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Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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January 02, 2008

Orthorexia Nervosa and Dietary Obsession

By Mark Sisson
59 Comments

I talk a lot around here about honing self-discipline, avoiding temptation, and the like. Yet, I also (let the record show) merrily encourage the importance of “sensible vices,” those splendid morsels (culinary or otherwise) of personal indulgence. We at MDA approach the pursuit of health as, undoubtedly, a worthy and wise endeavor. The pursuit of perfection, however? Well, that’s just no fun, is it?

For an increasing number of well-intentioned, health conscious individuals, some researchers say, the pursuit of healthful eating is taking an ominous turn toward clinical obsession, an as-yet unofficial eating disorder condition labeled Orthorexia nervosa. I thought it was time to explore the subject and ask you to weigh in with your thoughts.

Dr. Stephen Bratman, a holistic physician and practitioner of dietary medicine, initially proposed the condition in 1997, and simultaneously coined the Orthorexia label, from the Greek words “orthos” for correct and “orexis” for appetite.

Unlike those with anorexia or bulimia, orthorexics obsess over the quality, not quantity of their food intake. The condition develops with a continuing and increasingly more rigid pursuit of dietary purity. Some begin with food restriction based on genuine medical recommendations (e.g. allergies). Others begin with common health and ethical priorities, such as organic food, vegetarian or vegan diet, and/or raw or macrobiotic preparation. (Orthorexia is not applied to dietary restriction for religious purposes or to short term dietary focus for long term changes, whether they be for medical treatment or personal choice.)

For most of us, “sensible vice” (and not-so-sensible vice) indulgence might result in a pang of conscience. For those with orthorexia, however, a “slip” induces genuine psychological distress and, according to Bratman, a series of penitent measures, including days of fasting for a “transgression” as small as a chocolate chip.

Though orthorexics may start out with “normal” dietary goals, they gradually escalate their pursuit and narrow the criteria for “acceptable” food so severely that their social, mental, and (finally) physical health suffer. Although orthorexics enjoy proselytizing about their dietary views, it is common for sufferers to increasingly isolate themselves because of their fear and disgust of impure foods they will encounter. As their obsession grows, orthorexics spend more time planning their dietary regime and less time enjoying the things and people they used to spend time with. Their radical restriction can eventually cause various forms of malnutrition. In extreme cases, orthorexia, Dr. Bratman reports, results in anorexia and even death.

Bratman created a questionnaire based on the criteria he’d established for the disorder. (The test is intended as one tool to help assess risk for the condition, but it does not, by itself, determine diagnosis.)

The Bratman Test for Orthorexia

– Do you spend more than 3 hours a day thinking about your diet?

– Do you plan your meals several days ahead?

– Is the nutritional value of your meal more important than the pleasure of eating it?

– Has the quality of your life decreased as the quality of your diet has increased?

– Have you become stricter with yourself lately?

– Does your self-esteem get a boost from eating healthily?

– Have you given up foods you used to enjoy in order to eat the ‘right’ foods

– Does your diet make it difficult for you to eat out, distancing you from family and friends?

– Do you feel guilty when you stray from your diet?

– Do you feel at peace with yourself and in total control when you eat healthily?

“Yes” to 4 or 5 of the above questions means it is time to relax more about food.

“Yes” to all of them means a full-blown obsession with eating healthy food.

Researchers continue to study the condition and debate about the necessity of a formal diagnosis. Though psychologists and physicians agree that sufferers’ obsession is, ultimately, connected to personal mental health, some researchers are also pointing to the power of recent cultural changes surrounding food in the U.S. and Europe. They say that conflicting nutritional information, food recalls and the conclusive labeling of foods as “good” or “bad” have problematized our relationship with food. It seems, once again, that we have created more choices and pitfalls for ourselves than ever.

Researchers stress that the line between health consciousness and targeted obsession differs from one individual to the next. They encourage people to make diet related choices that are in keeping with both recommended health guidelines and personal enjoyment of life and social relationships.

