disorder where the individual is overly concerned with foods that are perceived as healthy,” explained Reem Shaheen, counseling psychologist and director of the BE Psychology Center for Emotional Wellbeing in DMCC. “The sufferer refuses to eat anything that is not in their heathy food list. It differs from anorexia and bulimia, in that the obsession is about the food rather than the weight. Individuals with orthorexia usually struggle to eat food that isn’t prepared by them and they tend to have extremely rigid eating lists. They might eliminate entire food groups and they feel shame and guilt if they divert from their eating regimen.”
This is something Gillet knows all too well.
“I was only aiming to eat more fruit and veg,” she explained. “Then I started counting calories and took up running. Within a few months, I ended up with a serious energy deficit. I got into the habit of eating as little as 1,200 calories a day and exercising for at least an hour, leaving my body with less than half of the recommended 2,000 calories necessary to just maintain body weight.” Although continuously exhausted, Gillet reveled in the validation provided by her peers.
“I became known as the ‘fit chick,’ the one that always refused treats and showed incredible self-control when glazed donuts made their appearance in the office.”
Gillet has since recovered and retrained, working as an eating psychology coach and founding the body positivity platform Beyond Body Image. Before continuing with her story, she insisted that we warn readers who might be in recovery or still struggling with eating disorders, that this article could be a trigger for them.
“I had no weight to lose to start with, but was reinforced by media narratives around eating less, as well as the validation of people around me,” she explained. “I truly felt empowered by my ability to ‘control’ my body.”
This new control was just what Gillet craved. She was 25, had moved from her family home in Belgium to London to work in PR: a new job in a new country, away from everything and everyone she knew, made her desperate for some sort of order and acceptance. What followed was four years of an escalating obsession with eating only healthy foods.
“I vividly remember lying awake in bed, absolutely starving, yet not allowing myself to eat until it was ‘time’ for my carefully measured, low-sugar, low-fat breakfast before going to work.”
By the time Gillet moved to Dubai in 2008, her body fat had fallen so low that her periods had stopped, and when she decided to try for a baby, she was diagnosed with hypothalamic amenorrhea (HA) – loss of periods due to an energy deficit that forces the body into starvation mode. “At the age of 29, I forced myself into a recovery period,” she said. “I had to let go of dieting completely to gain my fertility back, which I did, and I was blessed with two kids in a short span of time.”
Although Gillet, who is now affiliated with the Middle East Eating Disorders Association (MEEDA), may have forced herself to correct her obsessive eating habits, she had not dealt with the underlying issues around control and low self-esteem. When she developed Hashimoto’s disease (a chronic autoimmune disease affecting thyroid levels) and the skin disease vitiligo shortly after having her two healthy babies, her controlled eating resurfaced.
“As I turned 33, I went gluten-free because I had heard gluten could be detrimental to the management of auto-immune conditions,” said Gillet. “I had also been struggling with chronic acne since my first recovery and kept reading about gluten triggering inflammation and leaky gut. I believed I had to cut foods out of my diet to feel and look better.”
By now Gillet had been living in the UAE for five years and was working in the luxury lifestyle industry.
“This one diet change snowballed, and within a year I was eating strictly paleo, which meant no grains, no soy, no dairy, no processed foods, no refined sugar, no alcohol and no beans.”
Following such a strict diet was no mean feat.
“Day in day out, everything I ate had to be prepared from scratch and I was carrying my perfectly proportioned Tupperware everywhere,” she recalled. “I was eating separately from the rest of my family and I was fearful of simple everyday staples like bread or milk. Every potential outing triggered a host of planning, avoiding, creating a separate menu, or if I did eat the foods that were ‘not allowed’ I felt immense guilt and shame afterwards for ‘ruining’ my past efforts. I therefore mostly chose to avoid eating altogether, rather than eating something that was not compliant with my rules. So a lot of the time, I was starving and even more fixated on food.”
And despite people around Gillet being fully aware that she brought her own food to every outing and often missed meals, nobody was concerned. Instead, they commended her for her “willpower.”
“I was applauded for having a body that didn’t change despite aging and having kids,” she explains. “It kept me going since those comments fed my low self-esteem issues. In the long run, food rules and exercise were my whole identity. I was the ‘health nut.’”
But the “perfect body” and “healthy nut” labels hid a dark obsession.
“My lowest point was to cut out all carbs,” Gillet recalled. “Not only was I ravenous and had zero energy, but it made me even more anxious and irritable, I developed insulin resistance and in turn pre-diabetes. I had more and more acne and needed more thyroid meds rather than less, despite deploying immense efforts not to eat my favorite foods. And when my kids, who were aged four and five, started making comments about my eating habits, it made me realize that I could be setting them up to hate their bodies over time.”
What followed for Gillet was a slow two-year recovery that involved hundreds of therapy sessions, one-on-one body-image coaching, learning how to eat again and accepting that what she had been dealing with was an eating disorder called orthorexia, which can lead to other disorders including anorexia and bulimia.
