Adopting a theory of healthy eating is NOT orthorexia. A theory may be conventional or unconventional, extreme or lax, sensible or totally wacky, but, regardless of the details, followers of the theory do not necessarily have orthorexia. They are simply adherents of a dietary theory. The term “orthorexia” only applies when an eating disorder develops around that theory.
I feel a need to clarify the distinction because I have recently begun to encounter articles on orthorexia that incorrectly equate the two issues. This is partly my fault because my original orthorexia essay devotes some time to deconstructing dietary theories, for reasons that made better sense at the time than they do now. Another contributing factor is that the research test used in Europe for studies of orthorexia, the ORTO-15, needs some further refinement; as currently structured, it seems to identify members of healthy eating subcultures rather than those who truly have orthorexia. (Researchers are in dialogue to remedy this.)
There even seem to be people who proudly name themselves “orthorexic” because they choose organic, whole, relatively unprocessed foods, free of preservatives, antibiotics and GMOs. I hate to disappoint you folks, but you need to follow a much more restricted diet than that have a chance at the name!
Enthusiasm for healthy eating doesn’t become “orthorexia” until a tipping point is reached and enthusiasm transforms into obsession.
Orthorexia is a self-punishing, emotionally disturbed relationship with food that involves a progressively shrinking universe of foods deemed acceptable. A gradual constriction of many other dimensions of life occurs so that thinking about healthy food can becomes the central theme of almost every moment of the day, the sword and shield against every kind of anxiety, and the primary source of self-esteem, value and meaning. This may result in social isolation, psychological disturbance and even, possibly, physical harm.
To put it another way, the search for healthy eating has become unhealthy.
Diet as Risk Factor
The issues of “theory of healthy diet” and orthorexia are not entirely separate, because it isn’t possible to develop orthorexia without at first adopting a theory of healthy food. However, in most ways, the specific details of the theory are irrelevant. Orthorexia = disordered eating in relationship to [insert any theory of healthy diet here.]
Nonetheless, as a matter of practical fact, some theories present more risk of orthorexia than others.
The basic “clean eating” diet, which focuses on organic whole foods, free of preservatives, antibiotics and GMOs, barely qualifies as a restrictive theory of healthy eating and only occasionally leads to orthorexia. More risk accrues as increasingly practices related to the history of clean eating theories are added, such as detoxes, juice fasts and other “cleanses.”
Similarly, the standard paleo diet is quite mild, and regardless of whether one believes that gluten truly really is an issue for most followers of the diet, restricting gluten is a modest step unlikely to lead to orthorexia unless further restrictions follow. Simply remember to take a gentle approach with yourself, as Neil Stephenson advises on his popular Paleoista blog.
Raw foods veganism is on the other extreme, and has a fairly high orthorexic potential. This is a challenging diet to manage safely, and many people who will ultimately develop orthorexia begin as raw foods vegans. Nonetheless, there are also certainly many people who adopt the raw food vegan lifestyle and do not become orthorexic.
People who get in trouble with theories of healthy eating often have an underlying predilection toward going overboard. As Jordan Younger writes in her excellent piece on Refinery29, “Those of us who have a tendency toward extremes in other areas are more susceptible to developing it [orthorexia] — especially once we start cutting out entire food groups. “
The Tipping Point
Healthy diet turns into orthorexia when a boundary is crossed and a person’s relationship with food begins to impair various essential dimensions of human life. There is no bright line to mark this transition, but it can be recognized as a situation in which the search for a healthy diet has taken on a life of its own and no longer serves the goal of improving health.
Jaime A. Heidel captures this tipping point in her essay “Are you TOO Obsessed with Healthy Eating?” She began following theories of healthy eating in order to address certain personal health conditions. From a physical perspective, she found this effective. However, “somewhere along the line, my desire to keep my conditions under control developed into an obsession of the more questionable variety.”
She describes how “healthy” diet began to take over her life. “My diet became increasingly strict and I found myself feeling agitated and anxious whenever I couldn’t find organic or natural foods.“
Ultimately, she decided she should loosen up a little. “If your desire to eat healthily and avoid chronic disease begins to interfere with your daily living, social activities, and relationships, it may be time to take a step back.” Her conclusion: “While you’re in the process of improving and prolonging your life, don’t forget to live it.”
But even this advice will raise concerns for some people. In a post titled “Is Healthy Eating Doing us More Harm than Good?” popular blogger Kelly at Mummywrites says the same thing, but with a caveat: ” Life is too short to live on extreme diets, stressing about every morsel, but then life really will be short if we don’t look after ourselves!” [my italics]
Perhaps here it is worthwhile gently pointing out that the modern world is so chockful of chemicals that the trace quantity of pesticides and other chemicals in a serving of non-organic food simply doesn’t amount to disaster? The evidence suggesting potential harms caused by pesticides in food indicates at most a tiny fractional percent of an increase in the risk of health problems even when eating non-organic foods day in and day out. If you are afraid that occasionally straying off your perfect diet will give you cancer you might as well cower at home under your blankets.
A friend of mine is afraid of going to Italy because she thinks the leftover radiation from Chernobyl will kill her; in fact, the amount of radiation exposure on the plane trip to Italy is orders of magnitudes higher.
So let’s keep a sense of proportion: If you prefer to eat mostly organic, preservative- chemical- and antiobiotic-free foods (as I do!) and think that many overly processed foods are not foods at all (as I do!) it still doesn’t mean you have to follow those principles 100% of the time. That’s just perfectionism, obsession, orthorexia. Lighten up a little. Be gentler with yourself. To quote Jaime again: While you’re in the process of improving and prolonging your life, don’t forget to live it!
Steven Bratman, MD, MPH