By Michelle Yandle
More and more, diet has become increasingly important to Western society. With a growing prevalence of obesity, diabetes , and other chronic disease such as heart disease and stroke , people are becoming increasingly preoccupied with what foods they should and shouldn’t be eating. There always seems to be a food out there that is termed “bad” and others that are “good”. Today, it’s sugar—20 years ago, it was fat. Regardless, there always seems to be foods that are vilified and others that are considered downright saintly. We try our best to choose foods that are best for our bodies and those of our family—we are striving to “eat clean” and make the right choices, but when does healthy eating become obsession?
Where are the lines we cross that have us going from healthy eating to eating so healthily that our health suffers?
In this article, we’ll look at orthorexia, what it means, and when healthy eating can potentially cause a problem. We’ll clear up some misconceptions and in hopes to provide support for those who may be suffering from an unhealthy obsession with what is healthy.
Being in the health and wellness industry I know what it’s like to be constantly bombarded with different dietary theories, all of which claim to be the holy grail of health, weight loss and endless vitality. We have different food theorists often pitching against each other , or as Author Steven Bratman describes
“ Spicy food is bad; cayenne peppers are health- promoting. Fasting on oranges is healthy; citrus fruits are too acidic. Milk is good only for young cows (and pasteurized milk is even worse); boiled milk is the food of the gods. Fermented foods, such as sauerkraut, are essentially rotten; fermented foods aid digestion. Sweets are bad; honey is nature’s most perfect food. Fruits are the ideal food; fruit causes candida. Vinegar is a poison; apple cider vinegar cures most illnesses. Proteins should not be combined with starches; aduki beans and brown rice should always be cooked together.”(4)
It’s no wonder we’re so confused about what we should eat. It gets to the point where some end up not doing anything at all (paralysis by analysis) and others who potentially do too much. Healthy eating, like anything else, can become unhealthy when it is taken to the extreme:
When do our eating habits become a problem?
Shelley Ugyan, Problematic eating specialist and author of “Food Freedom” describes it thus:
“Problematic Eating is a term that describes any situation whereby a person is compromised due to an inability to eat in a way that does not cause stress physically, emotionally and/or mentally. Usually this involves an over-concern with weight and shape, or general concern about how one looks. A person with Problematic Eating will experience emotional, cognitive and/or interpersonal triggers that will lead them to act out in behaviours that are destructive around food.”(5)
We often associated problematic eating with emotional eating, binging, anorexia, and bulimia. But what about those who display the symptoms of problematic eating in relation to health and wellness? What happens when healthy eating causes stress physically, emotionally, mentally and even socially? There is a lot of overlap between orthorexia and problematic eating in general (6*) and so it is important to clarify for this purpose.
The term Orthorexia was coined by an American medical doctor by the name of Stephen Bratman, author of “Health Food Junkies: Overcoming the Obsession with Healthful Eating (1). Orthorexia is a pathological obsession with proper nutrition. Someone with anorexia may obsess over food in general, whereas someone displaying orthorexic traits may be seen engaging in restrictive eating, ritualized patterns of eating and rigid avoidance of foods believed to be unhealthy or impure (7) and as opposed to food quantity, they are obsessively scrutinising its quality (8).
As you can see there is some overlap between orthorexia and problematic eating in general;(7) (9) as the idea of certain “impure” foods can cause physical, emotional and mental stress as well as putting stress on our social lives as well.
You won’t find Orthorexia in the DSM and it remains the feature of some debate.
There is also difficulty in its diagnosis because the series of questions created by Bratman have also elicited some controversy (10*). It is however recognized in the DSM as an “other specified feeding or eating disorder” for the reasons above (10)
Isn’t this just healthy eating?
I’ve spoken with many people who strive to eat their best and view some of the orthorexic traits as simply eating healthy. They want what’s best for them and their family and see nothing wrong with choosing foods that they believe are beneficial towards ultimate health. It’s important to distinguish between healthy eating and problematic eating in the form of orthorexia.
When researching orthorexia there are some key-words that trend throughout the data, words such as “preoccupation” “obsession” “ restriction” “virtuous” “pathological” and “disordered”. Orthorexia crosses a line where wanting to eat healthily becomes exhibiting these types of behaviour (10). Another distinguishing feature is that orthorexia is often a long-term issue rather than a short-term one (such as doing an occasional ‘elimination diet’ or ‘detox’ program)(6).
And therein lies the difference; obsession vs. passion…
Lindsey Getz, author of Understanding Orthorexia (10) compares the two as follows:
For example someone who eats healthily chooses healthy items as often as possible, whereas someone who is orthorexic wouldn’t even bother eating out because they would be unable to control every single ingredient in the food eaten.