“I didn’t really know what orthorexia was, I mean I was conscious that most of my friends were not bringing their Tupperware to parties or feeling anxious about food and health all the time,” she explained. “But again, I truly felt like I was only doing what was expected of me or ‘needed’ for my health. That’s what makes recovery extra complicated.”
And it’s this complicated nature that makes orthorexia difficult to spot, said Shaheen.
“This is a disorder that is easily perceived as just making healthy food choices, which is always a good thing, hence the symptoms can be easily concealed, leading to under-diagnosis and to the disorder being more entrenched by the time clients reach out for treatment,” she explained. “I’ve worked with a couple of individuals presenting with the symptoms. However, they don’t usually come in presenting with orthorexia, they come in struggling mainly with an anxiety disorder and as the therapy progresses, the orthorexia is revealed. In all of the cases I have seen so far, it has yet to be the primary complaint. It is understandable since it is perceived as a healthy choice of living, which it can be. The only issue in it is the obsession and rigidity. Those are the determining factors in diagnosing the disorder.”
And it’s a disorder that’s on the increase. Although both global and regional statistics are hard to come by because orthorexia is not officially classified as a medical condition, a study at the Heinrich Heine University Düsseldorf in 2012 suggested that it affected just one percent of the population. But another German study in 2018 put the figure at 7 percent. A study published in 2014 showed that 25 percent of college students questioned at the University of Turin showed symptoms of orthorexia while research in Sweden involving students of exercise science showed the number could be as high as 85 percent. Furthermore, Portuguese research in 2018 showed that 52 percent of gym goers showed signs of orthorexia and a small study in Madrid showed that 86 percent of yoga instructors surveyed presented symptoms of orthorexia.
What is clear that this yet-to-be-recognized disorder is very much manifesting itself globally.
And what about in the UAE?
“Unfortunately, accurate statistics on any psychological disorder are very hard to obtain in the region due the stigma surrounding mental illness,” explained Shaheen. “In the case of orthorexia, it is even harder as it is still not recognized as an eating disorder. But it is as prevalent as in the rest of the world and definitely on the increase. Keep in mind Dubai and Abu Dhabi are extremely cosmopolitan cities, so residents tend to be affected by global trends.
“We’re becoming more conscious in our choices of food intake, which isn’t a bad thing. That said, the increase we are seeing in orthorexia, particularly in the UAE, is due to people being more concerned with their appearance and looks. Further, many of the residents have a high income and they can afford the natural, more expensive healthy food choices.”
So, what can bring on orthorexia?
“There are genetic and neurobiological components, there are personality factors, and there is the environment,” said Shaheen. “In the UAE, there is an over-emphasis on appearance and looks, with many influencers pushing different trends that allow the environmental factor to play its part in triggering the disorder.” Social media definitely increases the “environmental factor” – a statement backed by a British study published in 2017 that concluded that 49 percent of study participants who followed healthy eating accounts on Instagram met the criteria for orthorexia.
“Social media can reinforce the idea that our image is more important than our actual lived existence,” explained Gillet. “The fact that it is highly visual and encourages comparison, tends to lead us to self-objectification. By focusing so much on esthetics, we tend to forget that our substance is not in how we look, and that our bodies are simply the vessels to live our life in in the world, not the ‘be all and end all’ of our existence.”
Gillet, who considers herself fully recovered, still has difficult body image days but is using her experience to help others.
“I still have chronic acne, my digestion can be sensitive, I suffer from chronic hormonal imbalances and I need a lot more food than normal people to reassure my body I won’t starve it anymore,” she said. “But going through disordered eating and recovery also allowed me to grow, to heal many other traumas, to experience gratitude, a sense of community, to develop a passion and now to do a job I cherish.”
She created Beyond Body Image in 2018, following the work she did in recovery, which included hours of reading and research into the “health at every size” movement, social justice, body neutrality and body acceptance. She trained as a coach through the Institute for the Psychology of Eating, based in Colorado, and is a member of the Association for Size Diversity and Health (ASDAH).
“Most of my work is focused on body image and aims to instill body neutrality or self-acceptance in my clients,” she said. “I see clients face-to-face or online, and I also have a partnership with Dr Nicola Rinaldi, who is the global expert on hypothalamic amenorrhea recovery. My view is this: let’s change the culture, instead of changing our bodies because of fear of bullying or discrimination. And as parents, we might not be able to change the school or the media, but we can model body positive values at home and make our home a safe space for our children when it comes to appearance, food, exercise and health.”
Devinder Bains is journalist of 20 years, working as a writer and editor on some of the biggest national magazines, newspapers and online publications in the UK and the Middle East. She specialises in women’s empowerment, fashion, race, culture and travel, and as a qualified personal trainer and nutrition coach, she is an expert in health and fitness. She splits her time between freelance writing and running Fit Squad DXB – Dubai’s largest personal training and wellness company.