What is Orthorexia?

November 28, 2016

by Stephanie Sarra, Dietetic Intern

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Most of us understand that consuming a well-balanced diet nourishes our bodies as well as our minds. Then why is it that a strictly healthy diet can be unhealthy? Too much of anything – good or bad can be problematic.  Orthorexia nervosa is defined as “compulsive behavior and/or mental preoccupation regarding affirmative and restrictive dietary practices.” While orthorexia can be viewed as merely being extremely cautious about eating healthfully, this obsessive focus on making healthy food choices, can eventually lead to an eating disorder.

So how would orthorexia develop into an actual eating disorder? A lot of time, people with orthorexia will cut out entire food groups. For example, someone may start by totally excluding refined grains. This in and of itself would not be harmful. In fact, refined grains are known to cause undesirable spikes in blood sugar and may be in foods that also contain high amounts of added sugar. However, over time, this restriction may grow to include grains of any sort – both refined and good-for-you whole grains.

“What’s the big deal?” you might ask. Cutting out a major food group for long periods of time can lead to malnutrition. What may begin as a means to avoid unhealthy food items (ie: white bread, pastries, cake, etc.) can quickly lead to certain deficits in the diet if an entire food group is strictly avoided. For example, cutting out grains, can lead to iron and fiber deficiencies, if these nutrients aren't found in other parts of the diet. Even more than that, psychologically speaking, it can lead to unhealthy restrictive behaviors around food. The restrictions may grow more severe, cutting out additional food groups, and leaving a person with an inadequate diet.  In the most extreme cases, orthorexia may even lead to anorexia.

Aside from having nutritional implications, orthorexia can also lead to social isolation, anxiety, and depression. So much of today’s socializing revolves around food, which for people with overly restrictive diets can be problematic. Going to someone’s house for dinner and not knowing what will be offered can be extremely anxiety provoking for someone who has ruled out so many foods. Work meetings with colleagues or clients can also be difficult, especially when a set menu is involved. As a result, many people with severe orthorexia will often eat alone to stay in complete control of what they put in their mouths.

In addition to missing out on everyday social interactions, people with orthorexia will also hold back during those particular moments in life where we purposefully might “splurge.” For example, on your birthday you’ll likely indulge in a slice of birthday cake; traveling to Italy, you’ll likely order some perfectly al dente pasta and finish it off with a scoop of creamy gelato. You’ll do this knowing that these are special occasions and therefore the decadence involved can be enjoyed without ruining your generally healthy lifestyle and diet. Someone with orthorexia won’t, and if they somehow did, the guilt they would feel after would be overwhelming.

The inherent difference between someone with orthorexia and someone with healthy eating habits is their understanding of what it means to follow a healthy diet. Someone with orthorexia lacks balance. Those moments of indulgence that we described earlier are actually part and parcel of a healthy lifestyle and diet. They give us a break from the discipline we strive to maintain. Conversely the discipline we do maintain on a regular basis allows us to indulge during those moments without any guilt. The problem is, for a lot of people, striking that balance is not easy. If you find that you are having trouble with it, seeking the help of a registered dietitian is a great way to start building the skills and developing the knowledge to achieve a healthy diet, cake included!

What do you do if you feel like you have orthorexia nervosa?

• Work with a registered dietitian to develop a well-balanced meal plan.
• Try to slowly include a certain food that you once loved in your diet.
• If you feel signs of guilt, anxiety, or body image distortion, visit your therapist for social support.
• Join a social support group with other peers that may share similar experiences as you.

And for more information, check out this orthorexia fact sheet.

References:

Bratman S, Evans M, Setnick J. Orthorexia Comes of Age: Perspectives on the "Healthy" Eating Disorder. Academy of Nutrition & Dietetics. Food and Nutrition Conference Expo 2016.

Kelty. Orthorexia Nervosa. NCAA. refer to: https://keltyeatingdisorders.ca/wp-content/uploads/2016/05/Orthorexia-Nervosa-Fact-Sheet.pdf

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