A fixation on “healthy” eating can lead to an unhealthy set of problems, especially when people eliminate many products and foods from a normal diet. Orthorexia nervosa, a term coined by Colorado physician Steven Bratman, defines this subset of people who are obsessed with eating healthy.
A 2008 study published in the Turkish Journal of Psychiatry, for example, reported a strong correlation between those who exhibit obsessive-compulsive tendencies and orthorexia, and found that women were more prone to developing the disorder.
The main categories for eating disorders are anorexia nervosa, where a patient severely limits eating and weight, bulimia nervosa, characterized by binging and purging episodes, and eating disorder not otherwise specified. Orthorexia would fall under the third category, but many experts believe that many of its symptoms may align it with anorexia.
“Foods get categorized in both disorders as good or bad. So with orthorexia, food makes you healthy or not. With anorexia, it makes you fat or not. But either way they get the good-bad categories and the ‘bad’ gets cut out,” says Ellen Astrachan-Fletcher, a clinical psychologist and director of the eating disorders clinic at the University of Illinois at Chicago.
She explained that many orthorexics might initially start eliminating some foods because they believe their health will improve in the process. While anorexics are afraid of getting fat, orthorexics care less about their weight and more about their perception of health, said Astrachan-Fletcher.
Restricting and eliminating certain foods from the diet can be done in a healthy way, said Kelly Devine, a Chicago-based nutritionist and founder of Devine Nutrition in Chicago. For example, vegans, who eliminate all animal products from the diet including honey, and even raw foodists, who stick to a mostly raw diet and don’t heat foods above 116 degrees, can be healthy. The gold standard for determining healthy diets can be evaluated using lab tests, such as checking for blood sugar levels, said Devine.
Treatment options remain similar for orthorexia and other eating disorders and, as such, orthorexia doesn’t merit a separate category, said Astrachan-Fletcher. Also, there’s a high-level of crossover when it comes to eating disorders – a bulimic can become anorexic, or vice versa. And during the course of treatment, both anorexics and bulimics move through variations of eating disorders.
Orthorexia should be treated as anorexia, said Astrachan-Fletcher. According to the National Institutes of Health (NIH), the treatment for anorexia is three-pronged: “restoring the person to a healthy weight, treating the psychological issues related to the eating disorder, [and] reducing or eliminating behaviors or thoughts that lead to disordered eating, and preventing a relapse.”