An unhealthy obsession with healthful eating

Eavesdrop during lunch at a restaurant in a tony neighborhood, and one might hear this:

“I’m off sugar. It causes my wheat allergy to flare up.”

“You’re drinking water from a plastic bottle? Don’t you know the BPAs are toxic?”

“Is that coffee creamer organic? I only eat organic.”

“Oh … you let your kids have … soda?

In a nation saturated by reports of E. coli on spinach, hormones in milk, polycarbonates in plastic bottles and pesticides all over bananas, the line between eating healthfully and developing a full-blown eating disorder can be fuzzy for some people. Add to the mix the enticing shopping experience of stores such as Whole Foods, alerts from the green movement and a confusing list of evils, and one can end up leaving the market with an empty (but reusable) shopping bag and a mind full of anxiety.

Although an obsession with healthy eating is not officially in the DSM-IV, the diagnostic manual for psychiatrists, at least one doctor has given it a name: orthorexia. Colorado alternative physician Steven Bratman coined the phrase in his 2001 book, “Health Food Junkies,” saying it is a disease disguised as a virtue.

Dr. Bratman said orthorexics might spend considerable time thinking about food; care more about the virtue of what they eat than the pleasure of eating it; experience higher self-esteem when eating healthy food; and feel guilt or self-loathing when they stray from their diets. The loneliest characteristic: a sense of isolation.

“Once you’ve reached a certain point, the rigidity demanded by orthorexia makes it truly difficult for you to eat anywhere but at home,” Dr. Bratman writes. “Most restaurants won’t serve the right foods. … Even your friends inexplicably fail to cater to your personal preferences (or, as you see it, they willfully choose to ignore the one right way of eating).”

Judith Asner, a Bethesda licensed clinical social worker who has specialized in eating disorders for nearly 30 years, said she sees similarities between rigidly healthy eating and known eating disorders.

“People are overwhelmed by what’s coming out [in the media],” she said. “But sometimes the public doesn’t read everything — they may just read the headlines. … An obsession with healthy eating is similar to an eating disorder: It gives people a sense of control.”

Doug Bunnell, a clinical psychologist in Connecticut and past president of the National Eating Disorder Association, said strict diet rituals can push certain people toward disordered eating.

“Paying attention to a healthy diet is healthy enough for many people, and it doesn’t bleed into a full-blown eating disorder,” he said. “Since you don’t know how vulnerable you are, if you are prone, these rituals can kick off a full disorder. It can kick up stuff that makes people miserable.”

Angela Guarda, a psychiatrist and director of the Eating Disorders Program at Johns Hopkins University in Baltimore, said the condition is likely a form of obsessive-compulsive disorder.

“We occasionally see cases that do not seem to have anorexia nervosa as we usually know it,” Dr. Guarda said. “That is, they deny fear of weight gain and are underweight but have all sorts of food rituals, dietary exclusions and purported allergies. They typically consume a very restricted and inadequate food repertoire and may pursue lots of alternative cleansing and naturopathic remedies.

“Whether it is a different syndrome can be hard to tell,” Dr. Guarda said. “Most share an overvalued morbid eating restraint with anorexia, and this drive to undereat appears to be rewarding to them at some level.”

Mr. Bunnell said the same traits that make one vulnerable to a classic eating disorder such as anorexia nervosa can make one vulnerable to obsessively healthy eating. Studies have shown that anorexia is more common among white, well-educated, highly accomplished women.

Many of Ms. Asner’s patients come from that demographic. These days, when the headlines are about the dramatic rise in food prices and the stress on many families’ budgets, one would have to look hard to find a health-food obsession in a lower-income neighborhood.

“Some people are just trying to get the most food they can for the least amount of money,” Ms. Asner said. “The more leisure time you have, the more time you have to sit and look at the labels on the chicken package.”

Said Mr. Bunnell: “It is a class issue, for sure. Healthy food is much more expensive than other food.”

With time on one’s hands, it also is easy for disordered eating to spill over into parenting. A home free of white bread, soft drinks and bad carbs wins a gold medal in the theoretical food olympics. However, having a total Pop Tart lockdown in the pantry can backfire.

“That’s when healthy eating becomes tinged with moral superiority,” Mr. Bunnell said. “You see parents who want their children to have the best, be the healthiest. But in studying childhood obesity, we find a link to restrictions in early childhood, and restrictions can be a pathway to disordered eating in adolescence.”