Are You Orthorexic? Our Obsession with Healthy Eating

We seem to have forgotten that humans are omnivorous. Around the world and throughout history, people have thrived on diets diverse and extreme enough to shame the fad diet section in any modern bookstore. Populations have flourished on staples like whale blubber, insects, roots, or grains, often with little else. Even in recent centuries of European plenty, generations of aristocracy touched virtually nothing but sugary cakes and alcohol, while peasants across the street survived on rotten vegetables and hard biscuits; yet both experienced similar outcomes. In fact we differ little in this respect from the humble rat, able to live healthy lives on just about anything we can stomach.

Where we break from the rat is in our intelligence (though, as the impressed father of a rat-rearing daughter, I find the difference, in some cases, may not be as marked as we think). We have the conscious ability to analyze the content of our food, to understand its constituents. We know that too little food causes malnutrition and too much makes us fat, and we understand the consequences of both. The benefit of this understanding has driven some of us to seek deeper, and sometimes illusory, targets of super-health that are not merely within the wide margins of healthy eating, but that attempt to constrict those margins to allow only very specific foods in hyper-controlled portions. When taken to the extreme, the compulsion for such restrictive diets can lead to an eating disorder that may actually cause nutritional deficiencies (even as far as starvation and death) or, even more commonly, social isolation and obsessive behavior. This disorder is called orthorexia, from the Greek meaning “appetite for the correct food.” While the anorexic feels compelled to eat ever less in pursuit of an impossible body image, the orthorexic fanatically focuses on certain foods and avoids others, chasing an imagined model of perfect health, sometimes to the point of delusion.

A woman suffering from extreme emaciation as a result of anorexia nervosa, ca. 1895. Via Wikipedia.

A woman suffering from extreme emaciation as a result of anorexia nervosa (of which orthorexia may be a variation), ca. 1895. Via Wikipedia.

The dietary profile of an orthorexic could be anything, depending on his or her particular pet diet. It could be driven by a fad diet such as low-carb or low-fat or “paleo” or anything—it could be a bodybuilding or weight loss plan. It is whatever that person perceives to be the “ideal” diet, regardless of its actual nutritional value (like rats with different gastronomies, humans will generally do just fine on any diet, fad or otherwise). The psychological component of orthorexia may be more obvious. They may refuse food served to them when a guest, they may berate their friends or family for eating something, they may avoid social situations where food or drink they avoid will be served. They may become “healthier-than-thou” and look down upon friends, family, or coworkers with more typical eating patterns. And it is this impact upon their ability to enjoy normal interaction that characterizes a diagnosable, and hopefully treatable, disorder. When dietary concerns erode happiness, there is a problem.

As the growth of the Internet has driven an explosion in the spread of misinformation, belief in quasi-magical eating solutions has spread as well. A diagnosis such as orthorexia is important in that it is intended to help those whose quality of life has diminished as they have shifted focus to the pursuit of dietary optimization. As Jen Schwartz wrote in Popular Science, “They agonize over sourcing and cooking methods, isolate themselves from social situations, and develop magical thinking about what certain foods can do.” Most likely, we can all think of at least one or two people right off the bat who appear to fit this description.

It is important to note that not all doctors agree that orthorexia deserves a place as a discrete condition. Many feel that its psychological components are already covered by obsessive-compulsive disorder, and its nutritional components are adequately handled by a diagnosis of anorexia nervosa. Thus, orthorexia is not found in the current Diagnostic and Statistical Manual, the DSM-5. But like “night eating syndrome” and a few others, orthorexia has only been rather recently described; first proposed in 1997 by Dr. Steven Bratman, it may make it into future editions of the DSM. The main reason it’s not currently in there, according to Dr. Tim Walsh, who led the group responsible for the DSM’s coverage of eating disorders, is not doubt but scarcity of study data due to the condition’s newness.

Of the orthorexia studies that do exist, most have focused on making a reliable diagnosis. The current standard is called the ORTO-15 questionnaire, first proposed in 2004 by Dr. Lorenzo M. Donini et al. The questions cover the way food choices affect attitude and behavior. You can take the ORTO-15 right now, to see how you rank within the currently defined parameters:

THE TEST

ALWAYS OFTEN SOMETIMES NEVER
1. When eating, do you pay attention to the calories in the food? [ ] [ ] [ ] [ ]
2. When you go in a food shop do you feel confused? [ ] [ ] [ ] [ ]
3. In the last 3 months, did the thought of food worry you? [ ] [ ] [ ] [ ]
4. Are your eating choices conditioned by your worry about your health status? [ ] [ ] [ ] [ ]
5. Is the taste of food more important than the quality when you evaluate the food? [ ] [ ] [ ] [ ]
6. Are you willing to spend more money to have healthier food? [ ] [ ] [ ] [ ]
7. Does the thought of food worry you more than three hours a day? [ ] [ ] [ ] [ ]
8. Do you allow yourself any eating transgressions? [ ] [ ] [ ] [ ]
9. Do you think your mood affects your eating behavior? [ ] [ ] [ ] [ ]
10. Do you think that conviction to eat only healthy food increases self-esteem? [ ] [ ] [ ] [ ]
11. Do you think that eating healthy food changes your lifestyle (frequency of eating out, friends, etc.)? [ ] [ ] [ ] [ ]
12. Do you think that consuming healthy food may improve your appearance? [ ] [ ] [ ] [ ]
13. Do you feel guilty when transgressing? [ ] [ ] [ ] [ ]
14. Do you think that on the market there is also unhealthy food? [ ] [ ] [ ] [ ]
15. At present, are you alone when having meals? [ ] [ ] [ ] [ ]

