By most measurements and statistical analyses, Americans are really sick and really fat. As a result, grocery store shelves are filled with 100-calorie packs of cookies and crackers, while TV commercials promise magic pills for everything from diarrhea to migraine headaches, and books and blog posts admonish readers to go Paleo or else!
It can be a lot for people to sort through, so people who are actively taking at least some steps to better their health are typically seen in a favorable light, as they’ve managed to master their willpower and overcome temptation in a way that most of us only dream.
Unfortunately for some, however, the desire to be healthier can deteriorate into a full obsession, where every morsel of food is heavily scrutinized and, often, avoided. To address these extreme cases, the term orthorexia—meaning, literally, “fixation on righteous eating”—was first introduced by physician Steven Bratman, MD, in an article published in Yoga Journal in 1997.
In the article, titled “The Health Food Eating Disorder”, Bratman described his own experience with extremists from various healthy-eating sects, including vegans, raw foodists and Hindus who avoided garlic and onions for fear of provoking sexual desire. Often he found people who were overly focused on the food they ate, usually to the detriment of other areas of their lives. “Many of the most unbalanced people I have ever met are those who have devoted themselves to healthy eating,” Bratman wrote.
It should be no surprise, then, that in the 17 years since Bratman first wrote his essay, cases of orthorexia have been on the rise. There are groups who believe the consumption of grains is at the root of most major illnesses, while others think it’s dairy that compromises true health. And when taken to extremes, these beliefs can become dangerous.
“Oftentimes, people who are orthorexic have a dogmatic or trendy approach to what is healthy,” says Brandon Mentore, a strength and conditioning coach and sports nutritionist. “I’ve worked with many women who are Kale fanatics and have ended up with gut issues because they eat so much of it thinking it’s extremely healthy. These people, being misinformed, don’t realize that large amounts of Kale can cause a histamine release that unhinges gut function and causes problems. Another example is people who are vegetarian but are actually ‘starch-atarians’ and eats tons of carbohydrates.”
Though misinformation is at the root of the extreme behavior, Mentore notes that orthorexia is actually most prevalent among people who are already ascribing to healthy behaviors in some way or another. “The population that gets affected the most is women aged 25-45 because this is the age range where women typically get very into their health and nutrition, but can tend to take it overboard,” Mentore says. “It is also rampant in the yoga and bodybuilding communities because the common [eating] practices used in these communities alter your relationship with food and what health is.”
Mentore also believes the popularity of social media has contributed to the rise in orthorexia. “Social media provides a platform and an audience for orthorexia because you’re able to display your practices through pictures, posts, videos, etc., way beyond your immediate social circle,” he explains. “Validation, confirmation and affirmation can be easily acquired from social media and is a form of gratification for an orthorexic. Every like, retweet, or re-pin is just another dopamine hit.”
So how can people who legitimately want to become healthier prevent themselves from spiraling out of control? “Like with other disorders, once a person becomes involved and engaged in a compulsive pattern, it is much harder to maintain a balanced, objective approach and stop oneself from further deterioration,” says Dr. Rachel Lowinger, PhD, a licensed clinical psychologist. “I suggest that people set certain limits and safety rules for themselves ahead of time. For example, they may—in consultation with a nutritionist—set a minimal weight, which, if they fall below, they commit to seeking help and considering changing their diet.”
In this case, when it comes to being held accountable, social media can actually be a positive influence. “Like any other addiction, allowing friends and family to intervene and express their concerns and being open to their observations is another safeguard from going too far,” Lowinger says. “This implies trusting that others have your best interest in mind, which may be hard or impossible for some individuals to accept.” What’s clear, however, is that once an individual has made drastic changes to their diet, it is time to bring in professional help.
In her book, The Eating Disorders Clinical Pocket Guide, registered dietitian Jessica Setnick lists come of the symptoms of orthorexia, including:
- Phobic avoidance of foods perceived to be unhealthy, such as refusal to be in proximity to such food or experiencing panic while watching others eat the food .
- Severe emotional distress or self-harm after eating a food considered unhealthy.
- Following a restrictive diet prescribed for a medical condition that the individual does not have, or in order to prevent illness not known to be influenced by diet.
- Insisting on the health benefits of the diet in the face of evidence to the contrary.
It is for these reasons that Setnick believes orthorexia is more of a reflection of someone’s mental state than anything else. “Orthorexia is less likely to be about health and more likely to be a conscious or unconscious attempt to manage anxiety, an attempt to bolster self-esteem by demonstrating admirable traits such as willpower and self-restraint, or an unsuccessful attempt to ‘cleanse’ away one or more traumatic memories or experiences,” she writes. “It may also conceal a belief that one is unacceptable due to one’s intolerable desire for certain enjoyable or indulgent’ foods and a fear that ‘giving in’ to these desires may result in an unacceptable loss of control.”
Setnick says it is still unclear whether orthorexia should be classified as an anxiety disorder or an eating disorder that occurs as result of anxiety, but nevertheless, the most effective treatment is at a facility that treats other eating disorders. “The treatment [for orthorexia and other eating disorders] is the same—nutritional restoration and anxiety management, usually with medication and counseling,” she says. “In many cases orthorexia and anorexia are identical, except that the obsession in orthorexia may be with ‘health’ rather than weight, as it is in anorexia. In other cases they are indistinguishable as the orthorexia has caused a dramatic and unhealthy weight loss, or the individual is terrified of regaining lost weight, so he or she meets criteria for anorexia as well.”
Finally, Setnick says, treatment must involve a “move away from the faulty logic that to stay safe, food intake must be cognitively over-regulated,” as it is this thinking that creates a never-ending cycle of poor choices and poor nutrition. Adds Setnick, “The worse an individual with orthorexia feels, the more he or she may blame certain foods or food additives that must be eliminated or further restricted, and the more he or she may insist to others that the diet is healthy.”