Is an Obsession with Nutrition an Eating Disorder?

Experts are working toward diagnostic criteria for orthorexia nervosa, the 'healthy eating disorder.'

Meal prep

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In a 1997 article in Yoga Journal, Dr. Steven Bratman introduced a new term to the nutrition lexicon: orthorexia nervosa. He defined it as “a fixation on eating proper food,” to the point that healthy eating becomes paramount, and straying from it causes great shame and anxiety.

Though orthorexia is still not a clinically diagnosable eating disorder, today it’s a real topic of discussion in the nutrition world. On Monday, a session at the Food and Nutrition Conference and Expo, in Boston from October 15 through 18, addressed orthorexia, and potential criteria for its definition and diagnosis.

Bratman—who admits he coined the term somewhat flippantly back in the ’90s—led the session, and discussed the proposed diagnostic criteria set forth in a 2015 Eating Behaviors article he coauthored. He emphasized that the condition is primarily motivated by ideals of health and purity, not thinness, and that healthy eating only becomes a problem when it turns obsessive.

For someone to have orthorexia, Bratman said, he or she would have to show compulsive behavior and mental preoccupation related to healthy eating; fear disease and/or feel impure, and experience shame or anxiety, upon violating his or her nutrition ideals; and escalate dietary restriction over time, though not in a way motivated by weight loss. In addition, the condition would have to negatively affect the sufferer’s life, through malnutrition, impairment of social or professional activity, or damaged self-worth.

Bratman also discussed potential risk factors for developing orthorexia, including growing up with health-obsessed parents, having a medical or digestive condition that necessitates a restrictive diet, intense fear of disease, or an overall perfectionist or obsessive personality. It may also be accompanied by excessive exercise habits.

As Bratman and others—he was joined at the session by local dietitian Marci Evans, and eating disorders expert Jessica Setnick—work toward official diagnostic criteria, orthorexia is gaining prominence in the nutrition world. Still, it will likely take quite a bit more time and research for it to enter the annals of conventional medicine—if it ever does at all.