By: Jessica Glosson
Many people are familiar with commonly recognized eating disorders such as anorexia nervosa and bulimia nervosa. These clinical conditions are characterized by a fear of gaining weight, an obsession with being thin, and the constant need to have control over food composition and consumption. In 1996, American physician Steven Bratman first introduced and defined the term “orthorexia” to parallel a diagnosis of anorexia nervosa for a number of his patients that presented with extreme obsessions concerning dieting and health foods1. It wasn’t until after coining the term that Bratman discovered orthorexia to be a separate type of eating disorder in its own right.
A key feature that distinguishes orthorexia nervosa from diagnosable disordered eating conditions revolves around the fact that sufferers share an all-consuming obsession with eating healthy foods. These practices of “perfectly clean” eating nearly comprise the entirety of a sufferer’s day1. Orthorexia is thought to mirror many elements of Obsessive Compulsive Disorder (OCD); the strong compulsion to eat foods that are minimally processed, “clean”, or are considered to be “safe” can drive sufferers to spend exorbitant amounts of time shopping, cooking, and planning meals to eat2. Orthorexic sufferers often isolate themselves from friends and family and may avoid social situations, especially those that involve food or going out to eat. According to Bratman, the most unique feature of this condition relates to the adopted sense of self or identity an orthorexic individual embraces in conjunction with their perceived notion of “perfect eating”1. Some may consider their eating habits to be superior to others and feel a lofted sense of accomplishment the more “perfectly” they eat.
What is considered to be “perfect” eating? Orthorexic diets tend to follow patterns similarly seen in vegan or raw food diet plans. Meals frequently contain sources of uncooked fruits and vegetables and often times orthorexic sufferers spend lengthy periods of time choosing the most unblemished and perfect looking produce from stores or gardens1. A stark contrast between orthorexia nervosa and anorexia nervosa is the viewpoint on calories; anorexic individuals may painstakingly count every single calorie they consume on a daily basis, often in a manner that falls drastically under daily recommended values2. Orthorexic individuals, on the other hand, are not as concerned with the caloric content of an item so long as it contains ingredients they consider to be healthy. Calorie dense avocados or grapeseed oil, for example, may be used extensively by someone with orthorexia whereas an anorexic individual would strive to avoid such concentrated sources of fat and calories2.
At first glance, it may be difficult to comprehend that an obsession with eating healthy can actually be a damaging thing. Orthorexic individuals often exceed the daily recommendations for fruit and vegetable servings and virtually exclude processed foods and unhealthy forms of fat from their diets. As future RDNs or healthcare professionals, it almost sounds like the perfect patient, right? Wrong. It’s the all-consuming obsession with food, social isolation, and neglect on behalf of other aspects of health that can cause orthorexic sufferers to become malnourished, severely underweight, and in some cases, at risk for death2.
Our society today has become obsessed with two major topics in regards to nutrition and health: obesity and the trendiness of eating healthy. Despite the fact that obesity statistics have soared in past years throughout the USA and other countries, the increasingly influential trend of “being healthy” has grown as well. Nutrition and its impact on health is a hot topic; hashtags concerning food and nutrition are some of the most popular tags used on social media sites such as Instagram, Facebook, and Twitter. While the promotion of healthy eating practices and recipes should be a positive thing, over-emphasis on certain aspects of these topics can unfortunately be misinterpreted and taken too far. This obsessive side of modern-day food culture has led to the development of unhealthy relationships with food for many individuals2.
In addition to the adverse psychological effects orthorexia can exert on an individual, a number of nutrition-related complications can arise as a result of the continued practice of orthorexic eating habits. Existing literature on the subject has revealed that orthorexic patients often undergo severe weight loss which can increase the risk of infertility and kidney malfunction3. Muscle wasting, hair loss, and amenorrhea in females are other common health issues seen in orthorexic patients. The restrictive side of the condition in terms of food consumption frequently causes nutrient deficiencies in essential vitamins and minerals such as iron, calcium, potassium, and B vitamins2. These micronutrient deficiencies can lead to more serious complications like osteoporosis and decreased immunity3.
Currently, orthorexia nervosa is not clinically recognized as a diagnosable eating disorder2. Healthcare professionals (especially Registered Dietitians) should still familiarize themselves with the cardinal signs of this condition and understand how to help individuals that may be affected. Dietitians should strive to communicate the importance of balance to patients; labeling foods as “good” or “bad” has proved to be an ineffective strategy when counseling clients and could even worsen the warped ideology orthorexic patients have towards nutrition2. Encouraging moderation and mindful eating practices could serve as beneficial interventions and as always, practitioners should keep the thoughts and concerns of the patient as the focal point of every counseling session. By practicing active listening and remaining attentive to a patient’s concerns, RDN’s can effectively serve as an identifying force and combater of the evolving condition of orthorexia nervosa.
- Bratman S. What is Orthorexia? Orthorexia.com Web site. http://www.orthorexia.com/what-is-orthorexia/. Published January 23, 2014. Accessed August 21, 2016.
- Getz L. Orthorexia: When Eating Healthy Becomes an Unhealthy Obsession. Today’s Dietitian. 2009; 11(6): 40. Available online at http://www.todaysdietitian.com/newarchives/060109p40.shtml. Accessed August 21, 2016.
- Long-Term Effects of Orthorexia Nervosa. Futures of Palm Beach Treatment Center Web site. https://www.futuresofpalmbeach.com/long-term-effects/. Accessed August 22, 2016.