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When Healthy Eating Becomes an Obsession

SAR nutritionist on the dangers of orthorexia

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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.

31 Comments
Amy Laskowski

Amy Laskowski can be reached at amlaskow@bu.edu.

31 Comments on When Healthy Eating Becomes an Obsession

  • Malik ali on 07.26.2013 at 3:12 am

    thats nice vegetables for health

    • Paige on 11.19.2014 at 11:32 pm

      Obsession is Obsession…
      Genetic Roulette is an excellent documentary on GMO’s
      Awareness, responsibility, and conscious choice in regards to own health is good thing.

  • bugirl on 07.26.2013 at 9:13 am

    so this article says GMOs are okay? …
    there is much public debate about that… that surprises me that was written and published

    • Jake on 07.26.2013 at 12:03 pm

      Yes because if something is debatable, it shouldn’t be written about.

    • Anonymous on 07.26.2013 at 5:05 pm

      Feel free to argue otherwise, but I was under the impression that the “debate” about GMO’s is centered around the questionable business practices of companies like Monsanto, and that the actual science regarding GMO safety is pretty settled- really no different than selective breeding.

      • Annonymous on 07.27.2013 at 11:29 pm

        The science is not settled at all. Any time you alter an organism, you are altering an ecosystem, and there is no way to determine the long term effects of genetically modified organisms. GMOs are an ethical and environmental issue, regardless of the effect on human health.

    • Emma on 08.01.2013 at 12:18 pm

      The article never said that GMOs were okay, just that they are perceived as unreasonably harmful by orthorexic people. The author never said, “Eat as many GMOs as you can.” She said that orthorexics avoid GMOs (and other foods that they perceive to be unhealthy) religiously, and this can restrict their diet to excess, causing poor health.

  • KH on 07.26.2013 at 9:44 am

    Nice article – thank you. FYI, your “1+2+3 solutions” link is broken.

  • Amy M Laskowski on 07.26.2013 at 9:50 am

    Link is fixed, thanks for letting us know!

  • skrrr on 07.26.2013 at 10:05 am

    There’s nothing wrong with making an effort to eat healthier, but people need to learn how to do it correctly and what is needed to fuel the body. If anyone is looking for a better idea and very very specific information about this, I’d recommend you watch “Hungry for Change” – a documentary that details the current state of food today and how we can avoid getting sucked into it. You can find it easily online if you google ‘hungry for change full movie’.

    Good article. Many people are becoming interested in the “healthy” movement, but skipping essential steps needed in order to do so.

  • Deb on 07.26.2013 at 10:50 am

    I am absolutely shocked that this article was published as well. “Any time you cut out food from your diet for any reason you are at risk”? Monsanto would love this article. Pathologizing healthy eating and avoidance of processed foods and animal products? Writing that it is not in the DSM “yet”? Implying that only eating foods one prepares for him/herself is a warning sign of a psychological disorder? Absurd!

    • Emma on 07.26.2013 at 3:45 pm

      Thank you for your comment. The observed increase of an “abnormal” behavior gets posited as a candidate for the DSM’s next update. This is the kind of thinking in which informed divergence from “normal” habits of consumption can never be seen as responses to real problems – problems with the way food is produced, consumed, and perceived. As you say, such pathologizing runs the risk of amounting to blindness to criticism of a system that is indeed broken – a risk which, I would argue, is much greater than the “risk” of eliminating processed food from one’s diet. Yet another instance of the politics of food infiltrating itself into what may be our greatest weakness: the authority of the institution of western medicine. Sure, the article ostensibly seeks to make a much milder point; but which is the greater danger, this new “eating disorder” or the conflation of health with a political “normal”?

  • Luzmin on 07.26.2013 at 10:54 am

    This is another nonsense article. So flawed. This kind of advice is the reason why we are all fat and unhealthy.

    Fats are good for you: Coconut oil, avocado oil, pastured butter, and pastured eggs (with the yolk) are all good fats.

