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When Healthy Eating Calls For Treatment- A Desire to Eat ‘Clean’ Food Can Become an Obsession


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When Healthy Eating Calls For Treatment - WSJ

Orthorexia nervosa is an eating disorder that involves obsessive healthy eating, sometimes to the point of malnutrition. WSJ's Sumathi Reddy discusses with Tanya Rivero.

The growing interest in eating healthy can at times have unhealthy consequences.

Some doctors and registered dietitians say they are increasingly seeing people whose desire to eat pure or “clean” food—from raw vegans to those who cut out multiple major food sources such as gluten, dairy and sugar—becomes an all-consuming obsession and leads to ill health. In extreme cases, people will end up becoming malnourished.

Some experts refer to the condition as orthorexia nervosa, a little-researched disorder that doesn't have an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, considered the bible of psychiatric illnesses. Often, individuals with orthorexia will exhibit symptoms of recognized conditions such as obsessive-compulsive disorder or end up losing unhealthy amounts of weight, similar to someone with anorexia.

Researchers in Colorado recently proposed a series of criteria they say could help clinicians diagnose orthorexia. The guidelines, published online in the journal Psychosomatics earlier this year, also could serve as a standard for future research of the disorder, they say.

Diet Pros and Cons:

DAIRY-FREE: Pro: Some people feel better when avoiding dairy even if aren’t truly allergic. Challenge: Make sure to get calcium, phosphorus and potassium from other foods.

RAW VEGAN: Pro: Plant-based diets are nutritious and are associated with lower rates of obesity and chronic disease. Challenge: Some vitamins, especially B12, are mostly in animal products. Cooking can make some nutrients more bio available.JUICING DIETS, CLEANSES: Pro: If used short term to kick start eating more fruits and vegetables, this diet can be acceptable. Challenge: Juices aren’t nutritionally complete. And cleansing is a misnomer as your body is ‘cleansed’ by the kidneys, digestive tract and lungs.GLUTEN-FREE: Pro: Gluten is a must avoid for people with an allergy. Those who are sensitive may find they feel much better. Challenge: A complete diet can be achieved with energy- and nutrient-rich foods such as non-wheat grains.

Ryan Moroze, a psychiatry fellow at the University of Colorado Denver School of Medicine and senior author of the study, said more research needs to be done to develop a valid screening instrument for orthorexia, determine its prevalence and differentiate it from other more well-known eating disorders.

“There are people who become malnourished, not because they’re restricting how much they eat, it’s what they’re choosing to eat,” said Thomas Dunn, a psychologist and psychology professor at the University of Northern Colorado in Greeley, Colo., and a co-author of the article. 

“It’s not that they’re doing it to get thin, they’re doing it to get healthy. It’s just sort of a mind-set where it gets taken to an extreme like what we see with other kinds of mental illness,” Dr. Dunn said.

Among the proposed criteria: an obsession with the quality and composition of meals to the extent that people may spend excessive amounts of time, say three or more hours a day, reading about and preparing specific types of food; and having feelings of guilt after eating unhealthy food. The preoccupation with such eating would have to either lead to nutritional imbalances or interfere with daily functional living to be considered orthorexia.

Some orthorexia patients are receiving treatments similar to those for obsessive-compulsive disorder. “We’re getting the people who aren’t being treated well under an eating-disorder diagnosis and their disorder is better treated under the OCD dial,” said Kimberley Quinlan, clinical director of the OCD Center of Los Angeles, an outpatient clinic.

The condition seems to start with an interest in living healthy and then, over time, people develop an increased anxiety about eating food that is contaminated or that they deem unhealthy, said Ms. Quinlan. Treatment often involves cognitive behavioral therapy, a type of psychotherapy aiming at behavior modification. “We’ve basically taken a model that we use to treat OCD and applied it to this disorder which is so similar,” she said.

Experts say there is a gray area between striving to eat healthy and going to the extreme, which helps to spur skepticism about orthorexia. “People don’t believe how eating healthy can be a disorder,” said Ms. Quinlan.

Sometimes other illnesses can lead to orthorexia.

David Rakel, director of integrative medicine at the University of Wisconsin School of Medicine and Public Health, estimated that 10% to 15% of the patients who come in with food allergies and related problems develop an unhealthy fear of particular foods.

Nutritional therapy often involves elimination diets—stopping to eat certain foods to check if they are contributing to an inflammatory condition, Dr. Rakel said. Under the program, the foods are later gradually reintroduced, but some people continue to avoid them. “People are getting so strict with their health choices that they’re not getting the nutrients that they need,” he said.

Some eating-disorder therapists say many of the orthorexia patients they treat also suffer from anorexia. But other experts say orthorexics often aren’t underweight, which can make it difficult to identify them.

“Someone on paper may be perfectly healthy and their blood work is great and their weight is fine but their behavior has become obsessive with food,” said

Marjorie Nolan Cohn, a New York City-based dietitian and national spokeswoman for the Academy of Nutrition and Dietetics, a professional organization.

A red flag is when someone’s eating habits are making them avoid social engagements, Ms. Cohn said. “They may not be able to go out to a restaurant with their friends because they don’t know what’s in the food or it’s not cooked in a certain way or what if it’s not organic olive oil?” she said.

Jordan Younger, 24, of Los Angeles, started a popular Instagram and blog last year to post recipes and pictures from her plant-based vegan diet. Then her daily diet became all-consuming.

“I would wake up in a panic thinking, ‘What am I going to eat today?’ ” said Ms. Younger. “I would go to a juice place or Whole Foods or a natural grocery store and would spend so much time in there looking at everything trying to plan out the whole day. It just began to take over my mind in a way that I started to see was unhealthy,” she said.

Ms. Younger, already slim, said she lost 25 pounds on her restrictive diet. Her skin turned orange and she stopped menstruating. In May, she started seeing an eating-disorder specialist and nutritionist who helped her recover.

Now, Ms. Younger said she doesn’t restrict herself from eating anything except for processed food. Her skin has returned to its normal color, her hair has thickened and grown 5 inches and she has put back on her weight.

“With all these different dietary philosophies, there’s a lot more room for orthorexia to develop,” she said. “It makes it really hard to eat if you’re listening to all these theories and it gives eating and food a ton of anxiety when really food should be enjoyable.”

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If only it were clear what constitutes a healthy diet.

Everyone's body is different so there is no universal.

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