The eating disorders – Bulimia nervosa and anorexia are well known to everyone. Although Orthorexia nervosa (ON) is not very well known, the term has been in existence since 1996. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and International Statistical Classification Diseases-11 (ICD-11) do not include orthorexia nervosa as an eating disorder or obsessive-compulsive disorder. It also does not have standardised diagnostic criteria. 

It is simply defined as a fixation on healthy eating. One may begin as a sincere effort to eat healthier, in which case the attention to food selection is not in and by itself abnormal, but it may develop into a very engrossing fixation that permeates practically every part of the life of orthorexic people. 

This blog helps us understand the condition, its signs, and symptoms and how to cope with it.  

What is orthorexia nervosa?

The word Orthorexia nervosa (ON) was first used by Physician Steven Bratman in 1996. It originated from the Greek word “ortho” – correct and “orexi” – appetite. It is defined as a pathological obsession with “healthy” or “clean” eating. ON is not classified as an eating disorder or an obsessive-compulsive condition. 

The purpose of the ON diet is to achieve a feeling of purity or healthiness. Weight loss is not the intended outcome of the diet. Not all individuals tend to develop orthorexia. It can be challenging to tell the difference between genuine enthusiasm for a nutritious diet and orthorexia. 

Anorexia nervosa, bulimia nervosa, and orthorexia nervosa

Though orthorexia nervosa, anorexia nervosa and bulimia nervosa prioritise food in one way or another; they are different in their characteristics. There are so many questions about whether orthorexia is a different disorder or the same as anorexia and OCD (Obsessive Compulsive Disorder) as they have the same traits like perfectionism, high anxiety, and a need to control. 

In orthorexia nervosa (ON), eating is more about the quality and preparation of the meal than the quantity of calories consumed, whereas, in anorexia nervosa (AN) the focus is on the quantity and calories of the food and the body image. 

The condition Bulimia nervosa (BN), which most frequently affects female adolescents, is characterised by binge eating and inappropriate compensatory actions. They usually eat in large quantities at one time and use laxatives or puke the food to avoid weight gain. Studies have found many similarities between ON and BN. One similarity is that individuals with BN often follow orthorexic behaviours to control weight gain and appearance.  

Healthy orthorexia and orthorexia nervosa

There are few questionnaires to understand the eating behaviour. Researchers have developed a questionnaire to differentiate Orthorexia nervosa (ON) and Healthy Orthorexia (HeOr). 

Orthorexia nervosa is driven by an extreme obsession with eating only nutritious food. Whereas, HeOr refers to the non-pathological aspect of orthorexia, which is to emphasise a healthy diet and not a restrictive diet. HeOr takes an interest in consuming nutritious foods and experiences a sense of well-being. They recognise that life is about more than just eating.

To understand easily:

Are you “orthorexic”?

• Individuals with ON obsess over the quality of food and restrict themselves with food choices. 
  
  
• They research their food from its origin to the processed stage. They read through the labels of food products to understand the composition and ingredients.
   
• Most of the time they try to avoid any food or articles of food that is processed with any additive, artificial sweetener, or foods high in sugar and salt. They give importance to the processing technique used.
   
• Their goal is to eat clean food over quantity of food. They predominantly fear consuming food which is not clean or pure. This often leads to restricting many food items and sometimes leads to unintentional calorie restriction. This often leads to self-punishments by restricting themselves by following strict diets and cleansing fasts. 
  
  
• People with ON frequently avoid social dining situations and may experience health issues including starvation and rapid weight loss. 
  
  
• Orthorexic individuals also pay close attention to media warnings about potential risks related to consuming particular foods or different food ingredients and food additives found in processed foods as well as to advertisements with low-fat, high-protein, organic, gluten-free, sugar-free, lactose-free, or salt-free foods.
  
  
• Extreme diet restrictions often lead to physical signs of starvation, weight loss, exhaustion, digestive problems, and a general worsening in health. 
  
  

Who is likely to develop orthorexia? 

There was a high prevalence found in married women was shown in a study conducted in India. It was important to understand and research on orthorexia nervosa trends in the general population to get an overall understanding about the eating disorders and how it interacts with sociocultural diversity. Orthorexia nervosa trend was found mainly among the younger population. 