    Processed foods are bad: Pasta, wheat and grains are bad because they have been modified either by agricultural methods or by genetic manipulation and they have anti-nutrients that negate all the benefits they may have and prevent the body from absorbing other nutrients (think Celiac disease and gluten intolerance). If wheat products were so good why do they have to enrich them with all sorts of vitamins and minerals before they come up with the final product. Rice by the way is mostly calories, very little nutrition in it and arsenic to boot. Look at the ingredients list of bread next time you go shopping, oh and they also add sugar. More sugar on top of sugar.

    Sugar is bad for you: If you ate only protein and fat your body would would know how to make sugar out of glycogen stores in the liver and muscles, and then it would go to the fat stores for energy. We can get all the sugar we need from vegetables and never eat a piece of bread or starchy vegetables or worse, processed, added sugar, and function perfectly fine.

    Snacks: We do not need them and in fact they cause insulin resistance by constantly raising your blood sugar. If you eat whole, nutritionally dense foods like eggs, meats, vegetables and healthy fats 3 or 2 times a day or even once a day, you would not need to eat every two hours. Snacks and processed foods are the reason there are so many diabetics out there.

    There are studies to support all of this. The problem is that GMO companies and pharmaceuticals want to keep people in the dark so we can buy their products. It is up to us to find the truth.

    Remember you are what you eat.

    • Vadim85 on 07.26.2013 at 1:14 pm

      I completely agree. You’ve just described my entire way of life! Cheers!

      I’ve been eating this way for over a year and I feel amazing! So much energy! I went from completely inactive to crossfit three times a week. I got my blood work back and my doctor was in shock with how good my numbers were!

      Highly recommend this lifestyle!

      Awesome post!

    • Erin on 07.26.2013 at 10:36 pm

      Your comments are incredibly ignorant. I will not go so far as to say you have no idea what you’re talking about because you don’t have a degree in nutrition. However, you are clearly “hanging your hat” on single “studies to support all of this,” and it’s very possible said studies were flawed or conducted by those with conflicting interests. Please stop spewing garbage dietary advice; your poisonous words are one of the reasons we are all fat and unhealthy.

    • Richard on 07.27.2013 at 2:11 pm

      Luzmin, it is obvious after reading your comment that you are not qualified to be commenting about what is healthy and what is not healthy.
      You should read some books by leaders in the field like Drs McDougall, Campbell, Fuhrman and others that know what they are talking about through research they have performed.
      For example, You and nobody else in the world knows yet if egg yolks are harmful or not, especially if one already has heart disease. What is good about butter? At least avocado has vitamins and some minerals if actually eating the fruit. Why would someone avoid starchy vegetables?
      All the studies in the world do not clarify everything about a healthy diet. Maybe Americans are consuming too much animal protein and a significant reduction in meat and dairy products would lessen the rate of disease, especially heart disease.

    • derbywifey on 04.03.2014 at 10:41 pm

      Luzmin totally has orthorexia. ;)

      You are all taking it the wrong way and going on your liberal conspiracy theory rampage (and this is coming from someone who is very liberal).

      When you are so terrified of yellow #5 and eat nothing but raw broccoli all day, have osteoporosis at 32, and weigh 70 pounds, you are not “healthy;” you are pathological. THAT is what the article is saying, NOT that “you should totally not worry about what you’re putting in your mouth ever.” Orthorexia has exactly the same negative health outcomes as anorexia–only instead of obsessing over being thin, you are obsessing over “purity.”

      Again, the focus is not on eating healthy; it is on basically NOT eating at all, only for completely different reasons. Anorexia (the same behavior; different reason) causes osteoporosis, amenhorrhea (cessation of menstruation), infertility, immunodeficiency disorder, and can lead to cardiovascular disease or cancer.

      Just to reiterate: The article is not saying “healthy” people have a bad lifestyle. That is ridiculous. They are saying the obsession over what you eat to the point where you give yourself a chronic illness is NOT “being healthy.”

