Participant demographics
All the recruited bloggers were female, aged 19–32 years. Twelve bloggers were from the USA, with three bloggers identifying as from England, Australia, and India, respectively. Table 1 outlines the named bloggers and the number of blog posts per participant.
Table 1 Demographic information for participants Overview of themes
Three main themes comprising seven subthemes were identified (see Table 2).
Table 2 Themes and subthemes identified in this analysis Initial motivations for a healthier lifestyle
The bloggers described how their desire to do right when it came to health and food, and/or their quest to cure their health difficulties, were strong motivators for making initial dietary changes.
Quest to find what is wrong
Four bloggers described how initial health problems (often digestive issues) led to a quest to find what was wrong with their bodies and discover what needed to be ‘fixed’. This led to eliminating certain food groups.
“I have been on an endless search to heal various physical ailments through food elimination and diets… During this same time, I continued to suffer from gastrointestinal issues … So, in my mind, there was still something wrong. There was still something to fix…. The search consumed me.” (Ashley Bailey)
The initial health benefits experienced by themselves or their families spurred them on with their diets. However, these initial benefits were not always long-lasting, the dietary cuts were sometimes difficult to reverse, and so the quest to “fix” their problem continued.
Desire to do right
The start of ON for many bloggers, was a decision to be healthier, which spiralled into disordered eating. Some described how this initially involved exercising more, calorie counting, or adhering to specific diets such as paleo or plant-based.
“And so my “health transformation” began. I went from Friday night regulars at Hungry Jacks to making absolutely all my own “healthy food”, and I started running and doing as many gym classes as I could squeeze in. … Yep, I’ve got this, I thought.” (Nourish Everyday)
Diet was used to strive for ‘health’ and in some cases for ethical reasons or weight loss. However, ideas around ‘health’ were often individual and idiosyncratic, shifting over time.
“When I gained a bit of weight as a college freshman, I began counting calories and adjusted my diet. I transitioned from vegetarian to vegan…After that, I went gluten-free to further “perfect” my diet. Then I decided I’d eat nothing but raw foods, and I quit carbs and sugar, too. Eventually, the only thing left was raw vegetables…” (Experience Life)
The confusion around what constitutes ‘healthy eating’ caused some bloggers to transition through more extreme elimination diets, in line with their changing beliefs around ‘healthy/unhealthy’ and ‘clean/unclean’ foods.
Fuelling the problem—social influences
Social influences, such as unhelpful health claims and social comparison, were described by many as promoting their disordered eating. Some described how whilst they appeared healthy to others, their underlying difficulties with food were hidden. Their difficulties were further compounded by the confusion around diagnosis and lack of recognition of ON.
Unhelpful health claims
Many bloggers explained how the Internet, social media, and magazines normalised the notion that detoxing, restricting, and eliminating foods was healthy, fuelling their disordered eating.
“Orthorexia runs rampant on “healthy eating” blogs and Instagram accounts, in cleansing or detoxing programs, and with nutrition “experts” claiming you MUST cut X, Y, and Z out of your diet. All of the above have normalised this fixation on idealizing certain types of food.” (Real Talk)
Bloggers often believed and invested in these fear-based messages, researching how to better achieve ‘health’, often searching online or in magazines.
“I bought in heavily to the low carb, low fat mantra that dominated popular media, shrinking my diet to controlled portions… I was scouring every women’s mag going, flipping to the diet and lifestyle section and cycling through all of the 1,200–1,500 cal-per-day meal plans I’d find in there for more ideas.” (Nourish Everyday)
The many contradictory, and sometimes extreme, social messages about what constitutes ‘health’ and ‘unhealth’, thus shaped the diets that many bloggers invested in, in their desire to be healthy, and/or to ‘fix’ their health problems.
Comparing ‘healthiness’
Bloggers compared diets, appearance, and lifestyle with others, for example with friends, magazine images, or on social media. Some stated that upward comparisons about health or weight (i.e., comparison with those perceived as following a ‘healthier’ lifestyle) left them feeling below standard, leading them to instigate more food rules.
“I developed ideas about “okay” and “bad” foods based on people I admired. It wasn’t just one person or account, but a combination. I believed that if I ate what they ate, I would end up looking like them…” (Anon)
Some described how downward comparisons (i.e., with those perceived as less ‘healthy’) about health and calorie consumption led them to make judgements about other’s lifestyle choices, bringing a sense of superiority, that they were doing ‘better’ at being healthy than others.
“I became super judgmental of anyone that wasn’t eating paleo. In fact, I even became judgmental of those who were eating paleo. …. where are your organ meats and fermented foods? Why aren’t you brewing bone broth and drinking kombucha? I was not perfect in everything that I was doing, but boy, was it easy to point out that everyone else was doing it wrong.” (Wine to Weightlifting)
Many bloggers started their own nutrition blogs, shared diet/health pictures on Instagram, or worked professionally advising others on healthy eating. Bloggers stated that things were “not as they appeared”. Whilst receiving praise and admiration for their apparently ‘healthy’ lifestyle, their underlying difficulties often remained hidden unless their weight loss was extreme.
