“Are you sure there’s nothing else I can do?” one of my clients asked me, her eyes filling with tears. I hesitated. I knew how hard it would be for her to hear what I had to say. Here was a client that, at first glance, embodied eating standards that dietitians dream up for their patients. In other words, my client was by all accounts a highly motivated and intelligent individual who would no doubt comply with any dietary recommendations I made for her.
Unlike many of the people that hire me for nutritional counseling, the problem with this client wasn’t what she was eating. As I reviewed her food logs, where she had meticulously recorded every bite that passed her lips, I could find no fault in the all-organic, local, and free range fare I saw listed. Nor was it the quantity of food on the list that bothered me. While she could have stood to eat a little more, it was a far cry from a starvation-like diet.
What was wrong was her extreme preoccupation with eating healthy foods. As we sat and talked, she began to list her self-imposed “food rules”: no sugar, no dairy, no soy, no gluten, no alcohol, no caffeine, no nightshade vegetables, and nothing processed or packaged—ever. She only shopped at a certain grocery store, and confessed to skipping social gatherings where they didn’t have food she felt was “clean” enough to eat. While she claimed she was restricting these foods in pursuit of optimal health, it seemed as though her diet was leading her in another direction. She was on a path headed toward food fears and eating anxieties.
Sadly, this wasn’t the first time I had seen a client who appeared to be obsessed with eating healthy. Deep down, I knew it wouldn’t be the last. The behaviors my client was displaying were behaviors alarmingly similar to those who suffer from a new type of disordered eating called orthorexia. Orthorexia—which literally translates into “a fixation on ‘righteous’ eating”—is more than just wanting to eat healthy.
But how do you differentiate between someone who is careful to eat healthy versus someone that takes healthy eating to the extreme? And which side of the spectrum was my client on?
The problem lies in diagnostic criteria of orthorexia. Unlike other eating disorders such as anorexia or bulimia, orthorexia does not appear in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and there is a lack of research to help define what orthorexia is and what it isn’t. Further more, many people struggle to see the problem itself. After all, how can it be a bad thing to want to eat healthy in a world where most of us don’t? Are we stigmatizing healthy eaters by labeling those who care about what they eat as orthorexics? These unanswered questions remain controversial in the health and nutrition fields, and are being hotly debated by both experts and the public at large.
For arguments sake, many will point to so-called “workaholics” or those that experience exercise addiction as evidence that it’s possible to take a seemingly healthy behavior and turn it into an all-consuming obsession. More evidence that orthorexia can be dangerous comes from those who claim to suffer from the disorder. A quick Internet search on the term “orthorexia” yields numerous testimonials, support groups, and treatment information.
In my quest for more information, I stumbled across many other orthorexia articles, some of which included criteria for recognizing the disorder if you or a loved one has orthorexia. My curiosity piqued, I read through the list and asked myself to answer each of the questions. “Do you obsessively read labels?” Well, I thought, yes. Of course I do, I’m a dietitian. I also teach other people how to read labels. Shrugging that one off, I moved on to the next. “Do you spend an excessive amount of income on healthy foods?” I laughed to myself. Define “excessive,” I thought. I certainly spend more than a lot of my friends and family do on health foods, but then again, nutrition is a top priority to me. I’d much rather spend more on what I believe to be high quality food than things other people spend money on, such as clothes, movies, or eating out. I skimmed over the rest of the questions, which ranged from, “Do you train like an elite athlete?” to “Do you find yourself constantly talking about your diet to others?” For each question asked, I found there was more than one way to interpret it. To some people, I could be considered orthorexic. The thought of being labeled as such stunned me into silence.
As for my client, she broke down in tears—tears of fear that her diet wasn’t healthy enough—before I could tell her that nothing was wrong. “I am so sick of worrying about what to eat!” she confessed to me. “It’s all I think about,” she said, covering her face with her hands. I nodded and she continued, concluding on her own that she knew she needed to stop obsessing over everything she ate—that it wasn’t her diet that was problematic, but her.
When it comes to healthy eating, I am and will remain to be a proud advocate for better nutrition. However, I think most of us can agree that there’s a thin line between passion and obsession, and the criteria for each differs among us all. Passion toward healthy eating starts to become a problem when it negatively interferes with one’s quality of life; whether it interferes physically, mentally, emotionally, or socially. Eating well can be an extremely positive experience, but it’s equally imperative to strike a unique and healthy eating balance that suits you and leads you away from the extreme.