As the first month of 2024 almost draws to an end, many would have perhaps already broken their resolution to eat healthy. But there is another segment that takes a very dangerous trajectory, turning eating healthy into an obsession. In today’s era of misinformation boom, quacks and body shaming, the very less talked about orthorexia nervosa certainly merits our attention.
Q. So, what is orthorexia nervosa?
Orthorexia nervosa is a state of obsession with healthy eating, listed as a non-specific eating disorder under the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5).
Q. So, how does one distinguish between those with healthy eating habits and the ones with its obsessive version?
Orthorexia nervosa is not to be confused with those who make well informed dietary choices as long as it does not have a negative impact on their health and social life. Healthy eating transitions to orthorexia nervosa the moment it becomes a matter of pathological domination by healthy eating food centric thoughts every waking moment. Basically, it begins to dominate one’s life to the extent that it overshadows all other aspects of life. The aim becomes dietary perfection through pure and clean eating with emphasis on the quality of foods. This is followed by self-imposed rigid, inflexible rules and strict limitations as to what one can eat. Tweaks, if any, result in anxiety, shame and guilt, followed by self imposed punishment.
Orthorexics spend considerable amount of time and money researching, scrutinizing the source of their food, degree of processing, packaging of the food, planning, preparing meals, with the sole aim of ‘physical health’ (put simply, body image) and not overall well being. Infact, they express superiority over others whom they feel do not share the same pure and clean eating habits and may distance themselves from others resulting in social isolation.
Q. Who is vulnerable to orthorexia nervosa?
Though the literature is scare and evidence inconsistent, the following groups are considered at risk of developing orthorexia nervosa
- Adolescents
- Women
- Performance artists
- Individuals into athletic activities
- Dietitians
- Medical students
- Healthcare professionals
- What are the risk factors that may predispose to orthorexia nervosa?
Although there is no reliable data of prevalence and incidence available, it is postulated that that the cases of orthorexia nervosa may escalate in the days to come. Misconception of beauty associated with thinness, body image, anxiety about being overweight or obese, excessive focus on body appearance, misinformation boom about diets, promotion of fad diets, excessive focus on superfoods, total elimination of foods that may contain additives, dyes, carcinogens overall perceived to be harmful, have been touted to be some of the driving factors behind a rise in orthorexia nervosa.
Q. How is orthorexia nervosa diagnosed?
The history of onset of above symptoms should be atleast of six months duration. However, should the individual be underweight, the duration of history of symptoms should be three months old.
The tool most commonly used for the diagnosis of orthorexia nervosa is the ORTO-15, which is a self -administered questionnaire comprising of 15 questions. A normal eating behavior for each question earns a score of 4 points vs. eating pattern akin to orthorexia is given 1 point. The lowest score possible is 15, while the highest is 60. A cumulative score of 40 or below is considered depictive of orthorexia. However, the reliability and validity of ORTO-15 remains debatable. This should ideally be coupled with a clinical interview.
Q. How can orthorexia nervosa be treated?
Orthorexia nervosa requires concerted efforts of a team comprising of physicians, nutritionists, health psychologists who can clinically diagnose and manage the condition effectively to foster correct healthier eating habits as against the erroneous ones.
Q. What does orthorexia nervosa lead to?
Orthorexia nervosa has an adverse effect on all aspects of living. Nutritionally, it leads to malnourishment owing to complete exclusion of certain food groups which sooner or the later becomes evident as weight loss. Psychologically; there is health anxiety, attention and concentration problems, socially; the loss of social relationships owing to isolation and an overall poor quality of life. Physiologically, it can lead to osteopenia or poor peak bone mass, anemia, vitamin D deficiency, hyponatremia, metabolic acidosis, pancytopenia, bradycardia and hormonal abnormalities.
Q. How can orthorexia nervosa be prevented?
Efforts need to be directioned towards educating the groups vulnerable to orthorexia nervosa. There has to be easy access to evidence based information about balanced diets, importance of all the food groups as against fad diets (that usually remove a major macronutrient from the diet), emphasis on wholesome nutrition through a variety of foods as against superfoods and most importantly, discouraging body shaming.
Sadly, in the absence of scientific regulatory rules, evidence based health and nutrition does not gain as much traction as unverified information does that lures the ignorant people to cave into following prospects of anything and everything that would give them a ‘perfect’ body image.
Take home message?
Eat healthy in the realm of normalcy. Let doing so bring joy and not become a matter that one stays perennially occupied with. Always keep a qualified dietician or a nutritionist in the loop for evidence based inputs and learn to love yourself for the way you are.
Disclaimer: The information shared in the blog is aimed at increasing your awareness and is not a substitute for professional medical advice.
To consult Dr. Roy for a personalized nutrition plan, register here or write to her at info@nafldnutrition.in
References
- Bratman S, Knight D. Health Food Junkies: Orthorexia Nervosa: Overcoming the Obsession with Healthful Eating. Broadway Books, New York; 2000.
- Lorenzo M et al. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity. A consensus document on definition and diagnostic criteria for orthorexia nervosa 2022; 27:3695–3711.
- Varga M, Thege BK, Dukay-Szabó S, Túry F, van Furth EF. When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry. 2014; 14:59.
- Fidan T, Ertekin V, Işikay S, Kirpinar I. Prevalence of orthorexia among medical students in Erzurum, Turkey. Compr Psychiatry. 2010; 51:49-54.
- Barnes MA, Caltabiano ML. The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eat Weight Disord. 2017; 22:177-84.
- Gkiouleka M, Stavraki C, Sergentanis TN, Vassilakou T. Orthorexia Nervosa in Adolescents and Young Adults: A Literature Review. Children 2022; 9: 365.
- Campaioli G, Sale E, Simonelli A, Pomini V. The Dual Value of the Web: Risks and Benefits of the Use of the Internet in Disorders with A Self-Destructive Component in Adolescents and Young Adults. Int. J. Fam. Ther. 2017; 39: 301–313.