  • William J. Skocpol on 07.26.2013 at 11:36 am

    Be careful, folks. There are “studies” that purport to support any assertion somewhere on the Internet. This article warns that there can be negative health consequences to ruling out many whole categories of food based essentially on your own faith-like beliefs. The more you rule out, the greater the danger. You ought to be able to see that this danger is real, when carried to extremes. Be a careful consumer of information and research ALL SIDES of an issue before staking your health and perhaps even your life on it. Think carefully about whether things that may apply to certain people are appropriate for you. Also note that individuals who say that they feel so much better now that they are not eating X may just feel better because they subconsciously feel good about taking action, no matter what it is.

  • Ali on 07.26.2013 at 11:49 am

    I actually think that this was an interesting article. The naysayers above are missing the point- everything in moderation. You can go overboard with cutting out certain foods and restricting yourself to extreme diets.

    And in response to above: I personally need snacks. As an athlete that burns 2500 + calories a practice – I need to eat between meals. If I don’t have a snack or two, my blood sugar gets low and I don’t function all that well. (Aka hangry- hungry-angry).

    I think that the best diet is one that fits YOUR needs best- following generic rules like “no snacks” “no pasta” will not work for everyone and could lead to unhealthy habits.

    Everything in moderation.

    • Richard on 07.27.2013 at 2:13 pm

      Everything in moderation leads to the heart disease that shows up in people as young as 20…

      It is a nice thought, however, better to look at some populations like the Okinawans and rural Chinese to learn how they
      are eating while showing significantly less heart disease.

      • Meng on 09.01.2013 at 8:52 pm

        Am Chinese here….it depends on how you define moderation? Moderation in America seems to mean excess in Asia….One moderate serving of full fat dairy Cream does not exist in a traditional Chinese or Okinawan diet. we eat lots of rice (too much). A meal usually means bowls of rice with some salty side dishes to make the plan rice palatable. If one meal no rice the sky would cave in….we eat a lot of salt too, how to eat cheap and plan tasteless rice in huge quantities if without any taste or flavor? One thing is, we eat lots of varieties of leafy greens, which is absent in western diet….The main thing one forgets is the quantities, one serve of American steak was non existent and the equivalent amount of chicken or fish is enough meat for a family for a whole week in my younger days. Also the amount and variates of convenient processed foods that most so call modern societies have (just go to your supermarket and see all those attractive sweets and cookies) are also absent in a traditional Asian diet…sadly not the modern one.

        If one knows anything about nutrition….Foods are broken down into basically fats, sugars, protein, fiber, vitamins and minerals by our digestive system…Have a sensible approach and consume them in the recommended amount, whatever source, mix or origin they might come in. No need to have phobia of one food over the other or becoming judgmental and a food snob…your digestive system don’t know the difference! That said, worrying about how safe and the origin of food is justifiable…given that foods are becoming scares due to human overpopulation, especially in some overpopulated countries, where unethical food producers are out to make a quick buck…

  • K on 07.26.2013 at 12:18 pm

    I think the article misses what truly defines orthorexia – the mindset. There’s nothing wrong with trying to eat healthier, and there are plenty of people who follow very strict diets without having orthorexia. The difference is how food is perceived. Someone without orthorexia can eat something “impure” like nachos with the girlfriends once in a blue moon and be ok with that. Someone with orthorexia simply cannot; the thought of eating something impure is actually the mental equivalent of them poisoning themselves. Someone with orthorexia can actually have panic attacks if they eat “impure” foods because they are so afraid of “poisoning” their bodies.

    There’s nothing wrong with eating healthier or wanting to stick to natural foods – it’s all about the perception.

  • Annonymous on 07.27.2013 at 11:36 pm

    This article definitely missed important points and completely disregarded that a lot of the purpose behind eating non-processed food and organic food relates back to environmental consideration.

  • Gay on 09.07.2013 at 5:04 pm

    I do agree with K but I think orthorexia can also be obsession with loosing weight.
    My daughter admitted that a couple of years ago she lost lots of weight because she was not eating and is now under a personal trainer, nutritionist.
    I came across this article because I am worried about my daughter. She is trying to lose more body fat – she looks good – smaller than I ever was at my smallest. She is a size 6 and because she has not lost 1.4 body fat at her last nutritionist appointment she is down, moody and will not even go out for lunch for Fathers day as she does not eat out anymore! She has cut out fat, sugar and now any dressing for salads etc from her diet. She is eating healthy but is so strict that she will not go out even for Sunday brunch, coffee or meals – nothing that will tempt her to eat non diet food. No more lunches with colleagues on Friday either or social club activities as they center around fatty food and alcohol. I can understand part but when it affects your work / life balance it is becoming obsessive.