“I think to an outsider I looked really healthy, fit, caring about my diet… but mentally I worried about what I ate constantly”. (Anon)
Three bloggers described the realisation that, they too, began to proliferate unhealthy messages about health and diet that had first influenced them, and thus, the cycle of fear-based food messages continued.
Confusion around diagnosis
Bloggers described the implications of the widespread lack of awareness and official diagnostic criteria for ON. The lack of recognition of ON resulted in confusion around, and delegitimization of their disordered eating.
“For a long time I considered it a mild brush with disordered eating—just a little too “healthy,” with good intentions—not something worth sharing. I thought that since I wasn’t anorexic or bulimic, it wasn’t serious.” (Real Talk)
Five bloggers described experiences of other mental health difficulties such as depression or anxiety. Although several bloggers discussed the overlap between ON and other eating disorders, one blogger explicitly stated that she did not have a history of eating disorders or issues with her body image.
“I never had any eating disorders before, never had any sort of self-body-hate, nor did I ever strive to look like someone in a magazine. I was naturally thin and was not switching up my diet just to look good.” (Wine to Weightlifting).
In contrast, five bloggers discussed their experiences of an overlap between ON and other EDs, particularly anorexia.
“At first, I was “just” anorexic, but as my compulsion grew, I quickly transitioned to orthorexia.” (Experience Life).
While three bloggers described transitioning from AN to ON over time, one blogger described how she felt that her ON was transitioning to AN. Thus, experiences of ON were not always clear-cut.
When healthy eating becomes unhealthy…
Bloggers identified how their disordered eating became problematic, because it fuelled a punishing drive for perfection and control, and led to a confirmatory cycle of fear and avoidance which maintained, and further exacerbated, their disordered eating.
Punishing drive for perfection and control
Some stated that the need to be ‘perfect’ and ‘in control’ drove them to strive obsessively for increasingly unrelenting and unrealistic standards, until their diet and exercise regimes were extreme and debilitating.
“After a few months though—being a Type A, all-or-nothing perfectionist kind of girl—one or two lifestyle “improvements” weren’t enough…. Sweaty, extensive exercise, plus walking, was scheduled in every day, without fail. I needed to do it.” (Nourish everyday)
Rules around food and exercise were used to feel in control, as a coping mechanism to feel safe, particularly when other areas of life felt uncontrollable. Bloggers explained that the target of control could change, and thus, dietary rules might appear arbitrary, but were constant in serving the same purpose, providing a sense of perceived control for the individual.
“I didn’t know that I would replace counting calories with a low-fat obsession, which I later replaced with a variety of food aversions that transferred the sense of control from one thing to another.” (Real Talk)
Some described their later realisation that their adherence to rules had brought a ‘false sense of control’ as their obsession with control in fact ended up controlling them. For many, the unrelenting standards and critical self-talk resulted in a punishing relationship with themselves and their bodies.
“I did not know what my “natural” body looked like anymore, because I had manipulated my body for so long. I had abused her. Talked ugly to her. Worked her past her limits. Starved her. Punished her.” (Autumn Brianne)
Eight bloggers described how they engaged in restriction and deprivation, paradoxically to the detriment of health and wellbeing. Serious physical consequences included extreme weight loss, health complaints, difficulty concentrating, exhaustion, vitamin deficiencies, and amenorrhea.
A confirmatory cycle of fear and avoidance
Bloggers expressed an intense fear about eating certain foods and ingredients, as well as fearing certain food rituals (such as food combining) which were considered toxic or dangerous. Three bloggers stated that heightened fear of certain foods increased their physical symptoms, and caused their body to reject these foods.
“I started restricting myself to certain food items only, not because I wanted to be healthier, but because I genuinely believed that those foods would cause me physical and mental harm. I tried to give up eating cheese, butter and milk, and the more I avoided those foods, the more my body would start to reject them.” (Geekie Chic)
These bloggers believed that their digestive problems were due to physiological responses to anxiety (‘fight or flight’), with increased conviction that certain foods were a threat, exacerbating their physical symptoms.
“Do you know what physically happens to animal (including humans) when they are in ‘fight or flight’ mode?… I can’t even begin to tell you how much this resonates with me…. I’d like to especially point out the one on digestion and immune system shutting down to allow more energy for emergency functions. Wow, did it ever. Chronic diarrhoea and various other immune related symptoms is the main thing that plagued me during this time.” (Ashley Bailey)
This led to vicious cycle-anxieties around eating certain foods resulted in increased physical symptoms, thus confirming the threatening nature of these foods.
“… I have a theory … that when we consistently think negative and fearful thoughts about food, our body begins to see it as a threat. Literally. Our immune system encodes it, our digestive tract rejects it and our brains see it as a source of anxiety. What was once necessary is now the enemy - physically and psychologically.” (Emily Fonnesbeck)
Thus, fear and anxiety around ‘unhealthy’ foods, exacerbated by the societal fear-based messages, were believed by some to lead to food avoidance and increased physical health problems. Thus, health issues were fuelled by the fear itself, rather than the ‘problem’ foods per se.