Orthorexia and men: When eating healthy becomes an obsession

An obsession with reading and over-analyzing food labels. An obsession with following a rigid and inflexible relationship with food. An obsession with no “free pass” of allowing a slice of pizza or ice cream cone. An obsession that leaves men feeling severe anxiety or distress when eating unhealthy.

The above statements are true of someone with orthorexia, an extreme obsession with eating a healthy diet. On the one hand, choosing healthy foods daily is encouraged and applauded. Most Americans could vastly improve their food choices. But, when an intense interest in healthy eating turns into a phobia of cutting out entire food groups, this may lead to issues of malnutrition that can compromise day-to-day functioning.

Is orthorexia an eating disorder?

The term orthorexia was first coined in 1997 by Steven Bratman, a physician who suffered from orthorexia himself. The word orthorexia, when broken down, describes the basics of this eating disorder: “orthorexia” comes from “Orthos,” meaning ‘accurate, right, or correct,’ and “orexis,” meaning “hunger or appetite.’ 

The beginnings of orthorexia often start innocently in someone seeking to improve their health, treat a disease or help with weight loss. Gradually, for some, healthy eating becomes a severe obsession in their life, creating unrealistic demands on what they can or cannot eat. As a result, a person can resort to being overly selective on eating only healthy foods, refraining from any food with artificial ingredients or preservatives, making it a very restrictive diet solely based on a food’s nutritional quality instead of quantity. In essence, orthorexia is a pathological fixation on eating solely healthy food to the detriment of a person’s health and well-being.

Orthorexia, when taken to the extreme, can result in malnutrition, severe weight loss, or other medical complications from following an overly restricted way of eating. Mentally, orthorexia creates situations where a person’s self-worth, body image, and life satisfaction is excessively compliant with their “healthy eating” fixation. Therefore, if any food defined as ‘unhealthy’ touches their lips, they feel devastated and unworthy.  

How prevalent is orthorexia in men?

Few studies have determined the prevalence of orthorexia worldwide. However, one study found the overall prevalence of orthorexia was 6.9% among Italians, with men having higher rates than women.  

Athletes are especially at high risk for obsessive healthy eating. For example, when training to be their physical best to maximize their performance in sporting events, male athletes (41%) were found to have higher rates of orthorexia than female athletes (31%) in a 2016 study. 

This condition often occurs in male athletes whose weight and body image matter the most.  These athletes include male bodybuilders, gymnasts, wrestlers, rowing, and swimmers or divers. 

How is orthorexia diagnosed?

Orthorexia, compared to more well-known eating disorders like anorexia nervosa and bulimia nervosa, is not recognized by The Diagnostic and Statistical Manual of Mental Disorders as an eating disorder. While there is an overlap of symptoms that also can apply to anorexia or bulimia – food and eating preoccupation, restrictive eating, health-related consequences, and cognitive distortions – a designation as an disordered eating, at this time, does not apply. 

It has been shown, however, that orthorexia has significant similarities to an obsessive-compulsive disorder, such as highly obsessive ritualistic behavior and extreme anxiety. Because men with orthorexia usually do not have low self-esteem, poor body image, preoccupation with weight loss, or how much food is eaten, it has instead, been more closely aligned with obsessive-compulsive disorder instead of an eating disorder. 

There are a couple of different criteria for making a diagnosis of orthorexia in a person:

1. Criterion A – These people will obsess over healthy eating and become distressed if their food choices are unhealthy. Here are other criteria that would fit Criterion A:

• Obsessed with food rules 
• If food rules are broken, the person feels shame, anxiety, and fear of disease
• Over time, the food rules become more restrictive
• Person may do obsessive cleanses to rid the body of toxins

2. Criterion B – These people may have noticeable mental health or physical problems because of being orthorexic

• Malnutrition, severe weight loss, or other medical problems
• Their rigidity in eating and following food rules creates problems at work, school, or with social interactions
• They base their self-worth and body image based on their ability to follow healthy eating rules

How is orthorexia treated?

Treating orthorexia begins with training the person to think about healthy eating differently. They should want to nourish the body but not at the expense of causing harm or hurting relationships with others because of restrictive eating habits. 

Here are common treatments used to develop a more healthy relationship with eating:

• Behavior modification – Learning to recognize and understand how the actions of orthorexia is causing more harm than good
• Cognitive restructuring or cognitive reframing – Focuses on identifying habits and beliefs causing stress and then work on positive thoughts and actions to take instead
• Relaxation training – To reduce stress and anxiety, breathing exercises, guided imagery, mindfulness meditation, yoga, and tai chi, are used to achieve these goals
• Mindful eating – Learning to focus on the whole eating experience by bringing awareness to body sensations (hunger or fullness), thoughts and feelings about food, learning to enjoy the taste, smell, and textures of food, and to eat without judgment.  

For anyone who may or already has a diagnosis of orthorexia and needs more support, below is a link to ask for help:

https://www.nationaleatingdisorders.org/help-support/contact-helpline 

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.