by Marion Nestle
Jul 12 2011

Eating Liberally: unhealthy food obsessions?

Every now and then, Kerry Trueman (“KAT”) poses a question, usually about something challenging.  Her challenge today:

Let’s Ask Marion: Is it Possible to Have an Unhealthy Obsession With Healthy Eating?


(With a click of her mouse, EatingLiberally’s kat, aka Kerry Trueman, corners Dr. Marion Nestle, NYU professor of nutrition and author of What to Eat, Food Politics, and Feed Your Pet Right):

KAT: As one of our most influential advocates for healthier food choices, you must be pleased to see that more and more Americans are rethinking the way we eat and demanding better options. But is it possible to take a concern for healthy eating to an unhealthy extreme?

I have a friend whose son has become so fixated on what foods he thinks he should or should not be eating that he could be a textbook case of “orthorexia nervosa,” a supposed eating disorder characterized by an unhealthy obsession with healthy eating. Do you think this is a real disorder, and if so, how does one address it?

Dr. Nestle: “Orthorexia nervosa”? I’m not convinced it deserves inclusion in the DSM (Diagnostic and Statistical Manual of Mental Disorders) but let’s leave that to the shrinks. One thing is for sure. If you think people have it, you need to deal with them in the same way porcupines make love–very carefully.

Nothing is more intimate than food. It goes inside our bodies. Nothing could be more personal than food choices. Unless what people eat is doing them serious harm, I would not dream of commenting.

When people are chronically hungry, all they want is food, any food, and right now. But we live in an age in which food is so abundant and so easily accessed that it’s hard for those of us who are pretty well off to remember what hunger feels like.

For us, food is no longer about relieving hunger and getting basic nourishment. For many people, it isn’t even about traditional culture or, heaven help us, pleasure. Food is just there for the eating.

For some people, this means food is the enemy. If they do not vanquish food, food will vanquish them.

Vanquishing means being in control. Healthy diets may be about variety, balance, and moderation, but food fighters—or “orthorectics” if you prefer—are not comfortable with moderation or balance. If saturated fat raises blood cholesterol levels, don’t eat any fat at all. Whether high fructose corn syrup is worse than sugar or not, avoid it at all costs and never feed it to kids. Carbohydrates, trans fats, and color additives are bad for you when eaten in excess? Never touch them.

This may sound extreme but I can’t think of anything wrong with not eating these things. And I know lots of people who feel better when they don’t eat junk food and are actively controlling what goes into their bodies.

If your health food-obsessed friends are adults and their diets are reasonably varied, balanced, and moderate, they are probably doing just fine and don’t need an intervention. If they aren’t, and you think their dietary obsessions are harmful and causing them to lose too much weight, you can try an approach along the lines of “I love you and I want you to be healthy” and see if you can get them some professional help.

And if they are imposing extremely unvaried, unbalanced, and immoderate diets on children, you will want to get them some help right away.

Short of that, eating healthfully seems like a good thing to do and I have a hard time thinking of it as obsessive. What if eating healthfully were considered normal? As it should be, no?

  • Amelia

    It’d be great if eating healthily were ‘normal’ – I agree. But it’s not. I certainly agree with the writer that I know a few people who take their food choices VERY seriously. Perhaps to a level I find unhealthy. I find it unhealthy because like someone with severe OCD cannot walk into their own home, or work, or a friend’s house without following rituals (let’s say locking and unlocking doors or switching on and off lights), I know a few people who cannot have ‘normal’ interactions with food. They cannot participate in neighborhood potlucks, nor school bake sales, nor family thanksgiving dinner; this isn’t due to food allergies or physical disability but to mental blocks against eating anything that may not fit this strict standard. When we treat food like this, as a God, I find it remarkably UNhealthy to our brains… no matter if it’s good for our other systems.

  • Leslie

    I have found it interesting to note that the conception of food as the main influence on overall health is very culturally dependent.

