Americans are obsessed with weight and health. See how far you can get through the day without hearing a comment about what someone ate, what she did for exercise and whether she thinks she’s too fat or too skinny (or what she thinks about her coworker’s weight).
And don’t forget commercials, TV shows, articles and books about weight loss, healthy eating and fitness.
With this in mind, it’s not surprising that some people might take health to the extreme. This is the case for people who suffer from “orthorexia,” an unofficial eating disorder involving a preoccupation with eating healthy food.
Although the exact definition of orthorexia will vary, experts have advice on how to be healthy without becoming preoccupied and obsessed to the point of becoming unhealthy.
Carol Cottrill, a certified nutritional consultant, said that even though orthorexia is not considered an official eating disorder, it is a form of disordered eating that could eventually lead to an actual eating disorder like anorexia or bulimia.
“Orthorexia is an obsession with eating only healthy foods,” Cottrill said. “Though it is motivated by a desire to feel healthy, natural, and pure — not to be confused with anorexia, which is fueled by a desire to lose weight — it is nonetheless a disorder that has taken over the lives of many afflicted individuals.”
She said that in her professional experience, she sees more and more clients who show signs of orthorexia.
“Most begin by cutting out food groups like meat, and suspect they are ‘intolerant’ to other food groups, like wheat and dairy, so those foods are eliminated too,” Cottrill said. “I notice a rise [in] my impressionable younger clients who see celebrities following raw diets and cleansing diets. In my practice, I estimate orthorexia to affect one in 10 women and one in 20 men. I believe that the trigger for orthorexia is obsessive compulsive behavior.”
For people who are already prone to addictive or obsessive behavior and eating disorders, there are still ways to avoid becoming obsessive about health and eating healthy while still keeping their health.
“Since obsessive compulsive behavior is the root cause for orthorexia, I find it helpful to encourage my clients focus on the many pleasurable and positive aspects of life rather than food,” Cottrill said. “Many of my OCD clients feel the need to ‘count’ something, whether it be fat grams, points or calories. I coach them to count their blessings when this urge strikes. Certainly this does not mean that healthy eating goes out the window, but balance, moderation and pleasure take the place of deprivation, extremism and limitation.”
She said orthorexia can start out with the wish for a healthy diet, but soon spirals out of control.
“In most cases, pre-packaged foods are the first to be eliminated from the diet,” Cottrill said. “From there, meats are often next to go, followed by dairy, non-organics, and so on. One might even reach a point where only raw foods are acceptable, but even then, the obsession might not be squelched. As more and more foods that are perceived as unhealthy are eliminated, at some point, balance is lost and mania sets in. Before you know it, what constitutes good health becomes clouded, as obsession and stress over consuming only morally acceptable foods takes over.”
For people who are already suffering from orthorexia, she said it’s a matter of reshaping the way they think about themselves and food.
“Once orthorexia is identified, the path to recovery often centers around the recognition that diet alone does not make a better person, and that basing self-esteem on the quality of one’s diet is irrational,” Cottrill said. “Some may be able to come to this conclusion on their own, while others who struggle more deeply with the disorder may require professional help to overcome it.”
“At the end of the day, while food and nourishment are important, they are but one aspect of our lives,” she added. “The path towards obtaining a truly healthy relationship with food and overall wellness is in the shift from the identity of a person who eats healthy food to a broader definition of character, to that of one who loves, who works, who plays, and who is mentally free - living life and enjoying food in balance, moderation, pleasure and peace.”
Jill Nussinow, a registered dietitian and cookbook author of “The New Fast Food: The Veggie Queen Pressure Cooks Whole Food Meals in Less than 30 Minutes,” said in an email that there is a fine line between what would be considered orthorexia and healthy eating.
“I guess that orthorexia could be considered disordered eating around only consuming foods for health rather than for other reasons, which include taste, pleasure [and] social aspects,” Nussinow said. “I do not think that it should be considered an eating disorder, as many more people need to strive to eat in a more healthful way. The issue is whether or not you are obsessive about it.”
She thinks there is no problem with wanting to eat healthy all the time, and in fact wonders why that is not considered normal instead of a disorder.
