The Healthy Eating Obsession

Steven Bratman, MD, is credited with coining the term orthorexia nervosa (ON) from the Greek word ortho, meaning straight and correct. It refers to a pathological fixation on eating healthy and beneficial ("pure") food as a means of losing weight, overcoming chronic illness, or improving general health. At one time or another, most of us decide to change our diet to reach one of these three goals. When we reach our goal, we usually return to the old diets, but in moderation or combined with exercise.

ON individuals, however, do not. They adopt a diet that is radically different from the foods they have eaten in the past. The two most common diets are raw food (uncooked raw vegetables, fruits, and legumes) and fruitarian (only fruits, tomatoes and cucumbers). They rigidly police their diet until the pure foods are all they eat. Once that happens, they are constantly on guard against resuming old dietary habits. For most people, this is not an easy thing to do. Those that succeed become food snobs and look down on the misinformed wretches who eat French fries, cookies, pizza and ice cream. Moreover, ON sufferers feel compelled to lecture family and friends on the virtues of adopting a pure diet.

The term "kitchen spirituality" was coined to describe the effect that food has on ON individuals. Tiffany Reiss, Ph.D., an assistant professor in nutrition and exercise science at Bastyr University, says that orthorexia can lead to isolation, rigidity, and alienation. It can lead to a feeling of virtuousness. ON individuals feel that everyone should be eating as they do. They become like hermits.

Their diets are so rigid that they cannot eat meals anywhere but in their own homes. Eating pure food becomes an almost religious experience. These food acolytes often feel that the act of eating sprouts, umeboshi plums, and amaranth biscuits is as holy as working with the poor and homeless. Conversely, when an ON person slips up and eats regular food, it is perceived as a fall from grace and must be atoned for by the penitence of ever-stricter diets and fasts. The need to eat meals free of meat, fat, and artificial chemicals becomes the holy grail.

Because the desire for eating the proper foods assumes a central role in an acolyte's life, Dr. Bratman believes that ON is similar to anorexia and bulimia. Bulimic and anorexic individuals focus on the quantity of food, while the orthorexic fixates on its quality. All three give food an excessive place in their lives. Dr. Bratman feels that ON can be overcome by convincing sufferers that their diet has important elements, but they have alternative choices. Sharlene Hesse-Biber, PhD, a sociology professor at Boston College, describes orthorexia as an obsession "that our bodies need to look a certain way....It's not a healthy way to live." Julie B. Clark-Sly, PhD, a psychologist at the Foundation for Change, agrees. "They say what they're doing is healthy, but they fool themselves. It becomes an emotional disorder."

Dr. Bratman has his detractors. ON is not listed in the clinical Diagnostic Statistic Manual (DSM-IV). There is no clinical guideline for this disorder. Dr. Diane Mickley, a spokeswoman for the Seattle-based National Eating Disorders Association, describes orthorexia as a psychiatric disorder. Kelly Brownell, PhD, co-director of the Yale Center for Eating and Weight Disorders, states that without research to back his theory, Bratman is simply another guy trying to make a buck off the health-conscious public. "They invent some new term, a new diet, a solution to a problem that doesn't even exist. The burden should fall to the authors to prove that what they're saying is correct before they start unleashing advice on the public." Dean Ornish, MD, founder and president of the non-profit Preventive Medicine Research Institute in Sausalito, California said "I've never seen [orthorexia] in my clinic. Most people have the opposite problem; they don't care enough about what they eat."