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  • Aug. 2, 2011

    Orthorexia — When eating healthy goes awry

    By Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D.

27 comments posted

Everyone can benefit by paying more attention to choosing healthy foods, right?

For the most part, yes. However, a small number of people seem to become obsessed with the "perfect diet." These individuals fixate on eating foods that make them feel pure and healthy — to the extent that they avoid foods with any: 

  • Artificial colors, flavors or preservatives
  • Pesticides, genetic modification
  • Unhealthy fat, sugar or added salt

For some people with orthorexia:

  • Preparation techniques must result in "clean food," meaning it's been washed multiple times, cooked to ensure no bacteria and minimally handled.
  • Eating out is out of the question because it's important to avoid food that they don't buy and prepare.

The term "orthorexia" has been used to describe this disorder. It comes from the Greek words "orthos," meaning straight or proper, and "orexia," meaning appetite. According to experts including Dr. Steven Bratman, the doctor who first described and named this disorder, what tips the balance from being committed to healthy eating and having orthorexia is the extreme limitation and obsession in food selection. Orthorexics find themselves being unable to take part in everyday activities. They isolate themselves and often become intolerant of other people's views about food and health.

Studies have looked to at whether this disorder is more common in groups more likely to have a keen interest in a healthy diet, such as medical residents, dietitians, students in nutrition, fitness club members and those in the performing arts (ballet, symphony orchestra and opera singers). Each of the professions studied showed some incidence. However, the studies were unable to determine if the incidence was higher than that in the general population.

Health professionals have proposed that orthorexia be officially recognized as a new mental disorder. Currently it remains controversial and grouped with other not yet accepted disorders such as night eating syndrome, muscle dysmorphia (obsession with muscle building) and emetophobia (constant fear of vomiting).

Whether it's recognized as a true medical problem or not is beside the point. It's important to seek professional help when striving for a healthy diet becomes an overwhelming drive that takes over. Orthorexia that features obsessive compulsive behaviors can be effectively treated with medication and cognitive behavioral therapy by a trained therapist.

27 comments posted

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  • January 1, 2012 11:16 a.m.

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    - xutygmj

  • August 13, 2011 3:49 p.m.

    C'mon you guys. Many of you posting a comment have not gotten the real gist of this article: "... what tips the balance from being committed to healthy eating and having orthorexia is the extreme limitation and obsession in food selection. Orthorexics find themselves being unable to take part in everyday activities. They isolate themselves and often become intolerant of other people's views about food and health." Those who wrote the article are talking about the extreme nature of a true obsession -- not to be confused with healthy eating habits.

    - SusanB

  • August 10, 2011 10:04 a.m.

    Anything taken to an extreme is harmful. I don't believe the point of the article is that carefully monitoring what you put in your body is a disorder. The mindset that you can only eat peticide free, artificial color free,preservative free, free range, organic, etc.... to restrict your calorie intake and therefore control your weight becomes very unhealthy and is a disorder. This lifestyle choice has more to do with body image than maintaining a healthy diet.

    - Paula

  • August 9, 2011 7:55 p.m.

    This article totally ignores the FACT of allergies to specific preservatives and chemical sensitivity--an increasing phenomenon, especially among older women. Not a balanced view.

    - k

  • August 9, 2011 2:18 p.m.

    I am surprised to see that avoiding artificial colors, preservatives, GMOs, pesticides, sugar, salt and unhealthy fat is now a disorder. I have eliminated these things from my nutrition plan and have enjoyed greatly improved health, more lean mass, lower body fat, and have significantly improved my lifting strength. I'm concerned that a respected institution like Mayo would suggest that it's okay to eat these things. I agree with Susan; read Eat to Live.

    - Susan

  • August 4, 2011 12:36 p.m.

    Obsessing over food to the point where it disrupts normal living is clearly disordered. The article has that part right. But there is nothing wrong with avoiding unhealthy processed foods. The article has it wrong there. Unhealthy added fats, sugars, salts, etc... in processed food all have been shown to cause disruptions in appetites and metabolisms, making people who are struggling with weight and overeating blame themselves for losing control when really it is the food they are eating that is messing with them. Processed diet foods are particularly bad culprits which is completely messed up since the very people who need the most help are being targeted the heaviest. Seriously, check out _Eat To Live_ by Dr. Joel Fuhrman. I really don't think he has Orthorexia. The whole United Kingdom banned the use of artificial colors in foods because they know how bad they are. And pesticides can cause cancer, CANCER. Leave it to Americans to delude themselves into thinking that being healthy is unhealthy.

