It’s 2015 and dieting is officially passé.
Instead of counting calories and fat grams, the next generation of disordered eating includes going raw, eating clean, or going gluten-free. Few self-identify as dieters; by now everyone knows that “diets don’t work.” Instead, new and even more draconian methods of food restriction fly under the radar as healthy “lifestyle changes.”
Don’t get me wrong. As an eating-disorder therapist I welcome our societal willingness to soften our previously unhealthy focus on food quantity. However, I’m concerned that we are replacing it with an equally unhealthy—and perhaps more insidious—obsession with food quality.
Because let’s face it: Eating more raw vegetables is a lifestyle change, but eating only raw vegetables is disordered eating. And that’s what some might describe as “orthorexia.”
What is “orthorexia”?
Simply put, orthorexia is an unhealthy obsession with healthy eating. Physician Steven Bratman coined the term nearly 20 years ago by combining the Greek “ortho” (meaning “right” or “correct”) with the more familiar term anorexia nervosa. Importantly, orthorexia is NOT an official DSM-5 diagnosis because “orthorexic” attitudes and behaviors can occur across the spectrum of disordered eating—from anorexia to bulimia to binge eating disorder to other specified feeding or eating disorder. Indeed, whereas the media often covers “orthorexia” as a separate illness, clinicians may be more familiar with orthorexic features occurring along a continuum and that is present in some but not all forms of disordered eating.
For example, a boy who denies fat phobia but maintains a low weight because he eats little more than kale and Greek yogurt could have an orthorexic version of anorexia nervosa. Similarly, a woman who “eats clean” on weekdays, binges on processed foods on “cheat days,” and later tries to compensate for her perceived transgression by drinking detox tea may have an orthorexic variation of bulimia nervosa.
But isn’t eating healthy, well… healthy?
As Jenni Schaefer and I explain in our book, Almost Anorexic: Is My (or My Loved One’s) Relationship with Food a Problem, an obsessive focus on healthy eating can be a smokescreen for an eating disorder—something we refer to as “dieting in disguise.”
It doesn’t matter whether you are obsessing over calories or quinoa: If thinking about food or eating is interfering with your ability to take part in valued activities or leading to negative consequences such as irritability, nutrient deficiencies, cold intolerance, or excessive weight loss, you might have an eating disorder.
Perhaps more insidiously, “orthorexia” can profoundly affects one’s identity. While dieting is something you do, being vegan or macrobiotic is something you are. In my clinical experience, patients with “orthorexic” presentations are often delayed in seeking treatment because their purportedly purifying behaviors become a positive part of their identity, and may elicit more admiration than concern from loved ones.
Do I have a problem?
Some efforts to eat healthy are just that—healthy. To determine if you or a loved one might be dieting in disguise, consider whether you would respond “never,” “sometimes,” “often,” or “always” to the following items selected from the Questionnaire for the Diagnosis of Orthorexia (ORTO-15)*, which evaluates so-called “orthorexic” attitudes and behaviors:
- When you go in a food shop do you feel confused?
- Are your eating choices conditioned by your worry about your health status?
- Does the thought about food worry you for more than three hours a day?
- Do you feel guilty when transgressing [i.e., eating unhealthy foods]?
- At present, are you alone when having meals?
Scoring mostly “often” or “always” indicate probable disordered eating, as suggested in a recent study (http://www.ncbi.nlm.nih.gov/pubmed/16682853). Note that you could absolutely still struggle with an eating disorder—perhaps one characterized by less “orthorexic” attitudes and behaviors—even if you say “never” to all of the items above.
This confidential onlince screening can also help you determine if it's time to seek professional help.
How do I know where to draw the line?
Here is a simple exercise to get you started. Using the handout below from Almost Anorexic (link to http://www.jennischaefer.com/wp-content/uploads/2013/06/AlmostAnorexic_T... ), describe any dietary rules that you are attempting to follow and any methods you are currently using to try to compensate for food you have already eaten. If you don’t think you are trying to follow any rules, ask yourself whether you would feel guilty eating differently than you currently do. Then comes the hard part—examining the rationale for each behavior.
First write down what you tell yourself or others (e.g., “I avoid all processed foods in order to avoid getting cancer like my dad”). Next, write down any possible, more eating disordered alternatives (e.g., “I want to lose weight” or “I want to feel in control”).
Once you’ve summarized any potentially orthorexic behaviors, consider whether these might be negatively impacting you and if some of them might be worth changing.
The bottom line?
Whether you are dieting or detoxing, eating disorders are treatable and help is available. Despite what you may read, there is really no “right” way to eat. If you have concerns about your habits or your relationship with food, talk to a professional.
*The Eating Disorders Clinical and Research Program at Massachusetts General Hospital is currently recruiting participants for an NIMH-funded study. If you are a female between the ages of 10 and 21 years old you may be eligible for a research study using magnetic resonance imaging (MRI) to investigate the relationship between hormones, brain activity and appetite. Click here to learn more.
