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Orthorexia: When Healthy Eating Goes Too Far

Eating Disorders

By Dr. Lisa Petersen, Clinical Director, Eating Recovery Center of California

Do you obsess over the quality or purity of foods you consume?
Do you avoid restaurants, family gatherings and other settings where you can't eat healthy or "clean"?
Does the thought of eating "normal" food make you anxious or upset?
Does your ability to adhere to your strict eating regimen define your worth?

If you answered "yes" to one or all of the questions posed above, you may be at risk for—or suffering from—orthorexia. Orthorexia is an emerging pattern of disordered eating characterized by an extreme obsession with healthy eating and avoiding foods perceived to be unhealthy.

While other eating disorders like anorexia nervosa, bulimia nervosa and binge eating disorder are rooted in the quantity of food consumed (too little, too much, purging calories through vomiting, exercise or laxative abuse, etc.), orthorexia emphasizes the quality of food consumed. Eventually, a person's diet becomes so restrictive to eliminate the so-called "bad" foods that it begins to affect physical, social and emotional well-being and overall quality of life.

While orthorexia may become a serious condition, it is not an official eating disorder diagnosis. However, like other clinically recognized eating disorders, orthorexia is not just about food. In general, eating disorders develop from a complex group of factors, including genetic propensity, temperament, external pressures and triggering life events.

In someone suffering from orthorexia, an intense obsession with healthy eating is the means through which an individual copes with anxiety, sadness or fear. It provides the illusion of control, confidence and identity in circumstances that feel "out of control." For some, the desire to simply eat more healthfully can spiral into a full-syndrome eating disorder.

As a doctor specializing in eating disorders for nearly 20 years, I view the increasing incidence of orthorexia as troubling but not surprising, and I believe it is on the rise. We are bombarded by information about how to eat healthfully—fat-free, sugar-free, gluten-free, dairy-free, vegan, vegetarian, raw and more. Magazines, celebrities and personal fitness trainers offer conflicting non-professional nutrition advice, so it's no surprise that efforts at healthy eating can become misguided, extreme and even dangerous.

Even children—under the guise of the "fight on obesity"—are bombarded by information and terms they can barely understand, leading them to characterize foods as "good" and "bad," and then to eliminate them from their diets. Because these strong and pervasive messages tout the importance of healthy eating, most people do not understand that certain proposed versions of healthy eating may, in fact, become very unhealthy.

On the surface, orthorexia appears to be motivated by health. As a result, friends, loved ones and health care professions often overlook serious warning signs of this pattern of disordered eating, including:

  • Obsession with food cleanliness or purity
  • Increasing rigidity around what, when and how foods are consumed and prepared
  • Elimination of foods and entire food groups
  • Significant or rapid weight loss
  • Physical symptoms, including brittle nails, hair loss and pallid skin
  • Anxiety about eating
  • Atonement for "slip ups" through increased eating or exercise vigilance
  • Withdrawal from professional, educational, social or family activities and commitments in order to adhere to rigid diet protocols

Despite the risk of orthorexia for some individuals, healthy eating is a worthy endeavor—healthy bodies can support healthy minds and healthy environments. There is no right, correct or singular way to eat healthfully, and there are several precautions you can take to guard against the development of orthorexia and other eating disorders:

  • Consult a registered dietitian for guidance. Whether you are embarking on a healthy eating program or you have been following a healthy eating regimen for weeks, months or years, a dietitian can provide valuable insight related to goal setting, overall health status and meal planning. A dietitian can help you find the right way to eat healthfully based on your unique goals, medical conditions and food preferences.
  • Strive for a diverse diet, allowing all foods in moderation. Many eating philosophies claiming to be healthy call for elimination of certain foods or whole food groups. Stigmatizing foods and an "all or nothing" attitude about eating fosters the extreme rigidity and obsession characteristic of orthorexia.
  • Pay attention to how you feel about food and eating. Healthy eating should never hurt you physically, make you feel deprived or elicit feelings of anger, sadness or shame. Eating should be enjoyable, both for food's varied tastes and textures, as well as for the social element of meals. If psychological distress accompanies your healthy eating effort, consult a therapist or dietitian specializing in eating disorders as soon as possible.
  • Monitor weight loss and body image changes. Slow weight loss following certain eating changes for wellness may be positive for overall health. However, significant or rapid weight loss and increasingly negative body image may indicate the development of an eating disorder, particularly among individuals with a genetic predisposition toward these illnesses.

Dr. Lisa Petersen, Clinical Director of Eating Recovery Center of California, has 20 years of experience in treating those with eating disorders. Her focus is on providing high quality care for patients and families in an effort to give them hope, as well as the skills necessary for a full recovery. Eating Recovery Center of California is an eating disorder treatment center providing Partial Hospitalization, Intensive Outpatient and Outpatient care to adults, adolescents and families in Sacramento, CA.

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