Orthorexia: When Healthy Eating Becomes an Obsession
How to recognize the problem and get help
You’d think the current trend of eating healthful, organic and antibiotic-free foods would be welcome news. But even healthy eating can go too far. Some people who strive to eat only "clean" foods can develop a condition known as orthorexia nervosa.
The term is derived from the Greek “ortho,” meaning correct or righteous, and “orexia,” meaning appetite. It was coined by California alternative medicine practitioner Steven Bratman, MD, MPH. He used it to describe patients in his practice who became fixated on eating “proper” food.
“As orthorexia progresses, a day filled with sprouts, umeboshi plums and amaranth biscuits comes to feel as holy as one spent serving the poor and homeless,” Bratman wrote in an essay. “An orthorexic will be plunged into gloom by eating a hot dog, even if his team has just won the World Series.”
For someone with orthorexia, Bratman added, such a fall from grace would have to be met with acts of penitence, usually involving stricter fasts and diets. He concluded that transferring all the value in life into the act of eating is what makes orthorexia “a true disorder.”
The quest for purity
Unlike anorexia or bulimia — disorders that focus on calories, weight loss and body image — orthorexia is all about food quality and purity. Health seekers may turn to vegan, raw or macrobiotic diets (all healthful when pursued in moderation) according to the National Eating Disorders Association (NEDA). When these diets become extreme, good nutrition suffers.
What can push a healthy eater over the edge? Sondra Kronberg, RD, CDN, founder and executive director of the Eating Disorder Treatment Collaborative in New York, says the tipping point may include both hereditary and environmental influences.
“Some people are genetically predisposed to be rigid, obsessive-compulsive or anxious,” said Kronberg. “An eating disorder may cover up an underlying issue such as sexual abuse, struggling with sexual identity, parental divorce or death of a loved one.”
Related: Considering a Juice Cleanse?
Signs and symptoms
Because a person who develops orthorexia is perceived as eating healthfully, the condition can go unnoticed for a long time. But there are signs, including dry hair and skin, broken nails and insomnia, according to Marjorie Nolan Cohn, RD, a national spokesperson for the Academy of Nutrition and Dietetics. People with orthorexia also may be dehydrated and anemic and suffer from electrolyte imbalances, malnutrition, osteoporosis and organ damage. Some grow very fine, excess body hair on the arms, legs or face, a biochemical reaction to counteract the low body temperature that can be characteristic of people with eating disorders.
Friends and family members may notice their loved one no longer seems to be herself. Ultimately, someone with
orthorexia can lose the ability to participate in or enjoy life. “You may
notice they skip out on family meals or even become afraid of food unless
they know how and who prepared the meal,” says Nolan Cohn.
Kronberg adds, “We see a lot of people who can’t even go to a restaurant. They can’t go out for pizza with friends. There will be signs of isolation. Friends might notice they never go out anymore.”
If you’re worried you might have orthorexia, ask yourself these questions. The more questions you answer “yes” to, the more likely you are to have orthorexia, according to NEDA.
- Do you wish that occasionally you could just eat and not worry about food quality?
- Do you ever wish you could spend less time on food and more time living and loving?
- Does it seem beyond your ability to eat a meal prepared with love by someone else — one single meal — and not try to control what is served?
- Are you constantly looking for ways foods are unhealthy for you?
- Do love, joy, play and creativity take a back seat to following the perfect diet?
- Do you feel guilt or self-loathing when you stray from your diet?
- Do you feel in control when you stick to the “correct” diet?
- Have you put yourself on a nutritional pedestal and wonder how others can possibly eat the foods they eat?
What to do
Orthorexia has yet to be listed in the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, the official guidebook to clinical diagnosis. But it's headed in that direction, say both Kronberg and Nolan Cohn, and it's a hot topic among mental health and nutrition experts.
Someone obsessed with food purity should seek treatment, experts advise. Talk therapy and nutritional counseling are effective strategies, according to Kronberg. She suggests a full psychological assessment, along with a dietary program to make up for nutritional deficiencies. After treatment, you may want to consider stress relieving practices such as meditation or yoga. “Once a patient recovers, there are continuing challenges in trying to manage stress in an effort to prevent a relapse,” says Nolan Cohn. But it’s worth it, she says, to get back your life.