Healthy Gone Wrong: Orthorexia

For an article I wrote for AskMen.com on eating disorders in men--specifically, orthorexia--I interviewed a true expert on the topic, Dr. Jillian Lampert of The Emily Program. I wanted to share her full interview here because she provides fantastic information on this growing problem, as well as insightful advice.  

Healthy Hausfrau: What is orthorexia nervosa?

Dr. Lampert: 

Orthorexia is thought of as an obsession with eating healthy food. While not a clinically defined eating disorder nor an official diagnosis-it is a term coined to describe an emerging issue of over-concern with food. The obessionality with which some people approach their eating can be highly problematic. People described as struggling with orthorexia strive to eat only ‘clean’ or ‘pure’ food, shunning many foods and sometimes entire food groups. This type of ‘food perfectionism’ can lead to nutritional deficiencies, difficulties in relationships, and unnecessary or excessive weight loss.

HH: Statistics pertaining to the prevalence of orthorexia seem to be scarce. Can you give me any idea of how common this problem is? 

Dr. Lampert:

It is hard to assess since it is not an official diagnosis. Over concern with food is seen in many people struggling with eating disorders and disordered eating, problems that impact at least 14% of women and 8% of men.

HH: How common is orthorexia in Emily Program patients?

Dr. Lampert:

Clients with eating disorders often have preoccupations regarding the types of food they will eat. In that sense, it is exceptionally common, given that preoccupations and obsessions with food are hallmarks of eating disorder behaviors. We describe the obsessional quality people have with food as ‘food perfectionism’. This can be seen when people refuse to eat certain foods because they aren't exactly right. At The Emily Program we help people to make peace with food; to let go of needing to achieve perfectionism and find peace in a variety of food, eating situations, and settings.

HH: In your tenure, have you seen an increase, decrease, or no change in patients presenting with orthorexia behaviors?

Dr. Lampert:

As our societal focus on eating ‘fresh’, ‘healthier’ food has intensified, clients presenting with eating disorders increasingly are describing these concepts as part of what led them to change the way the eat in the first place, e.g., decreasing fats, eating only ‘whole’ foods, eating raw foods only, etc. Eating disorder behaviors often reflect the societal nutritional fads. In the days of the low-fat craze, many clients struggled having fat in their diets and sought to severely limit their fat intake. In the days of the high-protein, low carb craze, carbohydrate foods became increasingly difficult for people to consume and they had to be the ‘perfect’ carbohydrate. Since eating disorder behaviors are often the extremes of normal human behavior, any dieting or food craze that impacts the general public is likely to show up exaggerated in clients with eating disorders. Over the past 20 years, I’ve seen this kind of obsession with food follow the tide of the latest diet craze; the craze changes but the obsession and over-concern with food, eating, and weight continues. We’ve seen the numbers of people with eating disorders increase over the same time period. Fortunately, recognition is changing somewhat and more people are accessing help when they need it.

HH: In your experience, how does a person usually progress into orthorexia? 

Dr. Lampert:

It starts with a diet or an effort to change the way one eats. This change typically prompts more changes, which spiral into food obsession and limited intake of a variety of foods.

HH: What are the key differences between orthorexia and someone who just tries to eat a very healthy diet?

Dr. Lampert:

Someone who would be described as struggling with orthorexia, or overly obsessional about eating healthy food would likely have this obsession impact their relationships and their ability to interact socially with friends and family, particularly around food. As with many eating disorders, this difficulty with relationships and social and/or food related activities leads to isolation for the sufferer.

HH: Do you feel our health-obsessed society contributes to orthorexia? 

Dr. Lampert: 

Absolutely our health obsessed society contributes to the eating behaviors of the members of that society. Those that become most obsessed with ‘doing it right’ in terms of eating and health are likely to become swept away by a tide of over-concern about food, health, weight, and shape.

HH: Do you think that fad diets, "pop science" books demonizing foods and entire food groups (ie Wheat Belly, Grain Brain, The Sugar Detox), and sensationalistic media-driven messages such as "sugar is the new tobacco" fuel orthorexia?

Dr. Lampert:

They do seem to fuel an obsession with ‘getting it just right’ and finding the magic bullet to our nutritional woes. Packaged in slick-sounding solutions to complex solutions, these kinds of books fuel the idea that there is one solution to an overly simplified problem.

HH: If you think you or someone you know may be suffering from orthorexia, what are warning signs or questions to ask?

Dr. Lampert:

Does my eating impact my ability to be with family and friends? 

Does my eating keep me limited to a small array of foods such that I can’t enjoy myself in the presence of a typical meal? 

Does my concern about eating lead me to less interaction with people and limit my functioning? 

How do others view my eating? 

Can I take their feedback objectively or do I get defensive when someone attempts to ask me about my eating from a place of concern?

HH: What does recovery from orthorexia look like and how does one get there?

Dr. Lampert:

Recovery is individualized for any kind of eating disorder behavior. Peace with food is the ultimate goal. Eating when hungry, stopping when full, eating what appeals to you, in a way that is nourishing and balanced emotionally and physically. Typically recovery involved taking risks to express emotion, asking for help, learning new skills, and practicing without perfection.

HH: What is your advice for people who are very health/diet/fitness-conscious but don't want to overdo it?

Dr. Lampert:

Be moderate. Have fun. Don’t forget to enjoy a balanced array of foods and enjoy your food-not just for the nutrients, but for the taste, texture, socialization, and connection it brings.

About Dr. Lampert

Jillian G. Lampert, PhD, RD, LD, MPH, FAED is the Senior Director, Business and Community Development for The Emily Program, a comprehensive eating disorder treatment program with multiple Minnesota and Washington locations. Additionally, Dr. Lampert is President of the Residential Eating Disorders Consortium (REDC), an organization whose main goal is to ensure access to residential care for individuals by working collaboratively to address issues that impact the residential eating disorder treatment community. She is a current Board Member of The Emily Program Foundation and a member of the Eating Disorder Research Society (EDRS). She holds an adjunct graduate faculty position in the Department of Food Science and Nutrition at the University of Minnesota. One of her major goals in life is to have her 9 year old daughter grow up loving her body and herself.