Dear Dietician: orthorexia

Dear Dietitian,

My thirteen-year-old daughter started a new healthy eating program about six months ago. She seems obsessed with healthy eating and sometimes refuses to eat when she stays over at a friend's house. I am concerned about her behavior. Is this something serious or will she grow out of it?

Sheila

Dear Sheila,

The desire to eat right is a healthy, but too much of a good thing is no longer a good thing. New light is being shed on an obsessive pattern of eating known as orthorexia nervosa.

The term orthorexia is from the Greek meaning 'right appetite.' It was first coined in 1997 by Steven Bratman, M.D. Orthorexia may occur in someone who has unresolved trauma in his life. The obsession to eat healthy is pursued through a restrictive diet, a focus on food preparation, and rigid patterns of eating. People with orthorexia are concerned with the quality of food, rather than quantity. The obsession does not begin in an effort to lose weight, as with anorexia, but rather as a desire to eat healthy and live a better life. (1)

Currently, orthorexia is not formally recognized as a psychiatric disorder, and scientific research is lacking. Bratman cautions that just because someone adopts an alternative diet does not mean that person has orthorexia. It is when eating right becomes an obsession and affects other areas of the person's life that it becomes a problem. (2)

At this point, it is unclear if the disorder is a part of anorexia nervosa, stands alone as a disorder, or is a part of obsessive-compulsive disorder (OCD). It is known to affect women more often than men, and more so in Western countries than other parts of the world. Orthorexia may lead to nutrient deficiencies and malnutrition.

Another area of life that is impacted by orthorexia is relationships. One may socialize less frequently as these events often include dining out. They may spend less time with family and friends because they are obsessing about the foods that will be available at an out of town conference attend next week. As a result, the individual becomes to feel isolated and alone.

According to the National Eating Disorders Association, warning signs and symptoms of orthorexia include (3):

Compulsive checking of ingredient lists and nutrition labels

An increase in concern about the health of ingredients

Cutting out an increasing number of food groups (all sugar, all carbohydrates, all dairy, all meat, all animal products)

An inability to eat anything but a narrow group of foods that are deemed 'healthy' or 'pure'

Showing high levels of distress when 'safe' or 'healthy' foods aren't available

Help is available. The optimum treatment for orthorexia includes a team composed of a psychiatrist, a physician, a psychotherapist, and a dietitian. You may start by asking your daughter's pediatrician for a referral or contact the National Eating Disorder Association at 1-800-931.2237.

References

Brytek-Matera A, Donini LM, et al. Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students. J Eat Disord. 2015;3:2.

Bratman S. Orthorexia vs. theories of healthy eating. Eat Weight Disord. 2017: 22(3): 381-385.

https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia

Until next time, be healthy!

Dear Dietitian

Leanne McCrate, RD, LD, CNSC, aka Dear Dietitian, is an award-winning dietitian based in Missouri. Her mission is to educate consumers on sound, scientifically-based nutrition. Do you have a nutrition question? Email her today at [email protected]. Dear Dietitian does not endorse any products or diet plans.