Obsession with healthy food can descend into orthorexia, an unhealthy eating disorder

Orthorexia patients often limit themselves to fruit and other raw foods. (Photo by Chelsey Ballarte/Cronkite News)

WICKENBURG – An unhealthy eating disorder, so new it’s unfamiliar to most people, leads to an obsession with healthy eating that can upend lives.

Hannah Cook became obsessed during her freshman year at the University of Arizona.

“I would literally look up pictures of my ‘off limit’ foods and just remember what they tasted like,” she said. “At the grocery store I would spend hours just to pick up five items because there were so many rules that a food had to follow in order for me to feel like I was allowed to eat it.”

Cook suffered from an emerging eating disorder called orthorexia, a term coined two decades ago to describe people who are obsessed with eating foods believed to be pure or clean.

The condition, often spurred by anxiety, is just recently starting to gain recognition in Arizona and around the globe. It still eludes some medical professionals because it’s not an official medical diagnosis. Orthorexia is so little known sufferers are often misunderstood, with some people shaming them on social media and others praising their habits as healthy.

But medical experts who have seen patients with orthorexia said placing severe limits on the foods they eat can cause health problems such as bone weakening, emaciation and a loss of a menstrual cycle.

“People that are malnourished or go through any period of self-starvation, whether it’s chronic dieting or having an actual eating disorder, it does cause cognitive impairment,” said dietician Helen Pak, who works at a rehabilitation center in Wickenburg. “Their ability to rationalize becomes disturbed.”

While not a lot of research has been done on the eating disorder, a 2012 Hungarian study found nearly 57 percent of university students showed inclinations toward orthorexia.

Spiraling into an obsession

(Graphic by Chelsey Ballarte/Cronkite News)

Orthorexia often starts out as healthy eating, then descends into severe restrictions.
Someone might start out as a vegetarian, become a vegan, move to eating only raw vegan food, then create another rule to only eat organic. But it’s not the type of food that’s the problem – it’s the strict limits.

Dr. Steven Bratman, a California-based doctor who was interested in the healing power of food, later became disillusioned. He coined the term orthorexia in 1996.

Bratman was intrigued about people’s different beliefs about food. Some believed fruits are good for you but others thought they were too acidic. Some praised milk as nutritious while others said it was bad for your health.

“Diet is an ambiguous and powerful tool, too unclear and emotionally charged for comfort, too powerful to ignore,” Bratman wrote in a yoga magazine article, “Health Food Junkie.”

Cook said her food behavior was extreme.

“I had fallen into the trap of the diet industry and thought that I had to only eat certain things that were ‘pure’ and ‘raw,’ ” Cook said. “I initially struggled with anorexia, but my orthorexia was a cover so that other people believed the same lie I was telling myself; I was just being healthy.”

Pak, who directs nutrition services at Remuda Ranch in Wickenburg, said patients can suffer from orthorexia and anorexia. The difference between the two, she said, is motivation.

“With anorexia, they’re more driven to be thinner or weigh less,” Pak said. “A person with true orthorexia, their intention isn’t necessarily weight loss, it’s about trying to be healthy.”

Pak said there’s an underlying cause.

Trying to control a life using food

“Often times it’s a symptom of an anxiety disorder or trauma or some attempt of having some sense of control with their life,” Pak said. “They can’t control their divorce, they can’t control the loss of a loved one, but they can control what they put in their mouth.”

Someone whose father ate an unhealthy diet, leading to a heart attack, might become orthorexic.

“Rather than dealing with the loss of their father, it’s easier to focus on trying to prevent that from happening to them,” Pak said. “So they start to omit something as simple as fat or animal products. Then it gets more and more rigid to where they’re eating only five foods and having panic attacks if they even think or see someone else eating something they consider unhealthy.”

Cook said several stress situations triggered her orthorexia more than four years ago.

“I was in a new environment that was states away from where I grew up, living on my own for the first time,” she said. “I felt like everything was out of control. My boyfriend at that time continuously made me feel like I wasn’t good enough.”

Controlling what she ate soothed her.

“It felt like I had almost found a niche that I was better than other people at something,” Cook said. “You are literally rewiring your brain and facing your biggest fear three to six times a day.”

Her family, once they saw her, confronted her and urged her to seek treatment. In Tucson, she was treated for anorexia and orthorexia so she could stay in school. But she got worse.

“I eventually became so malnourished that I had to go to the hospital on campus at U of A until I was stabilized to move home to Washington to begin treatment there,” Cook said.

She remained in a hospital program for seven months before returning to Arizona. She continued treatment while going to school, seeing a team comprised of a therapist, dietitian and psychiatrist. Cook relapsed and needed treatment yet again.

While Cook primarily recovered from her eating disorder at an outpatient facility, Pak says that treatment for orthorexia nervosa at Remuda Ranch in Wickenburg is primarily inpatient.

(Video by Chelsey Ballarte/Cronkite News)

Orthorexia doubters pile on negativity

One difficulty in treating orthorexia is that some don’t acknowledge the obsession exists.

Popular blogger Jordan Younger, the Balanced Blonde, famously said she suffered from orthorexia. She said most of her followers supported her but she also got thousands of hateful messages from people angry at her decision to discontinue veganism.

Bratman acknowledged the backlash in a blog post on his website, saying that he doesn’t discredit the nutritional value of vegan or vegetarian diets. “… any reasonably health conscious person would wish to minimize intake of preservatives, pesticides, antibiotics and all the other garbage that pollutes our food supply,” he wrote. It becomes a problem when people’s health is impaired.

He is asking people to participate in a potential study of orthorexia.

Cook said one reason it was difficult to recover is that so many praised her for eating healthy.

“It is 4 ½ years later and I still have thoughts daily,” Cook said. “People just don’t get it and I can’t expect them to. I had to find my identity and what really makes me valuable. I had to learn that I am created to be so much more than something appealing to look at,” Cook said.

Today, Cook is a pregnancy counselor in Washington and advises those going through a similar situation to seek treatment with a professional who is aware of orthorexia.

“Find a professional that understands what orthorexia is, because it is so misunderstood and culturally accepted and even rewarded. So people may tell you that you are healthy, but if you feel anxiety from food, it should not have that much power over you,” she said.