Eating healthy and in balanced composition is important to keep up the overall well-being of the body. However, Orthorexia Nervosa is a situation where a person gets obsessed with eating healthy food. The obsession is not to lose weight, but to stay healthy. However, it is still not listed as an eating disorder by the American Psychiatric Association and the same is not mentioned as an official diagnosis in the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM). An Orthorexic person spends more time in preparing, planning and procuring healthy food than it is necessarily required. Also, it has been observed that they are ready to compromise with their social or personal life out of fear of eating anything unhealthy. It has also been reviewed in many researches that these people belong to a different field and have higher information about healthy eating. This is a relatively new concept which is now being studied in detail to understand the better perspective. However, the obsession can lead to disrupted self esteem as people get more inclined towards judging people involved in eating unhealthy or junk. This obsession is still being studied by many researchers to come up to a conclusion or develop a solution for it.
Since your young days, you have been told over and over again to make healthy eating choices. Ditching the junks and opting for fresh vegetables and fruits during meals and snacks were common tips given by all. But how many of you knew that maintaining a ‘too’ healthy diet can also bring health issues and is regarded as a disorder? Yes, people who eat too healthy are known to suffer from Orthorexia Nervosa. It is a new concept and is considered by many as an eating disorder in which a person is excessively preoccupied with healthy food. The term orthorexia nervosa was derived from two different words — “orthos” meaning accurate and “orexis” meaning hunger, that when combined forms obsession with healthy food and proper nutrition (Varga Márta et. al., 2014).
Orthorexia Nervosa reflects the fears and worries about health, eating and quality of food to such an extent that it starts hampering the overall social and personal life of an individual. However, it has not yet been recognised as an eating disorder by the American Psychiatric Association and the same is not mentioned as an official diagnosis in the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM), (Varga, Dukay-Szabó, Túry, & Van Furth, 2013).
Orthorexia Nervosa was first described by Bratman in 1997 where he entailed this as a fixation on healthy food or a health food dependence and developed a 10-item questionnaire. This was further modified to ORTO-15 by Donini et al, a 15-item self-report questionnaire that determines the prevalence of highly sensitive behaviour related to health and proper nutrition. These items assessed an individual’s behaviour more included towards obsessive attitude related to selection, purchase, preparation and consumption of food that they considered to be healthy (Donini L et. al., 2004). Each item is answered on a 4-point Likert scale where individuals are required to answer with “always-often-sometimes-never”. A lower score is associated with orthorexia tendency. The questions scored as “1” is related towards a person being highly an orthorexic while more of the questions scored as “4” is towards never.
This questionnaire was further modified and translated according to a country’s specific culture, habit and lifestyle including those of Hungary, Italy and Turkey.
Orthorexia Nervosa and Normal Eating
Taking care of one’s own health and fitness is overgrowing the intention to maintain a healthy lifestyle and the overall wellbeing. However, this will to focus on your own health can’t be related to orthorexia because a person suffering from orthorexia is emotionally disturbed, which can lead to social isolation and self-harming behaviour. The restriction of diet pattern in orthorexia is such hard and impulsive that a person can harm himself in cases of failure to have a healthy meal. This behaviour is destructive in which eating healthy becomes unhealthy and can be hazardous for a person’s life.
Obsession with healthy food turns a person’s life upside down as the person’s relationship with food begins to get impaired with the other dimensions of life. A person with orthorexia starts spending much time in preparing and planning for their meals and starts avoiding to meet people to keep themselves away from any introduction to unhealthy food. In general scenario, it is good to avoid food with the presence of pesticides or heavy metals, but in orthorexia, a person starts restricting their food to such an extent that they get obsessed with the presence of any of it and starts avoiding it, which can lead to any nutrient deficiency and other health hazards.
Orthorexia Nervosa and Exercise
It is healthy to include exercise in daily routine, but a person with orthorexia is also an enthusiast in the sector to remain further fit. Although, the desire to reduce weight or to achieve a particular body shape is absent. The aim of including exercise in orthorexia is to keep the body healthy and fit by including healthy and “pure” food options.
Exercise has dozens of health benefits and a person with orthorexia can be obsessed with any form of exercise including yoga, walking or jogging among the many types of workout, giving him or her the satisfaction of keeping the body healthy. Although, obsession with exercise is an additional characteristic which is studied in many researches, but orthorexia in itself is an obsession with healthy food and not exercise.
Orthorexia Nervosa and Supplement Use
Nutrition supplements are a convenient way to add nutrients in a diet that cannot be achieved otherwise. However, the quality of these nutrition supplements is important because nowadays, many supplements contain inferior quality ingredients that tend to slowly or rapidly increase side effects in the body. An orthorexic person has a varied relationship with the usage of supplements depending on his or her mindset as many people are seen to completely eliminate supplements from their routine, while others add supplements rich in natural ingredients. Supplements that are free from artificial flavours, colours, preservatives and thickeners are preferred by an orthorexic person in order to get the complete nutrition. However, the consumption of supplements in such people also depends on the daily physical activities and fitness status. Since, there is no aim of achieving weight loss or a particular body shape, an Orthorexic person is more inclined towards having supplements that can be categorised as whole or natural.
