She wasn’t eating kale smoothies because she loved them, and she never thought becoming anorexic would make her prettier.
Anna, a junior at a Spokane high school, set out on a path toward an eating disorder by trying to eat healthier.
Fueled partly by a desire to be a better athlete, influenced by a family member who emphasized a health-conscious, “very organic, very raw” diet, Anna traded junk food for a strict diet the summer before her sophomore year. Along with smoothies (the kale was organic), she ate vegetable salads, but no dressing (fat was bad) and no croutons (carbs were bad). She ate edamame and rice (brown rice, never white). And once a week, she treated herself to a quarter-cup of granola.
Orthorexia is often described as an “unhealthy obsession” with healthy eating – a fixation on the quality of food, rather than the quantity. It starts with good intentions. But as orthorexics become fixated, their food choices become so restricted that their health and relationships can suffer.
Anna said that’s what happened to her. Her commitment to “healthy eating” grew into calorie counting and food restriction. (Anna asked that her real name not be published, partly out of concern that it would hurt her sports-scholarship prospects.)
She was frail and exhausted and irritable, and her athletic performance faltered. At 5-foot-7, she got down to 95 pounds. Her parents took her to a doctor who specialized in eating disorders, and she learned she had bradycardia, an abnormally low heart rate. She was diagnosed with anorexia.
“It turned from eating healthy,” Anna said, “to, ‘Dude, you’re going to die if you don’t step it up.’ ”
Because orthorexia is not an officially recognized mental disorder, and therefore not an official diagnosis, it’s difficult to know how many people suffer from it.
But “we all have encountered orthorexia in the field,” said Krista Crotty, clinical manager of the Emily Program, an eating disorder treatment center in Spokane.
The term was invented by Dr. Steven Bratman, who wrote an essay about it for Yoga Journal in 1997 and published a book about it, “Health Food Junkies,” in 2001. From the Greek, “orthos” means straight, and “orexia” means appetite.
He intended it as a kind of “tease therapy” for his patients who seemed overly concerned about their diets, Bratman later wrote. But it’s come to refer to a condition in which obsession over “healthy eating” can lead to serious psychological and physical problems.
The term is getting mainstream attention partly because of media coverage surrounding MSNBC host Mika Brzezinski, who wrote about her experience with orthorexia in a book published in May.
But it’s also coming to light as a reflection on the culture’s focus on healthiness, particularly “how obsessed we are with healthy food,” Crotty said. “The conversation in our schools and in our media is very health-focused right now.”
Craig Hunt, a registered dietitian who teaches nutrition at Eastern Washington and Gonzaga universities, covers orthorexia in his classes.
“It’s really interesting to watch the students’ response,” he said. “I think almost everybody can see a little bit of themselves in that description.”
That people are using food as a way to get healthier is a good thing, Hunt said. But strict food rules can affect people mentally and physically, even those who aren’t orthorexic.
“People have lost sight of, for lack of a better term, moderation,” Hunt said. “It’s almost like people feel guilty for eating their macaroni and cheese.”
Lisa Geraud, executive clinical director at the Moore Center, an eating disorder treatment center in Bellevue, said she recently saw a reference in a grocery store to “clean eating.”
“The idea there is purity, right?” she said. “Goodness, purity – and that’s a very seductively orthorexic term, to my mind. And people are bombarded with that.”
Rather than a diagnosable disorder on its own, orthorexia is common as an “adjunct” problem, or a “gateway behavior” that can lead people to develop eating disorders that are medically recognized, Geraud said.
It usually starts with an earnest attempt to eat healthier. People might decide to limit saturated fats, avoid artificial chemicals and preservatives, or eat meat only from animals raised in a particular way.
“It’s very in vogue to do that, and there’s a lot of recognition that people get socially for doing so, which can really get the ball rolling with orthorexia,” Geraud said.
They’re praised for their “superiority” or willpower for eating in a “perfect way, so-called,” she said. And that praise feels good.
For some people, it becomes an obsession, mimicking obsessive-compulsive disorder.
The obsession can be fueled by “fad diets,” Crotty said, that use pop science to demonize entire food groups. The diet “becomes this magic bullet of fixing all my life problems,” she said, “based on nutritional magic, which doesn’t exist.”
Treatment includes nutrition education.
“People come to treatment with so many myths about nutrition,” Geraud said. “They think fats are bad for them. They think a certain additive is absolutely going to harm their bodies. They’ve read perhaps the literature on restricting energy in terms of prolonging life. But they don’t know the full science of things, so they’re operating on either too little information or information that isn’t put through scientific rigor.”
For most people, of course, health-improvement efforts don’t develop into unhealthy obsession. Most people who adopt rigid food rules can laugh it off when they break them.
People at risk of developing orthorexia tend to share certain traits, Geraud said. They have a hard time making transitions. They like to know what to count on and have a hard time recovering from surprises. They’re more cautious than spontaneous. They tend to be “rule-bound” and make decisions based on other people’s opinions.
While others who set strict rules they can’t follow might feel disappointed, Geraud said, it’s “not at the cellular level that someone with these temperament or character traits would feel.”
Orthorexics’ sense of self-worth and identity comes to depend on their adherence to the rules, she said. When they fall off the wagon, they get right back on, then hold themselves to even more severe restrictions “to atone for the so-called sin.”
By the time they seek treatment, they’ve usually developed a diagnosable eating disorder, such as anorexia, Geraud said, suffering drastic weight loss or other health problems as a result of poor nutrition. They’re spending big chunks of time worrying about their next meal.
“They’re suffering. They’re lonely,” she said. “Friends don’t want to be around them because they’re judgmental about or don’t want to participate in a basic social function that we call eating. They really want help, but they also can’t imagine parting from their rules.”
Anna said that after a year in treatment, her recovering body, “working overtime,” is experiencing a speeded-up metabolism that requires her to eat 3,500 calories a day. She lifts weights for her sport, so she needs to eat a lot of protein. After medical testing, she’s been diagnosed with celiac disease. All of that complicates things.
But these days she’ll happily eat a gluten-free cupcake.
And, she said, “I have not had a kale smoothie in a really long time.”
Along with nutrition education, treatment involves therapy to work on patients’ “psychological flexibility” – a sign of mental health, Geraud said.
At the Emily Program, Crotty said, patients practice eating without focusing on their notions of perfection: “There’s no perfect way to eat.”