Dear Dietitian,

My thirteen-year-old daughter started a new healthy eating program about six months ago. She seems obsessed with healthy eating and sometimes refuses to eat when she stays at a friend’s house. I am concerned about her behavior. Is this something serious, or will she grow out of it?

Sheila

Dear Sheila, 

The desire to eat right is healthy, but too much of a good thing is no longer a good thing. New light is being shed on an obsessive pattern of eating known as Orthorexia Nervosa. 

The term orthorexia is from the Greek meaning ‘right appetite’ and was first coined by Steven Bratman, M.D. in 1997. Orthorexia may occur in someone who has unresolved trauma in his life. The obsession with healthy eating is pursued through a restrictive diet, a focus on food preparation, and rigid eating patterns. People with orthorexia are concerned with the quality of food rather than quantity. The obsession does not begin with a desire to lose weight, as with anorexia, but rather as a desire to eat healthy and live a better life (1).

Currently, orthorexia is not formally recognized as a psychiatric disorder, and scientific research is lacking. Bratman cautions that just because someone adopts an alternative diet does not mean that person has orthorexia. When eating right becomes an obsession and affects other areas of the person’s life, it becomes a problem (2).

At this point, it is unclear if the disorder is a part of anorexia nervosa, stands alone as a disorder, or is a part of obsessive-compulsive disorder (OCD). It is known to affect women more often than men and is more prevalent in Western countries than in other parts of the world. Orthorexia may lead to nutrient deficiencies and malnutrition.

Another area of life that is impacted by orthorexia is relationships. One may socialize less frequently as activities often include dining out. They may spend less time with family and friends because they are obsessing about the foods that will be available at a conference next week. As a result, the individual begins to feel isolated and alone.

According to the National Eating Disorders Association, warning signs and symptoms of orthorexia include (3):

• Compulsive checking of ingredient lists and nutrition labels
• An increase in concern about the health of ingredients
• Cutting out an increasing number of food groups (all sugar, all carbohydrates, all dairy, all meat, all animal products)
• An inability to eat anything but a narrow group of foods deemed ‘healthy’ or ‘pure.’
• Showing high levels of distress when ‘safe’ or ‘healthy’ foods aren’t available

Whether this is a phase or a more serious problem for your daughter remains to be seen. You may start by asking your daughter’s pediatrician for a referral to a psychotherapist for an evaluation. You may also contact the National Eating Disorder Association at 

1-800-931.2237. There is help.

References

1. Brytek-Matera A, Donini LM, et al. Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students. J Eat Disord. 2015;3:2.
2. Bratman S. Orthorexia vs. theories of healthy eating. Eat Weight Disord. 2017: 22(3): 381-385.
3. https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia

Until next time, be healthy!

Dear Dietitian