Could You Have Orthorexia?

It’s been making headlines across the country: the fact that ‘healthy eating’ can become unhealthy. Huh? Way to cause more confusion!

Can healthy eating really become unhealthy? Well, the relatively new term orthorexia nervosa suggests that it can.

What is orthorexia nervosa?

The word was derived using the Greek word orthos, meaning right or correct and was intended as a parallel with anorexia nervosa. It was first coined by an alternative medicine physician, Steven Bratman, MD, MPH, in 1997. He believed that just like some of us are addicted to junk food, one could also have an obsession with healthy eating.

Orthorexia is not officially considered a true eating disorder, like anorexia or bulimia, by the current DSM (The Diagnostic and Statistical Manual of Mental Disorders). It does, however, present with similar characteristics of obsessive compulsive behaviours and control. Unlike anorexia or bulimia, orthorexia is not an obsession with the quantity of food and an underlying desire to be thin, but with the quality of food and the desire to achieve a “perfect” or “clean” diet. Eating disorder experts disagree on the classification of orthorexia and as such, there are limited studies on its prevalence and effects within society.

That being said, there are a number of doctors and dietitians who agree that regardless of whether it’s officially an eating disorder, that it is a form of disordered eating (these terms are not to be confused) that requires help. Sufferers of orthorexia become obsessive with eating healthy food through a desire to eat “clean” or “pure”. It takes lots of willpower to stick to such a rigid eating pattern, making people feel “righteous” and more superior than their peers. They also struggle with “slip-ups” and often become even stricter, fasting or exercising more. The behaviour can become so disordered that it interferes with a person’s quality of life through excessive worry and anxiety, compulsion and social isolation.

Even though the term was first used over 18 years ago, orthorexia has been getting extensive media coverage, especially in the past six months. Views on the topic are highly varied but it seems that overall the media cycle thrives on covering the hype and sensationalism of an “extreme”. Orthorexia is no exception.

I believe in healthy eating

I’ve been a nutritionist for over 12 years. During that time the face of the industry has changed dramatically. It was only a few months ago that I was discussing with fellow members of a university’s nutrition advisory board that I serve on, that healthy eating has never been more popular than what it is now. When I first started my career, we learnt strategies for motivating, encouraging and gently coercing people to change their eating habits for the better. And now I’m writing an editorial on the perils of the opposite extreme.

Make no mistake, there is nothing wrong with a desire to eat well and promote good health through a healthy, balanced diet. I have based my entire career and make a living on this concept. I aim to eat well myself every single day.

I wholeheartedly believe in it.

I do, however, believe in balance and in the field of nutrition you actually can have too much of a good thing. That’s generally the case with most things in life.

The birth of the wellness industry

Currently, over 60 per cent of adults are classified as either overweight or obese. Why? In a nutshell, major cultural and social changes over the past 50 years has led to an energy rich, poor quality diet and reduced activity levels. The research and interest in nutrition has also grown over the past 50 years and we now understand the link between a person’s diet and their overall, long term health. Dietary Guidelines have been established in nearly all western countries across the globe encouraging people to adopt a healthy diet and think about their long-term health. Public health nutritionists passionately spruik that even minor changes to a person’s diet, like a little less sugar and fat and a little more fruit and vegetables, could positively impact a person’s health.

Happening simultaneously was the birth of the “wellness” industry. About 12 years ago I was actually given a book titled The Wellness Revolution: How to make a fortune in the next trillion dollar industry. I never read it. But that’s beside the point. The point is that this industry has seen a dramatic increase in strict diets, weight loss programs, cleanses, detoxes, shakes, supplements, herbs, meal plans, vitamin injections and sooo much more. There are not only dietitians and nutritionists spruiking healthy messages but also chefs, bloggers, personal trainers, lawyers, journalists, clothing labels and others all offering their two cents worth.

As a culture, we may be more willing to eat well than we’ve ever been but we’re more confused than we’ve ever been too. With every program claiming to be the “right” way to live, the “answer” you’ve been looking for or the “secret” to improving your life, it’s no wonder. These programs and individuals may be well-meaning, but in my opinion many of them are selling an exaggerated truth.

Attaining enlightened levels of healthiness

Think about your overall health as a spectrum of being alive. At the extreme of one end of the spectrum you’re so sick (or old) you’re dead. As you progress along the spectrum you become less sick – the opposite end point being good health. This is not just the absence of sickness, but a feeling of overall wellbeing and happiness. Our place on this spectrum is fluid, meaning that we move up or down depending on what’s going on with our lifestyle. Our diet is just one factor that influences our spot on that spectrum. Other factors would be exercise, sleep, bacteria, pollution, radiation, recreation, love, family… So many things!

The wellness industry would like to have you believe that if you eat vast amounts of special superfoods, (cacao, kale, acai berry), drink their powdered ancient berries, use a special appliance that ‘extracts nutrients’, drink nothing but juice for a week, inject vitamins intravenously, cut out wheat, eliminate dairy, eat only raw food or follow their specially formulated program that you will achieve a new spot on the spectrum. I like to call this spot ‘super-duper-extra’ healthy.

