Dr Rachel Evans

Hi Dr Rachel, you’re an expert on the psychology of eating and work with people who suffer from disordered eating. In your experience, what are the main factors that contribute to eating disorders in the UK?

I think it’s nature and nurture (or lack of nurturing). Personality traits such as perfectionism and being highly sensitive or empathetic can put someone at risk of developing an eating disorder, but whether that manifests is influenced by life events and environment. Eating disorders are fundamentally a coping mechanism, which can help people to handle difficult emotions and experiences. A lot of my clients have experienced trauma whether that is a life-threatening situation or an accumulation of smaller stressors, such as bullying, the loss of a loved one and relationship breakdowns. An eating disorder such as anorexia can help someone feel in control of life through controlling food, while binge eating often helps people to feel calmer and have something to look forward to in the day.

We also know that dieting can contribute to the development of an eating disorder, with 25% of those who start a diet developing a diagnosable eating disorder, and I suspect the percentage of people with disordered thoughts or behaviours around food is a lot higher. Pressure to lose weight, whether from friends/family, the media or our own internal quest to feel ‘good enough’ can lead people to physically and psychologically restrict their food intake, which may contribute to further restrictive behaviours and over-exercise and/or binge-eating.

We’ve all heard of anorexia and bulimia, but what is orthorexia?

Orthorexia nervosa is a term derived from ortho which is Greek for “right” or “correct” and orexia meaning appetite or desire. While nervosa means “obsession”. So it is an obsession with eating correctly; typically restricting food intake to those judged to be ‘clean’. Whereas with anorexia or bulimia, there is a focus on weight loss and avoiding weight gain, in theory those with orthorexia characteristically focus on how ‘healthy’ or toned their body looks. However the line becomes blurred because weight or Body Mass Index is often used as an indicator of health (despite evidence that a person can be healthy at a higher body weight if they engage in health enhancing behaviours such as eating fruit and vegetables and getting sufficient sleep).

You may not have heard of orthorexia before because it isn’t an ‘official’ diagnosis in the current Diagnostic and Statistical Manual (DSM-V). You may, however, have experienced the symptoms including an obsession with maximising health by eating the ‘perfect’ diet, which often involves cutting out whole food groups (e.g. carbohydrates or fat) and previously enjoyed foods. This can lead to low energy, mood swings, anxiety and physical health complications, such as weakened immune system and hair loss as a result of eating a restrictive and unbalanced diet. I often see clients who are experiencing symptoms such as bloating, headaches or lethargy after a dietary change, who then think that they need to cut out more foods or eat even ‘healthier’, when actually it would help their body to include more variety!

What can start as making healthier choices can turn into black-and-white thinking about ‘good’ and ‘bad’ foods, with overwhelming guilt and shame when a food rule is broken. These thoughts lead to behaviours such as scrutinising food labels, avoiding food prepared by others (e.g. friends and family or at restaurants) unless the ingredients are known and even avoiding social situations involving food.

In my experience of orthorexia, I totally lost perspective of what was important in my life. I prioritised clean eating, exercise and ‘healthy’ living to the point that it became an unhealthy obsession. I could no longer get a doughnut with my friends unless it was raw and vegan, and even then I’d probably have looked up the nutrition information online beforehand. It made me uncomfortable to see other people eating what I thought was unhealthy foods, I couldn’t resist commenting on what my friends ate and silently (or sometimes not so silently) judging them for it.

Why do you think orthorexia is on the rise?

More people are speaking about orthorexia and research on this topic is growing since the term was first used by Steve Bratman in 1997; where this pattern of behaviour may have gone previously under the radar now it is being identified.

For me, orthorexia began from a perceived pressure to get healthier and look fit, which is a common thread I see between clients as well. I started following lots of health bloggers on social media; their life looked to be just what I desired, although I now know it was heavily filtered. I found so much health information, misinformation and conflicting information, that I became really confused about what to eat, and tried even hard to find the ‘perfect’ diet that I thought would give me my dream body and resolve my metal struggles about my place in the world and make me feel ‘good enough’!

