Orthorexia Nervosa - the too healthy eating disorder

Orthorexia nervosa, literally means a "fixation on righteous-or healthy-or pure eating." It's when over healthy eating is taken to obsessional extremes. It's people who soak up every bit of nutritional advice they read or hear about. Food is medicine and their pursuit is to eat more purely, more cleanly, or more healthily. Juicing, raw food, colon cleansing, no gluten, no dairy etc... etc... the list goes on and on...

It's when your healthy eating has gone way over what's healthy. Although don't you dare suggest that to orthorexics... you're likely to be met with strong resistance. But no matter what - when something impedes your lifestyle and becomes obsessional then it's not longer healthy.

Are you cutting out progressively more food groups?

Is eating Organic only a total obsession?

What do you know about orthorexia-nervosa?

It's easy to confuse with anorexia. Sufferers often present with the same physical symptoms. You can read the story of the two young women who I mis-diagnosed with anorexia when they had orthorexia nervosa here. They both presented with:

their menstrual cycle had stopped,
both dressed warmly even in summer,
both had developed, fine black body hair,
both obsessed about food and had rigidly controlling and restrictive diets.

Both denied the seriousness of their thinness insisting they were healthy.

Who suffers with Orthorexia Nervosa?

Both these young women (aged 19 and 21) were: academic top achievers with perfectionistic tendencies whose middle-to-upper class families were close-knit and somewhat (over) protective.

Their healthy eating patterns had emerged as they approached leaving their hometowns to attend university - often a key precipitating event in eating disorders. Both had ambivalent feelings about leaving 'the nest'.

They had strong needs for social approval and wanting to please others - especially authority figures (typical 'good girls'). And both presented as being emotionally composed and in control although guarded.

Men also get orthorexia.

These characteristics pretty much match what I'd come to expect in many young women with anorexia. But there was one more major warning signal that I never picked up on...

Both came from homes, not where appearance was emphasized but where there was an enormous emphasis on health and healthy eating.

My fear is you may be reading this thinking... "Are YOU nuts - emphasis on healthy living is GOOD!" I agree so - remember orthorexia is something good taken to obsessional extremes!

I remember an article I wrote for Shape Magazine on Orthorexia had no sooner been published when I had a shouting, screaming owner of a freshly squeezed juice bar telling me how dangerous my article was. I think that just like I didn't 'hear' these two young women, she did not 'hear' me either.

Health food junkies = Orthorexia Nervosa

Once I'd read 'Health Food Junkies', I could readily spot the non-typical symptoms of anorexia: Both declared they did not fear gaining weight. One told me over and over: "I'm more conscious of how my body feels than how it looks". The other in exasperation told me: "Stop obsessing about weight, I'm not trying to lose weight."

With the wisdom of hindsight, I could easily see that their session notes showed they took inordinate pride in their ability to avoid junk food and to be more health conscious than Ms. Average. Yes, similar to Anorexics they obsessed about food, but here was the difference. It wasn't so much the calories food contained as it was the amounts of unhealthy ingredients like sugar, or fats or preservatives, or msg that they were pre-occupied with. They spoke about vitamins and minerals. Anorexics spoke about being fat.Like Anorexic Nervosa sufferers their session notes record a progression of reducing what they would eat: "fats....bread...refined foods... cookies... chocolates...junk-food" Unlike an anorexic, this was not an attempt to eat less, but rather to make what was perceived as healthier nutritional choices. For one, her attempts to eat healthier started when she was feeling fatigued and thought cutting out bread would help, the other when she was put on a diet to reduce her high cholestrol. Diet had become a type of food therapy- food is medicine.

Anorexia Nervosa vs Orthorexia Nervosa

The pivotal difference? While anorexics fear fatness and diet to control their weight and lose weight as a result, orthorexia nervosa sufferers lose weight, because they progressively restrict what they can eat because their goal is to eat increasingly healthily.

While anorexics won't eat grandma's favorite apple pie because it has too many calories and it'll make them fat, orthorexia nervosa victims won't eat it because it has too much fat and sugar and it's not good for their body. They are the new generation of health junkies.

Typical of both anorexics and orthorexics, their main drive centered around controlling everything they eat. Both consider the nutritional content of every mouthful ("..takes me forever to choose, really stresses me out"). Both thought more about food and eating than they did about living, loving and laughing. Their supposed 'eating' crowded out other activities or interests and had started to isolate them socially ("can't go out for pizza anymore, it's way too fatty and I can't eat gluten"). It was interfering with their relationships ("mother gets really irritated because I can never decide what to eat").

All health food junkies want is to be fit, healthy and eat natural and pure foods. As disillusionment with traditional therapies increase, and more drug manufacturers are sued, I predict the 'healing through food' movement will gain momentum. The same can be said with 'organic' food and use of pesticides. And, for many ill people, improved eating can make dramatic improvements to their health.

But here's the problem with orthorexia. It often starts with an innocent attempt to improve health and eating more healthily (food is medicine) is a much pundited message.

We have multiple contradictory nutritional theories spreading

• vegans, raw-foodists, live-foodists, macrobiotics and so on.

We have social forces
• the push towards healthier eating, organics, pure foods and health-stores opening on every corner.

We have more emphasis on alternative health and holism
• Food therapy is often a central theme of holism which is core to alternative medicine.

Dr. Steve Bratman author of 'Health Food Junies' admits, "I'm no longer the true believer in nutritional medicine I used to be. Where once I was enthusiastically evangelical, I've grown cautious.... I have come to regard it as I do drug therapy: as a useful treatment with serious potential side-effects...."

What Orthorexia Nervosa is not....

• Orthorexia isn't when you're busy implementing a healthier way of eating and the initial attention on food choices is high. The focus of this initial pre-occupation should fade. But be aware if you experience growing pre-occupation with food (and the minute details of it) and a progressive narrowing of food choices, over the long-term. These are danger signs.

• Sticking to a way of eating for religious reasons is also not othorexia unless it becomes an obsessive pre-occupation based on fear rather than love.

• Striving for health through improved nutrition is good, unless it’s based on predominantly fear-based motivations (e.g. fear of cooked foods, or obsessions with aging or dying).

• You should be able to make exceptions to your dietary habits without being consumed with guilt or having to take obsessional corrective actions.

• It should not rob you of the fun and joy of eating or consume your thinking

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