Refined to 'pure' food


Some people become so fixated with eating healthy foods, they develop a disorder ‘orthorexia’

WITH THE obesity timebomb ticking loudly in the background, we find ourselves bombarded daily with conflicting messages about healthy eating.

On one hand, we are warned of the potentially disastrous consequences of consuming too much of the “bad stuff” – trans fats, refined carbs and starches, salt, additives and preservatives.

On the other hand, we discover that just because something is labelled “low fat” or “low sugar” does not necessarily mean it’s good for us. It’s no wonder people are confused about what we should actually be eating.

Some people become so fixated with healthy eating and obsessed with avoiding foods perceived to be unhealthy that they develop a disorder called orthorexia.

Although not currently recognised as a medical condition, the term orthorexia nervosa was coined by Colorado-based GP, Dr Steven Bratman, in 1997 from the Greek orthos, meaning “correct or right”, and orexis, meaning “appetite”.

While orthorexia is not listed in the psychiatry bible DSM-IV nor is planned to be included in the DSM-V to be published in May 2013, it is being used as a diagnosis by some practitioners, mainly in the US.

Bratman points out that sufferers avoid certain unhealthy foods such as those containing fats, preservatives, man-made food additives and animal products. If the patient does not eat appropriately, malnutrition and emaciation can ensue.

The author of Health Food Junkies, Bratman claims that orthorexia can be as dangerous as anorexia, although the underlying motivation is quite different.

“While an anorexic wants to lose weight, an orthorexic does not desire to become thin, but wants to feel pure, healthy and natural. Eating disorder specialists may fail to understand this distinction, leading to a disconnect between orthorexic and physician,” he says.

Unlike eating disorders such as anorexia nervosa and bulimia nervosa where people focus on quantity of food, Ursula Philpot, chairwoman of the British Dietetic Association and senior lecturer at Leeds Metropolitan University, has described people with orthorexia as being “solely concerned with the quality of the food they put in their bodies, refining and restricting their diets according to their personal understanding of which foods are truly ‘pure’.”

Dr Sarah Prasad, consultant psychiatrist with a special interest in eating disorders at St Patrick’s University Hospital, Dublin, has not yet come across orthorexia in her own practice, but is aware of colleagues who have.

“It’s a really interesting kind of disease as it becomes almost taboo to eat unhealthy foods. Orthorexia is still very controversial as it’s not recognised as a medical disorder and even a lot of psychiatrists are not aware of it.

“Proponents of the disorder were hoping it would be recognised in the upcoming DSM-V, but there is not enough evidence to suggest that it warrants its own diagnostic entity as such at this point.”

There have only been two peer-reviewed studies published on orthorexia to date, Prasad explains, and there is a need for more data to be collected on the condition. “A patient with orthorexia can present like somebody with anorexia. They become very undernourished and can be anaemic and osteoporotic,” she says.

“Some psychiatrists suggest it is maybe another type of anxiety disorder like OCD or a precursor to anorexia, while others warn of the dangers of misdiagnosing anorexia – the jury is still out on it.”

Another far bigger issue in Ireland as far as Prasad is concerned – and one that is not being talked about at all – is that of eating disorder and sport.

“Eating disorder and sport is a huge issue and I think we need to raise awareness of young boys and girls who are becoming preoccupied with fitness to the extent that it impacts on their health. How do coaches and gym instructors approach these young people without intruding on their privacy? It’s a hard one.”

Eating disorder is still a big taboo subject in this country, according to Prasad, who joined the team at St Patrick’s last September. She says parents do not know how to cope with a child who has an eating disorder, while patients are afraid of going for treatment and being forced to address their biggest fear.

“I think there are a lot of misconceptions about what eating disorder is. The fact that there is hardly a service for eating disorder in the health services says a lot about the Government and public’s attitude to this issue.

“It’s not about ‘girls who don’t want to eat’, it’s not a ‘fashion thing’. It’s a lot deeper than that. I was at a GP evening recently where I had to keep stressing that eating disorder was not just about girls who do not want to eat.

“We hear of girls going to their GP and being asked why don’t they just eat. I don’t think our media help either – we live in a very image-focused society and girls want to look like the thin runway models they see in magazines and on TV.”

Prasad is keen to stress that an eating disorder is actually a very treatable condition with early intervention and there is much emerging evidence to suggest that early treatment works very well.

Cognitive behavioural therapy has been shown to be very effective in the treatment of bulimia and binge eating and for anorexia, a combination of different approaches seems to have the most successful outcomes.

While anorexia is more common among girls and young women, bulimia and binge eating disorder tend to be more common in adults, says Prasad.

Binge eating disorder is not recognised as a medical condition by DSM-IV, but is included under Eating Disorders Not Otherwise Specified and this is another area where further research is needed, particularly given its link to obesity.

“While food and eating is a huge issue in any eating disorder, it’s not entirely about the food but about the thinking behaviour, the underlying thoughts about what eating represents,” says Prasad.

“While most of us evaluate ourselves on different aspects of our lives such as relationships, jobs and sporting prowess, people with eating disorders evaluate themselves predominantly on their weight and shape.

“As well as trying to help them develop a much more healthy relationship towards food and try to get back to eating as prescribed by the food pyramid, we need in tandem to work on the psychological issues which are the driving force behind the eating disorder.”