    - Susan

  • April 28, 2011 12:56 a.m.

    I know someone who went through and is going through this organic, home remedy regimen. I totally agree with healthy eating, but this was carried to an extreme. After a couple of years of doing this, her daughter and then she found they had developed many food allergies. Dr. said she did herself no favors with the diet. Now she eats even less and is very frail. I was actually glad to see there is a term for this and hope she goes for help. Many small health things are occurring and I am very concerned.

    - Sandy

  • March 30, 2011 4:55 p.m.

    I don't believe this to be a legitimate disorder. There is a lot of scary hype out there regarding the condition of our food supplies, etc. I can see how some people may react to this in a self-preserving sort of way; especially if very young and impressionable. Personally, I'm at the age where I'm over the perfect eating/body phase, but it is still an important, daily consideration. Honestly, I think that orthorexia was conceptualized by a mentally and emotionally unstable individual that feels threatened by those that choose more healthfully responsible lifestyles.

    - Rouillie

  • March 10, 2011 12:39 a.m.

    Since when is avoiding foods made with pesticides,GMO, artificial colors, unhealthy fats,etc... considered so wrong that it needs to be labeled as an eating disorder? Are you nuts? Maybe the growing number of thinking people who refuse to follow your "healthy" diet advices is giving you a big scare or you are so brainwashed that you don/t know what you are talking about!Either way I am discusted and sorry that I read your article. Who knows probably tomorrow I will find that I need psychiatric treatment because I refuse to drink water contaminated with all kinds of "goodies"produced by our chemical society.

    - Vanya

  • May 12, 2010 10:24 p.m.

    Just thought I'd say, I agree with Shelby. This Orthorexia seems to be a psychological problem with major physical effects on one's body. I can tell you I know firsthand because if this was a true, classified disorder, I would be diagnosed with it. As an OCD perfectionist, my body image relies on my obsession with self control. I avoid and refuse to eat food I have not prepared myself and food I consider 'bad' food(i.e. food with perservatives, hydrogenated oils, animal products, high fructose corn syrup, and so on). To a normal person, that may seem like a ridiculous idea, but to me, it's my lifestyle and I take it seriously. I'm also a vegan, so I don't eat ANY animal products(NO milk, eggs, meat, fish, etc). To prepare my meals doesn't take up ALL my time in the day(though it does take time), since I'm actually a professional cook(odd, isn't it?). I can cook amazing meals for others(yes, even with animal meats and seafood), but I won't eat the meal myself. Instead, I usually make myself a salad or soup or sandwich. About 99% of the food I purchase is 'organic' or 'natural', and I ALWAYS read the labels. My BMI is currently 17.6 since I'm 5' 2'' at exactly 96 lbs. Although, I don't excercise much, if at all. The one thing I don't agree with is about a guy who came up with a certain diet that orthorexics follow? I never heard of such a thing. My anorexic behaviors started all of a sudden after a great deal of family related distress, following the still ongoing depression.

    - Marie

  • January 5, 2010 2:16 p.m.

    What a scary thought, especially at this time of year when people are trying to follow their New Year's Resolutions of staying healthy! It's hard to think that one could go too far with striving to become healthy to the point that the journey itself becomes an unhealthy obsession. I've been researching Orthorexia all afternoon, and actually just stumbled upon a neat article by a woman named Dina Zeckhausen, a psychologist in Atlanta. Here's an excerpt of just a little of what she has personally experienced: "The other evening an acquaintance’s rail-thin 11-year-old daughter proudly showed her mother her washboard abs after running on their treadmill for two hours. “Good for you!” her mother beamed proudly. (Why wasn’t this girl playing in the backyard?) This same mom berated a mutual friend who took her two daughters for ice cream after they’d eaten Chinese food. “Why would you do something like that?” she asked incredulously. “Uhm, to enjoy life?” my friend responded." Here's the link to the rest of the article in case you want to finish it: http://www.sharewik.com/blogs/86995 Great article though! This is great advice that anyone striving to get in shape should keep in mind. I think that everyone should be aware that this is a serious disorder that requires significant attention. Thanks again!

