Orthorexia: An Unhealthy Obsession with Healthy Food

What’s your food status?

1. You eat whole foods only.
2. You shun processed food, refined sugars and flours.
3. You’re a fierce advocate of food quality.
4. You limit eating out because you are aware from my previous books that dining out is associated with greater risk of diabetes.

I’m thrilled if you do any or all of these things. But I have to ask, have you taken it too far?

Maybe you already eat whole foods only, shunning processed food, refined sugar, and flour. Or perhaps you are a fierce advocate of food quality. Maybe you are aware from my previous books that eating out is associated with a greater risk of diabetes. However, it’s possible to take things too far. For me and many of my patients, what begins as a commitment to clean eating can devolve into orthorexia, a pathological fixation with righteous eating that interferes with daily life and becomes unhealthy, physically and/or psychologically.[1] It’s a form of food fundamentalism, where you beat your appetite into submission, raising stress and cortisol to toxic levels. It’s as bad as consuming toxic, inflammatory foods.

Ruthie, a fifty-two- year-old-old chef and nutritionist, is one of my patients who has struggled with disordered eating since high school. At 5 feet, 6 inches tall, her weight has ranged from 105 to 150 pounds. In her thirties, she was at her lowest weight, and in her forties, at her highest. In her words, Ruth has been a restrictor and a binger, an anorexic and an orthorexic. “I know my brain chemistry is different around food. I don’t know what it’s like to be ‘normal’; it’s been a struggle most of my life. Food addiction and obsession with body image are a time suck that prevent you from living a full life.”

The unsustainable premise with orthorexia is that only limited foods are pure and acceptable, and that all other foods are dangerous. It’s an ideology of dietary perfection. The act of sitting down to a meal becomes fraught with conflict, stress, obsession, compulsion, and shame rather than an opportunity to nourish the body with fuel.  Although it may begin with the discovery of a food intolerance, orthorexia is not rooted in food allergies or sensitivities. It develops over time as an obsessive-compulsive focus on food content beyond rational food intolerance.  An extreme number of foods are excluded needlessly.  For a long time, I thought the healthier, the stricter, the better.

With orthorexia, you’re always eating in a fight/flight/freeze state, which is hauntingly stressful and compromises digestion.  The food plan of an orthorexic leads to addiction, anxiety, and nutritional deficiencies. Specifically, B12, DHA, iron, iodine, and zinc can get out of balance and contribute to poor mood, medical complications, and poor quality of life. The desire to optimize health backfires.

How do you find the balance between eating healthy food in an informed way, without becoming neurotically preoccupied and disproportionately restricting?

1. Eat a wide variety of foods to give your body everything it needs to function well. True health is not extreme.
2. Catch the obsessive thoughts as early as possible, before they become compulsive actions.
3. Seek help—ideally with a compassionate expert psychotherapist. Both dialectical behavioral therapy (DBT) and neurofeedback have been shown to help.

What helped Ruthie recover from her eating disorder first started with prevention. “I work at not getting started down any extreme path and not thinking in all-or-nothing terms. Life is much saner that way. I am not perfect and I still binge and restrict at times, but nowhere near as much as I used to. I think there are those who may not ever recover entirely from food issues but that they can manage them. Now when I binge or restrict I acknowledge it, forgive myself, and move on. Shame and ruminating causes an endless cycle. It’s never too late to rein it in and bust out of stuck.” Second, Ruthie exercises: “I still exercise because I love how it makes me feel, but I don’t overdo it compulsively. I work out, but for the right reasons, longevity, strength and mental therapy, not too burn off calories.” Third, she avoids slippery situations such as letting herself get too hungry, drinking wine on an empty stomach, isolating, and putting off plans to see friends.

Ruthie adds: “Food addiction, anorexia, orthorexia, and disordered eating can occur with anyone. It is possible to put food addiction and disordered eating in physical remission and then slowly to repair the psychological, social, economic, and spiritual damage it has caused.”

Conclusion

Yes, eat healthy, shun toxic foods, and exercise regularly, but more important, examine your mind-set around food and give grace to yourself. Health is the goal, not perfection.  As Ruthie now says, she maintains feeling good by eating nutritionally dense food, runs, and strength trains, and pays attention to taking good care of her skin. “I frankly feel that I look better at age 50 than 30.” Ruthie adds “Like anorexia nervosa, orthorexia is a disorder rooted in food restriction. Unlike anorexia, for othorexics, the quality instead of the quantity of food is severely restricted.”

For more on balanced healthy eating and positive food rituals, pick up a copy of my newest book, Younger. 

[1] Koven, N. S., et al. “The clinical basis of orthorexia nervosa: Emerging perspectives.” Neuropsychiatric Disease and Treatment 11 (2015): 385; Dell’Osso, L., et al. “Historical evolution of the concept of anorexia nervosa and relationships with orthorexia nervosa, autism, and obsessive–compulsive spectrum.” Neuropsychiatric Disease and Treatment 12 (2016): 1651; Dunn, T. M., et al. “On orthorexia nervosa: A review of the literature and proposed diagnostic criteria.” Eating Behaviors 21 (2016): 11-17.