Orthorexia: When Healthy Eating Goes Too Far

By Erica Sweeney 08/13/14

Is there such a thing as eating too healthy? The strange eating disorder that masquerades as concern for a healthy diet.

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Lauryn Lax knows the exact day that her relationship with food changed, and the overwhelming preoccupation with fat grams, carbohydrates and protein that has consumed most of her life began. 

She was in sixth grade, and one day during recess at the private school she attended, the school’s most popular girl asked Lax and a few other girls how much they weighed. Of the group, Lax was embarrassed to learn she weighed the most, though she was not overweight. 

“I resolved that day to get on a healthy diet and lose 10 pounds,” says the now 26-year-old who lives in Austin, Texas. “It slowly developed into an obsession.” 

Lax first eliminated all junk food from her diet, started running and began setting specific food and exercise rules and routines. Each day she tried to eat less than the previous day and took comfort in her growling stomach. She also continuously increased her exercise. Physically, she began to not look like herself, and became pale, developed a rash on her legs and her hair started falling out. 

While still in middle school, Lax was diagnosed with anorexia nervosa, and later orthorexia nervosa, and has spent much of her life in treatment to re-establish her relationship with food. 

In 1997, Dr. Steven Bratman, author of Health Food Junkies, first defined orthorexia nervosa as an unhealthy obsession with eating healthy. 

Individuals with orthorexia have such a preoccupation with eating as healthy as possible that they often develop their own, often distorted, rules about food, says Karin Kratina, a nutrition therapist in Gainesville, Florida, who has been treating people with eating disorders for more than 30 years. Eventually, the food rules take precedence and interfere with the person’s day-to-day life. 

Unlike most eating disorders, where the pursuit of thinness is the “underlying and obvious motivating variable,” in orthorexia, most often, the “underlying variable is the pursuit of health or purity, organicness, [and the] sense that everything needs to be clean, whole and pure,” says Sondra Kronberg, director of F.E.E.D. (Facilitated Eating Events and Direction), an outpatient program of the Eating Disorder Treatment Collaborative, based in New York.

Orthorexia often starts with a healthy value system about food, but how much it interferes with someone’s life is what makes it unhealthy, Kronberg explains. Adding elements of exercise and compulsion makes the disorder more extreme, and eventually negatively impacts health. 

Because orthorexia is not classified in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), it is difficult to determine how many people have the disorder, says a National Eating Disorder Association spokesperson. Orthorexia diagnoses usually fall into the “Other Specified Food Eating Disorders” category, along with other eating and feeding disorders. 

Even though it’s difficult to track orthorexia diagnoses, those treating individuals with eating disorders say they are seeing an increase in patients with orthorexia, particularly among teenagers and tweens, as today’s food culture continues to shift and healthy eating is emphasized. But many of these nutrition professionals question how “healthy eating” is interpreted. 

Food Culture and Healthy Eating 

In today’s seemingly food-obsessed culture, terms like gluten-free, veganism, organic, Paleo, chemical-free, clean eating and eat local commonly fill conversations and media reports. And, all this talk about food and what is supposedly healthy can negatively impact people predisposed to developing an eating disorder, like orthorexia. 

Individuals with rigid, compulsive and anxious personalities are not always able to sift through the mainstream, and often contradictory or incorrect, information about food, Kratina says. This leaves “eating healthy” up to interpretation, as individuals pick and choose what they consider healthy foods and establish their own sets of rules. 

Taken to the extreme, the abundance of food information causes individuals to become overly focused with the ideas of purity and health, Kronberg says. 

“People are doing things with their food that are extreme, and we won’t know the consequences until the long term,” she says. “You have to learn to eat and take care of yourself, and I don’t know that everyone knows how to do that. It [becomes] dangerous when people start excluding things from their diet. The body and brain are undernourished.” 

Kronberg says people with orthorexia are addicted to the belief system that something bad will happen if they eat a certain food and lack flexibility to make the best eating decisions. “If you have a rigid, anxious, depressed mind, it operates on one thought: ‘I can’t eat that,’” she says. 

Because weight loss, diet restriction and eating healthy are culturally accepted, orthorexia often goes undiagnosed. Kronberg says it’s difficult to tell how much internal turmoil an individual experiences over their eating lifestyle, and that’s what determines orthorexia. 

“In our culture, food is highly moralized,” Kratina says. “When we eat better, we feel better and think better things about ourselves. It’s easy to read about the need to eat healthy. It’s an obsession that’s really reinforced and easy to disguise. The way our society conceptualizes healthy eating is part of the problem.”

