Eating Disorders: Orthorexia - Good Diets Gone Bad
Her parents are health food nuts, says the 32-year-old North Carolina woman, who asks that her name not be used. "I can't remember a time when they weren't. It just got worse over the years ... much worse since they retired."
When she was a child, her parents first phased sugar from the family's diet. "Then they progressed into herbal remedies and supplements ... major pill popping ... then a vegan diet," she says. "They tried every extreme trend that came along in the '80s."
Growing up, she says, "I can remember always being hungry because there was no fat in the house. ... My middle sister ended up with anorexia. Another sister goes to Overeater's Anonymous."
When she read an article in Cosmopolitan magazine -- about an eating disorder called orthorexia -- her parents' pattern became crystal-clear. It was healthy eating gone out of control.
"The whole issue is obsession," says Steven Bratman, MD, who in 1997 coined the word orthorexia from the Greek ortho, meaning straight and correct. "This is about the obsession with eating to improve your health."
Bratman is author of Health Food Junkies: Orthorexia: Overcoming the Obsession with Healthful Eating, released in 2001. He went through his own bout with the disorder while living in a commune in the '70s. He then moved on to medical school at the University of California-Davis and practiced for 13 years as an alternative medicine physician in California. He is author of two other books -- Alternative Medicine Sourcebook and The Natural Pharmacist -- and is medical director of The Natural Pharmacist, an alternative medicine information web site.
The obsession doesn't necessarily lie just between the mouth and the other end. An out-of-control healthy eater feels a sense of spirituality, he says. "You're doing a good, virtuous thing. You also feel that because it's difficult to do, it must be virtuous. The more extreme you are, the more virtuous you feel," Bratman says.
In his practice, claims Bratman, he has seen many patients with this condition. "I saw two or three people a day who would ask how they could be stricter in their eating."
Very often, Bratman says, the food preoccupation stems from a problem like asthma. "Among those who believe in natural medicine, the progressive view is to avoid medicine, which supposedly has side effects, and instead focus on what you eat. But everyone misses the fact that if you get obsessed with what you eat, it actually has a lot of side effects -- mainly, the obsession itself."
One patient's story was all too typical: Even though the patient's asthma medication had very minor side effects, "she thought it was evil to use the drug, that she should treat the asthma naturally," he tells WebMD.
"She began working on food allergies and discovered that if she eliminated milk, wheat, and other foods, she didn't have as much asthma -- which was a good thing," Bratman says. "Except that after a while, she was eating only five or six foods."
In the process, he says, she'd sent her life into a downward spiral. "When I looked at her, I saw a person who was no longer on medication. And true, she had no side effects from the medication." However, she was socially isolated, spent a large chunk of time thinking about food, and felt extremely guilty when giving in to temptation.
"Are those not side effects?" Bratman asks. "I would call them horrific side effects. By avoiding food allergies, she increased her side effects enormously."
Various articles written on orthorexia have brought him calls from all over the country. "That demonstrated to me that this was much bigger than I thought. Orthorexia support groups were starting to develop. People were writing and saying I had changed their lives by pointing out that they were obsessed and they didn't even know it," he says.
So what constitutes orthorexia?
- Are you spending more than three hours a day thinking about healthy food?
- Are you planning tomorrow's menu today?
- Is the virtue you feel about what you eat more important than the pleasure you receive from eating it?
- Has the quality of your life decreased as the quality of your diet increased?
- Have you become stricter with yourself?
- Does your self-esteem get a boost from eating healthy?
- Do you look down on others who don't eat this way? Do you skip foods you once enjoyed in order to eat the "right" foods?
- Does your diet make it difficult for you to eat anywhere but at home, distancing you from friends and family.
- Do you feel guilt or self-loathing when you stray from your diet?
- When you eat the way you're supposed to, do you feel in total control?
If you answered yes to two or three of these questions, you may have a mild case of orthorexia. Four or more means that you need to relax more when it comes to food. If all these items apply to you, you have become obsessed with food. So where do you go from there?
Treatment involves "loosening the grip," says Bratman. "I begin by agreeing that the diet is important, but also saying, 'Isn't it also important in life to have some spontaneity, some enjoyment?'"
For most people, he says, making the change is a big step. "It doesn't happen in just one session. Once people recognize it, it's still very hard to change. It's been so long since they've eaten spontaneously. They don't know where to start. It's very tricky."
Bratman notes that sometimes orthorexia overlaps with a psychological problem like obsessive-compulsive disorder. Still, he thinks orthorexia "is its own illness as well."
He has not conducted human studies on the disorder, Bratman says, "because I'm personally more interested in affecting social change than creating a new diagnosis that you bill insurance companies for." He says he imagines his book will create controversy -- especially among diet gurus. "I'm just trying to bring people to the middle," he says.
Skeptical of Bratman's theory is Kelly Brownell, PhD, co-director of the Yale Center for Eating and Weight Disorders. "We've never had anybody come to our clinic with [orthorexia], and I've been working in this field for at least 20 years," says Brownell.
Without research to back his theory, Bratman is simply another guy trying to make a buck off the health-conscious public, Brownell says. "They invent some new term, a new diet, a solution to a problem that doesn't even exist. The burden should fall to the authors to prove that what they're saying is correct before they start unleashing advice on the public. These authors should be held accountable."
Well-known columnist Dean Ornish, MD, founder and president of the nonprofit Preventive Medicine Research Institute in Sausalito, Calif., also has doubts. "I've never seen [orthorexia] in my clinic. Most people have the opposite problem; they don't care enough about what they eat."
Still, Sharlene Hesse-Biber, PhD, has another thought about orthorexia. "It's part of this fear in our society ... this obsession that our bodies need to look a certain way," says Hesse-Biber, a sociology professor at Boston College and author of the book, Am I Thin Enough Yet? "This obsession is spreading in both directions, down the life cycle to younger and younger generations and to older generations of women and men. ... It's not a healthy way to live."
Finally, Julie B. Clark-Sly, PhD, a psychologist at the Foundation for Change, a small medical facility in Orem, Utah, sees a common thread in orthorexia and other disorders. "It's being fixated on the food and having a limited range of what they eat -- that's very similar to what anorexic women do," says Clark-Sly. "They do eat, but they don't eat fat, and they really restrict themselves calorie-wise. They say what they're doing is healthy, but they fool themselves. It becomes an emotional disorder."
Last Updated: 14 January 2014
Reviewed by Harry Croft, MD