Posted Feb 22 , 2017 06:57 PM

On orthorexia nervosa: A review of the literature and proposed diagnostic criteria

Dunn TM, and Bratman S. Eating Behavior 2016;21:11-17

What are the important points of the review (excerpted from the Abstract)?

There has been a growing interest among clinicians and researchers about a condition where people restrict their diet based not on quantity of food they consume, but based on its quality (or perceived quality). Bratman (The health food eating disorder. Yoga Journal, September, 1997) coined the term “orthorexia nervosa” (ON) to describe people whose extreme diets – intended for health reasons – are in fact leading to malnutrition and/or impairment of daily functioning. There has also recently been intense media interest in people whose highly restrictive “healthy” diet leads to disordered eating. Despite this condition being first described in the U.S., and receiving recent media interest here, ON has largely gone unnoticed in the North American literature. This review article details the literature of ON, describing its emergence as a condition, to its being discussed in the scientific literature. It also reviews prevalence studies and discusses marked shortcomings in the literature. Finally, diagnostic criteria are proposed, as are future directions for research.

Why is this important?

While ON is not currently a ‘recognized’ eating disorder according to DSM-V, it is a form of compulsive behavior that can have significant consequences. In this article, several criteria are proposed which could lead to the diagnosis which is defined as: “Obsessive focus on “healthy” eating, as defined by a dietary theory or set of beliefs whose specific details may vary; marked by exaggerated emotional distress in relationship to food choices perceived as unhealthy. Weight loss may ensue as a result of dietary choices, but this is not the primary goal.” Variations in food intake are a hallmark of a normal diet, but a mental preoccupation regarding affirmative and restrictive dietary practices can be un-healthy. While this condition is not common, we all know individuals who, for various reasons, restrict certain foods or food groups, claiming their particular diet is “better” or “healthier.” Health professionals need to be aware of this tendency and reinforce dietary variation as well as be knowledgeable that the obsessive adherence to such a diet may result in significant malnutrition. Have you seen symptoms of ON in any of your patients? Did you note weight loss that was unintentional?

Read the Abstract: