Orthorexia: the health-conscious woman’s eating disorder.

So two months ago I handed in this paper to my “joke class” of the semester: Women’s Medical Issues. I didn’t particularly work hard on the paper (again, easy class; I actually just noticed I started the first two paragraphs the same way, ha) but “orthorexia” has been popping up on my dash a lot lately so I thought I’d contribute. The prompt was to research a current women’s medical issue and argue for the importance of defining it as such. I got an A grade but can’t vouch for this paper being particularly good, so enjoy it with a pinch handful of salt.

It’s long, so it’s directly pasted (from the original document) after the cut.

Orthorexia: the health-conscious woman’s eating disorder.

Stephanie ****, Women’s Medical Issues with Dr. *****

 

     While anorexia and bulimia have long been known as the most popular eating disorders of American females, a new—but similar—eating disorder has come to national attention: orthorexia.4,9 Orthorexia Nervosa characterizes people who develop an obsession with a healthy lifestyle, particularly with avoiding foods perceived to be unhealthy and pathologically fixating on the consumption of healthy food.1 Coined by Steven Bratman, MD, he realizes that the disorder “sounds like an oxymoron. How can focusing on healthy food be bad for you?” This paradox is solved by placing emphasis on the “unhealthy obsession” aspect of orthorexia.3 Like workaholism or exercise addiction, orthorexia can take healthy habits to an unhealthy level. Bratman describes this as an extreme case of over-focus, using orthorexia to define the milder obsession, and Orthorexia Nervosa to refer to the near-anorexic fixation that can lead to death. In less severe cases—or what Bratman describes solely as orthorexia—sufferers attempt to follow a diet that causes them to have lower self-esteem as they blame themselves rather than their diets for constant hunger and cravings for “forbidden foods.”

 

     While orthorexia may include elements of anorexia, their characteristics are very different. Like all eating disorders, orthorexia is a maladaptive eating behavior that develops in adolescence and early adulthood in most individuals. However, orthorexics are more concerned with the quality of their food than the quantity, as with anorexics who eat an unhealthy minimum. The purity of foods is also considered, with organic foods usually preferred. Individuals with anorexia will often follow, or claim to follow, a diet plan that involves eating only certain foods that are deemed “safe” or “free.” Examples of these foods include celery and carrots, which are eaten under the idea that the energy expended to digest these foods is equal to the energy gained from them; meaning one could eat them without gaining any nutrients or calories, and therefore weight.6 These compulsory food restrictions are fed by a need to severely limit their intakes, dissimilar from the origin of orthorexic food restriction. For an orthorexic, meals are usually healthy, organic foods, created with strict planning and forethought in mind.

     In further relation to anorexia, orthorexia derives from the Greek ortho meaning “right” or “correct.” Orthorexics are therefore concerned primely with the quality of the food they put in their bodies and the resulting “purity,” restricting their diets based on their understandings of what foods are acceptable. Individuals with anorexia and bulimia restrict food based on taste, desirability, and calorie or fat content. Criteria for orthorexic restrictions many include desiring only organic foods, or foods of a certain color, or without preservatives and added sugars and colors. Allegies to wheat, corn, and soy can cause digestive distress, fatigue, allergic reactions, and relief from these symptoms can become a fixation for orthorexics. While initially, cutting out foods including gluten and dairy can increase an individual’s apparent health, they can also become destructive when these restrictions become more intense.These meals, while “healthy” in concept, may not always be so. Individuals who eat specific, “correct” foods, and who often repeatedly eat the same meals can be characterized as having eating disorders, and these habits can lead to malnutrition, as individuals cut out certain foods or entire food groups containing essential vitamins and minerals for healthy functioning.

     Food preparation and diet planning are of great importance as well, drawing an unhealthy focus that can detract from personal endeavors.7,9 Individuals with orthorexia may transfer their entire self-worth into their eating habits. Sufferers praise themselves for avoiding temptation and sticking to their diet plan, but can become frustrated and punitive during lapses. Punishment can involve further restriction or personal harm. Through controlling their eating, their eating becomes more than just their lifestyle, it becomes their life. Furthermore, anorexics and orthorexics may experience an undue pride or feelings of superiority over others without their eating disorder. These people may be seen as undisciplined, gluttonous, and orthorexics may shun them or be socially shunned for their assumed moral superiority.. This behavior as well as their extreme fixation may cause the sufferer to be alienated from friends and family, and avoid social situations to escape shame or trigger foods that may be offered or forced on them. Thoughts about food will intrude on every interaction and relationship, leading to a one-dimensional individual whose health begins to suffer physically and mentally.2

     This social isolation can often lead to mental illnesses such as depression and anxiety.7 Like anorexia, orthorexia can be considered to have elements of obsessive-compulsive behavior. It has been suggested in a study by the Ethox Centre Department of Public Health in Oxford that individuals with severe anorexia may even be incompetent to be part of their own recovery. The recovery process for anorexics has long been weight restoration paired with psychological treatment to attempt to remove and lessen the intense fixations that lead to their maladaptive behavior.10 Despite their impending death, patients will often refuse to comply with treatment. Individuals with anorexia nervosa will be unable to understand, or will be in considerable denial about, the problem and the degree of their weight loss. Similarly, in orthorexia, individuals can become so selective about their eating habits and practices that they eventually choose starvation over contamination with impure food, just as some extreme anorexics opt for death over gaining weight.2 With the connection of anorexic components found in typical orthorexia, the question of Orthorexia Nervosa as a DSM diagnosis should be reviewed, as some extreme cases of orthorexia can closely mimic anorexia while still maintaining the unique characteristics of orthorexia.

     Despite these links between orthorexia and OCD, not all orthorexics can be generalized to suffer from OCD.1 Furthermore, even Steven Bratman claims that orthorexia is “often not very much like typical OCD or typical anorexia.”3 However, this lesser-known eating disorder can still easily lead to malnutrition and eventual death; and may eventually become a DSM diagnosis. Currently, the closest orthorexia has gotten to appearing in the DSM is being categorized as a variety of anorexia.

 

     These qualities of orthorexia makes it a women’s health concern as women are 10 times more likely than males to develop an eating disorder. Men and boys with eating disorders have been considered rare because these disorders were assumed to be female-gender-bound.8 This therefore suggests that there is some biological piece of the disease, causing it to be atypical in males. While anorexia is a more notorious eating disorder among women, orthorexia should also be considered a growing health concern as its prevalence is increasing.

     Specialized diet plans have achieved notoriety in the United States in the last few years. The well-known Atkins Diet, South Beach, and similar diet plans allow little to no carbohydrates, and instruct their followers to restrict or eliminate certain food groups. These self-inposed severe dietary restrictions are made mainstream, and unusual or rigid diets become more socially acceptable, and even demanded.2 With the growth of morbid obesity in the United States over the past two decades, these healthy and socially-conscious eating habits have gained strength. Some of these individuals may slowly become pathologically fixated on food, and therefore develop orthorexia which can become their lifestyle, leading to the more deadly symptoms of Orthorexia Nervosa. In a study by DiDomenico and Andersen (1988), it was found that “magazines targeted primarily to women included a greater number of articles and advertisements aimed at weight reduction.”9 While this statistic is dated, there are still many women’s magazines dedicated solely to a woman’s weight and body shape. With the growing expectation that women should be concerned about their weight and diet, there is an equal emphasis placed on living healthy, especially with peaking obesity rates nationwide. The emphasis on weight loss directed towards women has pushed individuals into anorexia, and the same risk of being lead into orthorexia is growing with the increasing number and popularity of fitness and restrictive-yet-healthy diets such as the “paleo diet.”9 This sets up orthorexia as a rising women’s health concern whose growth parallels the mounting popularity of these orthorexic diet plans directed at women.

     Cultural pressure and shame about one’s body is a primary motivator for anorexic, and orthorexic, behavior. With 38% of surveyed women revealing they are trying to lose weight, there is no question that poor body image is a media-driven problem directed towards women. In a sample of 1,373 high school students, girls (63%) were four times more likely than boys (16%) to be attempting to reduce weight through exercise and caloric intake restriction.9 At every age, women are being told to feel ashamed about their bodies and to wish to be thinner. This, in itself, is a women’s health issue that needs to be addressed because of its associated problems. Orthorexia, along with other eating disorders, is included as a more severe complication. Therefore, orthorexia, while a new eating disorder and seemingly rare, is truly a women’s health issue. It is anorexia reincarnated to mirror new social expectations where women should eat organic and health-consciously, while still being concerned about their weight.

 

 

 

Bibliography

1.    Arusoğlu, G., E. Kabakci, G. Köksal, and TK Merdol. “Orthorexia Nervosa and

Adaptation of ORTO-11 into Turkish.” Turkish Journal of Psychiatry 19.3 

(2008): 283-91. Web. 21 Feb. 2012.

2.     Battaglia, Emily. “Orthorexia: A Little Known Eating Disorder.” Orthorexia:

A Little Known Eating Disorder. Eating Disorders Treatment. Web. 02 Mar. 2012. <http://www.eating-disorder.com/Eating-Treatment/Eating-Disorders/orthorexia.htm>.

3.     Bratman, Steven. “Orthorexia Home Page.” Orthorexia. Steven Bratman, MD, 4 

June 2010. Web. 02 Mar. 2012. <http://www.orthorexia.com/>.

4.     Cartwright, M. “Eating Disorder Emergencies: Understanding the Medical

Complexities of the Hospitalized Eating Disordered Patient.” Critical Care Nursing Clinics of North America 16.4 (2004): 515-30. PubMed. NCBI, Dec. 2004. Web. 21 Feb. 2012.

5.     Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C. “Orthorexia

nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon.” Eating and Weight Disorders 9 (2004):151-157. Web. 21 Feb. 2012.

6.     Ehrlich, Steven De Armas. “UMM Medical Reference: Anorexia Nervosa.”

Anorexia Nervosa. University of Maryland Medical Center, 11 Dec. 2010. Web. 02 Mar. 2012. <http://www.umm.edu/altmed/articles/anorexia-nervosa-000012.htm>.

7.     Kratina, Karin. Orthorexia Nervosa. Orthorexia Nervosa. National Eating

Disorders Association, 2006. Web. 21 Feb. 2012.

8.     Mathieu, J. “What Is Orthorexia?” Journal of the American Dietetic Association

105.10 (2005): 1510-512. Print.

9.     Shiltz, Tom. Males and Eating Disorders: Research. Publication. National Eating

Disorders Association, 2005. Web. 2 Mar. 2012.

<http://www.nationaleatingdisorders.org/nedaDir/files/documents/handouts/MalesRes.pdf>.

10.  Tan, Jacinta, Anne. Stewart, Ray. Fitzpatrick, and R. A. Hope. “Competence to

Make Treatment Decisions in Anorexia Nervosa: Thinking Processes and Values.” Philosophy, Psychiatry, & Psychology 13.4 (2007): 267-82. Pubmed. NIH, 7 Dec. 2007. Web. 2 Mar. 2012.

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