So, now we turn it over to you:

When do earnestness, discipline and conscience (normally our best attributes), lead us down a slippery slope? Though you may not see your own experience in this picture, what does this research say to you about the culture of food and diet in our society? Lastly, what do you think of Dr. Bratman’s test for orthorexia? Shoot me a comment.

malias Flickr Photo (CC)

Further Reading:

A Case Against Cardio

If You’re Gonna Cheat, Do It Right

Ridiculous Health Claims

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45 Comments on "Orthorexia Nervosa and Dietary Obsession"

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J Lehman
J Lehman
8 years 11 months ago

Orthorexia sounds like a very undesirable mental health issue. To be so consumed with every little detail about what we put into our bodies to distraction, is indeed a terrible every day hindrance.

Moe
Moe
8 years 11 months ago
If you ask me, some of the questions are silly. Perhaps the need more refinement For instance: – Does your self-esteem get a boost from eating healthily? Yes, I feel better about myself and my body when I’m eating healthy foods, rather then junk food. So what? – Have you given up foods you used to enjoy in order to eat the ‘right’ foods Yes… Sadly I gave up cake and cookies I used to enjoy every day as a kid (I have my occasional vice, mind you). Is giving up junk food a clinical disease now? – Does your… Read more »
Roland P.
Roland P.
8 years 11 months ago

Good point Moe. Though, I certainly know a few people who might be Orthorexia nervosics.

When I was a kid, my best friend’s mom was a health food pedant. Of course, he rebelled and became a junk food junkie because of it.

I’m not sure a health food obsession needs to be classified as an official disorder. It’s just a clear example of the problems with taking things to an extreme. The same goes for over-exercising (roiding), hardcore fundamental religious fanatacism, and guys who bass fish way too much.

Kery
8 years 11 months ago
I was wondering about the same things as Moe. I very much enjoy baguette bread with Nutella, or chocolate cake and coffee-flavoured ice-cream, but ‘giving up’ on that was kind of a prerequisite to put my health and weight back on the right track. And like everyone who has to face weight problems (if I ‘eat like everyone else around me’, a.k.a junk food and/or in too high quantities, I just put on weight, period), I unfortunately have to exert constant vigilance, plan my meals, etc. (Planning days in advance is another matter: I do it, but because I need… Read more »
Julie
Julie
4 years 10 months ago
I was an anorexic, and I have fallen into the “perfection” zone when it comes to eating. So this is a good reminder to me to be easy on myself. However having said that, I have a child with Autism and another one who is affected somewhat but doesn’t fit the diagnosis. I have to do GAPS diet in order to heal our leaky gut. In that sense, I DO have to be perfectionistic to a degree, otherwise my children won’t be healthy. I HAVE to change their food so that someday, they CAN eat the things they want to.… Read more »
Kevin Burnett
Kevin Burnett
8 years 11 months ago

Great points Moe and I totally agree with you statements on the questions.

Reminds me of the “tests” to see if you have a drinking problem. I drink only a few times a year most years, but on two occasions had 4 or 5 beers when I did. Acccording to the tests I’m a binge alcoholic because I consume more than 3 drinks in one night.

Carla
Carla
6 years 4 months ago

Good Lord! Who comes up with these tests?
one has to wonder!

Primal Palate
Primal Palate
5 years 6 months ago

Well it would take one to come up with all those silly questions…right?

tim
tim
8 years 11 months ago
I think anyone who reads this site on a regular basis and follows at least some of the guidelines, challenges, opinions, and directives given in most of the posts would have to score at least a YES on 4 to 5 of these questions. I have noticed since I have read this blog on a daily basis that my thoughts have been much more focused on the negatives of what I should not eat at a restaurant,at a dinner party, and fix for myself. I have been made aware of all sorts of dietary pitfalls, pratfalls and taboos as well… Read more »
Carla
Carla
6 years 4 months ago

I was thinking just that Tim. I seriously could answer yes to many of these questions.

Guess what? I have never felt so healthy in my life! My skin fo example, thanks me for it on a daily basis!

charlotte
8 years 11 months ago
This is deeply interesting to me as when I was diagnosed with an eating disorder, I “officially” got ED-NOS (not otherwise specified) but my counselor told me I was a textbook “Orthorexic.” I think the difference between me (then) and what you all are saying (“I eat healthy so do I fit the questionarre”) is that, given an “unhealthy” food I would choose to starve rather than eat it. (I mean literally starve – not just skip a meal) And I was so rigorous in my specification as to what “healthy” meant that it basically limited me to eating only… Read more »
LabRat
8 years 11 months ago
Don’t forget that in psychology, something is really only considered a disorder if it’s screwing up your life in some way. Being inconvenienced and finding it challenging to eat healthfully in modern society is a bit different than entirely withdrawing socially for fear of encountering “bad” food, or imposing penance on yourself like a medieval monk for the slightest food transgression. Mentally healthy people know that having a plate of potato skins on a rare night out at the bar is not an occasion for purging and fasting, though it’s no cause for self-congratulation either. Questionnaires like this are used… Read more »
Bert Q.
Bert Q.
8 years 11 months ago

