You are what you eat, so they say. I think most registered dietitians and healthcare providers will agree that the majority of Americans would benefit from a more colorful plate and a few less trips through the drive-through, but when does health-conscious cross the line into dangerous?

Orthorexia nervosa is an unhealthy obsession with clean, healthy eating. The term was introduced in the late 1990s by Steven Bratman, MD, and though orthorexia is not recognized as a DSM-V clinical diagnosis, many people struggle with symptoms associated with this condition. Orthorexia nervosa literally translates to "fixation on righteous eating" and differs from anorexia nervosa and bulimia nervosa in that the obsession is on healthy eating rather than weight and body shape. It often starts with an attempt to eat better for any number of reasons – health enhancement, disease prevention or management, weight loss, compulsion for control or desire for improved spirituality, self-esteem or identity related to food.

People with orthorexia have very rigid eating styles and struggle with an all-consuming need to control the type and quality of all foods they eat. Self-esteem becomes tightly wound up in maintaining a pure diet and a feeling of superiority arises when comparing an orthorexic's flawlessly controlled diet to others who have less willpower. They may also have specific disciplinary rules in the case of dietary slip-ups, such as more exercise or more restrictive eating. Intuitive and social eating become a thing of the past as life centers around crafting and maintaining the perfect diet.

Dangers of Orthorexia

Restrictive diets of any type increase your risk of developing both energy and nutrient deficiencies. Cutting out fat can lead to essential fatty acid deficiency (dry skin, hair loss, vitamin deficiencies, weakened immune system). Going gluten-free also limits your intake of B vitamins (energy metabolism) and fiber (bowel regularity). Vegan diets may leave you low in iron (anemia and fatigue), zinc (taste changes and poor immunity) and vitamin B12 (fatigue, depression, anxiety). If you were to combine the restrictions of all three and throw organic on top of it, there'd be very little left to eat.

Is it unhealthy to follow a healthy diet?

Not at all. Eating healthfully is fantastic…as long as it doesn't take over your life. There may be cause for concern if you:

  1. Spend the majority of your waking time thinking about your diet.
  2. Feel like your self-worth is synonymous with your ability to comply with dietary "rules."
  3. Your eating style isolates you and keeps you from enjoying social interactions.

Do I have orthorexia?

Below is the Bratman Test for orthorexia. If you answer yes to four or five of the questions, consider taking a more relaxed approach to your eating. If you answer yes to all questions, you may have an unhealthy obsession with food.

  1. Do you spend more than three hours a day thinking about your diet?
  2. Do you plan your meals several days ahead?
  3. Is the nutritional value of your meal more important than the pleasure of eating it?
  4. Has the quality of your life decreased as the quality of your diet increased?
  5. Have you become stricter with yourself lately?
  6. Does your self-esteem get a boost from healthy eating?
  7. Have you given up foods you used to enjoy in order to eat the "right" foods?
  8. Does your diet make it difficult for you to eat out, distancing you from family and friends?
  9. Do you feel guilty when you stray from your diet?
  10. Do you feel at peace with yourself and in total control when you eat healthy?

Recovery

The first step is realizing that you are more than your diet! Eating healthfully should add to your life rather than eclipse all the other aspects of it. If you're worried, check the NEDA website for more information or call the free, confidential Helpline at 1-800-931-2237.

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