When I see the labels of these superfood products, hear the sales pitch of a supplement company, watch the infomercial of a special blender or read the information booklet of a detox or cleanse, I can’t help but feel like the product is trying to sell me an enlightened level of healthiness. That it’s not enough to be alive, well and happy. That there’s another level you can achieve that will make you more healthy, more beautiful, have more energy and be more happy.

I don’t think that this extra-healthy spot on the spectrum exists. You’re either healthy or you’re not. And that’s the end of it.

Now, I’m not saying that if you use these products or adhere to these dietary patterns that you have orthorexia. Please don’t misunderstand me. It’s just that the majority of these products or programs are not based on good evidence; they’re just backed by hefty marketing budgets. You don’t need that powdered super berry to be healthier. Everything your body needs comes from food. You don’t need a blender that ‘unlocks’ the nutrients in your food. You have teeth and digestive enzymes for that. I could go on. What I’m saying is that we don’t need to strive for this extra state of healthiness, it just doesn’t exist.

Save your money and your time.

When healthy eating becomes an obsession

Back to orthorexia. The key word here is ‘obsession’. Like I said previously, there is nothing wrong with wanting to eat well the majority of the time. I fully support this and help people do it every single day. But that’s where it needs to end. Your diet doesn’t need to be perfect, it just needs to be consistent. One piece of cake won’t instantly clog your arteries, just like one bunch of kale won’t cure you of cancer.

You don’t have to consume a certain amount or type of superfood each day. In fact, meeting the dietary guidelines of five serves of vegetables and two serves of fruit each day is as super as you’ll need! You don’t need to cut out every single gram of sugar, nor is bread and pasta an evil dictator telling your body to store fat on your stomach. In excess, these foods are not good for our health. But that’s the same for broccoli or carrots. In excess, broccoli damages your thyroid but one to two serves per day is totally fine and promotes good health. There are documented cases of people dying from eating too many carrots.

What happens with orthorexia is that people think that their ‘clean’ eating habits are leading them towards the “super-healthy” end of the spectrum. In reality, the restrictive nature of their eating patterns can cause a shift in the opposite direction. There are some cases of orthorexia where people find themselves in poor health through malnutrition – the very thing they were trying to avoid.

These obsessive eating patterns can also start to cause severe levels of worry and anxiety when sufferers are faced with a situation where they can’t control the food or they don’t know where it came from. This leads them to thinking and planning about food so much that it impairs their ability to do other things, or avoiding social situations and becoming isolated. I’ve seen the phrases ‘”disordered thinking” and “psychological torment” used to describe the mental state of people whose healthy eating habits have become extreme, obsessive and restrictive.

The diets of sufferers of orthorexia usually become more compulsive and restrictive over time. So what may start out as a balanced approach to improve one’s diet spirals out of control as more and more food groups are unecessary eliminated.

Is moderation a dirty word?

Health, particularly in the area of nutrition, is about finding the balance between two extremes. Take sun exposure and vitamin D, for example. We know that too much sun exposure can increase our risk of skin cancer. Noted, stay out of the sun. However, we now also know that low levels of vitamin D, due to limited sun exposure, also increases one’s risk of cancer. Hmmmm… the sun giveth cancer and the sun taketh cancer away. So we need a little bit of sun, but not too much.

I genuinely, 100 per cent without a doubt, believe that the answer to good health, through good nutrition, is moderation. It’s such a weird word: moderation. I’ve heard one particular personality say that moderation is a just an unhealthy person’s excuse to eat whatever they want. I disagree.

The definition of moderation is the avoidance of excess or extremes. Moderation doesn’t mean eat whatever you want. The following two sentences, co-existing, is what moderation means to me:

You only live once, so get the best out of your body by feeding it well.

You only live once, so enjoy your life (and your food) to the fullest.

The two must go together. We must strive for a healthy balance, specific to ourselves, within these two extremes. You can’t have a perfect diet at the detriment of your social life, mental health and with the risk of malnutrition. You also can’t have the most epic social or ‘fun’ life at the detriment of your health through excessive poor quality food and alcohol.

If you suspect that your healthy eating patterns have become unhealthy with what you’ve read today or you know someone who may be struggling, encourage them to get help. It’s not healthy to feel anxious, stressed, guilty or worried about food choices. It’s not healthy to avoid social situations because you’re worried about food or to spend excessive amounts of time planning, shopping and thinking about food. It’s not healthy to eliminate foods because they’re not ‘clean’.

My private practice, The Healthy Eating Hub has a team of qualified nutritionists and dietitians who can help. We’ll get your diet meeting your nutrient needs, offering you the right amount of energy and helping you achieve a healthy balance so you can concentrate on what’s most important to you – getting on with your life!

Article by Kate Freeman

Registered Nutritionist. Writer. Presenter. Home cook. Mother. Wife. Runner. Hiker. Amateur photographer.