When eating healthy turns obsessive

Therapists, nutritionists, and eating-disorder experts have slowly begun to take orthorexia more seriously.

Story highlights

  • Orthorexia can lead to malnourishment, anorexia, or disabling anxiety
  • Orthorexia causes distress and interferes with everyday life
  • Orthorexics don't always lose weight since they fixate on the quality of food
In a vegan café in New York City, Nisha Moodley pushes a glass crusted with the remnants of a berry-açai-almond milk smoothie across the table and begins listing the foods she excised from her diet six years ago.
"Factory-farmed meats; hormone-laden dairy; conventional non-organic fruits and vegetables; anything hydrogenated; anything microwaved," the slender 32-year-old health coach says. "I would not eat irradiated food; charred or blackened foods; artificial coloring, flavoring, or sweetener; MSG; white rice; sugar; table salt; or anything canned.
Back then, a typical breakfast for Moodley consisted of buckwheat mixed with seaweed, raw cacao powder, flax oil, and flax seeds. Lunch was usually homemade brown rice with lentils, fresh vegetables, and kale, followed by a mid-afternoon snack of homemade flax-seed-and-buckwheat crackers. And for dinner, a salad with garbanzo beans, avocado, carrots, beets, and mushrooms.
Moodley initially adopted this diet to address recurring bad digestion. But her commitment to healthy eating -- something to be commended, ordinarily -- turned into an obsession that took over her life. "I was terrified of food that didn't fit within my idea of what was healthy," Moodley says. "I was terrified of cancer, of dying."
She couldn't eat out with friends, attend dinner parties, or shop at certain grocery stores because of her intense phobia. Her anxiety was so overwhelming that her stomach problems worsened.
Moodley knew she had a problem, but she didn't view it as an eating disorder. Although she had been a self-described "emotional overeater" for most of her life, the naturally slim Moodley had never been concerned about her weight, nor had she ever purged after her binges. Her unhealthy fixation with healthy food was something else, and it was years before she realized it had a name: orthorexia.
Orthorexia is not an official diagnosis. The American Psychiatric Association (APA) does not recognize it, and some eating-disorder clinics aren't even aware of it. But orthorexia -- which seems to include elements of other disorders, such as anorexia and obsessive-compulsive disorder—can be a serious problem. Left untreated, experts say, it can lead to malnourishment, anorexia, or disabling anxiety.
A murky diagnosis
Steven Bratman, M.D., coined the term orthorexia in a 1997 essay for Yoga Journal in which he described the disorder as a "fixation on eating proper food." Bratman, who himself had a food fixation while living on a commune in upstate New York, chose the prefix "ortho" -- which in Greek means straight, correct, true -- to reflect the obsession with maintaining a perfect diet. Bratman described orthorexia in greater detail in the 2001 book HealthFood Junkies, but it remains largely unrecognized and poorly understood.
It doesn't help that people with orthorexia can get positive feedback for behavior that appears healthy. For many people, strict diets such as veganism, locavorism, and fruitarianism (exactly what it sounds like) have become a way to eat healthier and also address their concerns about how food ends up on our tables.
"One of the things that's tricky about our culture is that orthorexia is socially acceptable and often even heralded as a great statement of self-control and doing the right thing for your health," says Amanda Mellowspring, a registered dietician in Miami who specializes in eating disorders.
The key difference between orthorexia and simply following a strict diet, Mellowspring says, is that orthorexia causes distress and interferes with everyday life. "What it boils down to is, how much does it negatively affect their life?" she says. "How much does it affect their social life? How much time do they spend thinking about food?"
Although orthorexia shares characteristics with anorexia, orthorexics don't always lose weight since they fixate on the quality (as opposed to quantity) of food. And they usually lack the distorted, negativeself-image -- known as body dysmorphia -- that causes some anorexics to look in the mirror and see oodles of fat when in fact they're severely underweight.
"Body dysmorphia will make you miserable, and those with orthorexia tend not to have that," says Alan Kauf