So the big question is, how many people have this? Because it does sound like a real disorder, but it also sounds like a disorder that could be misdiagnosed ad-nauseum if it gains any popularity. I feel I’m right in claiming a gross number of children are diagnosed with ADHD who are simply active children. The same could easily happen to people who are simply “very health concious.” In other words, you refuse to eat non organic veggies at your friend’s and consequently your friends hold an intervention to make you deal with your Orthorexia.

ann
ann
6 years 5 months ago
That is biggest concern, is that when we start telling our youth (or even start hinting) that eating healthy in this day and age of junk food is bad for you, we begin to walk a very fine line, as you ponted out with adhd/add and overmedicated our future generations during their developmental years with drugs unstudied for that purpose or not studied long enough, anything out of balance is unhealthy but to me nothing about taking care of the vessel I was given to travel through my life with, we may have lengthened our life span since cave an… Read more »
Crystal
Crystal
8 years 11 months ago

Anyone trying to improve their health can answer yes to most of those questions. The questions aren’t “extreme” enough to really get a good idea of what’s going on with the person.

Hungry Waif
8 years 11 months ago
Its hard to say if this is a real disorder, its a good avenue for a self-fulling prophecy. It sounds like another thing to be worried about. Its like “I am a health food nut! i must be abnormal! gahh i am orothrexic!”. and you know so what if you are, the real question is, are you hurting yourself. So what if your pre-occupied with health food. i though i must be disordered, but i need to look at my life, i am in culinary school, of course i am supposed to think about food! and heck we all need… Read more »
Kaitlin
Kaitlin
8 years 10 months ago

I knew someone like this, for whom eating healthy wasn’t just important, but a debilitating obsession. People stopped wanting to associate with this person because she couldn’t just settle down and enjoy life–or let other people enjoy theirs–without counting every scrap of carbohydrates, fat, protein. I think it progressed to some kind of athletic anorexia, though, because in the end she was only counting calories and exercising obsessively, and her hair was falling out.

primalman08
primalman08
8 years 10 months ago
A few thoughts from me – a licensed clinical psychologist: 1) Tests need to be normed and empirically validated before being useful. Until validation occurs, they are just a collection of questions that you might otherwise see while reading “Cosmo” in the grocery line (not that I do that :). 2) I would be surprised if this “condition” makes it into the DSM anytime soon. There is usually a long list of new “disorders” to be considered for the newest DSM edition and most of them do not make the cut – thank goodness. 3) I really do not care… Read more »
ann
ann
6 years 5 months ago

so true, the scariest truth being #4, I have heard that some peolpe treating this “disorder” are using heavy psychotropics such as can be found in some treatment of ocd, i do not get it, i am not about to poison my body with those things to make me well, please, even our kids know better, having had to deal with adhd/add phenom and all it’s new drugs, who will they come after next to dope

9er8er
9er8er
8 years 10 months ago
This is a VERY interesting article and while I agree that the “tests” are rather vague, I think it’s something to be aware of. As I was reading the article, I was astounded at how closely this matched the escalation of my strict eating habits over the past year. Recently, I have realized how much it has effected my daily life and social interactions and it’s not something I want to continue. Charlotte’s comments are spot on- these are the exact struggles I go through everyday in trying to plan out my meals, especially when I’m off my routine. The… Read more »
CEDquiz
8 years 10 months ago

There are some misconceptions about what specific behaviors are characteristic of someone having an eating disorder. I want to suggest an anonymous tool from the Center for Eating Disorders for any readers who may have questions about eating disorders. http://www.eatingdisorder.org/about_eating_disorders/resources/quiz.php. As the most common eating disorders are Anorexia Nervosa and Bulimia, this is a good place to get more information on other eating disorders and the right treatment for them.

olivia
8 years 4 months ago

thanks for sharing this very informative news

The Transient
8 years 2 months ago

I posted a blog on this subject – feel free to read!

http://lifeconundrums.blogspot.com/2008/09/orthorexia-latest-trend-in-disease.html

galepowell
galepowell
7 years 10 months ago

My sister-n-law is so obsessed with all this we no longer have a relationship with her and my brother and neices because they have to prepare all their meals. They stay away from us because of it.

