It’s 2019 - and with that comes unlimited access to the internet, smart phones and at home mechanisms that tell us all sorts of things- “Alexa can you tell me about…” - information has reached the masses.
It seems we all have more access to information on diet and health as a result. On one hand, it’s a positive that we have many resources regarding what and how to eat. We have more power in our decisions and in how we take care of our bodies.
On the other hand - do we know too much? Over the years there has been a trend towards eating “healthy”,“wellness”, “clean eating” and diet trends touting wellbeing. Gluten- free, wheat - free, dairy - free are just a few of the more trending diets. But what if the desire to “eat clean” controlled your social life? Or where you food shopped? What if you skipped meals because the food didn’t fit your plan?
Although the term itself was coined in the 1990s, the eating disorder community is now using a definition for this obsession with eating healthy: Orthorexia.
Orthorexia translates to an obsession with proper eating. “Ortho” meaning right and “orexia” meaning appetite. Orthorexia isn’t an official DSM diagnosis (how mental health providers diagnosis a client) but it is a way to define what we as providers are seeing amongst clientele.
WLRN.org shared the story of a young man who struggles with orthorexia. As a kid, he struggled with being overweight. In his early 20s, he tried various diets and experienced large weight fluctuations. Losing and gaining about 100 pounds in a years time. When he moved to Los Angeles after graduating college, a very health conscious city to begin with, things took an extreme. He limited himself to 10 foods and started posting his “clean” diet on social media. He’d avoid going to office parties in fear of limited options, and avoided going out with friends so he wouldn’t have to explain his current diet. This behavior would be classified as orthorexia nervosa.
There is limited research in the area of orthorexia, 145 published articles exist compared to the thousands available on more studied diagnoses like anorexia or bulimia. Cena and colleagues just this year took a look at the research available on orthorexia. Unfortunately the diagnostic criteria varied greatly. However, all studies cited the following as ways to identify the disorder:
An obsession with healthy nutrition
Emotional consequences (distress, anxiety)
Psychosocial impairments in relevant areas of life
Usually weight loss and/or malnutrition (not always)
In 2019, Ryman and colleagues published a study done in the Netherlands surveying psychiatric professionals (Ryman et al, 2019) . Out of 160 professionals, 78% agreed that Orthorexia Nervosa (ON) should be a separate diagnosis within the DSM criteria.
There is much work to do in the research realm of orthorexia as a whole. As dietitians, we applaud those who eat a balanced diet. The problem comes in when this diet or need to eat healthy, impinges on someone’s quality of life. This is when it’s recommended to seek treatment with certified professionals.
As friends, families, coworkers and caretakers there are several things that can be done when this behavior is noticed. If you notice any of the behaviors below and are concerned, reach out to a local professional for help or visit nationaleatingdisorders.org.
Compulsively checking ingredient lists or nutritional labels
Cutting out an increasing number of food groups (sugar, dairy, etc)
Inability to eat anything but a narrow group of foods that are “healthy”
Spending hours talking or thinking about food
Distress or anxiety noticed when “healthy” foods unavailable
Obsession of following food or healthy blogs on twitter, instagram, etc.
References:
Fulton, A. (2019). When Efforts To Eat 'Clean' Become An Unhealthy Obsession. Retrieved from https://www.wlrn.org/post/when-efforts-eat-clean-become-unhealthy-obsession
Orthorexia. (2018, February 22). Retrieved from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia.
Cena, H., Barthels, F., Cuzzolaro, M., Bratman, S., Brytek-Matera, A., Dunn, T., … Donini, L. M. (2018). Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 24(2), 209–246. doi: 10.1007/s40519-018-0606-y
Ryman, M., F. V., Tomris, Bood, Zarah, & V, E. (2019, February 27). Orthorexia Nervosa: Disorder or Not? Opinions of Dutch Health Professionals. Retrieved from https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00555/full.