Orthorexia: Healthy Eating Disorder?

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Beth Dunn and her son, Greye, study up on breakfast foods. Credit: Beth Dunn

When he was eight years old, Greye Dunn worried about calories and vitamins, and had a fear of sodium.

That was last year. Greye, who turns 10 this week, tells ParentDish that he's pretty much gotten over it. His list of favorite foods now includes turkey bacon, steak and hamburgers, even though he knows they're not as good for him.

Greye and his mom, Beth Dunn, of Mays Landing, NJ, were featured in a New York Times article last year about kids who develop an unhealthy relationship with food because their parents are obsessed with making sure they eat only what would be considered uber-healthy. Though obesity is mentioned as a concern, these parents are vigilant about their children's consumption of things like sugar, processed foods and trans fats because they think it will help protect them from conditions like heart disease, diabetes and hyperactivity.

But experts say there's a time when this vigilance crosses the line, and parents can end up doing their children more harm than good. This nutritional hyper-awareness in kids seems to be a growing trend, and one that concerns many doctors, dietitians and eating disorder specialists.

Parents who are obsessed with their kids' eating habits are likely setting them up for a lifetime of problems, including anorexia and bulimia, eating disorders that are on the rise in the U.S. According to the National Eating Disorders Association, four out of ten Americans have either had or known someone who has suffered from an eating disorder.

One of those eating problems may be a condition called "orthorexia," a term coined by Dr. Steven Bratman to describe people who are obsessed with health food. In his book, Health Food Junkies, Bratman explains that the term "ortho" means straight, correct and true in Greek, and describes orthorexics as fixated on "righteous eating."

Bratman says that orthorexia is an eating disorder that often begins, "innocently, as a desire to overcome chronic illness, lose weight, to improve general health or to correct the many bad habits of the American diet."

Charlotte Hilton Andersen, a health and fitness writer, tells ParentDish via email that she believes she had some sort of disordered eating for most of her life, but that the orthorexia started after the birth of her third child, when she was 28.

"I wanted to lose my baby weight but I wanted to do it the right way," she says. "Initially it was just a goal to get healthy. I wasn't even sure what that meant so I started reading up on the nutrition and fitness research out there."

According to the National Eating Disorders Association, orthorexics are fixated on food quality and purity, becoming increasingly consumed with what and how much to eat and how to deal with slip-ups. Eventually, their food choices become so restrictive in both variety and calories that their health suffers. Their obsession with healthy eating can crowd out other activities and interests, impair relationships and become physically dangerous.

Andersen, who chronicles her struggles on her blog, says "With every new piece of information I got (Dairy is bad for you! Vegetarians live longer! Drink a protein shake after every workout to preserve muscle!), I would alter my diet to incorporate it. If I couldn't decide whether a food was good or bad I just cut it out to be safe. You can see where that went. After a while all I would eat was 5 or 6 safe foods. It was very limiting."

As a college student, Kristie Rutzel was eating mostly raw broccoli and cauliflower, and her lowest weight was 68.3 lbs. on a 5-ft. 4-in. frame. Kristie, now 26, shared her story on Rachael Ray's daytime talk show, saying she began by eliminating fast foods and junk foods to avoid the freshman 15. But then she started getting rid of all carbohydrates, eliminating fats, became a vegetarian, got rid of anything processed with flour and cut down to anything but fruits and vegetables.

While the condition is starting to gain some public recognition, doctors and therapists will not find it in the bible of mental health issues, the Diagnostic Statistical Manual of Mental Disorders (DSM). Experts says that an official diagnosis with its own DSM entry would give orthorexics a better chance of getting treatment covered by health insurance and make it easier for researchers to receive funding.

Tim Walsh, a professor of psychiatry at Columbia University who led the American Psychiatric Association's work group that reviewed eating disorders for inclusion in the next version of the manual, DSM-V, wasn't convinced.

"We're not in a position to say it doesn't exist or it's not important," he recently told Time magazine. "The real issue is significant data. Getting listed as a separate entry in the DSM requires extensive scientific knowledge of a syndrome and broad clinical acceptance, neither of which orthorexia has."

Some experts view the condition as an eating disorder deserving of its own category, saying it does not always meet the diagnostic criteria for anorexia or bulimia. For example, according to the American Psychiatric Association's practice guidelines for the diagnosis of patients with anorexia, a patient must be at "85 percent of expected body weight" or demonstrate failure to achieve growth expectations, if still growing. This is not always the case with orthorexics.

Others believe that orthorexia is a form of anorexia, including Laura Collins, Executive Director of F.E.A.S.T. (Families Empowered and Supporting Treatment of Eating Disorders), who tells ParentDish via email that, "Anorexia is a biologically based brain disorder triggered by dieting and restrictive eating." Collins believes that orthorexia is just another name for anorexia. "Not all anorexia patients have obsessive thoughts about healthy foods, but many do," she says. "Others believe they are restricting for moral reasons, or out of reaction to distressing events. "

Still others, like Lisa Young, a nutritionist in private practice and author of The Portion Teller, see orthorexia as being more on the obsessive-compulsive disorder (OCD) spectrum.

"There can be OCD tendencies whenever diet and exercise go beyond a healthy lifestyle and cause you to completely restrict your food intake or not attend events, and take the beauty out of eating a healthy, balanced diet," she says.

Greye's mom tells ParentDish that her son had just learned about food labels in health class shortly before being interviewed last year, so he was naturally more concerned at the time. The young boy admits he still reads labels sometimes, and though he doesn't think his friends do, he says, "It doesn't make me feel different, just healthier."

How Can Parents Help?

So what's the right way to go about encouraging your kids to eat healthfully? Young says she tries to get her patients to look at the big picture, as well as the small.

"It's all about balance," she says, "If you're eating healthy 80 percent of the time, if you cheat a little here and there it doesn't mean you're a failure. One cookie or one thing not on the top of the list isn't going to create a problem."

Furthermore, parents shouldn't restrict certain food groups or label foods as "good" or "bad."

"Research shows that the more a child is restricted, the more they will overeat later -- later that day, or later in life," says Jessica Setnick, a registered dietitian and author of the The Eating Disorders Clinical Pocket Guide. "It's important to teach kids how to eat a variety of things, and blend those things in a healthy lifestyle."

Setnick likens the process of teaching kids about healthy eating to teaching them about fire safety.

"You have to teach them about matches, you can't just keep them out of the house," she says. "The same goes for food -- you have to teach kids about all foods, you can't just keep them out of your house, or your child may end up at a friend's house eating out of their pantry."

For more information on eating disorders, contact the National Eating Disorders Association at 800-931-2237. Additional resources can be found at The Renfrew Center Foundation.

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AdviceMama Says:
Start by teaching him that it is safe to do so.