Orthorexia Nervosa and Anorexia Nervosa
Orthorexia can also be related to Anorexia as there were a few similarities along with some differences too:
- Food and eating pre-occupation
- Restrive diet patterns
- Maintaining the right eating pattern
- Avoidance of certain foods because of anxiety
- Higher importance towards self-care and protection
- Superiority feeling over others based on one’s own eating preferences
- Obsession towards control in life
- Obsessive-compulsive personality traits
- Higher ego status
- Chronic nature towards different situations in life
- Nutrient-related deficiencies
- Orthorexia is more inclined towards consuming healthy and pure food, unlike Anorexia where the main goal is weight loss.
- There is an obsession towards the quality of food in orthorexia whereas, in anorexia, it is the quantity that matters.
- There is no obsession about physical appearance in orthorexia whereas in anorexia, self-appearance is a great obsession.
- There is no fear of gaining fat in the body in orthorexia, but in anorexia, the patient is in immense fear of gaining fat.
- Lack of obsession is present in orthorexia about body image disorder, but higher obsession can be seen in anorexia.
The Future of Orthorexia
Orthorexia Nervosa is still a theoretical concept and has still not been listed as an eating disorder or an obsessive-compulsive disorder. Many of the researches are based on a hypothetical questionnaire that is developed on knowing more about orthorexia tendencies. But, the behaviour of any person varies if the situation arises in the family, friend or with someone known. Further studies require being done to be sure about orthorexia tendencies in realistic perspective.
Many studies are done on varied ages of people belonging to different fields of science and non-science background to understand the effect of knowledge about right nutrition on orthorexia. It is said to state that people with more knowledge about healthy food are highly prone to orthorexia as compared to a less educated person. Further research is required in this field to conclude anything about realistic approach towards Orthorexia Nervosa.
Orthorexia is considered to be an obsession with eating healthy and pure food. Although, it is still not listed as an eating disorder or an obsessive-compulsive disorder. It is good to focus on your health and fitness, but making it an obsession becomes bad for the health. Obsession with healthy food restricts many food items, which can imbalance the ratio of macro and micro nutrients. An orthorexic person starts skipping his or her meal in case a desired healthy meal is not available. This can lead to any nutrient deficiencies and loss of muscles because of restricted calorie intake. There is a role of every macro and micro nutrient in human body, which gets disturbed because of excessive restricted eating pattern. On the longer run, this can have other side effects like slower metabolism, unwanted weight loss or muscle loss that are not desirable.
A person with orthorexia starts spending much time in planning and preparing their healthy meal, which actually starts affecting their personal and social life. There are many dimensions in life including creativity, love, family, friends, personal space or working time. However, a person with orthorexia starts damaging these separate areas in his life just to manage their healthy diet. They even start avoiding meeting friends or going out for meal just because of the fear of not getting healthy meal. This not only makes them socially isolated, but also affects their life’s perspective.
An orthorexic person becomes obsessively judgemental towards other people who are involved in eating unhealthy, junks or impure foods. The thought being with someone who is involved in such an action makes the orthorexic person anxious, guilty and disturbed. This also affects their personal perspective of peace, happiness, joy and self-esteem as the only thing which keeps them sane is healthy and pure eating. Although, the will of losing weight or to achieve a specific size or look is absent in an orthorexic person. The only thing that they are concerned about is eating right and healthy.
There are different theories around this, with one being that more knowledge about healthy foods can be bad for health because it makes them more prone towards obsession. Hence, people working in the field of health, nutrition and fitness are more prone towards this situation. Although, more research is required in this field so as to conclude about this obsession.
- M. Nevin, Suzanne & Vartanian, Lenny. (2017). The stigma of clean dieting and orthorexia nervosa. Journal of Eating Disorders. 5. 10.1186/s40337-017-0168-9.
- Håman, L., Barker-Ruchti, N., Patriksson, G., & Lindgren, E.-C. (2015). Orthorexia nervosa: An integrative literature review of a lifestyle syndrome. International Journal of Qualitative Studies on Health and Well-Being, 10, 10.3402/qhw.v10.26799. http://doi.org/10.3402/qhw.v10.26799
- Varga, M., Thege, B. K., Dukay-Szabó, S., Túry, F., & van Furth, E. F. (2014). When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry, 14, 59. http://doi.org/10.1186/1471-244X-14-59
- Brytek-Matera, Anna & Donini, Lorenzo & Krupa, Magdalena & Poggiogalle, Eleonora & Hay, Phillipa. (2015). Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students. Journal of Eating Disorders. 3. 10.1186/s40337-015-0038-2.
- Arusoglu, Gulcan & Kabakçi, Elif & Köksal, Gülden & Türkan, Kutluay. (2008). Orthorexia Nervosa and Adapta on of ORTO-11 into Turkish.
- Bratman, S., & Knight, D. Health Food Junkies: Orthorexia Nervosa: Overcoming the Obsession with Healthful Eating.—2001. Broadway.—256 p.
- Donini, L. M., Marsili, D., Graziani, M. P., Imbriale, M., & Cannella, C. (2004). Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 9(2), 151-157
- Koven, N. S., & Abry, A. W. (2015). The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatric Disease and Treatment, 11, 385–394. http://doi.org/10.2147/NDT.S61665