Obsessive behaviors with healthy eating? New research evaluates the causes and drawbacks of orthorexia nervosa

15 May 2019 --- Individuals who have a history of eating disorders, obsessive-compulsive traits, dieting, poor body image and a desire to be thin are more likely to develop a pathological obsession with healthy eating or consuming only healthy food, known as orthorexia nervosa. This is according to new research by York University’s Faculty of Health, in Ontario, Canada, who conducted a meta-analysis of existing research on the subject. Although eating healthy is an integral attribute of a healthy lifestyle, the researchers are urging consumers and healthcare providers that an excessive preoccupation with healthy eating can become physically and socially impairing.

Previous research has shown that unlike patients with anorexia nervosa – who restrict calories to maintain very low body weight – people who have the condition have a fixation with the quality of food eaten and its preparation, rather than the number of calories. Over time, they spend increasing amounts of time and effort purchasing, planning and preparing “pure” and healthy meals, which eventually becomes an “all-consuming obsession” that interferes with other areas of life and results in weight loss, the study notes.

One of the main reasons for conducting this study was that current research on the condition is limited. Unlike other eating disorders, such as anorexia and bulimia, orthorexia is not recognized in standard psychiatric manuals for healthcare providers.

The study iterates that other eating habits, such as being a vegetarian or vegan, also put individuals at higher risk for developing orthorexia nervosa. Lacto-vegetarians were at highest risk for the condition and people who are on a strict eating schedule, spending large amounts of time preparing meals, were also at greater risk.

This would appear to be a concerning thought, considering how consumer focus on health is more prominent than ever, in this day and age. In recent years, emergent trends such as personalized nutrition have further enabled health-conscious individuals with greater oversight of their dietary regimes.

Orthorexia associated with psychological predeterminants
In the first exhaustive review of the psycho-social risk factors associated with orthorexia nervosa, York University psychology researchers examined all studies published up until the end of 2018 in two popular databases. In particular, they examined previous research showing how orthorexia nervosa is related to psycho-social risk factors that predispose an individual to develop the condition.

Following the analysis, the team amalgamated all available findings for each risk factor to reach conclusions about which psycho-social factors were most reliably associated with the condition.

“The long-term impact of these findings is that they will lead to better recognition among healthcare providers as well as members of the public that so-called healthy eating can, in fact, be unhealthy. It can lead to malnourishment or make it very difficult to socialize with people in settings that involve eating. It can also be expensive and time-consuming,” says Jennifer Mills, Associate Professor in the Department of Psychology and senior author of the study.

“When taken to the extreme, an obsession with clean eating can be a sign that the person is struggling to manage their mental health,” she adds.

Sarah McComb, a master's student in Mills' lab and first author of the study, says she found it surprising that the overwhelming majority of the articles in this field were of “neutral-poor quality,” indicating that the results of these studies must be interpreted with caution.

“It really suggests a call for more valid measurement tools of orthorexia, so that more reliable conclusions can be drawn about the true prevalence of orthorexia in the population and which psychosocial factors really put a person at risk for developing orthorexia nervosa,” McComb explains.

“In our research, we found equal rates of men and women who struggle with symptoms of orthorexia nervosa,” says Mills. “We still think of eating disorders as being a problem that affects mostly young women. Because of that assumption, the symptoms and negative consequences of orthorexia nervosa can fly under the radar and not be noticed or taken seriously.”

The researchers say that developing a consistent definition of orthorexia nervosa will make it easier for health researchers to develop reliable measures and provide better diagnosis and treatment of the condition.

NutritionInsight has reached out to researchers of the study for comment on the further clinical applications of these findings.