In 1997, Steven Bratman, M.D. introduced the term orthorexia nervosa to describe an eating disorder marked by excessive preoccupation with healthy eating. He coined the word orthorexia from Greek roots meaning “correct appetite” and added the nervosa to suggest a psychological imbalance. (The term resembles anorexia nervosa, a well-known, potentially life-threatening emotional illness characterized by loss of appetite, often driven by obsessive fear of gaining weight.) Orthorexia nervosa is not yet recognized as an official diagnosis, and experts are divided as to whether it is a true eating disorder.
People may choose not to eat animal foods for ethical or religious reasons or avoid gluten because it gives them distressing and measurable symptoms. Others may experiment with restrictive diets promoted for beneficial effects on metabolism. These are reasonable eating strategies. The concern of Dr. Bratman and many of his medical colleagues is that some people who limit their food choices may do so to a degree that impairs both physical and psychological well-being, leading, possibly, to social isolation, anxiety about eating, and even malnutrition.
Here’s Dr. Bratman’s self-test on whether you could be affected with orthorexia nervosa:
(1) I spend so much of my life thinking about, choosing and preparing healthy food that it interferes with other dimensions of my life, such as love, creativity, family, friendship, work and school.
(2) When I eat any food I regard to be unhealthy, I feel anxious, guilty, impure, unclean and/or defiled; even to be near such foods disturbs me, and I feel judgmental of others who eat such foods.
(3) My personal sense of peace, happiness, joy, safety and self-esteem is excessively dependent on the purity and rightness of what I eat.
(4) Sometimes I would like to relax my self-imposed “good food” rules for a special occasion, such as a wedding or a meal with family or friends, but I find that I cannot. (Note: If you have a medical condition in which it is unsafe for you to make any exception to your diet, then this item does not apply.)
(5) Over time, I have steadily eliminated more foods and expanded my list of food rules in an attempt to maintain or enhance health benefits; sometimes, I may take an existing food theory and add to it with beliefs of my own.
(6) Following my theory of healthy eating has caused me to lose more weight than most people would say is good for me or has caused other signs of malnutrition such as hair loss, loss of menstruation or skin problems.
Eating disorder specialists report seeing more and more patients with orthorexia nervosa and the problems associated with it. They also maintain that it is important to distinguish people who merely follow a non-mainstream theory of healthy eating from those whose disordered eating patterns lead to impairment of physical, psychological, or social well-being.
I was in Okinawa recently, famed for its abundance of centenarians and healthy seniors. In Ogimi Village, reputed to be a focal point for longevity, I talked with a group of Okinawans in their upper nineties and lower hundreds, all of whom looked vital and happy. I asked for their advice about aging well. The first answer from all of them was, “Eat everything!”
In countries with the best food – Italy, France, Japan, for example – people eat everything. They regard eating, first and foremost, as a source of pleasure, best enjoyed with others. They do not approach the table as a minefield, where one false move might be disastrous. Their relationships with food are much less neurotic and much healthier than ours.
Andrew Weil, M.D.
Thomas Dunn and Steven Bratman, “On orthorexia nervosa: A review of the literature and proposed diagnostic criteria,” Eating Behavior, April 2016, doi: 10.1016/j.eatbeh.201512.006. orthorexia.com