Michelle Hamilton explores a disorder called orthorexia

By Michelle Hamilton

Filling your grocery cart with organic vegetables and whole grains is a smart way to personally combat the nation’s obesity epidemic. Yet for some people, a dedication to eating “right” can cross a line into a disorder called orthorexia.

Alternative medicine physician Steven Bratman, M.D., himself an orthorexia sufferer, coined the term in 1997 to refer to an extreme fixation on health food. Unlike anorexia, an eating disorder characterised by consuming too few kilojoules, orthorexia is a preoccupation with the quality of food, rather than the quantity, and the condition can have severe mental and physical repercussions.

The disorder often begins with a real desire to improve health, says Maria Rago, Ph.D. People stop eating white flour or processed foods, and aim for organic produce and whole grains. Such healthy practices should be applauded, but when restrictions become so severe – cutting out fats or salt or food groups – you put yourself at risk for nutrient deficiencies or other problems.

The physical consequences of orthorexia are real, but what distinguishes the disorder from healthy eating is obsessive and compulsive behaviour. “How preoccupied someone is about eating the right thing, that’s the measure of orthorexia,” says Rago.

Orthorexics can spend hours planning and preparing meals, consuming a disproportionate amount of time and mental energy that might otherwise be directed at work or family. They may avoid going out to eat because they believe restaurant food is not “pure.” Social events around food – an office party, potluck, or a post-run group breakfast, for example – can cause anxiety. Orthorexics may begin to withdraw socially, and experience depression and mood swings.

“If food is interfering with other parts of your life or causing anxiety, it’s a problem,” says Emily Slager, LMHC, assistant program director at Walden Behavioral Care, Massachusetts, US.

Orthorexia is not a clinically recognised condition, so no statistics are available. But over the last few years, eating-disorder specialists have reported a rise in the condition. Some experts say it’s hard to pinpoint whether orthorexia is a growing problem, or if it appears more prevalent due to greater awareness. (There’s also debate on whether it is an eating disorder or a subset of obsessive-compulsive disorder.)

Slager, however, worries that orthorexia may be a bigger issue than we know. “It flies under the radar because healthy eating is a good, acceptable thing,” she says.

“It can be perplexing to parents, partners, and coaches because it might seem as if the person is really just trying to take care of their health or eat to optimise performance,” says Cynthia Bulik, Ph.D., director of the University of North Carolina Eating Disorders Program.

One of the biggest fears among experts is that because orthorexia is a progressive disorder, it can be a step toward anorexia. Lindsay Calvario, a sports dietitian, has seen this pattern in a number of her patients, including a collegiate runner she’s currently counselling. The runner began to make healthy tweaks to her diet as her running intensified. But as she cut out foods she considered unhealthy, her condition spiralled into severe kilojoule restriction. Depression and a stress fracture followed, forcing her to eventually quit the team.

The runner’s situation is extreme, but it highlights the fact that culture plays a role in disordered eating. Athletes operate within groups that are very conscious of their bodies and their health, so they’re more predisposed to orthorexia, says Calvario. The same is true for any body-conscious community, from running clubs to professional dancers and models.

No one, of course, is immune societal pressures. Men can be orthorexic. You can be overweight and have the disorder, or eat plenty of kilojoules (i.e. not at risk for anorexia) and still be orthorexic.

“Our country’s obsession with health and thinness, a fear of obesity, has brought a wider range of eating concerns to the forefront,” says Slager.

Nancy Clark, M.S, a prominent sports dietitian and author of Nancy Clark’s Sports Nutrition Guidebook, sees this playing out in her practice. “Some people think that if they have a piece of cake, they negate all the good stuff they put into their body,” she says.

She counsels that black-and-white thinking is counterproductive. “You don’t have to have a perfect diet to have a good diet,” says Clark. “If 90 per cent is quality and 10 per cent is whatever, that’s fine.”

At times, Clark may refer someone to a mental-health professional. “I help people with the nutrition end, talk about balance and control and perfection,” she says. “If they can take my information and use it, great. But it they can’t, then food is the symptom, not the problem.”

Writer Michelle Hamilton is a Runner's World contributing editor.

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