The Irony in Orthorexia

The trouble with orthorexia is that it starts out as an attempt to improve our health and wellness.

 Would you worry that any of these people had orthorexia?

1. The seventh-grader who adopts a vegan or vegetarian diet out of love for animals.
2. The college athlete who strives to “optimize” his fitness and improve his performance by streamlining his food intake.
3. The middle-aged individual who is committed to eating only organic, free-range, locally grown, and ethically-sourced food items.
4. The retiree who has just received a dire medical diagnosis and hopes “eating clean” will heal them.
5. The religiously observant person who fasts and/or follows a strict set of dietary guidelines as a way of practicing their faith.

Not only might we not worry about them, but we might admire them. They are shining examples of the principled, determined people we sometimes wish we were.

When a dietary lifestyle becomes inflexible

For some, particularly those predisposed to mental health issues (most commonly anorexia nervosa and obsessive-compulsive disorder) their adherence to their dietary lifestyle becomes rigid and inflexible. That might look like:

1. The seventh-grader who adopts a vegan or vegetarian diet out of love for animals but now lacks the ability to feed herself a variety of foods.
2. The college athlete who strives to “optimize” his fitness and improve his performance by streamlining his food intake now cuts out any food that isn’t needed for “fuel” and obsesses over every calorie.
3. The middle-aged individual who is committed to eating only organic, free-range, locally grown, and ethically-sourced food items now has trouble eating with family and friends and feels isolated.
4. The retiree who has just received a dire medical diagnosis and hopes “eating clean”will heal them and whose limited time and energy are now taken up by shopping, cooking, and eating unsatisfying food.
5. The religiously observant person who fasts and/or follows a strict set of dietary guidelines as a way of practicing their faith who is now undernourished, nutrient-deficient, and exhausted.

Drive to be healthy diminishes quality of life

This is the grand irony of the pattern of eating and behavior we refer to as orthorexia, described broadly as an obsession with eating healthily, purely, or righteously. What originally starts as a good faith effort to improve health via diet becomes a diet that diminishes the quality of life.

If you are worried about your own (or a loved one’s) deepening obsession with “healthy living,” compulsive checking of ingredients and nutrition labels, rigid food rules, increasing depression, anxiety, or distress, you are not overreacting.

Authorized Bratman Orthorexia Self-Test

It’s worth looking into the Authorized Bratman Orthorexia Self-Test, which may offer further insight.

Bratman Self-Test Questions

If you’re interested in taking the Bratman self-test for orthorexia, this is one version of the test.

• Do you believe you spend more than three hours per day thinking about your diet and caloric intake?
• Do you plan what meals you’ll eat several days in advance?
• Do you think your food’s macronutrient values are more important than their taste?
• Have you experienced a drop in the quality of your life due to changes in the quality of your diet?
• In general, have you adopted a stricter mindset lately?
• Do you experience heightened self-esteem when you are eating healthy?
• Have you stopped eating foods you enjoy in order to eat healthily?
• Does your diet make it stressful or difficult to eat out?
• Has your diet reduced the amount of time you spend eating with family and friends?
• Has your diet reduced the amount of time you spend on creative ventures or hobbies?
• Do you experience feelings of guilt or shame when you don’t follow your diet?
• Do you enjoy the feeling of control you get when eating healthily?

Once you’ve responded to these questions, make sure you tally up your answers. If you answered “yes” to more than five of these questions, you may have or be at risk of orthorexia nervosa.

Help for Orthorexia is available

Even though orthorexia is not recognized as a stand-alone condition, specialists take orthorexia symptoms seriously and strive to treat sufferers at the earliest stage possible.

In treatment, we see all these symptoms, and more. We see individuals who have cut out entire food groups, who eschew eating for pleasure, who eat in isolation. We see malnutrition, and the many physical health issues that come with it, including dramatic weight change. We see high levels of depression and anxiety. We see over-exercising to the point of exhaustion and injury.

We see everything but health. Isn’t it Ironic?

If you think you or a loved one might need some help, know that there are programs to treat orthorexia and its related issues, and much hope for recovery.

For example, Walden’s GOALS program provides intensive outpatient eating disorder treatment for competitive athletes.

At Walden, we know finding care can be tough. That’s why we are here for you. If you are concerned that you, or a loved one, may have an eating disorder, please reach out by completing the form on this page or email us at intake_coordinators@waldenbehavioralcare.com.

Stephanie Haines, M.Ed., CHES (she/her/hers) has been providing school communities with specialized addiction prevention education since 1999 and has taught students of all ages in most U.S. states and more than 25 countries across five continents. After completing her graduate work at Plymouth State University’s Eating Disorders Institute in 2013, Stephanie joined Walden Behavioral Care as their Prevention Education Specialist, creating an eating disorders prevention curriculum designed for use in school communities. Stephanie takes great joy in raising awareness about the prevention and treatment of eating disorders and substance use disorders as a private consultant, and helping families get the care and support they need and deserve as a member of the Walden team.

*This blog post does not necessarily represent the views of Walden Behavioral Care and its management. The Walden Blog is meant to represent a broad variety of opinions relating to eating disorders and their treatment.

References

Simpson CC, Mazzeo SE. Attitudes toward orthorexia nervosa relative to DSM-5 eating disorders. Int J Eat Disord. 2017 Jul;50(7):781-792. doi: 10.1002/eat.22710. Epub 2017 Mar 28. PMID: 28370208.

Cena H, Barthels F, Cuzzolaro M, Bratman S, Brytek-Matera A, Dunn T, Varga M, Missbach B, Donini LM. Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature. Eat Weight Disord. 2019 Apr;24(2):209-246. doi: 10.1007/s40519-018-0606-y. Epub 2018 Nov 9. PMID: 30414078.