I think that diet culture, which has evolved into wellness culture, has a lot to answer for in the rise of Orthorexia. Each new diet or way of eating (e.g., paleo or intermittent fasting) is promoted as ‘one-size-should-fit-all’, but we know that everyone is unique and what is healthy for one person isn’t necessarily for another. I think that a lot of people are looking for a way to fit.

in, a sense of belonging, and feeling of achievement for being successful at something, following a pure or healthy diet and engaging with that community can provide those things… notably at the expense of previous relationships and hobbies. Then there are also the category of people with a genuine health concern who turn to the internet for help resolving it and learn to cut out, and eventually fear, certain foods.

I predict that cases of Orthorexia will continue to rise as more people #cleaneating and model how to have a disordered relationship with food, while making it look like the solution to life’s problems. Let me hold my hand up and say that after reading so many blogs I started my own award-winning health food blog that shared sugar-free, gluten-free, paleo, vegan (sometimes taste- free, hahaha) recipes. However, as my eating disorder turned from orthorexia to bulimia (making myself sick if I ate something ‘unclean’), I realised that maybe trying to be healthy can become very unhealthy.

What is the biggest misconception about eating disorders?

When people think of eating disorders they typically think of how the media portrays anorexia – a Caucasian female in her early teens, who is very underweight, probably with bones showing for shock value! However, the truth is that eating disorders don’t have a certain ‘look’ and can affect anyone of any age, gender, or ethnicity. It is estimated that 25-30% of those with eating disorders are male and we know that individuals in a larger body who develop anorexia show equally unstable vital signs and eating-disorder thoughts and behaviours as those whose BMI has dropped to the underweight category. All presentations of disordered eating and eating disorders should be taken seriously.

Also, as I mentioned above about my own eating disorder journey, it is common for people to move between diagnostic categories or for their symptoms to not fit neatly into a diagnostic category. For example, to go from restricting to experiencing extreme hunger and binge eating. We need to remember that everyone’s experience of an eating disorder will be different and is valid.

Why do you think it’s important to take a 360-degree holistic approach to recovery from mental illness?

In my work with clients we focus mindset shifts at a conscious and subconscious level, as well as rebalancing physiology, energy work and looking at the systems in which someone lives. I believe that the mind and body are connected and we can’t sustain positive changes in one area without the other. For example, it’s very hard to think your way out of feeling anxious about eating a certain food when your hands are feeling clammy and your heart is racing. I teach my clients to use breathing techniques in the moment to regulate their nervous system so that they can physically relax, take a mental step back from the racing thoughts and begin to reframe them, so eating that food feels easier.

Especially with eating disorder recovery, it is important to understand the impact of starvation, bingeing and purging (e.g. self-induced vomiting), which may keep someone stuck falling into unhelpful patterns despite their best efforts to recover. Once we understand what is happening in terms of biology and psychology then we know where best to intervene.

Can you tell us a bit about your courses?

My work with clients is very multi-dimensional since eating disorders are not just about the food. I recognise that there’s not a one-size-fits-all when it comes to recovery and offer bespoke one-to-one support as an intensive 3- hour breakthrough session, weekend retreat and a longer Nourish Programme with out-of-hours support between sessions. In our time together, we unlock the past causes of the eating disorder, build skills and use new techniques in the present, and gain clarity on the future you free from an eating disorder so that you have something motivating to move towards and leave behind anything that was keeping you stuck .

I choose to work exclusively with 5 clients at any one time, because I believe you deserve my complete focus and attention; I’m so honoured when clients choose to work with me and commit to their recovery because that’s where the magic happens. After mapping out your bespoke Recovery Route Map as part of the Nourish Programme, we rebalance physiology, upskill mentally and physically, and create subconscious transformation, which allows you to build body trust and learn how to maintain recovery long after their programme finishes.

As someone who has recovered from an eating disorder, I understand how important it is to have a safe space and opportunity to be heard. I also know how important it is to not get caught up in the problem and instead use conscious, subconscious and energetic tools to shift limiting beliefs and install new ones that are aligned with the life you deserve to be living.

I love to enthuse my passion and energy into everything that I offer to clients, which means that I usually only announce new courses or workshops a few weeks before they start!

