Doctor's Review: Medicine on the Move

January 24, 2022
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Can your diet be too healthy?

While doctors encourage patients to adopt healthy eating habits to help ward off the likes of high blood pressure, heart disease, cancer and osteoporosis, sometimes a patient can become obsessed with eating well and develop a disorder.

Orthorexia nervosa is used to describe patients who have become obsessed with following a healthy eating pattern.1 Although this sounds health promoting, it can lead to severe consequences. Initial small changes give way to a restrictive way of eating, which can lead to nutritional deficiencies, severe caloric restriction and weight loss. Not only do these people want to eat healthy, they strive for perfection, not wanting to deviate from the plan. “Cheating” is followed by more restrictions. There is also a pseudo-spiritual component with individuals feeling virtuous because they eat so well.

Is this an eating disorder?

The term orthorexia was first used by Dr Steven Bratman to describe his own experiences. It’s not currently recognized as a specific eating disorder and is lumped into the category of “eating disorders not otherwise specified” in the Diagnostic and Statistical Manual of Mental Disorders along with binge-eating, purging and night-eating syndrome.2 Since there is little research on the topic, it’s not clear how this disorder is best treated. It’s different from anorexia nervosa because the goal is not weight loss, but the pursuit of the healthiest diet. Some clinicians disagree that orthorexia is an eating disorder; they believe that it’s actually a form of obsessive compulsive disorder.

Is the biggest problem nutritional?

Although this disorder can have huge nutritional implications, it can also have an enormous impact on one’s social life. Patients with orthorexia are socially isolated.3 After all, if you spend hours a day planning your menu and shopping for special food you have little time to do anything else. As well, socializing is limited because it’s difficult to eat in restaurants and at other people’s homes.

How can you tell if your patient has orthorexia?

A list of questions has been developed to screen for the disorder.4 If a patient answers yes to all, they are exhibiting symptoms of being obsessed with food. Answering yes to four or more could be cause for concern.

1. Are you spending more than three hours a day thinking about healthy food?

2. Are you planning tomorrow’s menu today?

3. Is the virtue you feel about what you eat more important than the pleasure you received from eating it?

4. Has the quality of your life decreased as the quality of your diet increased?

5. Have you become stricter with yourself?

6. Does your self-esteem get a boost from eating healthy? Do you look down on others who don’t eat this way?

7. Do you skip foods you once enjoyed in order to eat the “right” foods?

8. Does your diet make it difficult for you to eat anywhere but at home, distancing you from friends and family?

9. Do you feel guilt or self-loathing when you stray from your diet?

10. When you eat the way you’re supposed to, do you feel in total control?

Regardless of what classification we give this disorder, most individuals will need their health-care team to recover from it.

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