What, exactly, is orthorexia?
Dr. Bratman calls it “an unhealthy obsession with healthy food” and considers it similar to anorexia.
The NEDA website [2] gives these “warning signs and symptoms:”
- Compulsive checking of ingredient lists and nutritional labels
- An increase in concern about the health of ingredients
- Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
- An inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
- Unusual interest in the health of what others are eating
- Spending hours per day thinking about what food might be served at upcoming events
- Showing high levels of distress when ‘safe’ or ‘healthy’ foods aren’t available
- Obsessive following of food and ‘healthy lifestyle’ blogs on Twitter and Instagram
- Body image concerns may or may not be present
Orthorexics seek “purity,” not necessarily weight loss--though they may effectively starve themselves thin (like anorexics) by restricting supposedly impure or unhealthy foods.
Adverse health impacts range from social (withdrawal, estrangement, superiority complex, unbalanced or extreme food-related behaviors) to major medical: malnutrition, starvation, neurosis and death. [4]
Controversy over signs and symptoms
Taken at face value, the inclusion of ingredient-checking, sincere concern over ingredients, cutting out certain food groups, keen food- or health-blog interest, and distress over lack of healthy food choices seems provocative—possibly even targeted at dieters who resist conventional paradigms.
Large, successful populations of these dieters, including thousands of Paleo adherents, routinely implement these behaviors. The perceived demonization of these widely accepted practices has generated pushback.
Many see this “diagnosis” as suspiciously aligned with corporate and government interests.
Dr. Bratman’s website includes a “hatemail” page, showing accusations of collusion with government, Big Pharma, and other corporate interests. [5] (Dr. Bratman reports that he has made very little money from his original book, and has no financial relationship with any of the above-named entities.) [5]
He also clarifies that healthy dieting, itself, is not obsessive behavior.
The unfortunate power of medical language
Nevertheless, the new dieter or casual reader can easily be alarmed when told they are showing symptoms of an eating disorder. Articles like Orthorexia: do you have an unhealthy obsession with healthy eating? by Emily Fonnesbeck surface periodically, reminding the public of “the dangers of eating clean.” [2]
Readers outside the medical profession may also be confused when dietitians and psychologists express this apparent concern, but also mention that “orthorexia is not an official diagnosis.”
(The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, also called “the DSM” or “DSM-5,” does NOT include orthorexia as a separate, stand-alone eating disorder. Literally, providers can’t code bills for treating orthorexia yet.) [7]
None dispute that “orthorexic” patients, who pathologically obsess over “healthy” diet and food behaviors, really exist. For now, most providers classify and treat these genuinely ill persons similarly to anorexic or OCD patients.
However, careless (or carefully selective?) use of the NEDA symptoms list and medical terminology should still be viewed with suspicion. All too often, hasty or undiscerning readers will assume they are ill—when in fact they are not.
Stampeding gullible or tentative dieters using this language can only serve—artificially and needlessly--to increase the patient population.
Heal the sick, not the dieters.
Eating disorders can be very serious. Raising awareness of any eating disorder can save families and lives. Any information that brings a truly ill patient in for treatment is good information.
Paleo newcomers must also remember that strict dietary observance is not obsessive behavior--and that conscientious dieters don’t need to be herded into medical offices...to be screened “just in case.”
Dr. Bratman’s website offers his authorized “orthorexia self-test,” which clearly distinguishes between normal and obsessive dietary pathways. Interested readers should try it. [8]
[Author’s note: this article is not meant to disparage any health condition. No one should ignore any eating disorder. See your doctor if you think you are ill.]
References
[1] Introduction to orthorexia nervosa by Dr. Steven Bratman, retrieved here
[2] National Eating Disorders Association introduction to Orthorexia, including the video “The Dangers of Dieting and Clean Eating,” retrieved here
[3] History of a patient’s demise, recounted by Dr. Steven Bratman, retrieved here
[4] Health consequences of eating disorders from the National Eating Disorders Association website, retrieved here
[5] “Hatemail” page at the website of Dr. Steven Bratman, retrieved here
[6] KSL.com, “Orthorexia: do you have an unhealthy obsession with healthy eating?” by Emily Fonnesbeck, RD, 6/26/2018, retrieved here
[7] American Mental Health Foundation, “Orthorexia Nervosa: not in the DSM-5” by Evander Lomke, 11/7/2016, retrieved here
[8] The Authorized Bratman Orthorexia Self-Test, created by Dr. Steven Bratman, retrieved here