Mental health and ON

Pure eating obsessions have a negative impact on mental health. It may coexist with OCD, eating disorders, and anxiety disorders. 

• They avoid and isolate themselves from dining outside since they have no control over the food. This often leads to loneliness and depression. 
  
  
• They could feel shame and guilt if they deviate from their restrictive diet and this could affect their mental health.
  
  
• They tend to develop anxiety since they are always worried about the quality of food and are obsessed with dietary choices. 
  
  
• They have a rigid thinking pattern and find it difficult to adapt to different situations. 
  
  
• Orthorexia may be developed due to body dysmorphic disorder and body dissatisfaction.
    
• Although the obsession is heavily on the quality of food and dietary choices, there are chances to miss out on certain nutrients which could lead to malnutrition. Micronutrient malnutrition often leads to cognitive impairments and other deficiencies. 
  
  
• Orthorexic individuals experience low self-esteem and self-worth, which can affect their mental health negatively. 
  
  

Factors influencing orthorexia

It is important to understand the factors influencing ON because it can affect each individual differently. 

Factors influencing include 

• The constant exposure to fitness, unrealistic body standards and body images in social media have an effect on altering the way of differentiating healthy and obsession over being healthy. 
  
  
• Society, culture and environmental pressure to maintain certain dietary habits and body health have a huge impact on developing orthorexia. 
  
  
• There is an increased risk of developing orthorexia in individuals who have a history of eating disorders. 
  
  
• Individuals with pre-existing eating disorders are at risk of developing orthorexia.
  
  
• A health scare or a medical diagnosis can raise the focus of dietary choices and sometimes it becomes extreme. 
  
  
• Nutrition education is very important. Restrictive eating frequently results in misconceptions about what constitutes a balanced or healthy diet.
  
  
• Getting influenced by healthy trends and fad diets leads to extreme restrictions on dietary habits. 
  
  
• Online community participation in following extreme dietary habits can encourage individuals to feel a sense of comfort in like-minded individuals and engage in orthorexic behaviours. 
  
  

How to cope with orthorexia nervosa?

• Orthorexics frequently have incorrect assumptions about food and a healthy diet. This often puts them on extreme diets. This affects their mental health. Seeking professional help from a therapist, psychologist, or psychiatrist will make them understand the problem. Dialectical behaviour therapy (DBT) and Cognitive-behavioural therapy (CBT) are commonly used in the treatment of orthorexia. You can address the underlying ideas, feelings, and actions connected to the condition through therapy.
  
  
• You can develop a balanced and healthy eating strategy by working with a qualified dietitian with expertise in eating disorders. They can advise you on how to include a range of foods in your diet while taking into account your personal nutritional needs. Maintaining a food journal can help in understanding the food pattern and analysing any concerns over a balanced diet. 
  
  
• Spend time with those who have positive attitudes about eating. This can assist you in developing new perspectives on food and eating.
  
  
• Set attainable, practical goals for your eating habits in collaboration with your healthcare team. Make it a goal to experiment with new foods. This can assist you in diversifying your diet and overcoming your aversion to foods. 
  
  
• Move your attention from an intense focus on dietary purity to a comprehensive approach to wellness. This encompasses social relationships, life pleasure, and physical, mental, and emotional health. Manage anxiety and stress related to nutrition and food by incorporating mindfulness meditation, deep breathing exercises, and other relaxation techniques.
  
  
• Don’t be too hard on yourself. Orthorexia recovery requires time. Be kind to yourself and acknowledge your achievements as you go.
  
  
  

Concluding, It is important to understand and differentiate between healthy eating and obsessive healthy eating. Common misconceptions should be taken into account to understand the terms of restrictive diet and individuals’ health concerns. Seeking help from a professional dietitian or nutritionist will help one achieve eating healthy without obsessing and on not losing any nutrients and becoming deficient. Having good mental health is important to have good health. Reminding oneself that you are not alone is essential. You can recover and lead a healthy, happy life with the correct help.

Kripa N,
Senior Clinical Dietitian, Simplyweight