Eating too healthy: orthorexia

Every year, the goal that tops many of our new year's resolutions lists is to 'eat healthier'. We promise ourselves to cut the simple carbs, incorporate more fruits and vegetables, and use less sugar – the different ways to improve our 'eat healthier' goals are endless.

After all, you can never eat too healthy, right?

The ironic answer is yes, obsessing over a "too-healthy" diet can backfire. A new eating disorder called orthorexia is increasingly affecting more people, garnering attention from dietitians. Coined by American physician Dr. Steven Bratman in 1997, "orthorexia" is taken from "orthos", the Greek word for correct, and "orexis", meaning appetite.

What are the signs of orthorexia?

"The first thing is not to assume that just because someone is eating healthier or trying to take care of their diet that they necessarily have orthorexia or they’re on their way to developing it," said Jennifer Sygo, a Toronto-based registered dietitian and sports nutritionist who has written on the topic. 

"The signs you look for is when a person’s interest in health has bordered towards obsessive behaviours – in particular, antisocial behaviour. It's when they'll no longer eat with other people or in social situations because they fear what they’re eating doesn’t fit within the rules they’ve established for what should eat."

These "rules" orthorexic people usually set for themselves are goals to eat healthy and more "purely". This can range anywhere from a combination of diets including: Paleo, vegetarian, grain-free, dairy-free.

Foods consumed isn't the main issue

However, the diets alone aren't the issue. "It’s the mindset behind the person following it, when it becomes obsessive," said Sygo.

Some noticeable signs of the shift from a regular, healthy eating person to orthorexia include increases in the number of food rules and restrictions the individual has set for themselves. What might start off as simply trying to eat more fruits and vegetables may turn into drastic diet-restritive decisions such as becoming gluten-free, vegan, or avoiding all foods with genetically modified organisms (GMO) in it.

"But none of those things in isolation is a problem," said Sygo. "The issue is when it crosses the line into being self-destructive, obsessive, all-consuming, and doesn’t allow the person to function properly in society. Or they have so few foods that they’re becoming undernourished as a result."

Sygo reminds us that eating is a social behaviour. When someone's healthy obsession prevents the individual from participating in normal social eating activities, it has evolved into a serious problem.

What makes orthorexia different from other eating disorders?

Anorexia is a morbid fear of becoming fat. People with orthorexia do not always have the end goal of becoming thin. "It’s not necessarily about looking at one’s body and creating an evaluation based on that," said Sygo. "Orthorexia is about evaluating the food, and the obsession stems from that."

While there may be physiological damaging effects such as undernourishment, orthorexia is still difficult to diagnose. The new disorder is not currently recognized in the Diagnostic and Statistical Manual of Mental Disorders, the common criteria for psychological assessments. Unlike anorexia or bulimia, which has established sets of particular diagnostics, there is not a single consensus with orthorexia yet.

Who does orthorexia mainly affect?

In Sygo's practice, she finds a trend in athletic teens and young women. She believes this may be a result of both the maturity of the age group and the massive volume of health information constantly circulating.

"The stakes are always getting higher, the food is getting cleaner, and it’s easier to make more and more rules. Each person who is in each camp or category makes proclamations that their diet is the healthiest."

"Paleo people will say that their diet, which does include meat is the healthiest, vegans whose diet doesn’t include meat, will say theirs is the healthiest. People who don’t eat sugar will say theirs is the healthiest. People who only eat organic will say theirs is the healthiest."

For a young person still beginning to understanding the world, all of this can be confusing. 

"It can be confusing for anybody at any stage of our lives. When you get a 17-year-old, especially who is involved sports–because sports tends to be something high-functioning, perfectionist individuals gravitate towards– they tend to be perfect about their training and try to be perfect with their diet. You put those two together and you’ve got a recipe for an athlete who is starting to make the list of foods they can’t actually eat."

As an example, one of Sygo's clients decided to become gluten-free when there was no particular medical requirement. She had eliminated many foods from her diet. As a result, during long training sessions, she felt weak and faint because she had few food options left. "Had she eaten something with gluten, she would have felt better," said Sygo. "Instead, she was exhausting herself by being so fixated on being gluten-free."

What should you do if you have orthorexia or a friend affected?

Prepare to research and discuss it, as orthorexia is not completely acknowledged or accepted in the scientific or medical community yet.

Seek medical attention

Because there is not a lot of awareness about orthorexia yet, it may be difficult seeking medical attention and finding the right practitioner. Sygo suggest looking for psychologists, dietitians, and physicians trained in helping eating disorder-related issues.

Seeing a dietitian may help ease some orthorexics' misplaced anxieties about what exactly is a healthy food and what is not. "Just being able to educate people, that relatively speaking, the amount of sugar in that yogurt isn’t so bad in the context of their healthy diet can ease some of their worries."

Show concern for their social habits, not diet

When you approach someone with orthorexia, don't focus on whether their diet is healthy or unhealthy. Focus on their mindset and behaviour, instead. Bring up the possibility that excluding so many foods is putting thems at risk in the long-term.

"Don't focus on their eating habits because the counter the person will say is that, 'so you have a problem with me being healthy?'"

"Address the issue by saying, 'no, I don’t have a problem with you being healthy, but I expect you to eat with your family at dinner time.'", said Sygo. "You can address their social issues, for example, by saying, ‘you can’t even attend someone’s birthday party because the stress and anxiety of going is so great that you don’t even feel comfortable leaving the house to eat with other people.' Tell them those are the things you're worried about."

Encourage your friend to pay attention to how much stress and strain their diet causing for themselves. "When eating stops being fun and positive, those are good signs something’s gone wrong," said Sygo.