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When clean eating becomes an obsession

Dr. Steven Crawford is co-director of The Center for Eating Disorders at Sheppard Pratt in Towson.
Dr. Steven Crawford is co-director of The Center for Eating Disorders at Sheppard Pratt in Towson. (HANDOUT, Baltimore Sun)

Many people are adopting clean eating habits, trading in processed foods for natural, nontoxic and organic choices. Doctors say it can lead to better health, but for some it can become an unhealthy obsession. Dr. Steven Crawford, co-director of The Center for Eating Disorders at Sheppard Pratt in Towson, said some people can become so focused on eating the right foods that they develop an eating disorder called orthorexia. Crawford says more research is needed on the disease, which is not yet listed in the Diagnostic and Statistical Manual of the American Psychiatric Association, the gold standard for psychological disorders.

What is orthorexia?

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Orthorexia describes specific disordered thoughts and behaviors associated with an obsessive focus on clean food consumption. The literal translation is a "fixation on righteous eating." While traditional eating disorder diagnoses tend to focus on the amount of food a person eats, orthorexia is unique in that it focuses on the quality of food consumed. What may begin as a realistic effort to eat healthy or avoid illness can spiral into an unhealthy obsession; a search for food that is "pure." Food choices can become all-encompassing, socially restrictive and inextricably tied to a sense of self-worth or morality.

What are the health risks of the disease?

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While weight loss is generally not the goal for people who fit the description of orthorexia, weight loss and malnutrition can occur as safe food choices become more and more limited. Even in the absence of notable weight changes, restrictive diets can result in a deficiency of nutrients necessary for normal function. Restrictive diets can also impair normal hunger cues and increase the risk for binge eating. Psychological and interpersonal consequences include social isolation, obsessive or intrusive thoughts regarding food, anxiety associated with meals, diminished self-esteem, mood swings, and reduced quality of life.

Why is there still debate about whether it is an eating disorder?

Orthorexia is not an official diagnosis listed in the Diagnostic and Statistical Manual of the American Psychiatric Association mainly because we still lack sufficient data on this condition and its intricacies. We know orthorexia shares characteristics of anorexia nervosa and obsessive-compulsive disorder. It also shares features of avoidant restrictive food intake disorder, in which intake is limited due to a lack of interest in eating, difficulty with sensory characteristics of food or concern about potential aversive consequences of eating. More research is needed, however, before a diagnostic definition can be confirmed.

How is orthorexia treated?

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Treatment draws on techniques used in the more commonly known anorexia nervosa and other eating disorders. Often, this includes patients working with a therapist and registered dietitian. Treatment goals involve challenging irrational thoughts about the safety and purity of food, becoming more flexible with food choices, increasing exposure to eating socially and cultivating a sense of intrinsic self-worth that is unconnected to a specific dietary pattern.

What is driving the growth in orthorexia?

Culturally, restrictive food trends have become quite common. For example, cleanses, certain diets such as paleo or raw food diets and others based on elimination of entire food groups, can become a gateway to orthorexic behavior in susceptible individuals. Individuals often receive encouragement and information about these diets directly from companies that profit from the sale of associated products, or from online sources with no medical or nutritional training.

Online sources may even be struggling with disordered eating themselves. In fact, some health and fitness bloggers have chronicled a rigid adherence to "clean" eating for years before publicly disclosing to readers that they've been diagnosed with an eating disorder. In these cases, and in many we see here at the Center for Eating Disorders, an interest in a specific way of eating becomes an obsession leading to illness and unhappiness instead of health.

What are the signs that someone may be suffering from orthorexia?

•Constant worrying about the quality of food one is eating.

•Feelings of superiority because of rigid dietary habits.

•Excessive social media use focused on dietary "pureness" or restriction.

•Extreme guilt after eating foods considered to be unhealthy or impure.

•Feeling very competitive about food or criticizing the eating habits of others.

•Spending significant time planning, preparing, and consuming food.

•Eliminating foods once enjoyed in order to eat the "right" foods.

•Difficulty eating anywhere but at home.

•Increasing social isolation due to an inability to find "safe" foods elsewhere.

•A feeling of being in control of one's life when adhering strictly to a "pure" diet.

Twitter.com/ankwalker

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