Orthorexia Nervosa and Dietary Obsession

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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TAGS:  mental health

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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