In 1997, Steven Bratman, MD, coined the term “orthorexia” to address a particular kind of disordered eating that he personally experienced, and saw in his practice and in his community. Ortho, meaning “right” and orexia, referring to the condition of the appetite, describes an individual who is obsessed with “right” or healthy eating. This is subjective, of course, and may manifest in a variety of ways, such as eating only raw foods, being macrobiotic, eliminating food groups such as dairy or carbohydrates, or even a single ingredient, such as high fructose corn syrup. This differs from the eating disorders that have diagnostic codes in the DSM. Orthorexia is not a recognized, diagnosable eating disorder.
Now, before I go any further, I bet some of you are thinking, “Yeah, so what’s the problem?” Well, the problem is the obsession. And even before that, I need to address that very word-obsession—at the risk of digressing for one second. When did being obsessed or OCD become a term that’s dropped in a conversation like a casual announcement such as buying a new sweater, or really looking forward to your date on Friday night? “I’m obsessed with mid-century furniture!” Really? Do you have to bring an Eames chair with you everywhere you go? “I’m so OCD (laughing)!”
Ok, I’m probably preaching to the choir here, but c’mon! Those of us in the trenches, as it were, know that obsessive-compulsive disorder is a very real, painful, sometimes debilitating condition. So, when I’m talking about being obsessed with healthy eating, it’s not that I’m just talking about shopping at Whole Foods. It’s also very real.
Since I specialize in working with eating disorders and body image, and also since I live in the very progressive, health-conscious city of Seattle, I see orthorexia not only in my office, but also in my community. If you’re a fan of the show Portlandia, you may recall a sketch in which characters played by Fred Armisen and Carrie Brownstein are in a restaurant considering the chicken on the menu. Portland, Oregon is similar to Seattle in its love of all things local, organic, farm-raised, and sanctified sustainable. Not a bad thing, for sure. The scene from Portlandia is a great satire of this love, highlighting an extreme that could be considered obsessive. Note that they walk out of the restaurant without eating a bite, determined to get more information on said chicken, presumably missing out on their dining experience for the evening.
So what constitutes orthorexia? It is the obsession, (persistent, preoccupying thoughts) with eating healthfully, eating the right foods, or implementing the right diet, from the perspective of an individual or group.
Dr. Bratman outlines concerns in a checklist for orthorexia:
• Are you spending more than three hours a day thinking about healthy food?
• Are you planning tomorrow’s menu today?
• Is the virtue you feel about what you eat more important than the pleasure you receive from eating it?
• Has the quality of your life decreased as the quality of your diet increased?
• Have you become stricter with yourself?
• Does your self-esteem get a boost from eating healthy? Do you look down on others who don’t eat this way?
• Do you skip foods you once enjoyed in order to eat the “right” foods?
• Does your diet make it difficult for you to eat anywhere but at home, distancing you from friends and family?
• Do you feel guilt or self-loathing when you stray from your diet?
• When you eat the way you’re supposed to, do you feel in total control?
His criteria? Answering yes to two or three of these questions may mean that you have a mild case of orthorexia. Yes to four or more means that you may need to relax more when it comes to food. And if you can relate to all these items, you may be obsessed with food.
Orthorexia can look a lot like obsessive-compulsive disorder, for sure, but I think it casts a wider net when it comes to anxiety. I have recently been on two panel discussions on orthorexia, and I began my portion of the discussion with the obvious: we live in an anxious world. When it comes to food, we are getting more and more anxiety-ridden. Although there is not much research on orthorexia to date, I hypothesize that this is an issue most relevant to those who do not experience food insecurity. It is an issue for those of us with access to a lot of information and many choices. We have access to a kind of abundance that is a cause for gratitude, as well as confusion. Orthorexia is part of this confusion. It looks like the right way, but it’s just another cover-up.
I believe the root of the problem is existential anxiety, including fear of death, identity crises, and finding purpose and meaning in life. Socio-cultural anxiety is also identifiable, including a need for control of chaos, perfectionism, finding identity, and conformity. In addition, spiritual and moral anxiety, including idealism, finding identity, and achieving purity may also have a role.
We are all seeking a sense of safety in one way or another, to address the anxieties we face as humans. What begins with a fear of death may turn into the pursuit of perfect eating. The search for immortality and the fear of disease, for example, may manifest as a fear of fat and toxins.
When life feels out of control, harnessing something that seems good and wholesome seems like the answer. We are actually told that this is the answer. We see, on a daily basis, many such “answers” to our deepest fears. Headlines, TV commercials, doctors, internet searches, check-out aisle magazines all promise “the best,” “the miracle,” “the cure,” to assuage our anxieties. There is an engagement with “covert conformity”: a “healthy” way to align with cultural ideals of beauty and longevity. Who would ever say that eating healthfully is a bad thing? And indeed, it is not, until or unless it is the only thing.
There can be an engagement with overt conformity as well, including finding a community of like-minded eaters. This is associated with finding identity—when you aren’t sure of who you are, and instead of living with the discomfort of this human discovery process, there is a grasping for identity through food and eating behavior. “Who am I? I’m paleo…I’m vegan”, etc.
Finding spiritual fulfillment and satisfaction may also be part of finding community, but can be a form of spiritual materialism or spiritual narcissism, relating to the practice as being a higher, better way of being spiritual than others, and can spill over into the right way to eat. For example, asceticism in eating would be denying yourself the pleasures of food and finding satisfaction in denial and self-punishment. “If I cut out all sugar, I am proving to myself (and maybe others) that I am strong/dedicated/committed/worthy/capable…”
When these anxieties are addressed by the quest for perfect and right eating, what seems like the answer to freedom is actually the entrapment of obsession. What looks like a healthy and good way to connect with the body is actually disconnecting us more, and I think this will only make us more anxious as individuals and as a culture.
Certainly, identifying that there is a problem can help to dislodge some of the disordered thinking about an eating pattern, and move one towards creating a more moderate, fluid, sustainable relationship with food and eating. Getting sound nutrition information may help. Dispelling myths about certain dietary trends can be useful. When someone is fully engaged with orthorexia, it can take just as much work to disengage as any diagnosable eating disorder. However, I think we all can fall prey to the mass of messages and “right ways” that are available.
As society, I think it’s important to ask some deeper questions. What is individually sustainable? What brings you peace? How can we trust ourselves, our own bodies, our food supply, and each other to know what feels best? And perhaps the most valuable consideration—what are we anxious about—individually and collectively—as humans? How can we accept that we live in an anxious world; that there is uncertainty and ambiguity; that we are beautiful and imperfect; and that maybe we fear death? How can we have that conversation first and foremost—instead of quietly (or loudly) being anxious about carbohydrates?
You can live to be a hundred if you give up all the things that make you want to live to be a hundred. –Woody Allen
Bratman, S. & Knight, D., (2001). Healthfood junkies. New York, NY: Broadway Books.
— Sibel Golden