obsession with healthy eating nearly killed Kristie Rutzel. In college, the 5’
4” student’s weight plummeted from 120 to 68 pounds, as she stopped eating
carbs, fats and anything processed. She became a vegetarian, then a vegan,
following a strict raw-foods diet. At one point, she ate little more than
organic cauliflower and broccoli.
she was hospitalized with anemia and osteopenia, a precursor to
osteoporosis, the brittle-bone disease that leads to fractures. Now 29, Rutzel
has a name for her eating disorder: orthorexia, a controversial diagnosis
marked by an extreme fixation on avoiding unhealthy foods.
began suffering with orthorexia and within a year, it spiraled into anorexia,”
she told me in an email after I
blogged about her case in 2011. “It was a stepping stone, and had I
received help earlier on, I would not have been so sick.”
the list of unhealthy foods swells—from high fructose corn syrup to trans fats,
diet soda and pink slime—eating-disorder experts across the US are seeing a
surge of patients like Rutzel, who would rather starve than eat anything
unwholesome, Time magazine recently
What is orthorexia?
Orthorexia is a term coined by
Steven Bratman, MD, a physician in Fort Collins, Colorado, to describe a
condition he had been seeing: a fixation on healthy eating that may be a cross
between an eating disorder and obsessive compulsive disorder (OCD).
is derived from a Greek words meaning “right” or “correct” and rexia means “appetite.” Bratman also
identified what he called orthorexia nervosa, which may turn out to be a
not-so-distant cousin of anorexia nervosa, the scariest of eating disorders
because it can be fatal.
far, orthorexia hasn’t been officially recognized as a psychiatric condition.
Unlike anorexia nervosa and bulimia, the binge and purge syndrome, orthorexia
isn’t listed in the current or forthcoming editions of American Psychiatric
Association’s Diagnostic and Statistical Manual (DSM), the “bible” of mental
disorder that isn’t listed in the DSM exists in psychiatric limbo:
insurance is unlikely to reimburse treatment and researchers have trouble
getting grant money for studies to better understand it. As a result of its
exclusion, orthorexia isn’t very well known even among therapists who treat
search of the medical literature turned up only 23 scientific studies on the
subject (compared to 11,661 on anorexia nervosa). One study by Italian
researchers published this year defines orthorexia nervosa as a
“psychopathological condition characterized by the obsession for high quality
foods” and concluded that it occurs frequently in athletes.
What are the symptoms?
those who suffer from anorexia nervosa or bulimia, orthorexics aren’t yearning
to be slim. Body image isn’t their thing. They’re focused on healthy food, and
ruthlessly remove from their diets whatever they perceive to be unhealthy.
can begin with a perfectly understandable avoidance of foods containing
artificial colorings or flavorings, meats with hormones, non-organic fruits and
vegetables, and artificial sweeteners, and then veer off into the ultimate
severe cases, people cut out entire classes of food, such as all carbs or all
fats. Here’s where the fixation with healthy eating seems to meld with obsessive compulsive
disorder and where orthorexia becomes a march toward malnutrition. In the
throes of the disorder, Rutzel believed that few foods were safe to eat, and
spent hours planning her next meal.
eating-disorder specialists have suggested that orthorexia may begin with
health problems, primarily digestive troubles that lead to a focus on food and,
perhaps for better or worse, medical advice to avoid certain types of food.
Experts also say that women may be more at risk for micromanaging their diets
to the point of seriously undermining their health.
specialists argue that an extreme obsession with healthy eating may be a
symptom of other disorders, such as OCD, anxiety disorder, or anorexia, and doesn’t
need a separate diagnosis.
How dangerous is orthorexia?
to an extreme, obsessing over a healthy diet can even be fatal. Dr. Bratman
reports that a young woman named Kate Finn
died in 2003 after her weight dropped dangerously low while she was eating a
limited number of healthy foods. The official cause was heart failure brought
on by starvation.
to her death, Finn wrote her ordeal, attributing her orthorexia to stress plus
digestive problems brought on by a vegan diet during her college years that
provided her with plenty of carbs but not enough fat or protein.
seven years, she tried a number of so-called healthy diets, which didn’t make
her feel better and resulted in extreme weight loss her relatives attributed to
anorexia nervosa. Yet Finn, like others with orthorexia, maintained that her
goal was healthy eating--not weight loss.
What’s the treatment?
specific treatment exists for orthorexia, but what seems to work best is cognitive
behavior therapy (CBT), which has been successfully used to treat other
eating disorders as well as depression, anxiety, and substance abuse. When used
to treat eating disorders, the goal of CBT is to change obsessive thought
patterns relating to food.
the obesity epidemic surrounding us, we all should be focused on healthy eating, bearing in mind that too much of a good thing can backfire.
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