Keri-Ann
7 years 5 months ago
Wow. What a very interesting blog. Thank you very much for this. I hate to admit this, but this really hits home because – I DID answer yes to almost every one of those questions. 🙁 I’ve always considered myself to have an eating disorder (although, obviously never diagnosed) – but mainly more an obsession over food. I feel that I’ve finally found the way I want to live (low-carb) but, admittedly, all I do is read about low-carb living, research recipes and research “healthy living”. Sometimes I really do hate it – because I can’t enjoy any kind of… Read more »
Carrie
Carrie
6 years 6 months ago
I can appreciate what everyone has said. I think if you are to the point of a disorder I think you would know it. Right after I had my daughter I felt compelled to start excercising and eating healthy. My goal was to set a good example for my children because of the epidemic of obesity in children these days. Anyway, I got into the best shape of my lift via excercise and eating right. I educated myself on nutrition and do think I am the better for it. I was very proud of myself and when I reached my… Read more »
Keith
Keith
6 years 5 months ago
A very big THANKS to Mark for sending me this entry. I had originally read to current articles on the subject and thought that I, and many fellow MDA-ers, were being chastised for intelligent decision making as it pertains to food. A read of this entry and a re-read of the Guardian News (UK) article makes a real case for this condition. My hope, however, is that this (like many mental/emotional ailments) could be remedied through therapy and not through medication. I do have to add that this might be 1 of a very small number of entries from the… Read more »
Ann
Ann
6 years 4 months ago

While the particularly obsession being described might be more prevalent given the overload of dietary information nowadays, the disorder doesn’t actually require a new label, as it clearly falls under the established diagnosis of OCD (which, contrary to popular belief, can consist of many other obsessions along with or in place of germophobia).

Ann
Ann
6 years 4 months ago

(That should be ‘particular’…)

Jazz
6 years 4 months ago
I can understand why there is such debate on this topic. It really depends on how you look at it; it can definitely have a negative impact on one’s life when one takes ‘dieting’ to the extreme, using diet as a punishment, and eating foods that don’t nourish your body and result in physical and emotional damage. But if you look at it from the perspective of, say, someone eating primally, the exclusion of grains and sugars is in place to improve health and wellbeing, not to punish yourself. If you know that your body reacts negatively when you eat… Read more »
Anonymous
Anonymous
6 years 5 days ago

hahahahhahahahhahaha…….

Jim
Jim
4 years 10 months ago
I think the issue he is describing is probably real. However, his test questions suck. If you don’t grocery shop more than a few times a week and don’t keep a well stocked freezer, you have to plan your meals several days ahead. If you switch from a standard Western diet to any other diet, you have to answer 5, 6, 7 and 10 in the affirmative. That’s 5 for anyone who is proud of making an effort to improve their health. Bratman’s test is built in stigmitazation for any attempt to deviate from uncontrolled eating. Compare this to the… Read more »
Wario
Wario
4 years 10 months ago
As a recovering EDNOS sufferer now so frustrated that I’ve begun to binge and become a junk food junkie, I think that this is an understated and quite common phenomenon. I definitely agree that there are points to advocate in living Primal. At the end of my restrictive/orthorexic phase which caused me to lose 2 stone in a couple of months, through the “gaining” process I went fat-phobic and had to eat most of my calories from carbs, cue hell for my immune system as I deprived msyelf of EFAs and even protein sources. However, as much as I can… Read more »
Wario
Wario
4 years 10 months ago
Another quick q, guys: I think from being a generally healthy teen I’m pretty damn insulin-sensitive. So much so that if I ate some sweets, I’d lose sleep over it, it’d take HOURS for my body to settle down. Yet my Dad or mates could do the same thing and then head right off to bed or get on with their day, no trouble. I’d put this down to them being more insulin-resistant but feel this could refeed my ED and give me a reason to look down upon the mere junk-laden mortals. I’ve had teratment for anxiety over this… Read more »
Wario
Wario
4 years 10 months ago

Charlotte, just re-read your post. Wanna take back the criticism and say congrats on beating your ED! The fight continues for me.