  • Paul on 11.23.2013 at 11:49 am

    I was a bit like this and I’ve come to the conclusion that it’s just not worth it cutting yourself from all the dietary pleasures. If 70-80% of your calorie intake consists of good foods (vegetables, legumes, lean meat, fruits, whole grains), then the remaining 20% can have sweets and other unhealthier components. I feel being too strict about your diet really deprives you of pleasures.

    Moderation is key.

  • A Mother on 04.06.2014 at 6:06 am

    Thank you for this article. The palio diet is a diet that cuts out entire food groups and is dangerous in my opinion. I watched my daughter become obsessed with her diet and her childrens after she started this diet. I believe she developed this disorder.

  • Li on 05.09.2014 at 11:43 pm

    Wow I have to completely disagree with this article. We can start knit picking at anything someone has a passion for or aka obsession. Is working out everyday bad for you? Is smoking an obsession? Is going to church everyday bad? People eat clean for Lots of reasons. It heals sickness and disease. we have much more energy, you feel good, faster recovery, saving energy from killing animals. This list could go on. When it comes to food everyone immediately thinks they are a nutritionist. Let people do what they want as long as they aren’t hurting themselves. People smoke and drink everyday. There is nothing wrong with eating clean except making sure you eat enough calories which requires to eat large quantities. Besides…humans are designed to eat what’s in nature after all. We didn’t have all this processed foods millions of years ago

  • Paul D. on 08.19.2014 at 11:45 am

    My wife suffers from this terribly – not just an obsession with pure food, but obsession with a couple hundred different vitamin pills and supplements that fill an entire kitchen cabinet. We can no longer eat out and simply enjoy a meal or go on vacation, because the food she “needs” is not available. It is not only the ruination of our marriage it is financially ruining us too. The things she claims she is allergic to via either self-diagnoses or quacks increases each week, leading to even more extreme dietary behavior.

    There is no hope for treatment, because she won’t admit that there is anything wrong with her.

  • melpy on 09.05.2014 at 4:32 pm

    I hate that they say cutting out gmos is dangerous. There’s nothing about gmos that is healthier than organic. Just as healthy? Debatable at most. Healthier? don’t be ridiculous.

  • Kaleb on 08.03.2015 at 10:56 pm

    So I only eat natural foods. 6 meals a day. Strictly healthy. High protein, healthy complex carbs (whole grains) and healthy fats very low in saturated fat. And my only sugar comes from skim milk and fruit. I dont put anything unhealthy in my body and ill tell you I’m in the best shape I’ve ever been.

  • Jordan on 03.25.2016 at 7:17 pm

    “Someone with orthorexia is not really focused on weight, but obsesses about this idea of a very pure diet.” I haven’t found this to be true, actually. I’ve known a number of orthorexic people (all women) and they are all very weight-focused. One woman I knew in particular would talk ad nauseum about what new food group she’d read was killing her, but she also casually talked about weighing herself every single day, complained of gaining 15lbs by the end of her pregnancy, and was incredibly critical of other women’s weight. But if you’d asked her, her diet was all about “eliminating deadly toxins,” etc.

    The draw of orthorexia is that, in almost all cases, you will lose weight – yet you can still easily stave off any criticism or concern by claiming that your goal is really to “eat the way God intended” or “get my Lyme’s under control,” or whatever. Often, it’s important for orthorexics to convince themselves that these are their real goals. Meanwhile, they will continue to restrict and restrict, eating up every new blog telling them to throw out yet another pantry staple, and getting more and more sickly and worn out in the process – in short, anything but “healthy,” because that was never really the goal. It all comes down to skinniness for women in the Western hemisphere – no matter how they try to couch it.

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