We’ve all had our fill of lectures about the unhealthy American diet, with our mounds of junk food and lazy, inactive lifestyles that cause a host of negative health impacts, including obesity, chronic illness and shortened life spans. Nearly every there’s a new report about a study or diet designed to help us ditch those bad habits.
Most people can tune out this barrage and move on with life as usual, healthy or not. But that’s not the case for everyone. Some, in a search for optimal health, enthusiastically adopt the latest health trends, creating a set of rigid rules designed to keep their bodies pure.
While adopting a healthy lifestyle is important for long-term health, there are cases when this behavior can cross over the edge into an unhealthy obsession. Healther Gallivan, PsyD LP, clinical director of Melrose Center, an eating disorder treatment program based in St. Louis Park, said that her program is seeing a growing number of patients with orthorexia nervosa, an eating disorder in which individuals severely limit their intake to a small number of foods that they consider to be healthy.
“There is a point where this behavior crosses over from healthy into the area of obsession,” she said, “where the rules that are set up become so rigid and limiting that a person actually isn’t getting all of the nutrients they need to be healthy.”
One of the largest eating disorder treatment programs in the state, Melrose treats “an active patient caseload of about 1,000 patients at any given time,” Gallivan said. People seeking treatment for orthorexia take part in outpatient and inpatient programs at Melrose, which sees high success rates for treatment of this disorder.
Gallivan sees orthorexia as a byproduct of our cultural obsession with diet and health, of the way we celebrate food and excess while at the same time holding up unobtainable standards of beauty and fitness. We spoke earlier this week about how an enthusiastic approach to health can sometimes go awry.
MinnPost: How do you define orthorexia?
Heather Gallivan: Most often, orthorexia is an obsession with overall health, although the term literally means an obsession with healthy eating and maintaining the “correct diet.” Most of the people we are seeing at Melrose for this disorder are obsessed with good health to the point where it takes over their lives. This usually takes the form of a preoccupation with restrictively healthy eating and exercise.
We don’t officially use the term “orthorexia” here at Melrose Center because it is not an official diagnostic term in the DSM-5. But we do treat many individuals with an unhealthy obsession with exercise and healthy eating.
MP: We hear so much about how important it is to maintain a healthy diet and lifestyle. At what point does healthy eating and exercise morph into orthorexia?
HG: What often happens is that an individual sets out on a path to improve their diet and eating habits and get healthier in general, and then somewhere along the way it just gets out of control. With disordered eating, an individual initially maybe sees weight loss, or another sign of “success,” and in order to see more of this “success,” they start severely limiting the kinds of foods they eat. In a misguided attempt to be healthy, a person with orthorexia actually eventually becomes unhealthy because their body is not getting an appropriate variety of the nutrients required to maintain good health.
MP: In this country, people often get a lot of positive feedback for maintaining a healthy diet or lifestyle, so it must be hard to switch gears and think of a behavior you’ve considered super-healthy to be unhealthy.
HG: That is part of the problem. People will make positive comments, like, “You eat so healthily,” or, “You look great. What’s your secret?” Until things get really out of whack, no one is sending the message that this behavior is potentially problematic and needs to change.
MP: How does a person cut through the morass of health “news” and diet tips that we see every day?
HG: It’s really confusing for many of us. With so many mixed messages everywhere we turn, it is hard to figure out what we should and shouldn’t eat and what is truly healthy behavior. Every week there is a different message in the media. It gets really confusing about what we are supposed to do.
When we hear about things that celebrities are doing to stay “healthy” or thin, or the news reports on the latest eating trends, that carries a lot of power. It sends a very strong message. When we are bombarded with this kind of information, we just assume that these behaviors are good or healthy. But we don’t really know what’s underneath those messages. Most of us don’t understand how to find the truth in those kinds of stories.
MP: There’s always something new out there. It’s hard to sort through it all.
HG: Yes. This week, the big news was that processed beef causes cancer. How do we react to that? A person with orthorexia might react to this news innocently at first, thinking “I’m going to be healthy,” and then their reaction could morph into the extreme of, “I’m going to cut out all beef from my diet,” or, “I’ll never eat meat again.”
But we usually don’t have good background information about these nutrition studies. Most readers don’t know how many people were in a study or who the research was conducted on or what organization paid for it. Most people are not trained in research methods. So we don’t always know if something we are reading is solid information or not.
