In the name of health, part three

Orthorexia nervosa, or an obsession with "healthy" or "pure" eating, is generally considered a type of eating disorder, even though no formal definition exists. Clinicians have been saying that this unhealthy obsession with healthy food has been increasing the past few years, and I wouldn't be surprised if that was the case. Becoming more aware of what we eat (which is good) has also fueled the worries of those who aren't sure what to eat. Everyday, it seems, some new research adds another item to the litany of things we should and shouldn't eat.

How could you not be anxious?

Steven Bratman originally coined the term "orthorexia" in the 1990s, after himself suffering from the condition, and explains it as follows (excerpted from a Smithsonian Blog on the subject):

Orthorexia begins, innocently enough, as a desire to overcome chronic illness or to improve general health,” he writes. “But because it requires considerable willpower to adopt a diet that differs radically from the food habits of childhood and the surrounding culture, few accomplish the change gracefully. Most must resort to an iron self-discipline bolstered by a hefty dose of superiority over those who eat junk food. Over time, what to eat, how much, and the consequences of dietary indiscretion come to occupy a greater and greater proportion of the orthorexic’s day.”

I started to twitch just a bit when Bratman says "willpower." Because it's not willpower. It's fear. And fear is a remarkably strong motivator. Sufferers of orthorexia aren't avoiding foods because they're "better" or "stronger" than those Oreo-loving, Cheez-Whiz guzzling "normal" folks. It might seem that way--when I was restricting, I often used words like "strength" or "willpower" as so-called motivation. Yet these words cloaked what was really going on: I was afraid to eat. It's a pretty bizarre concept, when you get right down to it, and my brain understood it much better when I thought I was super-strong because I could exist on a diet of lettuce and air.

A sub-headline on a MomLogic blog post about orthorexia explained it much better: Obsessive-Compulsive Driven Disorder. Although I've never been obsessed with food in a strictly orthorexic way, I do have OCD and anorexia, and I know quite a bit about food obsessions. I wouldn't call anorexia the same as OCD, but there does seem to be a significant amount of overlap, both in personality traits and the percentage of anorexics who also have OCD. And orthorexia also seems similar to OCD, with the obsessions focusing on quality of food rather than calories and fat grams.

But Bratman says there is one main difference between anorexia and orthorexia:

"Someone with anorexia does not see her/himself as emaciated, but as fat. Where someone with orthorexia is aware of their extreme thinness but is fine with this, as long as they feel pure."

Except there are well-known cases of non-fat-phobic anorexia, especially in younger children and non-Western countries. So I'm not sure this difference holds up. Another similarity is the fact that both disorders seem to be largely egosyntonic- their illness is giving them the "desired" outcome.

In the end, both disorders can be deadly and debilitating. We need to learn more about orthorexia so that we can start to define it and devise treatments for it.

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I Hate to Weight said...

i don't strive to be a "pure" eater. healthy foods are great -- fresh produce, free range chickens, anything that doesn't include artificial sweetener, et. al. but obsessing about it would drive me crazy.

i really think that when we're healthy, our bodies tell us what they need and want. it's hard to get there, granted, but i don't think our bodies (and minds) want to spend all our time thinking about food and where it came from and what it's made of and all that jazz.

i don't know why this popped into my head but the hold thing doesn't seem very -- sexy

Anonymous said...

First a pet peeve: why does no one use the term "healthFUL" to describe food? People are HEALTHY, food is HEALTHFUL.

Aside from that, I'm just sick to death of reading about both. Even the NY TImes is startting to get my goat with its health and diet articles on the annoying Well blog. Will this food madness ever end? Not as long as we publish calories on menus and have mazines of ALL types preaching HEALTHFUL eating. If it's an obsession, it's a national affliction.

Kim said...

I hadn't even heard of orthorexia until I entered the blog world. More and more, I'd say I suffer from this more than anorexia. Case in point: I'd rather eat Breyer's ice cream with "all natural" ingredients than fat free frozen yogurt with a bunch of chemicals. I get very caught up in the "health" of a food. I'll eat pretty much anything if it's "healthy." While this seems innocent enough, I've seen how it has a hold on my life. I have to keep coming back to the idea that it's just food.

Anonymous said...

orthorexia defines me in a nut shell. i am ridicuously obsessed with what i find as good food and pure food. i refuse to eat anything with more than maybe 3 ingredients and even thats a stretch.

i eat farm raised free roaming eggs, pasture butter, cream and raw organic cheese, and meat, soon to be grass fed meat.

there is no consumption of food outside this parameter for me because i view EVERYTHING most people eat not even as food. someone can put a plate of pasta or a cupcake in front of me, and i see it a poison...its not food, nor were humans EVER meant to consume it.

while i dont see it as a bad thing, i just simply choose not to eat food that is not food. i dont think im missing out on anything because i dont have toast, fiber or chemically altered is just food by the way, just eat what IS food and get on with life.

i am a recovered anorexic by the way and i do understand how this plays into my past, however im healthy as a horse by any doctors standards

Anonymous said...

