Orthorexia: When healthy eating goes astray

By Pamela Wiegartz, Ph.D.

What is orthorexia? The term comes from the Greek words ortho, meaning straight, right or correct, and orexis, or appetite; so orthorexia literally means “correct eating”.   Orthorexics are characterized by an obsession with healthy eating, avoiding any foods that they perceive to be unhealthy.    While the origin of the word and its meaning are easy to trace, the phenomenon itself is actually quite controversial.

Anecdotal accounts of orthorexia abound but few data exist on its true prevalence and research studies are lacking. While some eating disorder experts suggest that this condition is nothing more than a form of anorexia, others argue that orthorexics can easily be distinguished by their focus on healthy or virtuous eating rather than on thinness or weight loss.

In some ways, orthorexia seems more similar to OCD than to anorexia—the sense of control that comes from rigid and ritualized behaviors, the quest to protect one’s health, the belief that there is a “right” way to do things and the emphasis on virtue. The orthorexic’s preoccupation, or obsession, with food leads to meticulous and inflexible eating that looks very much like the compulsive behavior seen in OCD.

What’s wrong with healthy eating? Just in the same way that having good hygiene is not a bad thing but showering for several hours a day is, there is nothing wrong with eating healthy foods unless this inflexibility consumes your life. Health conscious eaters have diets based in moderation. They can make choices that are not dictated by food, can be flexible in eating when they need to be, and don’t think about food all that much. Sufferers of orthorexia, on the other hand:

  • Have an extreme preoccupation with food and the quality of the food
  • Eliminate many “unhealthy” foods and eventually only eat a few foods
  • Focus on the virtuousness of eating
  • Eat in a way that negatively impacts quality of life
  • Are judgmental of others’ food choices
  • Become socially isolated because of their eating
  • Have rigid eating habits and lack moderation
  • Experience guilt or self-loathing when they stray from their diet

And because orthorexics often have such a limited diet there can be serious health consequences from vitamin, mineral, and caloric deficiencies. Ironically, the quest for perfectly healthy eating can instead result in anemia, osteopenia or other health detriments.

What is the treatment for orthorexia? Orthorexia is such a newly named phenomenon that there are no scientific studies demonstrating what treatments may be most effective for this condition. However, because of orthorexia’s similarities to OCD, we may be able to extrapolate methods that could be of benefit. For example, cognitive-behavioral therapy strategies that work well in OCD, such as targeting distorted beliefs and graduated exposure to feared stimuli, may also be useful in orthorexia.

In cognitive therapy, distorted orthorexic beliefs about the need for perfection and the danger of occasionally eating unhealthy foods could be addressed. Detailing the true benefits of eating in this manner versus the costs—social isolation, loss of spontaneity and decreased quality of life—may be useful in motivating sufferers to relax their standards to more realistic levels and to gradually reincorporate feared foods into their diets.

What’s the bottom line? Research studies are needed to better delineate what orthorexia is and how it can be treated. It appears that a significant number of people fall prey to this preoccupation with eating correctly. And because this condition far exceeds simply “healthy eating”, the consequences can be serious. Until treatment protocols specifically tailored to orthorexia can be created and studied, cognitive-behavioral strategies similar to those used in OCD may be modified to address the perfectionistic beliefs and compulsive behavior that characterize orthorexia.

Pamela Wiegartz, Ph.D., is a clinical psychologist specializing in cognitive-behavioral therapy (CBT) for anxiety.  Dr. Wiegartz is the Director of CBT Services and Training in the Department of Psychiatry at Brigham and Women's Hospital and is on faculty at Harvard Medical School. She is a member of the Scientific Advisory Board of Beyond OCD  and is a Fellow of the Academy of Cognitive Therapy. Dr. Wiegartz has authored numerous research publications and presented on topics related to the understanding and treatment of anxiety disorders. Her books include “10 Simple Solutions to Worry,” “The Pregnancy and Postpartum Anxiety Workbook,” and “The Worrier's Guide to Overcoming Procrastination,” all from New Harbinger Publications.

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