The difference could be likened to packing lunches to avoid fast food, compared to spending hours meticulously prepping food—to the point where you avoid social engagements or spending time with family in order to prepare.
It’s someone who skips dessert most of the time vs. someone who wouldn't even touch the stuff if it were a special occasion.
Someone who strives to eat healthy might feel a tinge of guilt for eating something unhealthy whereas someone who is orthorexic will experience emotional turmoil and will find forgiveness difficult. (10)
Someone who is orthorexic may also withdraw from friends and experiences because of food to the point that they experience a decreased quality of life. This restriction may lead to some people avoiding eating altogether in fear that they may ingest something that is ‘unhealthy’ (10).
Those suffering from orthorexia may experience mineral or other deficiencies (6) because of the elimination of foods from the diet—such as avoiding vegetables altogether because they are not organic (or meat for the same reason). It can also be socially isolating, may compromise relationships and cause excessive anxiety around food.(6).
The question when determining when this line has been crossed is simply: “Are my eating habits having a negative effect on my life?”
So what can we do?
When it comes to food we need to practice forgiveness. We need to enjoy eating as a cultural experience, and as a time to become closer to our loved ones in sharing the fruits of the earth. In my personal opinion, deprivation is never sustainable especially when it comes with the risk of health issues that outweigh any potential benefits.
Let’s enjoy food, eat as healthy as we can and spend more time together building social connections.
Is it really better to eat sprouts alone at home while your family goes out for a delicious meal?..
If you have symptoms of problematic eating avoid the online “health-hype” and seek advice from only qualified professionals providing peer-reviewed evidence. It seems that everyone is calling him- or herself a health expert online these days and for those who are already predisposed to anxiety over health and wellness – the media hype will only further perpetuate this anxiety. (7)
If you feel as though you may have an issue with problematic eating or Orthorexia please seek assistance from a qualified Cognitive Therapy coach or through Eating Disorder Help NZ (http://www.ed.org.nz) (or your local eating disorder support clinic).
“Intrusive thoughts of sprouts came between me and good conversations. Perhaps most dismaying of all, I began to sense that the poetry of my life had diminished. All I could think about was food”
– Steven Bratman “Orthorexia Nervosa - Health Food Junkies"
(1) World Health Organisation, January 2015. Obesity and Overweight. Fact Sheet N 311. Retreived from http://www.who.int/mediacentre/factsheets/fs311/en/
(2) American Diabetes Association, June 2014. Statistics about Diabetes. Retrieved from http://www.diabetes.org/diabetes-basics/statistics/
(3) Centres for Disease Control and Prevention, 2015. Chronic Disease Overview. Retrieved from http://www.cdc.gov/chronicdisease/overview/
(4) Bratman S., Night D., (2000). Orthorexia Nervosa –Health Food Junkies. New York, United States of America: Broadway Books Publishers.
(5) Ugyan S. (2015) Food Freedom: Breaking Free From Problematic Eating – A Twelve Week Program. Self Published, Create Space publishing
(6) CHAKI, B., PAL, S., & BANDYOPADHYAY, A. (2013). Exploring scientific legitimacy of orthorexia nervosa:a newly emerging eating disorder. Journal Of Human Sport & Exercise, 8(4), 1045-1053.
(7) Koven, N. S., & Abry, A. W. (2015). The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatric Disease And Treatment, 11385-394. doi:10.2147/NDT.S61665
(8) Mellowspring, A. (2010). Orthorexia Nervosa: A Primer: Is it possible for healthful eating to become unhealthy?. IDEA Fitness Journal, 7(9), 67-70.
(9) Werner, R. (2015). PATHOLOGY PERSPECTIVES. Orthorexia Nervosa. Massage & Bodywork, 30(4), 44-47.
(10) Varga, M., Dukay-Szabo, S., & Túry, F. (2013). [Orthorexia nervosa and it's background factors]. Ideggyógyászati Szemle, 66(7-8), 220-227.
(11) Asil, E., & Sürücüoğlu, M. S. (2015). Orthorexia Nervosa in Turkish Dietitians. Ecology Of Food & Nutrition, 54(4), 303-313. doi:10.1080/03670244.2014.987920
(12) VANDEREYCKEN, W. (2011). Media Hype, Diagnostic Fad or Genuine Disorder? Professionals' Opinions About Night Eating Syndrome, Orthorexia, Muscle Dysmorphia, and Emetophobia. Eating Disorders, 19(2), 145-155.