Paul
Paul
4 years 8 months ago

Answered a double yes to every test question..
This really really sucks. I’ve been like this for 2 months now. I’m only 15 I hope it’s just a teen thing and it’ll pass..

Lindsay
Lindsay
4 years 7 months ago
Hello, I wanted to offer some insight as a former Anorexic, Bulimic, Anorexia Athletica. I am now a healthy Personal Trainer/Nutritionist who is becoming happier and healthier each year as I gain life experience and by reading, researching, trial and error. Thanks to Mark and others who were obsessed enough with their own nutrition to help spur the concept of Primal eating being our most natural way of eating. I have realized that each day is a new struggle, however I do find pleasure in eating! I feel the most important advice is: 1. Read, learn, follow healthy sound science/mentors… Read more »
KariVery
KariVery
3 years 3 months ago

“Take each day 1 at a time. Tell yourself today I will honor and respect my body. I’ll do my best to fuel my body with quality foods. I’ll use my muscles to get my to do list done. I’ll share my compassion with some one I care for today. I will make this day the best one I can.”

That’s really wonderful. I am going to make it one of my mantras.

Marni
Marni
3 years 5 months ago
So many exclamations about the quality of the questions. But I find it a little hard to respond when I can say yes to all the questions. Before Paleo it was with Caloric restrictions, simply calculating constantly so I could be under my goal every day, obsessing over it constnatly…WHen I found Paleo / Primal, it made a lot of sense. I felt relieved, that this would be my out. But as I’ve followed it I’ve put on weight, and I’ve felt myself panicking and going back to the old ways in a sense, only this time calculating and muling… Read more »
Martha
Martha
3 years 3 months ago
I didn’t take the little test too seriously, but obsessing over food and/or exercise is a concern I have. I do that with a lot of things. But I’m an older dog now, and I’ve had to learn to solve a couple of OCD-type problems in my life — used to smoke, used to like to be intoxicated every day — and this is just another one. Maybe some people don’t lock on to things like that, but I do, and a lot of other people do, so I just put it down to the human condition. Right this minute… Read more »
Martha
Martha
3 years 3 months ago

And while we’re on the subject, I think if you care about your diet at all, you are going to be diagnosed as mentally ill with that test. Why should I care more about pleasure than nutrition? Isn’t it a sign of adulthood to be concerned about the consequences of your actions?

Carnivorous Sarah
Carnivorous Sarah
3 years 3 months ago

http://impruvism.com/clean-eating/

Would love to hear your opinion on this article Mark. It’s been floating around my facebook and instagram accounts all day.

While I agree that moderation is a beautiful thing I think this guy way over simplifies eating/ sugar addiction as well as making some pretty bold claims about GMO’s, Naturopaths, Preservatives etc. He also has a list of references almost as big as his ego.

Not going to lie I would love to see someone take him down with some solid evidence- based arguments to refute his claims.

Etana
Etana
2 years 11 months ago
As one who had this label thrown at me soon after this whole issue began surfacing in various media outlets, I have to say my bit. Those questions are ridiculous at best, and most people who care about their health and well-being could easily answer ‘yes’ to most of them; so does that mean we possibly have a disorder? I think not. I have a rather long list of food allergies and sensitivities. While I don’t plan my meals way in advance, or sit around obsessing about food, I do make sure to carry something safe with me to eat… Read more »
Slowneal
Slowneal
2 years 1 month ago
I think this is a spectrum. IF it is affecting your life in a negative way, then yes it is probably some sort of eating disorder. If it makes you happy, it probably isn’t. However, this is also about context. To the average person who relishes in the ways of SAD, many of us can easily be seen to them as Orthorexia Nervosa. The problem is, if you want to follow the primal blueprint, an enormous amount of conventional wisdom, which comes from all angles from our external environment, needs to be overcome. And from the perspective of people who… Read more »
Slowneal
Slowneal
6 months 21 days ago

I scored at least 8. But I’ve never been happier. And healthier.

Back when I scored 0, you’d take one look at me and free up space on your calendar for my funeral.

Great test. I’d better go see a doctor.

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