When it Comes to Eating, How Healthy is Too Healthy?

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Everybody knows a few aggressively healthy eaters. These are the people who condescendingly nibble tofu while everybody else is indulging in a Twinkie binge, the people who demand at dinner to know the provenance of the chicken, the people who read every label on every supermarket packet, searching for the organic, the sugar-free, the gluten-free, the low-fat, the low-salt, and the local.

Don’t get me wrong: I’m all in favor of healthy eating. It’s admirable, desirable, and all of us should do more of it. But, as it turns out, too much of a good thing isn’t necessarily wonderful.

A new eating disorder is popping up in the news lately that describes people who take eating healthfully to an extreme. But the term was actually coined almost 20 years ago.

Back in 1997, physician Steven Bratman, author of Health Food Junkies , coined the term “orthorexia nervosa.” Orthorexia – the word comes from the Greek ortho, meaning true or correct, and orexis, appetite – can start small, with a desire to adopt a healthier lifestyle, to feel better in general, and/or to cope with a chronic medical condition, such as debilitating allergies or indigestion. In some, however, healthy eating topples into obsession as orthorexics amass ever-increasing lists of forbidden foods. One recovering orthorexic’s dietary no-nos, for example, included factory-farmed meats; hormone-containing dairy products; non-organic fruits and vegetables; anything hydrogenated, microwaved, or irradiated; charred or blackened foods; anything containing artificial coloring, flavors, or sweeteners; MSG; white rice; sugar; salt; and anything canned.

As orthorexia progresses, writes Bratman, “a day filled with sprouts, umeboshi plums and amaranth biscuits comes to feel as holy as one spent serving the poor and homeless.” Such a regime requires an extraordinary amount of vigilance and self-discipline; and extreme dietary purists soon find themselves spending an inordinate amount of time planning, purchasing, and preparing their meals. They also tend to become self-righteous about their superior eating habits, and often proselytize: Bratman, a recovered orthorexic, recalls that he continually lectured family, friends, and acquaintances on the evils of processed food and the dangers of pesticides and additives.

This is a different sort eating disorder from those associated with people who want to be skinny, explains Thomas Dunn, professor of psychology at the University of Northern Colorado, and co-author of a 2014 paper on orthorexia in the journal Psychosomatics. “Rather, it’s linked to people who are trying to be as healthy as they can be.”

At the far end of the orthorexic scale, ultra-healthy eaters become socially isolated, since their restrictive food habits make it difficult – if not impossible – to share meals with others or to eat away from home. For orthorexics, eating is “almost like a religion,” says Sondra Kronberg, director of New York’s Eating Disorder Treatment Collaborative. “You can’t eat out with a friend. You can’t go to a party. You have to bring your own food wherever you go.”

In some cases, orthorexics’ limited food choices lead to malnutrition; in others, the struggle to maintain a blamelessly pure diet leads to guilt and anxiety. Some develop anorexia or exhibit obsessive compulsive behaviors. In other words, what often begins as a cure can end up as a disease.

Orthorexia is not an official medical diagnosis, and there are no plans as yet to add it to the American Psychiatric Association’s definitive Diagnostic and Statistical Manual of Mental Disorders (DSM), the latest edition of which was published in 2013. (Orthorexia’s closest official equivalent may be a condition known as Avoidant/Restrictive Food Intake Disorder, an affliction of kids and preteens who are excessively picky eaters.) Nutritionists, eating-disorder specialists, and therapists, however, are becoming increasingly aware of orthorexia, and – though there are no hard numbers available – anecdotal evidence suggests that that this formerly unnoticed ailment is becoming increasingly common.

How did Bratman crack his own orthorexic habit?

He was saved by a kindly Benedictine monk, he says, who bought him a triple-scoop ice-cream cone.

Do you think you might have orthorexia? Check out this questionnaire from the National Eating Disorders Association. The more “yes” answers, the more likely that you may want to seek a doctor’s advice: