Are You Eating Too Healthfully to Be Healthy?

The 14-year-old patient sitting in front of me insisted that her decision to become a vegan was unrelated to being bullied and called “chubby” in elementary school.

Instead she cited reasons related to animal rights and a desire to become “healthier.”

Nothing about this straight-A student with severe muscle wasting, skeletal limbs, and a protruding abdomen heralding liver failure was healthy. She brought to my mind images from global health posters depicting starving children. This local teen was unlike any eating-disordered patient I had ever encountered.

That was nearly 10 years ago. Since that time I have encountered a number of patients at the Loma Linda Behavioral Medicine Center’s Eating Disorders Program with orthorexia—an eating disorder driven by an obsession with healthful eating. The Diagnostic and Statistical Manual doesn’t formally recognize this as a separate eating disorder. By understanding the warning signs, symptoms, and health consequences, mental health professionals can better treat patients who present with orthorexia.

The term orthorexia was coined by physician Stephen Bratman in 1996 to better express the obsession with eating healthfully. Over time, vigilant focus on proper nutrition can evolve into an increasingly restrictive diet. Patients with orthorexia can no longer eat out at restaurants with others, must rigidly shop for food ingredients, and have ritualized patterns of food preparation and eating. These individuals spend a substantial amount of time researching food, preservatives, or additives. Their diet eventually becomes so restrictive that their physical health becomes compromised.

There is a significant crossover between orthorexia, anorexia, and obsessive compulsive disorder (OCD). Of patients with anorexia, up to 30 percent simultaneously have OCD. A recent study of patients with orthorexia showed limited abilities to process information and problem-solve on neuropsychological testing. Additionally, like patients with anorexia and OCD, those with orthorexia struggled with memory, planning, and being able to transfer from one task to another (“set shifting”). As the field of psychiatry advances, we hope to better understand the underlying neurobiological causes of orthorexia.

People who have an obsession with eating healthfully are likely to compulsively check the ingredients of each thing they eat, being overly concerned with the health of the ingredients they’re consuming. They also may avoid eating things they do not deem “healthy” or “pure,” and become visibly distressed when healthful foods aren’t available.

Those who suffer orthorexia also restrict the amount and type of foods consumed, making malnutrition a possibility.
Among the warning signs of orthorexia, experts mention rigid eating patterns and extreme inflexibility with diet, serious emotional distress when firm eating rules are broken, and extreme and drastic weight loss.

Some of the potential health consequences of the disorder are permanent health damage, such as osteoporosis, kidney failure, or infertility; a lowered immune system and nutritional deficiencies; and emotional instability and a low sense of self-worth.
I still remember my first orthorexia patient’s response to seeing the health consequences of her mental illness. As we reviewed her lab results together, she began to cry. “I never meant for this to happen,” she said. “I just wanted to be healthy.”

By learning to understand and respond to signs of an eating disorder, we can help the people in our lives who may be struggling with this condition.