When does focusing on a healthy diet become an unhealthy way of life?
Every nutritionist will tell you that avoiding sugar, fatty carbs, deep fried or processed foods, instead prioritising leafy greens and vegetables, is very good for you but when does an enthusiastic interest in 'clean eating' become a problem?
First described in 1997, orthorexia - the obsession with eating foods that one considers healthy - is on the rise among those in the wellness and fitspo circles. And men in particular.
A hidden epidemic
New research from the University of the Sunshine Coast this month found that those chiselled, perfected physiques of men in TV ads are potentially triggering feelings of body dissatisfaction amongst impressionable males.
"One in fifty people have body dysmorphia but it's definitely on the rise amongst men," says clinical psychologist Romy Kunitz.
"The gender gap is closing as men feel increased pressure to maintain an attractive appearance."
What's more, some may not be aware there's a problem
"We're not always aware of our cognitions and behaviours. Body dysmorphic disorder is an imagined 'ugliness' – barely noticeable to others. Men can think that what they experience is normal and what every other male also contends with," Kunitz explains.
David James, 36, is a self-confessed clean eater. Although he has turned down nights out in Brisbane so he can focus on his food prep, the benefits for him have been manifold.
"Since I completely changed the way I eat in October last year, I became more alert, I became a better cook, my mental wellbeing improved - and I lost 17 kilos in six months."
A code of conduct
He does have a "very strict" diet where all his meals must be a certain percentage of protein to carb (tonight for dinner he had lean mince with broccoli.) But he has "cracked the code" of what works for him.
There are drawbacks. The first thing James noticed was the impact to his professional life
"I say no to office snacks. If there's a client event, I turn down food or prepare something beforehand. Or I'll calculate how many calories I'll need to lose in week in order to have a drink."
Going out has become "difficult" when he can't track what he's consuming and he "gets a lot of pressure" from friends.
"Eating out is a big challenge. One wrong meal can set you back quickly. I've learnt to assert myself, just step back, or say no politely. It can unfortunately make you unpopular with people who don't see eye to eye."
But is it a disorder?
According to Juliette Thompson, Psychologist and Manager at the Butterfly Foundation, the jury's still out on whether orthorexia is an official eating disorder.
"Orthorexia isn't recognised in the Diagnostic and Statistical Manual of Mental Disorders," says Thompson.
"It's an emerging area of research with debate over whether it's a distinct eating disorder, or a subset of a known eating disorder."
But it's the insidious way it can begin to control your life that is most worrisome.
"It can have a devastating impact on health and socialisation" says Stephen Touyz, professor of clinical psychology at Inside Out, the Institute of Eating Disorders at the University of Sydney.
"Look at what that does to your social life, if you're having a relationship, or making excuses not to go on that crucial business trip."
He points out that 'clean' eating isn't necessarily healthy eating. For example, cutting out meat and dairy means you could develop osteoporosis or anemia.
A common thread
While patients that come to Kunitz's practice often display far more quixotic food fixations than David's healthy diet, they all share a similar trait.
"In my practice I've seen lots of men with orthorexia – not only with food but also with drinking water – they'll only drink filtered water with specific minerals and are absolutely against anything else," she says.
"They'll eat only "whole" and organic food. A lot of these men are gym junkies, invariably unhappy with their outward appearances. They're perfectionists: they worry about how others see them."
If you or anyone you know is experiencing an eating disorder we encourage you to reach out for support. You can call the Butterfly Foundation National Helpline on 1800 33 4673.