    - Diana

  • September 11, 2009 11:03 a.m.

    I think with all of the different foods and convenience of fast food these days, people really need to learn what they are putting in there body. Using a tool such as a calorie counter can teach you about the types of foods you put in your body. Not so much obsessing about the calories, but learning about them. If people were to know about the kinds of foods they eat from day 1, they might be more likely to have a healthier lifestyle and see food as fuel instead.

    - Wade

  • September 8, 2009 9:51 p.m.

    As if you're not stuck eating your usual fare, the same as your friends and colleagues! Do you know anyone outside your own culture? Ever heard the word diversity? Could you eat in a restaurant that offered food other than what you're used to? Or would you just make fun of people who choose differently than you. The assumptions you make about other tastes is not what I'd expect from a doctor.

    - Cynthia

  • August 10, 2009 7:02 p.m.

    If, as Shelby points out, this is an extreme condition, and that people with this condition stop eating altogether, I would suggest this has not been conveyed correctly in this article. The opening paragraphs highlight:"Artificial colors, flavors or preservatives Pesticides or genetic modification Unhealthy fat, sugar or salt " as food ingredients people may be avoiding. Many people are avoiding these, on a daily basis, and manage a healthy diet by mostly home cooking, spending more time than the average American in doing so and caring about their health. I don't think there was a sensible balance in this article. It did not convey well enough that putting some effort (ie, time and money) into eating good and uncontaminated food is perfectly OK.

    - Fran

  • August 2, 2009 5:27 p.m.

    It seems like a lot of people are missing the point in the comments. This is an extreme problem, not comparable to someone watching sugar for diabetes or sodium for a heart problem, or even a dieter. Orthorexia is a psychological problem more than anything with devastating effects on physical health (which is of course intertwined with emotional health). Because those with Orthorexia are so obsessed with the purity of their food, they would rather not eat than eat something "bad." The money and time it takes to buy, plan, and prepare pure food takes up most of a person's day. Because animal products and fatty foods are usually avoided, dangerously low body weight and BMI, not to mention the loss of needed nutrients is common. I believe I've heard that the guy who came up with the pure diet orthorexics try to follow was very underweight and died at a young age anyway, case and point. I think this disorder should be classified in the DSM-V under eating disorders, but I'm sure it would be comorbid with OCD or obsessive personality disorder. The reason a well-balanced diet and an active lifestyle is so often endorsed is because it is the best thing for everyone's bodies.

    - Shelby

  • July 31, 2009 2:10 p.m.

    I think some people would say that I have this condition, but it's by necessity. I am allergic to pesticides, sulfites and many other preservatives, so the only way for me to feel well is to avoid these things completely. When it comes to potluck meals it's much easier just to skip it. The final straw for me - I asked a cook what was in her dish so I could determine whether I could eat it. Well, she forgot to mention worcestershire sauce - a huge problem for me. I had a disabling headache for a day and a half. So yeah, I'm a bit of a freak about what I eat :-)

    - Tracy

  • July 15, 2009 1:51 p.m.

    I saw a show on TV re these people. There ARE people who spend every waking minute obsessing over their food, to the point that they have no time for anything else. It's a real condition. Then there are the borderline types--my housemate is always dieting, but can't lose weight. She is obsessed about cooking, low fat foods, portion control, and cooking appliances that promote all of the above. She still avoids what she really needs to do--eat more vegetables, eat less sugar, and get a hell of lot more exercise. She's happy and has lots of friends and activities. The problem is she spends a lot of money on her obsession, and her house is full of ingredients, appliances, food storage containers, and cook books, none of which she uses. She also has a missions to save the environment and help the needy. So she hates to throw anything out. She has a huge collection of foam coffee cups, individual yogurt containers, etc. I throw out my containers in my room, because she will take them from the kitchen garbage and wash them out and save them. I'm far more obsessed about what I eat than she is, in reality, because I'm so broke, and I have a health problems to deal with, like pre-diabetes and GERD. But I never "diet," I just eat the best foods for me. So she may end up with diabetes, esophagal cancer, and a house so full of junk, it's hazardous. Scary but true.

    - Susie

  • July 15, 2009 11:37 a.m.

