As a registered dietitian, a lot of people come to me hoping to improve their health and lose weight. Pam, a 44 year-old married mother of three, was one of those people. Last fall, she talked to me about her goals: stress less, move more and eat better. She also wanted to lose about 25 pounds. Her diet was the largest challenge and we worked for months on eliminating sugar, processed and fast foods, and refined carbohydrates. We replaced those foods with fruits, vegetables, lean sources of protein, whole grains and healthy fats.
By the time January rolled around, she had lost her excess weight and had turned her diet around, but just two months later, Pam’s husband contacted me with his concern regarding Pam’s overly clean eating obsession.
Pam had become, in his words, so obsessed with healthy and “pure” eating that that they could no longer eat out as a family. Pam didn’t have access to nutrition labels at restaurants and had no control over how the food was prepared.
Pam had also eliminated a huge number of foods for a variety of reasons (it contained GMO wheat, it had more than two ingredients, it was not organic, it had dairy, etc.) deeming them “unclean.” She spent hours searching for foods that would meet her healthy criteria, and began following hundreds of clean eating social media accounts and blogs.
On a positive note, Pam’s weight remained stable, evening out at a healthy BMI, her exercise routine did not become obsessive and she was finally happy with how she felt in her clothing. Pam was not as concerned with the quantity of foods in her diet, but she became fixated on the quality. This once overweight, fast food lover had all the signs of a disorder you probably have never heard of: orthorexia nervosa.
What is orthorexia?
Although acknowledged by the National Eating Disorders Association, orthorexia has not yet been recognized in the Diagnostic and Statistical Manual of Mental Disorders that clinicians use for diagnosis and treatment of eating disorders.
The term evolved just over 20 years ago as a way to describe obsessive traits attributed to healthy eating. Often times, people who find themselves in an orthoexic state become fixated on the purity or cleanness of their foods. The condition differs from other eating disorders in that it does not include body image obsessions or overly secretive behavior (as seen in anorexia) or binging and purging (as seen in bulimia). Studies however, do show some overlaps between anorexia, orthorexia and obsessive-compulsive disorder such as perfectionism, rigid thinking or depression.
When healthy eating becomes an obsession
Is there such a thing as being too healthy, or too clean, when it comes to our diet? The answer is yes. When the quest for clean foods involves cutting out food groups or severely restricting certain foods within a food group, nutritional deficiencies and ultimately illness, can arise. When you can’t go to a friends house for dinner anymore because you can’t control what will be served, quality of life is impacted, and when more brainpower is given to food than it is to family and friends, relationships may suffer.
Pam is not the only patient I have seen take healthy to a somewhat dangerous level. The question is, do you think you have it, and if you do, what do you do next?
How to add flexibility to a clean eating plan
Proponents of clean eating believe that a clean eating approach is the answer to preventing disease and managing weight. There is a difference however between cleaning up your diet and a highly restrictive approach to clean eating. The difference may lie in flexibility. A non-organic fruit or vegetable may be totally acceptable sometimes and having a genetically modified snack at a backyard barbecue won’t cause irreversible harm to your health.
I recommend my patients embody a balanced, healthy eating pattern at least 85-90 percent of the time, focusing always on progress, not perfection. Approaching your diet in this manner may facilitate a healthier approach to food. This is easier said than done, but as with all things in life, we can in fact take good intentions too far. Lessons from across the globe show that it’s balance, not restriction that increases happiness and longevity.
When do good intended healthy behaviors become a problem? A first step may be to look at whether your clean eating goals are taking up the majority of your time with restrictions and planning and/or impacting relationships.
For Pam, her husband telling her how worried he was for her health and well being helped her bring back moderation into her life but for others, more intensive treatment may be necessary. There is no validated treatment to date for orthorexia but seeking guidance from a professional may help to identify, and change unhealthy practices.
Kristin Kirkpatrick, MS, R.D., is the manager of wellness nutrition services at the Cleveland Clinic Wellness Institute in Cleveland, Ohio, and the author of "Skinny Liver." Follow her on Twitter @KristinKirkpat.