SCORING
Now total up your score as follows (note that the points for A, O, S, and N are different for the various questions):

1. A-2, O-4, S-3, N-1
2. A-4, O-3, S-2, N-1
3. A-1, O-2, S-3, N-4
4. A-1, O-2, S-3, N-4
5. A-4, O-3, S-2, N-1
6. A-1, O-2, S-3, N-4
7. A-1, O-2, S-3, N-4
8. A-4, O-3, S-2, N-1
9. A-4, O-3, S-2, N-1
10. A-1, O-2, S-3, N-4
11. A-1, O-2, S-3, N-4
12. A-1, O-2, S-3, N-4
13. A-2, O-4, S-3, N-1
14. A-1, O-2, S-3, N-4
15. A-1, O-2, S-3, N-4

So what does your total say about your tendency toward orthorexia? We’re not too sure yet. But a study published in 2011 by Dr. Carla E. Ramacciotti et al. came up with some interesting results when the test was self-administered to 177 adults in the general population—a relatively small sample size. The scoring is designed so that lower totals are more orthorexic. When the threshold was set to a high number of 40, 57.6% of respondents were deemed orthorexic. If the ORTO-15 is valid, the higher your score, the lower your risk of unhealthy compulsion toward healthy eating. If you score is below 40, it may be time to relax a bit and remember your omnivorous nature.

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About Brian Dunning

Science writer Brian Dunning is the host and producer of Skeptoid.
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7 Responses to Are You Orthorexic? Our Obsession with Healthy Eating

  1. Kevin says:

    Interesting read – some of the questions in the quiz don’t make much sense with the answers – so not being confused when I walk into a grocery store or having my mood dictate how I eat means I might have a higher tendency for an unhealthy compulsion toward healthy eating? Not sure I see the connection there. Otherwise – great read!

  2. Rod says:

    What are the scores for question 8?

  3. Bradley Hare says:

    Very interesting. About 15 yrs ago, i had lunch at a fav eatery. After most of the meal, i started feeling very ill. My friend took me home, where I started feeling worse. Ended in the hospital, Dr.s couldn’t identify a problem. They had put me under, for part of exam. When I awoke. Felt great. Time passed, then it happened again. Result was I threw up and kept retching (or vomiting if I drank fluids) ever 5 mins or so for close to 12 hrs. After 12 hrs, I’d be okay. This has continued for years, with the problem occuring once or twice a year. Eventually, I noticed it would frequently coincide with greasey food made with low grade oils or fats. Ah, a possible solution! But no, as time went on, the association became weaker. I’ve seen the Dr. about many times with no solution. Eventually I saw a top gastroenterologist. After explaining my experience and she (the Dr. examining my history, the Dr stated that there was nothing wrong with me. I asked if it could be a pyschological problem. She (the Dr) stated emphatically and categorically that ONLY females can have psychological eating disorders. I was told to just eat. So, I did! And it happened again! Long and short is that I am now governed by my fear of these events. I generally eat only food I am sure was prepared with clean high quality ingredients or food I’ve prepared. If I get any odd feeling when I’m eating, I stop eating. I eat alone so I can moniter myself and so I won’t be embarassed if something happens. In short, eating is really messed up for me.
    I am writing this while traveling in India. So far, I have eaten very little here. Lots of fruit, bread abd tea. I know this is messed up. I know it is most likely a head problem. That does not help.
    I’d love to find a Psychologist/psychiatrist to help, but 1/ hard to find psychological help in Alberta, CAN 2/ very little psych is covered under ANY of the 3 health insurance policies I am covered by.
    Your article gives me some hope that perhaps I am now permitted to have a psych problem!
    Love your blog, it has frequently given me clearer insights!

    • Swampwitch7 says:

      Brad: dump your gastroenterologist, find a qualified allergist with a good reputation, and get tested for food allergies. Allergies of any type can develop or worsen with maturity. You are permitted to have psychological problems, but start with the basics. Fruit, bread and tea are OK as long as you are getting enough protein. Enjoy your food! Be sure you get the basic nutrients to keep your bones strong and your elsewhere happy.

  4. Ian Coleman says:

    I was born in 1952. Growing up in the fifties and sixties was in most respects simpler than it is today, and my mother fed us all food that was nutritionally identical to the food you can buy at MacDonald’s, which is held by just about everybody these days to be poisonous. Miraculously my brother and my sister and I all grew up to healthy adults. Between the ages of eighteen and twenty-five I routinely ate at least 5000 calories a day, without any damage, including weight gain. And so did everybody I knew. Certainly we were a lot more active those days, as television was two channels of black-and-white programs, so we just went outside and played. We walked back and forth to school twice a day, and ran around at recess. Very few people owned cars before the age of twenty-five, so we walked just about everywhere we went. We also had to work at jobs that required constant physical effort. I was a laborer in a mine, and a farmhand and an oil field roughneck.

    Now I”m old, and I diet. The diet is, I eat about a third of what I did when I was in my twenties. But I don’t worry about what I eat. I drink soda pop and I eat potato chips. I eat hamburgers. I just don’t eat them all day. In fact I try to get empty-belly hungry ever day, before I do eat. So many people seem to believe that you have to eat every four hours or you’ll get sick. This is the mistake that people make that causes them to get fat as they age. People love to eat and so they tell themselves that there are magical healthy foods that won’t make them sick, and sinful, poisonous foods that they must shun, when in reality you can eat shingle nails and roofing glue if you want to, just as long as you wait long enough between meals for your body to digest what you eat.

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