Almost everyone has heard of the eating disorders anorexia nervosa and bulimia. The first condition is exhibited by an intense fear of gaining weight, the second by a pattern of bingeing and purging. But now, some nutritionists and doctors are reporting seeing a growing number of patients who are exhibiting an obsessive preoccupation with avoiding foods they deem unhealthy and restricting themselves to a diet of foods they consider “pure.” The condition is known as orthorexia, a term first coined in 1997 by a physician to describe his own approach to food and pattern of eating. While orthorexia is not yet an officially recognized eating disorder, many health care workers and nutritionists have expressed concern at the number of people they’re seeing who are so consumed with food purity and quality that they are restricting their diets in potentially dangerous ways.
While people suffering from anorexia nervosa are obsessed with the quantity of their food, orthorexics focus on the quality. One trigger, says Jennifer Culbert (SAR’09), a registered dietician at the Sargent Choice Nutrition Center, may be society’s growing interest in organic and healthy foods, which has made some people fearful of ingredients like fat, sodium, and sugar—all of which are important, albeit in moderation, in a person’s diet.
Culbert specializes in eating disorders and weight loss. In addition to providing counseling at the center, she manages Sargent Choice’s practicum curriculum, helps in the placement of undergraduate nutrition majors, and oversees the center’s Weight Loss Essentials program. BU Today spoke with Culbert about orthorexia’s potential dangers, how it differs from other eating disorders, and how to get help.
BU Today: What is orthorexia? Can you define it?
Culbert: Basically, orthorexia is a fixation on eating only healthy or pure foods, or what an individual perceives as healthy or pure.
How is that different from when people just want to eat natural or organic products?
It’s different when it goes to the extreme. For instance, oftentimes it starts when someone is dieting, or when they decide they want to start eating a healthier diet. They plan to cut out candy, sugar, and saturated fat. If you’re cutting fat out of your diet, you are then unable to absorb all the nutrients from the wonderful things you are eating. Fat is necessary to absorb fat-soluble nutrients and all of the antioxidants that are found in fruits and vegetables. So you can be eating what seems to be a very pure diet—salad with lots of vegetables and fruits—but you’re not really getting the benefits of any of those things because you are not able to absorb the nutrients. That’s orthorexia, although I hesitate to use that word because it hasn’t been officially diagnosed and it is not yet in the DSM-5, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.
How do orthorexics harm themselves?
Someone might start out trying to have a healthier diet, which is a good thing. They then cut whole groups of foods out of their diets. They cut out meat because they heard that meat is bad, then they cut out dairy because they think it’s fattening, and then they move on to anything that’s processed. But processed foods aren’t necessarily bad; for example, brown rice, whole-wheat pasta, and whole-wheat bread are actually all processed foods. So if someone cuts out processed food, or things that are genetically modified, or not grown organically, the danger is that they can become malnourished or underweight.
So few people know anything about orthorexia. How does it differ from anorexia?
Someone with anorexia would want to lose weight because that’s their priority; they focus on weight, calories, and wanting to be thin. Someone with orthorexia is not really focused on weight, but obsesses about this idea of a very pure diet. Whereas someone with anorexia would restrict pretty much everything that they were eating, someone with orthorexia would focus more on the quality of the food.
Do you have any sense of how common orthorexia is and how many people suffer from it?
There haven’t really been any clear studies, so I don’t have numbers for you, but it is becoming more common.
Are there any diets or lifestyles that pose an increased risk for developing the disorder?
I think anytime you’re cutting out food for any reason, you become at risk of continuing down this path and start having disordered thoughts about food. Any diet can put someone at risk. Most times it doesn’t lead to an eating disorder like anorexia or orthorexia, but it certainly can put you at risk.
What are the warning signs that might indicate someone has orthorexia?
I think that the biggest warning sign is when you notice that your friend is no longer participating in his or her life fully, that they’re not going to dinner with you any more, that they’re unable to consume a meal that is prepared by someone else, or even have a meal at home with their family. It gets to that extreme. Someone with orthorexia often gets to the point where they can only consume food that they themselves have prepared.
What advice do you have for people who want to eat a more pure diet?
Well, I would recommend going on the Sargent Choice website. There we have some general information about meal planning called 1+2+3 solutions. That’s all about making sure that all of your meals have certain components: a lean source of protein, whether or not it’s vegetarian, a non-starchy fruit or vegetable, and then having a whole grain with that meal.
For instance, it could look like the classic meal that you grew up with: chicken, brown rice, and broccoli. Have one or two or three snacks per day. Maybe not ice cream every night, but going out in the summer for an ice cream cone, that’s perfectly fine.
If someone has concerns about their diet, where do you suggest they go for help?
They can come and see us. Anyone can schedule an appointment with a registered dietician who will take a look at their diet to make sure that they have all the nutrients that they need. Every student here is eligible for one nutrition visit per calendar year and more if needed—for example, if someone is diabetic, has a food allergy, or an eating disorder. There are all kinds of reasons why someone may need to see us more than one time a year. We also accept insurance. We have five registered dieticians, with dieticians who specialize in all sorts of gastrointestinal disorders, sports nutrition, and eating disorders.