Orthorexia Nervosa

There is no doubt about the benefits of practicing a healthy diet. Renouncing sugar, fat, and flavor enhancers in favor of healthier alternatives helps protect the body from obesity and heart problems. Over the last few years the nutrition consciousness has increasingly shifted away from industrialized food products, making it easier than ever to eat healthily. Today local vegetables are all the rage and the stamp of organic quality omnipresent. In itself, this is a positive development. Yet choosing the right diet can become an obsession that can quickly transform into the opposite. The term Orthorexia Nervosa was first introduced in 1997 by the American physician Steven Bratman, and refers to the excessive pathological compulsion to eat healthily. It can result in malnutrition, unhealthy weight loss, and social isolation. While most people over the last centuries considered themselves lucky just to be sated, it seems that in our times of low-carb diets, lactose intolerance, and Paleo diets, eating disorders such as orthorexia are encouraged. Despite the excess of nutrition options, an estimated 1-2% of the world’s population chooses to vehemently reject the bulk of it.

or3Photo @ Quest

The question of whether the symptoms can be classified as a unique disorder is debated in the research. The DSM (Diagnostic and Statistical Manual of Mental Disorders) has no exact classification for orthorexia due to the symptoms of other disorders with which it is accompanied. In the 1990’s Bratman first diagnosed orthorexia nervosa in himself. At the time he lived and worked as a chef and farmer in a large commune in Upstate New York. To cook dinner he had to incorporate the large number of requests and dietary plans of the food idealists, who were drawn to the commune as if by magic. Meat needed to be prepared in a separate kitchen because many of the vegetarians refused to intake food from a kitchen that had been “contaminated” by meat. Residents who identified as Hindu refused to eat onions because of the sexual desires they could arouse. Himself an advocate of alternative nutrition medicine, the ideologies quickly rubbed off on him. He reports that at a certain point, he ate only raw fruit and vegetables, which had to be harvested no longer than 15 minutes before consumption. Every morsel was chewed at least 50 times. In contrast to anorexia nervosa (anorexia) – a quantitative eating disorder – orthorexia is qualitative in nature. The affected person’s goal is not to lose weight, but to feel healthy, pure, and natural.

One of the biggest problems is that in seeking the feeling of purity, among other things, a moral shift in values accompanies the quest. The affected person perceives certain foods as “good” and others as “bad.” This generates feelings of superiority as well as a missionary zeal towards people who eat less healthily. Understanding or insight is rarely exercised in these cases, as from the perspective of the affected people, maintaining a “healthy” diet is incontestable. This mixture of suspicion, indoctrination, and obtuseness can quickly shut the orthorexic out of social life. Dining at a restaurant or enjoying a relaxed evening cooking with friends becomes completely impossible.

At the onset, it’s very difficult to draw a clear line between orthorexia and a diet or a trend-conscious lifestyle. As a rule, it becomes critical when the strain of the person’s disorder exceeds any real relation to its value. Friederike Barthels, of the Heinrich-Heine Universität Düsseldorf, recently presented criteria for the diagnosis in her Düsseldorf Orthorexia Scale. Among others she included: constant and exaggerated reflection upon healthy dieting, pronounced fear of supposed “unhealthy foods,” ritualized handling of food, which when not adhered to, results in strong self doubt, as well as severe weight loss and malnutrition.

The research assumes that eating disorders such as anorexia or orthorexia often serve to compensate failures in other areas of life. A bitter or traumatic setback at work or in a relationship, for example, can lead to excessive control or the compulsion for perfection in other realms. Nutrition presents itself compellingly in this scenario. What could be easier to control than the contents of one’s stomach? There are no written laws that could forbid a person from eating exactly what they want. What we do have is media coverage, which over the last decades has transformed our understanding of good nutrition. Whereas a few decades ago, being able to afford to eat meat several times a week was considered a sign of well being, today over-consumption of meat is reprehended as unethical and unhealthy. This is partly due to the excessiveness of the food industry, but also partly to the contemporary image of people put forth, which depicts performance and productivity as a social status.

Or 4Photo @ ruminou

We can welcome the fact that health occupies a prominent place in this image. In most cities it’s become easy to access healthy and local food with which to form a balanced diet. Street food markets, urban gardens, and organic food baskets made to order from farms have arisen out of this Zeitgeist. Sustainable production and a conscious discussion around food have slid into focus. The food industry has faced the challenge on an economic as well as an environmental level. This does not mean that one is forced to forgo everything – a healthy, organic beef filet can be just as much a part of a healthy diet, as a freshly caught fish or a well-ripened cheese.

By now “healthy eating” has become a stylish brand; there is no café that doesn’t serve a decaf soy latte and no grill that doesn’t offer a halloumi burger. Often, the question “why?” is never even posed; somehow it will be healthy. It’s no surprise that over the last years nutritional psychology has increasingly focused on orthorexia. The number of people affected still hovers on a similar spectrum to anorexia (2%), but experts suggest that this figure could continue to rise over the next few years. If eating disorders do in fact emerge from pre-existing personal problems, our current approach to nutrition produces the ideal conditions for the development of orthorexia. The Information Age makes it easy to examine and judge every imaginable product for its content and means of production. We have unprecedented knowledge regarding nutrition – knowledge, which for some, is an almost unbearable burden.

At this point there are various tests in circulation, including one designed by Steven Bratman that can be used to make a first assessment from home. Do you think about your diet for more than 3 hours a day? Do you plan your meals several days in advance? Have you become stricter with yourself lately? The fact that there is a need for online self-tests suggests that orthorexia, at least in its basic features, is possibly more common than we think. The one thing that should therefore not be forgotten is that nutrition trends only make sense if they can live up to their names and actually provide nutrition.


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