Orthorexia, sometimes referred to as orthorexia nervosa, is a perfect example of too much of a good thing. People who exhibit this behavior are so fixated on healthy eating that it becomes an obsession, which ironically can lead to poorer quality of life and health.
Dr. George Christophi, a gastroenterologist with Orlando Health, says the condition goes several steps beyond trying to eat a healthy diet.
“Most studies have found that it takes the majority of people several years to go from having a well-balanced desire to be healthy to practicing this obsessive behavior,” says Dr. Christophi.
The National Eating Disorders Association reports that many individuals with orthorexia also have obsessive-compulsive disorder or OCD.
Dr. Christophi explains that lack of awareness is the biggest problem because the condition isn’t commonly discussed or well recognized, even though it’s estimated that 2 percent of the population in the U.S. and 7 percent in Europe have it.
Orthorexia – a term was first coined by American physician Steve Bratman in 1997 – is actually considered a form of “disordered eating”, which refers to food- and diet-related behaviors that don’t meet diagnostic criteria for recognized eating disorders but may still negatively affect physical, mental or emotional health.
“There are warning signs of orthorexia that should raise a red flag for patients, the people who interact with them, and their doctors,” says Dr. Christophi.
“They include picky eating, losing enjoyment of eating, avoiding certain foods even if you like them and there is no legitimate health reason to reject them, and continuous preoccupation with avoiding undesirable food.”
Other symptoms include cutting food into small pieces, slowing down the pace of eating, or otherwise attempting to trick yourself into feeling fuller from less food, and following overly strict food rules or rituals.
The Center for Discovery explains the differences between anorexia nervosa and orthorexia nervosa. Although they share the same Greek root word, “rexia,” meaning “hunger,” they are drastically different from each other. For starters, “ana” means “without” and “ortho” means “right,” indicating that individuals who struggle with anorexia nervosa will go through drastic measures to restrict food whereas individuals with orthorexia nervosa will go through extreme steps to eat only pure foods.
Dr. Christophi explains that diagnosis can often be nuanced. “Is it [harmless] obsessive behavior? Or does it lead to clinical impairment resulting in physical or emotional problems?
“If the latter description fits, it’s orthorexia.”
Since much research on the condition is relatively new, information on risk factors is sparse.
“We know there are no clear differences relative to gender,” says Dr. Christophi. “But there does appear to be a higher risk factor for those of Hispanic or Latino background, and people who were formerly overweight.”
Dr. Christophi believes only about one-third of people who have orthorexia also have additional conditions such as anxiety, obesity or obsessive-compulsive disorder.
The treatment of orthorexia requires a multi-disciplinary team, explains Dr. Christophi.
“Cognitive behavioral therapy is often effective. Patients need to be coaxed to slowly expand the list of foods with which they’re comfortable and learn that the new foods won’t cause them harm.”
WebMD, a website that provides health information and services, lists other common treatments:
- Exposure and response prevention: The more you’re exposed to the situation that causes you anxiety, the less it’ll upset you.
- Behavior modification: Understanding the negative effects of your actions so you can change what you’re doing
- Various forms of relaxation training, like breathing exercises, guided imagery, mindfulness meditation, yoga and tai chi
A diet as limited as the one adhered to by someone with orthorexia is bound to have negative physical side effects, according to Dr. Christophi. “Loss of weight, malnutrition, vitamin deficiency are common,” he says.
There are psychological and social effects, as well.
People with orthorexia can experience intense frustration when their food-related habits are disrupted. Breaking self-imposed dietary rules can cause feelings of guilt and self-loathing or a compulsion toward “purification” through dangerous cleanses or fasts.
They spend a lot of time scrutinizing whether certain foods are “clean” or “pure” enough.
Outside of meals, they may spend extra time researching, cataloging, weighing and measuring food or planning future meals.
On the social side, those with orthorexia feel anxious or threatened when they consider giving up their perceived control around food. They often follow strict self-imposed rules dictating which foods can be combined in a sitting or eaten at particular times during the day.
These rigid eating patterns can make it challenging to take part in social activities revolving around food, such as dinner parties or eating out.
“The most important thing is awareness,” says Dr. Christophi. “If you suspect that you or someone you care about may be suffering from orthorexia, ask questions. Your doctor may pick up on it, but that’s not always the case.”
George Christophi, MD, Ph.D., is a gastroenterologist with Orlando Health specializing in inflammatory bowel disease. He is accepting new patients at his Palm Bay office located at 5151 Babcock Street NE. Call 321-637-2345 to schedule an appointment.