Well I would rather eat Breyer's ice cream than fat free frozen anything, because to me fat free frozen anything tastes like crap.

I also eat locally grown fruits and veg, and locally raised grass fed meat. Why? It tastes better, has a lesser toll on the environment than pesticides, shipping grass fed beef from New Zealand or supporting the cruelty and poor environmental stewarship of factory farms. On the other hand I do eat bread and cakes from a wonderful local bakery.
My point: there are many reasons why people eat the way they do. It seems to me that (not aimed at the posters here) there is an increase in labeling and denigration of people as "orthorexic" that is very nearly judgmental. Ironic, when I read such columns alongside those promoting calorie counts on menus and condemning a hamburger as evil.


Samantha C. said...

the way I understand it though, it's not orthorexia until it negatively impacts your life. If you're avoiding social occasions because you might be asked to eat pizza, it's a problem. If you're losing your friends because you can't stop telling them how pure and wonderful and awesome your chemical-free diet is, and because you're actively looking down on them for eating things you don't, that's a problem.

Orthorexia isn't about eating farm-fresh and whole grain. It's about coming to believe that any amount of sugar will make your teeth fall out, or that eating a steak once a year on a special occasion will clog up your arteries and you'll have a heart attack right there and then. It's when you're afraid to eat foods that aren't 100% within your parameters of "pure".

There was a NY Times article that I used as a jumping-off point for a presentation about Orthorexia in my bio class last year. One anecdote was about a girl who was talking to a nutritionist because she wasn't eating, she was becoming dangerously thin. She didn't seem to show symptoms of eating disorders on her own, but she didn't like the food her mother served-- the battle food was brown rice. The girl would eat white rice, but hated brown enough to not eat it at all. When the nutritionist suggested that the mother might want to serve white rice so her daughter wouldn't starve, the mother berated him about how "white rice is just like eating sugar", and her daughter wouldn't be poisoned with it. ( article here)

THAT'S Orthorexia. The inabiliy to recognize that while brown rice is more healthful than white rice, white rice is more healthful than nothing.

Carrie Arnold said...

Harley raises a really good point: that it's not a disorder until it negatively impacts your life. With EDs I hesitate to say that as it can be used to justify any number of unhealthy behaviors. You can be essentially blind to those negative impacts, but that doesn't mean they're not there.

I don't think "healthful eating" and being conscious of your food is necessarily bad. We all have our preferences and styles of eating.

As a society, we're very confused about food and eating, and that's where we start throwing labels around like orthorexic and junk food and the rest of it.

Crimson Wife said...

I actually passed up an opportunity to have my DS be in a co-op preschool because I had an issue with the heavy-handed rules they had regarding food. The snacks provided by the parents had to be nut-free (fine), vegan, no trans fats or saturated fats, no HFCS, no artificial colors, and on and on. I'd be willing to bet quite a large sum of money that at least one (if not more) of the moms in that group suffers from orthorexia.

I try to feed my kids a fairly healthy diet but this was WAY over the top. So I decided to pass...

Entangled said...

I went through this and it's hard to articulate exactly how it differs from eating natural and eating well, but it does. I think for me it started because my metabolism would not allow me to eat as little as I thought I should, so I decided every single meal or snack needed to be as healthy as possible. I would avoid eating rather than eating something I deigned a bad food, even if I was shaking with hunger. I ate so much fiber that I had serious intestinal pains pretty much every day. I once threw a tantrum when my boyfriend dared to saute something in more than a teaspoon of oil.

I was eating healthful foods, but I was not eating healthfully. Food was definitelty a battle zone and despite putting so much thought into it, I was still eating far less than I needed - at least 1-2 hours a day were spent battling hunger headaches and dizziness.

I still eat a lot of vegetables, a lot of fairly natural unprocessed stuff because that's the kinds of food I like. But I've managed to move past doing it in a way that abused myself both mentally and physically. Mostly. The one side effect is I absolutely cannot tolerate preachiness and morality around eating.

e.m.b. said...

Thank you so much for writing this powerful post. It brought tears to my eyes to know that I am not alone, and no finally look at where I have been and what I have struggled with. I have celiac disease, and after diagnosis, when I was still feeling rotten, I turned to a raw food diet. I thought whole, natural foods would help heal me. I lost 40 lbs. off my already thin frame. I started eating cooked foods again, because my mom told me I was dying. I hated seeing her cry. So, I ate.

Orthorexia is SO hard, because I thought I was being "healthy." Not processed....LOTS of fruits and veggies....I had the model diet! People were impressed and asked my advice and yes, that felt good (even while my stomach still did not.)

I wouldn't eat out. I wouldn't eat anything other people made.

I am trying to eat more, and teach my intestines how to digest again. It feels uncomfortable to eat more than green smoothies and vegetables...

Now, I am rambling. But thank you. Thank you, for writing about orthorexia.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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