Fixed On Food: When Healthful Eating Becomes Harmful
By Dena Nishek
Photos by Jeff Padrick

One often overlooked side effect of nutritional therapies—including popular health food diets—is food obsession. It's a condition that occurs when a person becomes fixated on eating nutritious food. How can a healthy diet be a bad thing? According to Steven Bratman, MD, when healthful eating becomes an extreme pattern of dietary purity and causes psychological damage, it is orthorexia nervosa and is certainly not healthy.

Bratman, author of Health Food Junkies—Orthorexia Nervosa: Overcoming the Obsession With Healthful Eating (Broadway Books, 2000) and medical director for Prima Health, coined the term "orthorexia nervosa" in 1997 to help his patients recognize how their eating habits had begun to control them.

Ortho in Greek means right or correct, orexia relates to eating or appetite, and nervosa is obsession or fixation. Bratman wanted a serious-sounding word to describe food obsessions so extreme that they interfere with people's lives. This goes beyond counting daily servings of fruits and vegetables; people with orthorexia think about food all the time, make decisions based on food, preach the virtues of their food views and often judge others based on diet. They restrict their world until there is nothing left but food.

Orthorexics often treat their chosen dietary belief with near religious reverence. "To become orthorexic you have to fall in love with some theory of eating such as Eat Right for Your Type or The Zone or something," Bratman says, clarifying that it is not the theory, but one's reaction to the theory that can be unhealthy. "You have to come into believing that that theory is true and then get obsessed with it—and a lot of people do that."

Taking Food Too Far
Practitioners like Bob Rountree, MD, of Boulder, Colo., have seen patients who take a dietary philosophy too seriously. "The bottom line is that there are no absolutes when it comes to a specific way to eat—there is no universally 'correct' diet that will work for everyone," he says.

"People often latch onto concepts like macrobiotics or other dietary trends because they think it will help them live decades longer," says David Johnson, PhD, author of Feel Thirty for the Next Fifty Years (Avon Press, 1998) and associate professor of physiology and pharmacology at the University of New England's College of Osteopathic Medicine, in Biddeford, Maine. "The problem is that most nutritional trends are based on inadequate science; no one really knows the long-term consequences," he says. "It is simply too difficult to do the types of studies required to show if a certain diet is truly beneficial in terms of health and longevity because long-term benefit or harm from eating a certain way can take many years to manifest." Therefore, Rountree suggests people use information about dietary modification as general guidelines and not as rigid rules.

Orthorexics take pride in strictly following a specific diet. Bratman says that adhering to an eating theory evokes a sense of spirituality for some—they feel holy, pure and proud of their extreme self-discipline. In his book, Bratman, who was once orthorexic himself, shares examples of his own "food worship." For several years he was a total vegetarian, ate only freshly picked vegetables, chewed each mouthful 50 times, ate in a quiet place (meaning alone) and left his stomach partially empty after each meal. "After a year or so of this self-imposed regime, I felt light, clear-headed, energetic, strong and self-righteous," he says. "Feeling an obligation to enlighten my weaker brethren, I continuously lectured friends and family on the evils of refined, processed foods and the dangers of pesticides and artificial fertilizers." After two years, he began to realize something was wrong. "The need to obtain food free of animal products, fat and artificial chemicals put nearly all social forms of eating out of reach. All I could think about was food. The center of my life's meaning had been transferred inexorably to food, and I couldn't reclaim it," Bratman says. Once he was so distracted by a perfectly ripe avocado, that he brought a dinner party to a close prematurely so he could eat it—a sad moment that helped him realize he had a problem.

Recognizing The Signs
Identifying orthorexia is pretty straightforward. It is a long-term style of eating, not the short-term attention to detail many people pay their diets when they've made a change for health purposes. Orthorexia has a negative impact on life, namely social isolation, and is characterized by food rituals that have no solid basis in religion or science. Orthorexics think about food most of the day, a tip-off to the excessive meaning they've attached to food. On rare occasions, people with this disorder can become malnourished, but Bratman says the psychological damage is the greatest danger.

The underlying causes are trickier. For some people, their emphasis on food could be connected to obsessive-compulsive disorder, but for most there are emotional agendas that they may or may not have acknowledged. Bratman proposes seven hidden agendas that drive people to fanatically control their diets. His theories range from what he calls kitchen spirituality (seeking God in food), to creating an identity for oneself based on what you eat, to motivations such as fear of other people (an intensely specific diet can be an excuse for social isolation). Bratman says these motivations share some common tendencies. "They all involve using food as more than food, laying a weight on diet that diet shouldn't have to carry—using food as a symbol for identity, spirituality and safety," he says. "Transferring too much of life's meaning onto food makes orthorexia an eating disorder."

Bratman also says it is important to acknowledge food obsession as a side effect of nutritional therapies. "The very fact that you can't eat something you like or that you can't eat with your friends or your family, that's a gigantic side effect. It might be worthwhile in some cases to eat a strict diet, but to pretend that there are not side effects is to be unrealistic." If treating a condition with dietary modifications means eliminating all but six or eight foods, then the patient should weigh if that's really better than taking medication and enjoying a more full and balanced life, he says.

Rountree has seen the side effects of nutritional therapies, too. "I have seen people starving themselves to lower their cholesterol or their blood pressure when the primary problem was that they had a genetic disorder that caused the symptoms," he says. "And I've seen people so obsessed with avoiding dietary fat that they ended up with an essential fatty acid deficiency, which actually made their problem worse."

Practitioners often contribute to the problem, Rountree says. "I've seen people with multiple chemical sensitivities and food allergies that were given so many long lists of things to avoid eating—sometimes they get a different list from every practitioner they see—that they were afraid to eat at all."

Finding Freedom From Food
The very hard first step for anyone with an eating disorder is admitting they have a problem. Then, and often with psychological help, the person can begin addressing underlying emotional issues. "The first thing is to change your attitude [about a particular diet plan], to no longer see it as being a perfect thing to do," Bratman says. "Realize you have a problem rather than a virtue." He says that most people, once they start to change their perspective, will come into balance by themselves. But it isn't easy to override ingrained eating habits. Some orthorexics feel completely unable to eat what was previously forbidden. Sometimes they don't know what a "normal" diet is or how to begin eating in a more balanced way. If this is the case, the best advice is to work with a health care provider or therapist.

The value of a healthy diet is indisputable. Wise choices can help you reduce your risks of numerous diseases. But obsessing about diet to the point that you aren't enjoying life is not healthy. The key is moderation and balance. Food's rightful place is a sensual experience to share, not a badge of honor or a shackle.

Dena Nishek is a freelance writer and editor.