Orthorexia – when healthy eating misfires

Orthorexia – when healthy eating misfires

We’re all encouraged to eat healthily, with the familiar mantra “the right amount of the right food at the right time” underlining what we feel we should be doing. But what happens when that focus on health becomes an unhealthy compulsion? This is a condition called orthorexia.

Orthorexia, meaning a fixation on healthy eating, was coined by Dr Steve Bratman in 1997. Whilst orthorexia starts with the intention to eat healthily the increasing restrictions on food choices actually lead to poorer health. The person affected may then blame themselves for their poor health, only to redouble their efforts to eat more “healthily”. Over time the obsession with eating only food deemed as healthy can reach a point where it closes off other interests and relationships, and can lead to emaciation and malnutrition.

With its pattern of falling weight, and the increasing exclusion of more and more foods, orthorexia can easily be mistaken for anorexia. However the fundamental mind-set is different – anorexia is concerned with the quantity of food consumed orthorexia is concerned with the quality. Whilst an anorexic wants to lose weight the person with orthorexia wants to feel healthy or pure.

Although the mind-set is different the underlying trigger for orthorexia can be the same as for anorexia and other eating disorders. The person affected may be responding to real or imagined health fears; they may be trying to evoke control over an aspect of their life; they may be trying to bolster their self-esteem; or they may be using their relationship with food as a way to mark themselves out as an individual.

What are the signs of orthorexia?

Researchers have established a set of fifteen questions used to tease out peoples’ attitudes to food and to health. The results of this are weighted to provide an overall picture of individuals’ relationship with healthy eating. Whilst it’s not appropriate to replicate that questionnaire here I have included eleven representative questions. Answering “yes” to three or more of these questions may indicate a mild case of orthorexia.

  1. I consume only healthy foods
  2. I spend a large amount of time preparing my meals
  3. I feel guilty when I break my healthy eating rules
  4. I think the quality of food is more important than the taste
  5. Healthy eating has affected my eating out, or eating with friends
  6. When I eat the way the way I’m supposed to I feel in control
  7. In the last three months, the thought of food has worried me
  8. I believe that being overweight is a sign of weakness
  9. I skip foods I once enjoyed in order to eat healthy foods
  10.  I am critical of people who don’t follow the rules of a healthy lifestyle
  11. In the last three months, I have become stricter with myself

What is the treatment for orthorexia?

People with orthorexia often display symptoms and behaviours of obsessive compulsive disorder. Whilst there is uncertainty over whether these are the effect of starvation rather than the root cause it makes sense to look at talking therapies as a way of addressing orthorexia.

Whatever the talking therapy chosen (CBT, ACT, MBCT, hypnotherapy) it will look at the thought patterns and assumptions that lie behind the obsessive approach to “health”. Treatment won’t be predicated just on reaching an increased weight or eating a specified number of other foods, but will focus on making sure that the person achieves a healthy and proportionate relationship with food. This will mean addressing the emotional issues behind the orthorexia, and the benefits that the behaviour was designed to bring.

For these reasons orthorexia won’t respond to a diet plan, but that doesn’t mean that you shouldn’t consider contacting a dietitian. Some dietitians are skilled in the use of CBT to deal with the mental behaviours that support and accompany eating disorders. Not only may they be able to offer the same skills to those with orthorexia, their scientific background gives them authority in addressing misconceptions about what constitutes healthy eating.

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