“Eating a healthy diet does not have to be strict or obsessive … generally choosing healthy foods is not an eating disorder but potentially a life-saving measure,” Nussinow said. “As I said, more people could stand to do this. We are losing far more people to overweight, obesity and the diseases associated with that eating than with people choosing to eat healthfully – disordered eating or not. I think that many people want to turn things into a disease, disorder [and] syndrome, but this might be pushing things too far. The choices are not the issue – the behavior around it is.”
She gave her own suggestions for how to avoid becoming truly obsessive with eating healthy.
“[People can avoid becoming obsessive but still be healthy by] keeping healthy foods around, socializing with other people, not always asking what’s in their food but still being conscious, letting loose once in a while and throwing caution to the wind and eating something that might be a little less healthy,” Nussinow said. “It’s the mindset that makes this a problem, not necessarily the choices. People who see only black and white have trouble with gray.”
She said that she can see more women than men possibly having an issue with orthorexia.
“I think that many more women are concerned about their weight and health, and eating healthy food might be one of the easiest ways to influence weight and health,” Nussinow said.
Here are some warning signs for people who might be heading toward orthorexia instead of just living a healthy lifestyle:
“These people will not socialize without bringing their own food or having to choose where they eat,” Nussinow said. “Or will skip meals with other people if they are eating something or somewhere that they feel is unacceptable. It’s being too rigid that might be the issue. Only eating a handful of foods and shunning anything with sugar, salt or fat or things like that.”
Jessica Setnick, an eating disorders expert, registered dietitian, author of “The American Dietetic Association Pocket Guide to Eating Disorders” and the national director of education and training for Ranch 2300 Collegiate Eating Disorders Treatment Program, said in an email that orthorexia is comparable to anorexia nervosa, and it can end up in malnutrition in some cases instead of actually being healthy because of the severe restriction of foods that are “safe” to eat.
“I in fact think it should just be called anorexia nervosa – it is the exact same thing with the only difference being that the individual endorses wanting to be healthy rather than wanting to lose weight,” Setnick said. “I think that calorie restricters who do that same thing in the name of postponing death have anorexia too.”
Fortunately there are solutions and professional help for people who are taking their healthy eating to the extreme.
“Manage your anxiety. Identify what you are really stressed about, separate it from those free-floating anxious thoughts, and don’t blame it all on food,” Setnick said. “We live in a scary world. Completely eliminating _____ (insert latest contaminant) will not fix it. By all means, avoid contaminants. But there is a point where you simply must eat. Everything cannot come in a hermetically sealed package.”
“Orthorexia and anorexia both are not about food, weight, or health,” she added. “They are about trying to manage a thought problem with a behavior solution, similar to Obsessive-Compulsive Disorder. So if you eliminate some food and feel good about it, great. But if you eliminate one food and either compulsively crave it or immediately move on to the next food to eliminate, identify that something is not right about this process and get an appointment with an eating disorder dietitian.”
Judith Matz, a licensed clinical social worker and co-author of “The Diet Survivor’s Handbook: 60 Lessons in Eating, Acceptance and Self-Care,” said in an email that there is a certain way of eating that can help people avoid obsessive eating behaviors. It involves really listening to your body.
“Rather than focus on ‘healthy’ foods, the goal for everyone should be to have a healthy relationship with food,” Matz said. “This means that you eat when you are physically hungry, eat what you are hungry for - choosing from a wide variety of foods - and stop when you feel satisfied. This style of eating is known as attuned or intuitive eating. People find that when they listen to their bodies, they want all types of foods, including healthful foods.”
“When you have orthorexia nervosa, your eating is rigid, giving you a sense of being in control,” she added. “At the other end of the continuum are people with Binge Eating Disorder, whose eating is out of control. The healthy, balanced way to eat is attuned eating, which allows for flexibility, the inclusion of nourishing foods, and pleasure from eating. Attuned eating lets people feel in charge of their eating, rather than needing to control their food and constrict their lives.”
How do you keep balanced while eating healthy foods? Have you ever struggled with orthorexia? Share your stories in the comments section.
Sources:
Cottrill, Carol. Email interview. March 13, 2012.
Nussinow, Jill. Email interview. March 13, 2012.
Setnick, Jessica. Email interview. March 13, 2012.
Matz, Judith. Email interview. March 13, 2012.
Reviewed March 14, 2012
by Michele Blacksberg RN
Edited by Jody Smith