Tuesday, February 9, 2016

What is Orthorexia?

By the way, I’m not a relevant health professional and I haven’t had first or second hand experience of orthorexia or of any other eating disorder.  This isn’t meant to diagnose or treat orthorexia, be a personal story, or a defence of a mainstream criticism of Paleo.  The purpose of these blog posts is to discuss what I consider to be about an important and relevant issue that hasn’t got the quality of attention it deserves

Orthorexia, or othorexia nervosa, is an eating disorder (not currently recognised by the DSM) that is “characterized by extreme or excessive preoccupation with eating food believed to be healthy”.  Dr. Steven Bratman coined the term in an essay written in 1997 in response to what he saw as a new form of eating disorder (link, also see his blog and a new brief post on what is orthorexia)

Orthorexia is a fairly new concept that is only occasionally discussed in the media and on blogs.  The media mainly introduces the topics and gives one or two examples, whereas the conversation on blogs seems to be dominated by two extreme views:

  • The view often promoted by dieticians and health industry critics that conscientious or restrictive eating strongly suggests the person has orthorexia.  These people may also weaponise the concept of orthorexia to criticise dietary approaches they disagree with
  • And on the opposing side, often promoted by diet gurus, that discusses orthorexia with a great deal of defensiveness and usually either states that orthorexia isn’t in the DSM and so isn’t a real condition, considers orthorexia to be a made up disease to pathologise health eating for someone to profit from, or simply downplays its prevalence

From what I’ve read, I also don’t think this topic has usually been discussed well or thoroughly, and with little reference to the (rather quite small*) body of scientific literature.  This is a pity because orthorexia and related topics like moderation and diet and identity are important discussions to have, not just for orthorexia, but also regarding what are reasonable strategies to navigate the modern food environment, improve health and reduce chronic disease

A lot of the discussion by the media and on blogs about orthorexia has largely focussed on the behaviours and less on the thoughts.  For example the most common example in the media is Jordan Younger (probably because she has a book called ‘Breaking Vegan’), who adopted a raw vegan diet to fix her GI symptoms.  The diet worked for some time and she started a raw vegan blog, but then the problems came back.  So she tried cleanse after cleanse and grew fearful of regular raw vegan food before she realised she had a problem (link).  The narrative on the progression of orthorexia (in this case, in other examples and generally) focusses on restrictive eating and that healthy eating can be a slippery slope.  In this case it’s the restrictive raw vegan diet followed by the very restrictive cleanses that caused orthorexia

However, not enough attention has been placed on her thoughts, or why she engaged in those behaviours.  This is important because two people can engage in the same behaviour, but it is their motivation for the behaviour that determines whether they have a mental illness or not.  For example: two people choose not to go to a party or social event.  One person does this because they would rather spend the night reading (etc), the other does this because they fear being judged by others – one is expressing a preference, the other might be indicative of social anxiety.  Likewise a person can have abnormal thoughts and behaviours (e.g. sexual fetishes and eccentric mannerisms) or display what appear to be quite obsessive behaviours (e.g. the checking and second guessing that is required in some jobs).  Similar to before, it is whether these things cause suffering and impair function that determines whether they are an issue or not.  So focussing on eating healthy foods and avoiding unhealthy foods can be an indication of whether someone has orthorexia, but not necessarily.  You need to examine their thoughts/motivations/internalisations of their eating behaviours

With the example above I see the obsessive behaviour and progression towards orthorexia coming from a place of increasing feelings of powerlessness/loss of control and anxiety in regards to her GI health combined with making your diet a large part of your identity (more on this later)

* There are 45 published papers at the time of writing this.  PubMed even asks me if I really meant ‘orthodeoxia’, a cardiovascular conditions with 326 papers.  I’ll be discussing several of these papers later


  1. This is an interesting topic that doesn't really get much nuanced discussion. It's always presented in very black/white terms.

    I see many skeptics or "evidence based" nutrionists use this in a way to criticize healthy eating. Pretty common in the IIFYM / Flexible Dieting groups to laugh at someone for eating a healthy dessert (berries & cream) in place of pop-tarts, candy etc.

    At the same time, it does seem like there are dietary approaches out there (Bulletproof comes to mind) that are genuinely rooted in exploiting orthorexic tendencies.

    In listening to Asprey's podcast - even organic Kale can't be "bulletproof" - you have to grow "Dino Kale" in your backyard because it's low in oxalates (nevermind he's glossing over the oxalate content of the sweet potatoes he's eating and the dark chocolate he sells on his website).

    By the way, great blog - I really enjoy your posts!