Orthorexia takes healthy eating to the extreme

There’s no shortage of eating styles to choose from as people go vegan, try paleo, test out raw, gluten-free, grain free, or sugar free. But delving too deeply into a restricted style of eating can be a signal that a desire to eat healthy foods has gone too far.  

Colorado's Dr. Steven Bratman coined the term "orthorexia" back in the late '90s. It means "correct appetite." And though orthorexia isn’t clinically classified as an eating disorder like anorexia or bulimia, it is a type of disordered eating that describes what happens when a desire to eat pure foods becomes an unhealthy obsession.

Lisa Naylor is a counsellor at the provincial eating disorder prevention and recovery program at Women’s Health Clinic in Winnipeg. She said what sets orthorexia apart is that the initial motivation isn't necessarily about losing weight. 

"But what happens is that people who struggle with orthorexia become really preoccupied with food quality versus food quantity," she explained. "And food rules begin to take up a great deal of time and energy exactly like they do for people with other disordered eating, but the rules may vary a little bit."

Naylor said orthorexia is similar to diagnosable eating disorders in that it's not really about the food, but tends to mask underlying issues. While the average person may be able to alter their diet to eat a little healthier without any problem, someone with high anxiety or obsessive compulsive disorder might start with a similar motivation but not be able to stop.  
"Someone who is more prone to this is very strict and the rules get tighter and tighter as they operate out of 'all or nothing' thinking. There’s no flexibility around food so it starts to interfere with relationships and normal routines because so much focus is going to the orthorexia," Naylor said. 

Roberta Anding is director of sports nutrition at Texas Children's Hospital in Houston. Anding said while there can be beneficial reasons to making dietary changes like going vegan or vegetarian, "the not so beneficial reasons are to cover or mask an eating disorder."

"If you're a female or male athlete who is struggling with food-related issues, the more you put out publicly, 'I can't eat this because, I don't eat meat because I'm vegan, I don't eat cheese because I'm vegan,' it allows you societal permission to restrict your food because no one wants to violate your own personal choices. So you get to restrict your food and therefore cover up your eating disorder to your health-care team," she said. 

It's something Naylor has seen at her own clinic, when she worked with a client who presented with a healthy eating plan that included some very nutrient dense foods. 

Overly tight food rules

"But that would be all the foods she was eating," Naylor said. "Sure it looked good, almonds and avocado and kale … But there was no variation in her diet. So she was missing out on all kinds of nutrients that weren’t in her weekly intake. And eventually her health was suffering, her weight dropped as it might when someone’s restricting for other reasons."

Finding out about the food we eat has never been easier. But for people with orthorexia, a few simple Google searches can lead them down a research rabbit hole.

"In fact, it’s never good enough. It might not just be avocados, now it’s got to be avocados from a certain region. You can imagine that if you already have some anxiety about the nutrients of your food, that might become more heightened the more research you do," Naylor said.

When someone takes steps to make healthy food choices, it doesn't always signal a potential issue with disordered eating. It only becomes a problem when it’s all-consuming and that initial motivation to be healthier is no longer part of the story.

"When somebody’s on one strict way of eating for a few months then they move on to another strict way of eating, that definitely is indicative that they’re searching for something that probably isn’t going to come off of a healthy eating website," Naylor said.