In June, Jordan Younger, of “The Blonde Vegan” blog, shared her struggles with orthorexia stemming from her restrictive diet. On her blog post, “Why I’m Transitioning from Veganism…,” she discussed once walking a mile out of the way to get a specific juice that fit within her food rules, and why she’s giving up the vegan lifestyle to incorporate a more balanced diet. 

“I started living in a bubble of restriction,” Younger wrote. “Entirely vegan, entirely plant-based, entirely gluten-free, oil-free, refined sugar-free, flour-free, dressing/sauce-free, etc. and lived my life based off of when I could and could not eat and what I could and could not combine. There is nothing wrong with any of those things (many of them are great, actually!!) but my body didn’t feel good, and I wasn’t listening to it.”

Lax’s orthorexic tendencies started with obsessively watching fat grams and setting goals to eat fewer grams of fat each day. Over the years, the rules changed. While spending a summer in New York City during her senior year of high school, she rigorously followed the Atkins Diet and cut out all carbohydrates. 

She saw most foods as toxic. Most recently, when she was in graduate school at Belmont University in Nashville, Lax had a short list of foods that she “could” eat: specific ground turkey patties that her mom shipped her from a restaurant in her hometown, steamed vegetables, protein shakes and Crystal Light. 

Her rules also revolved around counting the grams of protein and dictated specific eating times: breakfast by 8 a.m., lunch by 1 p.m. and dinner by 7 p.m. — if she didn’t eat on time, she waited until the next meal. 

“The rules changed some, and the focus was different,” Lax explains. “But it was always food-rule behavior. It was more a checklist of eating perfectly, a checklist in my head that you have to do it or else.”

Challenging the Rules of Orthorexia 

In her practice, Kratina says many patients with orthorexia devote so much time to avoiding certain foods that when they start reintroducing them into their diets, they binge. It’s when they are no longer able to follow their own food rules that they seek treatment because they want help re-establishing the rules, not for help creating a balanced diet. 

Treatment for orthorexia includes nutrition counseling and therapy. Kratina says she helps patients see the consequences of their eating behaviors and rid themselves of rigid belief systems regarding food. Depending how entrenched the disorder is, treatment usually lasts around three months. 

“We work on changing the underlying [feelings of] purity and power,” Kronberg says, and treatment also includes increasing flexibility around food and discussing new food exposures. 

For much of her life, Lax says she underwent a series of treatments, including many hospitalizations, and therapy and nutritional counseling sessions. She calls much of her treatment “horrifying experiences,” which focused on weight restoration, placing a “band aid” on the problem and never getting to the root of it or addressing her orthorexia. Once treatment ended, Lax usually reverted back to her old ways. 

For Lax, the breaking point came just a couple of years ago during her second year of graduate school. Her weight was down to 79 pounds. She ate only a select few foods at specific times and worked out seven hours a day. A group from her gym staged an intervention of sorts and convinced her to seek treatment. 

She spent four weeks in the hospital before being transferred to a treatment center in Miami, where she spent nine months. This is where she says her life changed. 

“I made up my mind that when I got out, life would be different,” Lax says. “I didn’t want to go back to my old ways.” 

She credits self-reflection and the supportive environments of her CrossFit box and church in Austin with helping her turn the corner with recovery. After sharing her story, she said she felt accepted, and, with the help of her nutritionist and counselor, whom she continues to work with, she started getting better.

Now, she says she rarely struggles in her newfound relationship with food. She’s learned to function without the food rules and now focuses on eating a balanced diet. 

“I started trusting my body more, and challenging the rules [I set] for myself,” says Lax, who hopes to one day open a treatment center for people with eating disorders. “I started becoming in touch with my body and started caring less about the rules. I gave it a shot and felt great, and the world went on. It was internally deciding to do something different.”

In understanding the disorder, Kratina says it’s important to remember that living with an extreme diet isn’t necessarily orthorexia, as long as the food and eating rules don’t consume someone’s life. People with orthorexia are so consumed with food that it affects their relationships and the ability to participate in social events. They may also go to extremes to access the foods they deem safe, tell others the right way to eat and bring their own food wherever they go. 

The NEDA helpline is 800-931-2237 or visit www.myNEDA.org for treatment referrals. 

Erica Sweeney is a freelance writer and editor based in Little Rock, Arkansas. She serves as the editor of Savvy Kids, and writes regularly for the Arkansas Times. She last wrote about drug testing students.

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Erica Sweeney is a freelance writer and editor based in Little Rock, Arkansas. She serves as the editor of Savvy Kids, and writes regularly for the Arkansas Times. You can find Erica on Linkedin or follow her on Twitter.