What is orthorexia? Well here’s one high-profile example: Ashton Kutcher recently opened up about being hospitalized for what he called “crazy pancreatitis,” which he developed after adopting Steve Jobs’ fruitarian diet to get into character for playing the Apple co-founder in the 2013 film Jobs. Fruitarian diets consist mostly of raw fruits and vegetables, and the actor told YouTube celebrity-interview show “Hot Ones” that he drank carrot juice “nonstop, all day” after learning that Jobs regularly drank the vegetable juice. When most Americans do not eat enough fruits and vegetables, living strictly off of produce may seem like a healthy choice. But, as Kutcher’s story illustrates, a diet that’s too restrictive—even when the diet is healthy food-focused—can actually be harmful. It could also be a sign of an eating disorder called orthorexia, which experts say is a widely misunderstood condition. Here’s everything you need to know about it.
What is orthorexia?
Orthorexia nervosa is a “pathological obsession with proper nutrition that leads to dietary restrictions and a rigid avoidance of foods deemed unhealthful,” says Ginger Hultin, a Seattle-based registered dietician nutritionist, owner of ChampagneNutrition and spokesperson for the Academy of Nutrition and Dietetics. Hultin explains that, unlike anorexia nervosa, which is driven by a desire to lose weight, orthorexia centers on a desire to want to eat “purely” to the point of self-imposing unhealthy limitations. The condition often does lead to weight loss (or other health issues, like Kutcher’s), which could be extreme enough to require treatment or hospitalization. Since the foods people with orthorexia eat are considered healthy, there tends to be a misunderstanding around condition rooted in a misunderstanding about what it means to be healthy, says Chevese Turner, chief strategy and policy officer at the National Eating Disorders Association (NEDA). Turner says when healthy, but restrictive, eating becomes disruptive to someone’s life, it becomes an eating disorder. Orthorexia also often accompanies “extreme exercise,” which may be too much to be considered healthy for the body. People with orthorexia may say, “‘I run and I watch what I eat; I eat really healthy.’ They may not be aware that they’re not getting enough food to sustain the amount of movement that they’re undertaking and that they’re not getting enough nutrients from foods that their bodies need that they’ve cut out of their diet,” she explains.
What’s the line between healthy eating and orthorexia?
The line between healthy eating and orthorexia is sometimes blurry. Turner says when healthy eating becomes too “all-consuming,” someone may be at risk of an eating disorder. Signs of the disorder are when “the majority of the thoughts in your head during any given day are around what you’re eating, how much you’re going to exercise, is this healthy for me, what I’m going to put in my mouth,” she says. People with orthorexia may avoid accessible foods if they deem them unhealthy, no matter how hungry they are. For example, Turner explains, someone may consider organic milk the only healthy option, and the thought of drinking nonorganic milk could make them feel physically sick.
Any restrictive diet ups the risk for orthorexia
Any diet that restricts certain foods—whether it’s self-imposed or for health reasons—could put someone at risk for orthorexia. That includes fad diets like keto diet or clean eating, or medically prescribed diets, like gluten-free for celiac disease, as well as a vegan diet or vegetarian diets, which have documented health and environmental benefits. But, Hultin cautions: just because someone follows these restrictive dietary patterns doesn’t mean they have orthorexia. Hultin, who has treated patients with orthorexia, says when people continue to add restrictions, it puts them most at risk. For example, someone who is gluten-free and vegan may start avoiding eating nuts and seeds, soy and nightshade vegetables, like peppers and potatoes. “People get so restricted that they hardly have any options for foods left to eat,” she says. “It occupies a lot of time and they want to eat more, but fear stops them from doing so.” Along with being time-consuming, very restrictive diets can be socially isolating and expensive, Hultin says. She urges anyone who needs to restrict foods in their diets for any reason to keep an ongoing dialogue with their dietitian to make sure what they eat meets their nutrient needs—and to be careful about adding extra food restrictions. A person’s intent with their diet is what usually separates an eating disorder from an eating pattern that restricts certain foods, Turner explains. Whether someone who embraces a vegetarian or gluten-free diet is more likely to develop an eating disorder, or those predisposed for eating disorders embrace restrictive diets is difficult to say. “But, we do know that restriction is the gateway to eating disorders,” Turner says.
Why is orthorexia is so difficult to diagnose?
Getting a handle on the prevalence of eating disorders in general is difficult, Turner says. It’s even tougher for orthorexia, which doesn’t have a designation in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). It’s also sometimes misdiagnosed as anorexia. Hultin believes that orthorexia is more common than people realize. “I see it very, very often in my practice and especially with complex medical conditions, including cancer, which seems to breed a lot of fear of food through internet searches and getting unsolicited advice from well-intending people,” she explains.
Celebrities and social media perpetuate healthy eating misinformation
While online searches can turn up a wealth of misinformation about which foods and diets are so-called healthy, celebrities posting on social media or talking about their eating habits can add to the confusion and misunderstanding. NFL star Tom Brady has been open about his diet, which restricts nightshades, dairy, gluten and trans and saturated fats, for example. Twitter co-founder and CEO Jack Dorsey has discussed his extended fasting. Hultin urges people to “take a step back” and not put too much stock in what celebrities say about their diets. “What works for one person doesn’t mean it works for another,” she says. “People do have different needs and they should be working with a trained professional on meeting their own unique needs rather than being influenced by testimonials.” Instagram recently announced that it would block content that promotes weight loss and cosmetic surgery targeted to users under 18. NEDA worked with Instagram on creating the new policy, Turner says.
How to seek treatment for orthorexia
Turner encourages anyone worried they have orthorexia or any eating disorder to contact the NEDA helpline at 1-800-931-2237 to get connected with local treatment options. Treating eating disorders, including orthorexia, often takes a team of professionals, and finding the right clinicians trained in treating eating disorders is critical. Eating disorder treatment can be costly and insurance may not always cover it, Turner says. NEDA is working at the federal and state level to change that. “It’s extremely important to seek help if you notice that you have an unhealthy relationship with or fear of food, or if you notice you’ve been adding on more and more restrictions to your diet lately,” Hultin says. Find out how TV writer Marti Noxon turned her personal eating disorder battle into a movie.
Sources
Ginger Hultin, a Seattle-based registered dietician nutritionist, owner of ChampagneNutrition and spokesperson for the Academy of Nutrition and DieteticsChevese Turner, chief strategy and policy officer at the National Eating Disorders Association (NEDA)
