Although we live in an obese nation of fast-food eaters, the camp of health-food advocates is alive and well. However, even healthy eating can go to the extreme. The enigmatic eating disorder, orthorexia nervosa (ON) is just that, healthy eating gone awry.
Orthorexia nervosa refers to "ortho," meaning straight, correct and true. It was named in the late 1990s by a physician, Steven Bratman. Media attention was brought to this condition with his book "Health Food Junkies." Unlike its counterparts, anorexia and bulimia nervosa, ON elevates food to a righteous level.
The catch is that only certain "good for you" foods, such as whole grains, fruits, vegetables and lean protein, warrant eating privileges, whereas foods such as trans fats, white bread, sugar and salt are permanently banished from the diet.
The hallmark of ON is that it often leads to social isolation, impaired relationships and, in the extreme, psychological and physical harm such as low body weight, excessively low blood pressure or subclinical levels or vitamins and minerals.
ON often manifests in conjunction with anorexia nervosa, where eating becomes very strict, and calories are restricted. "Anorexia nervosa tends to have a similar effect as orthorexia," according to Angela Celio Doyle, a psychologist in the eating-disorders program at The University of Chicago Hospitals, "because they [patients] planned their food, became quite rigid about their eating and had more trouble socially."
Celio Doyle explained that "unlike orthorexic patients, my anorexic patients did not maintain a healthy body weight because of inadequate calories."
But "eating becomes very black and white, and there is no bending," explained Rhonda O'Brien, a registered dietitian in private practice in Boise, Idaho. O'Brien looks for orthorexic tendencies, such as strong aversions to fat, extremely low-carb, and/or high-fiber diet in her patients. "Healthy eating is taken to an extreme with 15 servings of fruits and vegetables a day or absolutely no white-flour products--they are looked at as poison," O'Brien said. The running theme inherent in this disordered eating pattern is the loss of pleasure and enjoyment with eating. "Eating becomes a task and who cares if it's enjoyed?"
"Typically, patients with orthorexia present with different dietary issues, such as lactose intolerance, kosher considerations or low-fat diet because of a family history of heart disease," explains Ann S. Litt, a registered dietitian and author of "The College Student's Guide to Eating Well on Campus."
Although the impetus for dietary restraint varies, the need for patients to seek therapy with both a dietitian and a psychologist who specialize in eating disorders is a primary part of the plan for these patients. "Many times I see this behavior imposed by parents on their children. Everything has to be natural and whole grain. It's dangerous because dietary needs are not the same for children as adults. All kinds of food, even a little junk food, can fit in a healthy way for children," Litt said.
Loosening this puritanical mind-set takes nutrition education and a willingness to experiment with different foods. Healthy eating does not have to close the door on social interaction but rather allow for sharing balanced, nutritious meals with others. Patients are encouraged to experiment with foods that contain some fat and moderate fiber for greater satiety. Without dietary restraint, the rigid strings unravel and eating becomes an enjoyable, pleasurable part of life.