MP: When does healthy behavior turn unhealthy?
HG: What typically ends up happening is a person’s supposedly healthy diet starts to become unhealthy when it creates nutritional deficits. One example is fat: Generally we’ve been told that fat is bad for us, but the reality is that some amount of fat is an important part of our diet. Fat is an important substance in our bodies. If you are so concerned about healthy eating that you are basically consuming no fat, it is eventually going to catch up with you and create a health situation.
MP: How’s that?
HG: Fat is an important nutritional substance. Fat, in moderate amounts, helps make our brain function properly. It coats our nerves. If you’re not taking in any fat at all and you have lost weight because of your restrictive diet, a lack of fat is going to start to impact your thinking. And when a person starts to become malnourished, they can become obsessive. These obsessions tend to center around food and eating. For a person with orthorexia, it can be hard to see outside of their narrow, self-imposed limitations to see that a behavior that was first intended to help improve their health is now actually hurting their health.
MP: When a person is worn down like that, is he or she more vulnerable to disordered behavior?
HG: It’s true that when we are malnourished our brain does not work very well. We don’t think very clearly. That’s where the rigid, obsessive thinking starts to come in and more and even more types of food get cut out. Then the food obsession starts to take a life of its own and control the person’s life. It overshadows everyday interests in activities and other social things. As orthorexics progress in their illness, their food variety and selections get narrower and narrower.
MP: It sounds lonely.
HG: It is. If you feel like you can only eat 10 things, you are never going to go out to a restaurant to eat with your friends. And you aren’t going to go out to dinner at a friend’s house, because they aren’t going to be able to offer you anything you can eat. Your world is really going to get small.
Making food and eating it together is a really big part of our culture. Not eating the same thing as others do eventually has a negative impact on your social relationships. That’s something we see with eating disorders in general, where the disorder takes over and most of your time is spent thinking, planning and doing the things that are needed to accommodate your food or health obsessions.
MP: What’s your take on popular health-based dietary trends like veganism or gluten-free? Do you believe that they contribute to rates of orthorexica?
HG: When we look back over time, there is always some sort of nutrition trend. Now the trend is gluten-free. In the past, other big trends were fat free or low carb.
The gluten-free trend is tricky, though. There are people with celiac disease who truly cannot have gluten, but the problem is that most people that are gluten-free these days can actually eat gluten. I think that because they can be so rigid, following some of these trends can contribute to disordered eating.
MP: How is orthorexia treated?
HG: At Melrose, we treat people with a multidisciplinary approach. Because orthorexia can have serious medical complications, each patient is assigned a primary care physician who monitors their health. Patients are also assigned a dietitian. We want them to get on a more balanced path with their eating. We will also have a mental health professional involved to help treat any other issues they might be dealing with. Orothorexia has a high co-morbidity with anxiety, for instance. Sometimes an eating disorder is a way for a person to cope with anxiety, so anti-anxiety treatment and medications may be indicated.
Though it is usually treated on an outpatient basis, sometimes we need to hospitalize patients with orthorexia. We need to monitor them. If they have a low heart rate or their BMI has gotten really low, we need to bring them in to get them to stat eating again — and make sure they start gaining back some weight.
MP: Is orthorexia a woman’s disease?
HG: We see both men and women with orthorexia. Just like with all eating disorders, it tends to be more women than men, but I also think that is partly because it is more culturally acceptable for women to seek treatment for an eating disorder. There is more social and cultural bias against men having eating disorders. But men do come here for treatment, too: I can say that I saw at least three men in the last year for orthorexia.
MP: If you are worried that a friend or family member is showing signs of orthorexia, what should you do?
HG: I always encourage people to be very open and honest if they are concerned that a friend or family member has an eating disorder. One problem we have in our society is that we are unwittingly reinforcing unhealthy behaviors when we are too afraid to talk about them.
The more a person with an eating disorder hears from people in a kind, caring way, the more loved ones say things like, “I’m worried about you and your eating,” it will reinforce that there is a problem and people are noticing. But you don’t want to approach this conversation in an accusatory or harsh way. You want to be gentle and point out what you’ve been noticing.
Catching and treating eating disorders early is important for positive long-term outcomes. The good news is there is hope for recovery with all eating disorders.