Do you belong to the army of food faddists who confirm ingredients, calories and macro and micro nutrient contents of menu items in advance of stepping in a restaurant? You are not alone! Until recently, being terribly selective in making the food choices was a healthy trend to follow. Those who unfailingly kept accurate track of every calorie they consumed, and obsessively scanning latest published reports of food science resonated with the educated and the elite. The statute of salad executed the easy-going food lovers. Preoccupation with eating healthy food and selected nutrients gradually spread across cultures and continents.
Eating disorders are mental diseases, not our conscious lifestyle choices
During the last decade of twentieth century, excessive preoccupation with eating healthy food was proposed as an eating disorder. This pathological obsession with eating proper nutrients and healthy food was termed as ‘Orthorexia Nervosa’ in 1997 by American physician Steven Bratman, who suggested that although dietary restrictions are intended to promote positive health, excessive obsession with such restrictions may paradoxically lead to unhealthy consequences, such as anxiety, social isolation1, loss of ability to eat in a natural manner, depression, and declined interest in the other healthy human activities.
The term ‘Orthorexia’ is derived from the Greek words, orthos (proper) and orexia (appetite), and the term ‘nervosa’ means nervous. Orthorexia nervosa rightly means nervousness about proper eating patterns and describes a set of eating related anomalous behaviors that mainly include a rigid fixation to eat healthy, organically-pure, unadulterated foods. Such individuals typically display an inflated expectation about the personal benefits of healthy eating. They typically steer clear of food that has been treated with chemical fertilizers, herbicides, pesticides, preservatives, or artificial colors. Their apprehensions are obvious in their behaviour and revolve around the modes and materials used in food preparation; such picky eating style leads to total omission of many food groups, eventually leading to different nutritional deficiencies and diminished quality of life1.
Orthorexia Nervosa shares many symptoms with another prominent eating disorder, Anorexia Nervosa, such as attitude of perfectionism, marked anxiety, self-starvation3, and need for control2. Patients suffering with Orthorexia Nervosa, just like individuals with Anorexia nervosa, associate the ability to follow a restrictive diet with self-discipline and any deviation from that restrictive diet is considered to be failure of self-control, thus hurting their own self-esteem.
The ultimate goals of patients are diagonally different; orthorexic patients strive hard to improve or manage their health by eating only healthy diet, whereas patients of anorexia nervosa are driven by fear of overweight and obsessed with lean physical body image. While anorexics usually hide their eating habits, patients of Orthorexia Nervosa tend to flaunt them1.
Considered to be much closer to phobia than a food disorder, patients of Orthorexia frequently manifest obsessive compulsive tendencies, such as, repeated measurement of food, obsessed meal planning, and recurrent thoughts of food, well outside of meal time. Similar to OCD, Orthorexia nervosa is known to interfere with the individual’s normal routines and social interactions.
Your beliefs are your destiny’s lampposts
Erroneous food beliefs are associated with certain food preferences, and the notable examples include;
- Living water diet: About 70% of our food should be high in water content as our bodies are 70% water.
- Chakra-focused eating: Eating yellow food helps with productive activities and strengthens the spiritual center. Eating blue food increases communication, wisdom, speech, and trust.
- Veganism: Eating unprocessed, plant based food helps one connect to the divinity.
- Blood type diet: Eating food associated with one’s blood type prevents diseases and enhances general health and sense of well-being.
- Raw food diet: Also known as raw foodism, it involves consuming foods and drinks that are not processed, are totally plant-based, and ideally organic.
- Atkins diet: It focuses on controlling the levels of insulin in the body through a low and selective carbohydrate diet.
- Zone diet: It aims for a nutritional balance of 40 percent carbohydrates, 30 percent fats, and 30 percent protein in each meal.
- Alkaline diet: To avoid illness, no more than 30% of the diet should consist of acidic foods.
- Warrior diet: Eating at the wrong time of day hinders one’s ability to manage stress due to disturbance of autonomic nervous system (warrior diet).
Regardless of whether they are culturally, socially or religiously accepted, delusionary beliefs about food are of medical concern when exclusion of food and persistent food refusal lead to severe nutritional deficiency.4
The Battle of ‘The Blonde Vegan’: A Case in Point
Popular blogger and Instagrammer Jordan Younger, opened up in 2015 about her struggles with Orthorexia nervosa. She got the balance of her life back after she stopped the obsessive behavior of food selection, and admitted that she had turned into a food phobic. Now, a spirited supporter of The Anti-Diet Project, Jordan has published a book 'Breaking Vegan', which is about her personal story of struggling with orthorexia. She has lent her voice and true experiences to many anti-Orthorexia campaigns and posts regularly about her ongoing recovery. Also, she changed the name of her blog from 'The Blonde Vegan' to 'The Balanced Blonde' to reflect her new pursuit of enjoying the 'eating equilibrium'.
Get diagnosed with doctor’s discretion and deal with it decisively
Though the disorder is expanding in the communities with alarming rates, it is currently not recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The diagnosis is a matter of clinical precision that undertakes eliciting history of the patient and performing targeted psycho-evaluation. The ORTO-15 is a 15-item measure that evaluates beliefs about the perceived effects of eating healthy food, attitudes governing food selection, habits of food, and the extent to which food concerns influence daily.5 Responses are scored on a 4-point scale and added together, with scores below 40 considered suggestive of Orthorexia and higher scores pointing to the likelihood of normal eating behavior.
Estimated prevalence of Orthorexia ranges from 6.9%6 to 57.6%7 in the general population, with rates as high as 81.8% in specific group of populations8. It is unclear whether the disease is more common among women or men.
Psychotherapy, as a treatment measure, can work wonders in teaching the patient alternate ways of thinking, behaving and reacting to the eating and food related stimuli and thoughts. Medications are also prescribed for treating the disease, especially anti-anxiety, stimulants, and anti-depressants, however, precise pharmacotherapy is yet to be developed.
Neurofeedback and dialectical behavioral therapy are also used with varying degrees of encouraging responses.
Societal focus on healthy eating habits makes the biologically vulnerable people to get pulled in the direction of this eating disorder. We need to raise awareness by promoting integral and holistic health that does not aims at picking and banning food items, but encourages an inclusive approach to food and all matters of nutrition.
 Bratman, S. and Knight, D. (2000) Health food junkies. Broadway, New York.
 Fidan, T., Ertekin, V., Isikay, S. and Kirpinar, I. (2010) Prevalence of orthorexia among medical students in Erzurum, Turkey. Comprehensive Psychiatry, 51, 49-54.
 Donini, L.M., Marsili, D., Graziani, M.P., Imbriale, M. and 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, 9, 151-157.
 Geddavalasa L. Food preferences and taboos during antenatal period among the tribal women of north coastal Andhra Pradesh. J Community Nutr Health. 2013;2(2):32-37.
 Orthorexia nervosa: validation of a diagnosis questionnaire. Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C Eat Weight Disord. 2005 Jun; 10(2):e28-32.
 Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C Eat Weight Disord. 2004 Jun; 9(2):151-7.
 Orthorexia nervosa in the general population: a preliminary screening using a self-administered questionnaire (ORTO-15). Ramacciotti CE, Perrone P, Coli E, Burgalassi A, Conversano C, Massimetti G, Dell'Osso L Eat Weight Disord. 2011 Jun; 16(2):e127-30.
 Prevalence of orthorexia nervosa among Turkish performance artists. Aksoydan E, Camci N Eat Weight Disord. 2009 Mar; 14(1):33-7.