What inspired you to set up the Just Eat Normally Podcast?

I think it’s really important to break the stigma and correct misconceptions about eating disorders. Often the family and friends of someone with an eating disorder think that the person suffering can instantly snap out of it if they want it badly enough. I called my podcast Just Eat Normally, because I wanted to highlight that quite often someone with an eating disorder wants to eat normally but there are psychological and physiological processes that make it incredibly difficult to just go back to normal overnight. I want to explain to people why and how eating disorders are complex mental illnesses and while I believe that recovery is 100% possible, it doesn’t happen overnight. The podcast covers essential information and education about nutrition, exercise, and eating disorder thoughts and behaviours, as-well-as recovery tips and methods.

On the podcast I chat with eating disorder survivors who share their experience of the ups and downs of the disorder and recovery, which I think can be really relatable and inspirational. I’m naturally quite chatty and so the podcast feels inviting and easily understandable; I’d hate anyone to feel like they were being given a lecture or I had regurgitated a textbook! I’ve had quite a few messages from listeners saying ‘thank you for putting into words what I haven’t been able to’ or ‘I wouldn’t wish an eating disorder on anyone, but I feel better hearing I’m not alone in feeling out of control around food’.

What advice would you have for someone who may be suffering from disordered eating?

The number one thing is to recognise that your experience is valid and that you deserve to recover. Often people compare themselves to others and think “I’m not sick enough” or “other people need help more than me”, but if you are struggling and disordered eating is reducing your quality of life then you deserve a happier life.

As someone who has recovered from an eating disorder, I know that it can also feel like there is no one who understands what you’re going through and no hope of changing. Please let me assure you that there are people who understand how you’re feeling and why you’re stuck in certain habits and cycles (myself for one!). I believe that full recovery is possible and it is so much easier to recover with support.

If you have acknowledged that you’re struggling then seek help from your GP or qualified health professional. I would always recommend seeking individual help as soon as possible. Early intervention is key.

What advice would you give to their family of friends?

Firstly, I would suggest researching the signs and symptoms of eating disorders. The BEAT is a great resource.

Secondly, be prepared for your loved one to get defensive! When I was in the depths of my eating disorder, I remember my dad almost crying and saying he was worried I’d end up in hospital, but I didn’t believe him and wanted him to leave me alone (I was 24 at the time!). I think it helps to approach your loved one with compassion and an ‘I-can-see-you’re-struggling’ attitude, rather than go in ‘all guns blazing’ and say how they must change or try harder to recover.

Thirdly, being a good role model around food, exercise and body image can really help. For example, being flexible around food, eating all food groups and not commenting about any disliked body parts or weight gained during the pandemic. Listening to ‘diet talk’ can be very distressing and triggering for someone with an eating disorder and often makes them think they should be dieting or that their body isn’t good enough as well, which can worsen eating disorder symptoms.

Lastly, acknowledge that it’s hard to see your loved one in pain and not being able to fix it for them. Give yourself some compassion and take care of yourself.

As someone who has recovered from orthorexia and bulimia, what are the main lifestyle changes that have helped you heal?

At the height of my eating disorder, I felt comfortable eating a very small range of foods and I wasn’t giving my body the nutrients that it needed, which led to bingeing and then me making myself vomit to try and compensate for what I ate (F.Y.I. this strategy doesn’t work as well as you might think). The biggest change I made was to eat mostly balanced meals, including complex carbohydrates, fruit or vegetable protein, fats such as avocado or olive oil. I find this gives me energy, helps me to feel satisfied and my mood feels more stable. It’s not a new food rule, I can eat whatever I want, but now I listen to my body and see how the food makes me feel physically and mentally.

Another big change has been to exercise for enjoyment, I love going on a walk while listening to a 60-minute podcast episode, and I see a PT once a week for weight training. Before I’d make myself walk for hours on end if I hadn’t reached my step count, now I’ve said goodbye to my Fitbit and tuned into moving in a way that makes me feel good.

I realised that I know what is best for me and my body. I still love health and fitness; trying new protein powders and exercise classes. However, I decide how much I like and benefit from it, rather than just accepting that something must be good for me because someone else said so!



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