    I have a young relative, 20s, who appears to have this condition. She will put virtually no fat into her body; eats only "healthy" foods. It got to the point where she has stopped menstruating. Her doctor has also told her she is affecting her bones which need a certain amount of fat. It's like talking to someone with anorexia however; she refuses to, or can't stop this behavior.

    - nikka

  • July 15, 2009 6:10 a.m.

    I have no appetite and hate to prepare food now. I have copd, barretts esophagus, knees bone on bone, osteoarthritis, Gen. Anxiety Disorder and depression(some),diverticulitis and menopause. Oh, also have had 13 teeth pulled and got a new partial yesterday. Ive tried to eliminate each med temporarily to see what the culprit is and even take xanax, which used to make me hungry. Not anymore.Dont sleep well at night either and just dont know what to do. I hate to cook now(used to love it) so Im thinking its depression/anxiety. I have no interest in food; period! Any ideas? Anyone?ps:lost 20lbs wrong way!

    - jo

  • July 14, 2009 8:34 p.m.

    what could possibly be wrong with avoiding artificial coloring, sweeteners, pesticides ,etc? that's not orthorexia. That is following everything the "experts " recommend. I just wish I had the self-control. Barbara- If I may- I have an eating disorderand it sounds as if your friend may have one- such as anorexia- anorexics ARE starving and DO snap and binge.

    - Deborah

  • July 14, 2009 7:26 p.m.

    I can understand if one is so obsessed that they can't eat anywhere, or prevent their child from indulging occasionally at a birthday party, etc. However, I don't see how harmful it is to be interested in the quality and safety of one's food - again, as long as it doesn't truly interfere with the OVERALL quality of one's life. As for the one person who worried about her son's not eating dairy (one example), you don't need dairy to eat well (as long as you get those same nutrients from other sources). Meat versus legumes? A small amount of lean meat - healthy. You don't need more than three ounces of it. Plants producing more antioxidants due to pesticide and fungicide use? Well, that isn't necessarily good (it says something to me, actually, about how smart plants are) and not all antioxidants have a known use, so more doesn't indicate quality. I think Orthrexia, while a real worry for some people, is just that - a worry for some, very few, people. Obsessing about anything isn't healthy, but we also can't get concerned, interested, informed, and knowledgeable confused with obsessive.

    - Judy

  • July 14, 2009 4:35 p.m.

    I have a friend who is on a diet that controls the time that she eats. She is obsessed about being tiny. When we go to a retaurant, she eats as though she is starving. There is anorexia amang younger family members. Perhaps there is a genetic relationship between orthorexia and other eating disorders such as anoexia.

    - Barbara M

  • July 14, 2009 3:53 p.m.

    My son eats only foods that are either organic or have been washed thoroughly.a few times. These foods are things that can be eaten raw. The protein is not legumes. It is a small amt of either chicken, beef or fish. The hing that is worrying me is that he is obsessed with exercising at least 1 hour per day eveni f it cuts into his sleeping time. He eats no wheat products, no sugar or anything that doesn't come directly from the earth or things that can't be eaten unless they are processed. Ex macaroni, bread He eats no dairy.

    - judy

  • July 13, 2009 5:25 a.m.

    Recent research suggests that the use of certain weedkillers stimulates plants such as sweetcorn to produce more antioxidant nutrients (15% more!) than you would otherwise get, so this whole "organic" thing would seem flawed in that case...

    - David Bradley

  • July 13, 2009 5:15 a.m.

    I'm so glad to see this issue addressed. I have long suspected that such a thing exists and is an emotional problem. I have a male friend who is obsessed with healthy eating and lifestyle. He exercises daily, eats food with little or no fats or sugars, takes multiple supplements, fasts once a week and drinks only teas without caffeine. He became this way after retiring from years in the military and having some neurological issues which may be as a result of his exposure to toxins while in the service. His initial desire was to reduce the effect of toxins on his system by "whole body" cleansing through diet and exercise changes, however, I have observed that it is now the mainstay of his conversations and behavior. In a word, "obsessive". He is a bachelor and has the luxury to indulge in his behavior without outside interference. I believe he is healthier and feels better now, despite having an undiagnosed health condition from his military service, but his behavior is alarming regarding his relationship with food and a "healthy" lifestyle.

    - Collin S

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