When “Healthier” Is Not Better: Orthorexia Nervosa

Have you ever heard of orthorexia nervosa?  Most people have not.  In simple terms it is an extreme focus on eating healthy foods to the point that it interferes with daily life.  The old adage says that you can never have too much of a good thing, however this is one area where that statement is simply not true.  Even with healthy behaviors such as exercise, diet, and nutrition there becomes a point where they go too far, where “healthier” is not better.

There is nothing wrong with eating healthyfully- in fact, there is a lot right to it!  As a dietitian I wish more people would make healthful choices.  The problem with orthorexia nervosa is not with the diet itself, but with the attitude toward it.  Orthorexia nervosa is a name coined by Steven Bratman, MD to describe his own experience with food and eating and writes about it in his book, Health Food Junkies (a highly recommended and interesting read).  Orthorexia is a relatively new term and was first introduced in a 1997 article in Yoga Journal.  Orthorexia nervosa literally means “fixation on righteous eating.”  It often starts out as an innocent attempt to eat healthier, to make some small changes in diet, to do something differently, but then it transforms into much more.  An individual with orthorexia becomes fixated in the name of health on food quality and purity (i.e. some specific aspect intrinsic to the food or diet itself such as organic, gluten free, dairy free, raw, clean, etc…) to the point that it interferes with physical health and creates social problems.

With orthorexia individuals are consumed with thinking about food including what to eat, how much to eat, and how to eat the “right” way.  The diet is very strict and the quality of foods consumed is more important to the individual than anything else including relationships, personal values, career plans, social activities, personal interests, and can become physically dangerous.  In addition, individuals with orthorexia often associate their self-esteem with the purity of their diet.  Some individuals may even feel superior to others based solely on their food intake.  It is also common for individuals with orthorexia to proclaim the value of their diet to others and may frequently instruct others on why they should follow the same diet.  Over time, food choices become more restrictive in both variety and calories, and health begins to suffer.  What starts initially as a healthy diet can become unhealthy leading to nutrition problems and deficiencies.   An individual with orthorexia may be socially isolated, because they plan their entire life around food, have little time in life for anything other than thinking about food, refuse to eat foods that do not meet their “healthful” standards, and lose the ability to eat naturally or normally.    This extreme focus on eating healthier often results in overwhelming guilt and shame when a food that is “bad” or “unhealthful” is consumed.  (This good food/bad food thinking and its associated guilt is talked about elsewhere.)

You may think this eating pattern is similar to the eating disorder anorexia nervosa, however one important factor to note is that with orthorexia nervosa the focus is on food quality, healthful foods, or following a strict meal plan in the name of health.  Individuals with orthorexia are not as weight focused and lack the fear of gaining weight compared to an individual anorexia nervosa or bulimia nervosa.  In addition, with orthorexia the obsession is about the quality of food consumed (again in the name of health) not the quantity of food consumed.  An individual with orthorexia might have aversions to foods that are considered impure or toxic compared to an individual with anorexia or bulimia that has aversions to calorically dense foods.  With orthorexia the desire to be thin is not the driving factor (such as in anorexia or bulimia).  Instead, with orthorexia the driving factor is associated with being “healthy” leading to obsessive ideas and thoughts revolving around consuming healthy food.

In a society so focused on rising healthcare costs and obesity it is hard to imagine that being health conscious could be considered unhealthy.   Following a healthy diet does not mean that you are orthorexic, and again, there is nothing wrong with eating healthfully.  Recall from previous posts however that there is a difference between eating healthy food and healthy eating.  With orthorexia the focus is solely on consuming healthy foods and a healthy relationship with food is lacking.  If your diet is consuming an inordinate amount of attention in your life, results in guilt and self-loathing if you deviate from it, or if it is used to avoid life issues then this could signal a problem.  Orthorexia is so new that standardized criteria for diagnosis are not yet available.  (This however does not mean that the problem does not exist.)  Consider the following questions developed by the National Eating Disorder Association (NEDA).  The more ‘yes’ responses you or someone you know has, the more likely you are dealing with orthorexia.

•  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 on living and loving?
•  Does it sound 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 the ways foods are unhealthy for you?
•  Do love, joy, play and creativity take a backseat to having the perfect diet?
•  Do you feel guilt or self-loathing when you stray from your diet?
• Do you feel in control when you eat the correct diet?
• Have you positioned yourself on a nutritional pedestal and wonder how others can possibly eat the food they eat?

Orthorexia Nervosa is technically not classified as a unique eating disorder requiring its own diagnosis such as anorexia nervosa, bulimia nervosa, or binge eating disorder. It is unlikely that it is something that your doctor would diagnose, however recovery can require professional help.  Incidence of orthorexia is increasing, and it can be fatal.  More and more eating disorder inpatient facilities are accepting individuals with orthorexia for treatment and behavior modification.  Even if it is not a “diagnosable condition” per say, it can still be severe and require direct care.  If you or someone you know is working on eating healtfully, remember that healthy eating is multipronged and it is not just about eating healthy foods!

References:

Mellowspring, A.  Orthorexia Nervosa: An Unhealthy Obsession with Healthful Eating.  SCAN’s Pulse. 2008;4:10-13.

Kratina, K..  Orthorexia Nervosa.  Available at: http://www.nationaleatingdisorders.org. Accessed May 10, 2012.

Bratman, S, Knight, D.  Health Food Junkies:  Orthorexia Nervosa: Overcoming the obsession with healthful eating.  New York, NY: Broadway Books; 2000.