Healthy Eating Turned Unhealthy Obsession

When a focus on healthy food becomes a dangerous obsession

By Stacey Schultz October 14, 2013


This article originally appeared in the December 2013 issue of Seattle magazine.

!–paging_filter–pLinda*, a 35-year-old attorney in Seattle, is the first to admit that going out for breakfast with her is rather tortured. She calls herself über-controlling, and it starts with not eating anything with fat in it. No butter on her toast (and only one piece of toast, thank you), no cream in her coffee, no yolks in her eggs. No syrup, no pancakes, no red meat. Oatmeal is OK. “You make so many modifications to your meal, and the waiter gets upset with you, and your friends are looking at you like you are crazy,” she says. brbrRecently, she fled the line outside a beer-and-brats place in Leavenworth where she was going to have a meal with friends. “I knew that I was going to be put in a position where I was going to get a beer, because everyone was getting beer, and I was not going to drink it,” she says. The brat was a nonstarter as well. “I thought, ‘I like sauerkraut a lot and I could just fill a bun with sauerkraut,’ but then people would look at me funny because I’m doing that, so I just felt like exiting the whole situation.” Afterward, it took many talks with her friends to smooth things over. brbrLinda might sound like a character straight out of Portlandia, but here in Seattle, “you are what you eat” is serious business. For the majority of us, it’s all just a good-faith effort to eat healthily. But for some, that interest crosses over into disordered behavior, known as orthorexia nervosa.brbrPeople with orthorexia are striving for the most healthful and pure way to eat, but when it is taken to the extreme, ironically, they can end up malnourished and underweight. Perhaps less dangerous but nonetheless disturbing, orthorexia wreaks havoc on people’s social relationships and can have an impact on their ability to work or go to school. “It’s totally consuming at times,” Linda says. “It’s all you think about and it ruins your ability to think about anything else. It can be very debilitating.”brbrUnlike with other eating disorders, people with orthorexia focus on the quality of the food they are eating, rather than the quantity. “It can often start as a simple diet and then it can go to only eating organic food, then to organic, non-processed food, and then it becomes more pure and simplistic,” says Kimberley Quinlan, a psychotherapist at the OCD Center of Los Angeles. “So it develops in a stepping-stone way…[becoming] more and more restrictive, right to the point that sometimes it comes down to two or three food items only, because of the anxiety or the concern of what other foods are doing to them internally.”brbrA physician named Steven Bratman coined the term orthorexia nervosa in an article he wrote for Yoga Journal in 1997. Bratman, also a practitioner of alternative medicine, noticed some of his patients were maintaining very rigid rules about what they would eat. He described people who spent inordinate amounts of time planning for, purchasing and eating food. Their inner lives were consumed with efforts to resist temptations, self-punishment for lapses, self-praise for compliance and a sense of superiority over others whose dietary habits were less pure. The term orthorexia broke into the mainstream earlier this year when Fox News anchor Mika Brzezinski said she suffered from it.brbrRaven Bonnar-Pizzorno, director of nutrition services at The Moore Center, an eating disorder treatment facility in Bellevue that offers psychological and nutritional counseling, says that our Northwest culture idealizes healthy eating. “So people who are eating healthy are maybe smarter or more affluent, and we take this leap from just food to how it defines us as a person,” she says. “I think that’s where we start getting into trouble.”/p
pOrthorexia is not officially recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association and provides standard criteria for diagnosing various conditions. Still, orthorexia is widely recognized among professionals in the field, says Neeru Bakshi, a psychiatrist at The Moore Center. “It is something that is accepted, talked about and recognized,” she says. “But it is just not official, so to speak.” brbrWith scant research on the disorder, doctors and dieticians don’t have a checklist for diagnosing orthorexia. They also don’t know how common it is in the wider population. (As many as 24 million Americans suffer from an eating disorder, either anorexia, bulimia or binge eating, according to the National Association of Anorexia Nervosa and Associated Disorders.) brbrSo when does an interest in healthy eating cross over into disordered behavior? Bakshi says she looks for signs that a person is becoming rigid in their food routines and avoiding social situations because they can’t control the food that is offered. In his book Health Food Junkies, Bratman says that people with orthorexia often become socially isolated because they avoid eating in restaurants and at friends’ houses. Or they bring their own food in separate containers, causing others to feel judged. nbsp;brbrUsually friends and relatives notice the extreme nature of the person’s diet and begin to comment. Relationships can be further strained as the person with orthorexia, who believes that they are eating in the most healthful way, becomes irritated when others raise doubts about their choices. brbrBut if orthorexia goes unchecked, people can risk serious health consequences, such as vitamin B-12 and iron deficiencies due to a lack of enough protein or calories. Weight loss is not usually the goal of the person with orthorexia, but it is a side effect of eliminating so much food from their diet.brbrQuinlan says that orthorexia often overlaps with anorexia, as well as with bulimia. But it can also coincide with other problems, such as obsessive-compulsive disorder (OCD) and social anxiety. She treats clients with orthorexia using cognitive behavioral therapy and mindfulness training. Clients gradually are exposed to foods that cause fear. “Maybe they would start by eating a tablespoon of white rice, or it might be eating more of a food that they are already eating,” she says. “This is off-the-charts uncomfortable for them, but over the course of treatment, they can slowly get there.”brbrAmy*, who is 20 years old, just completed a year of treatment for orthorexia at The Moore Center. Over the course of her freshman year of college, she eliminated everything from her diet except nuts, raw vegetables and beans. At The Moore Center, she ate all of her meals supervised, and participated in group and individual counseling sessions. She also worked with a dietitian to create a meal plan that she followed throughout her time in treatment.brbrAs she learned to eat normally again, Amy had to face her fear of food. “I didn’t even really know what I was afraid of, just that I didn’t think the food would do anything good for my body and I was afraid to see what the bad effects would be.”brbrSeattle is saturated with new diet fads and advice on how to eat. Some people can take these messages as helpful guidelines, while others become more rigid. Doctors don’t know why some people develop eating disorders and others do not. Genetics play a role: People with family members who have an eating disorder are more likely to develop one themselves. brbrBut messages from the culture also seem to have an impact. In Seattle, high-profile diets, such as raw, paleo or gluten-free, are the stuff of everyday conversation, and many people demonize whole categories of food, from meat and bread to dairy products and anything that has been processed. “That’s the thing with orthorexia,” Amy says, “I thought that I was taking care of myself, that I was protecting myself…but really I was hurting myself and I just didn’t see it.” brbrFor now, Amy’s life has started to get better. This summer, before heading back to school for her sophomore year, she went on vacation with her family in Idaho. “Just being able to enjoy more fun foods and be more flexible without so many rules, I just feel a little more free,” she says. “It’s by no means gone, but I can see more of life without all these restrictions.” nbsp;brbr*We used pseudonyms for Linda and Amy to protect their privacy./p


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