    Most societies today recognize that food is the major factor in obesity and lifestyle diseases, but American culture goes far beyond that, focusing on what we ingest as the major determinant of our health – with nutritional supplements, superfood trends, an obsession with which specific nutrients cause obesity (one thing I love about this blog is that it emphasizes the macro level of food systems, culture, and availability rather than fads like “it’s POTATOES that make you fat!”), studies on caffeine intake and memory loss, and more. It would be easy to draw the conclusion from the American media that there is some “perfect,” health-perpetuating diet out there – 20 blueberries a day, three tablespoons of flax seed, fish twice a week – and we just have to find it.

    I mean, maybe in industrialized society food intake really is the root of most disease, given how much other disease we’ve eliminated – but I was struck when I spent a couple of years in Russia and found that the emphasis there is much more on regulating body temperature, and the collective relationship to food is much simpler. That’s not a value judgment- But when my students scoffed at their host moms not allowing them outside with wet hair even in the middle of summer, I pointed out that there are plenty of medically inconsistent folk beliefs in U.S. culture – but most of them are about food.

    Long story short, I think “orthorexia” is problematic and arises from our cultural conception of food – *specific* foods – as the magic key to health.

  • Thib

    I partly agree with Dr. Nestle, but also partly disagree. Dr. Nestle, you seem to take more of a biological point of view of eating when you responded to this question but the question asked is actually one that is more of a socially-oriented and psychologically-oriented situation than a biological one. From the biological perspective, that health person in question, is doing just fine. He is being very careful of his food choices and eating what is healthy from a biological point of view.

    But let’s switch the point of view into a psycho-social one. When you begin to see a small amount of certain kinds of food as “the devil” (or just too unhealthy to ever EVER touch) then it could be a problem for your own mental health and social health.

    Before I went to do research in Africa, I was living in the U.S. and generally a vegetarian. Where I lived in the U.S., it was normal to be around mixed companies of vegetarians and non-vegetarians and in that particular region of the U.S., it was very normal to cater to BOTH vegetarian and non-vegetarians at general parties, dinner get-together etc.

    When I went off to do years of research in Africa, being a strict vegetarian was truly socially not an option. It made my interactions with other people very awkward. And, I also had to learn to accept more of the cultural foodways of local peoples such as using more palm oil (oh horrors, for the trans-fat, eh?) and especially eating more meat. At first I resisted even though they kept piling on meat on my plate. But, eventually I realised that to just push away what people offered all the time was just socially unacceptable. Food, as I’m sure you well know, is a form of social commensality. Of course, one shouldn’t also just accept entirely what is socially acceptable in that region but there needs to be a constant play and evaluation (push and pull and tug) between your personal desires and figuring in and working in with social norms. So, what I ended up doing was when I cooked privately at home it was vegetarian but when I ate with others I would eat a little bit of meat and mostly vegetables. Sometimes when the hosts would offer me more meat I would accept and other times I would say I’ve had enough. It’s a constant back-and-forth.

    So, while I wouldn’t necessarily call that young man a type of food-phobic, I would be say that just like eating junk food we can go to the extreme, being socially and psychologically awkward about food is equally an extreme even if biologically it is healthy. Indeed, when it comes to food, it’s never just a statement about biology. It’s always a mesh of psycho-social factors.

    If we can imagine a germa-phobe (excessive fear of germs) can we not also imagine a type of food-phobe who is excessively fearful of and hateful towards certain types of food that are not exactly poisonous?

  • Thib

    And if I can leave another example here:

    I have a close friend who has over the years gone from regarding certain foods (meat, for example) as just awful and evil, to admitting that yes she loves the taste of meat but just can’t consume a lot of it because the thought of all that bad dpolitics of the meat industry doesn’t jive with her well.

    That’s a good change in her! She noticed that her disgust over meat actually wasn’t so much about the immediate biological product which she actually loved the taste of but it was the politics over the meat industry. Why is that important? It’s important for her to have noticed this because it wasn’t really the biological food she was having a problem with even though for years she just proclaimed meat to be disgusting and evil. Rather she eventually realised that her emotions were aligned that way because of the politics of the meat industry she didn’t agree with.

    So, here’s an example of how a particular biological viewpoint of the food (meat) is actually not about the biological food but about the industry that processes that food (meat).

    I suspect that many vegetarians (not all of course) have misaligned the stimulus of their feelings and their feelings. That is, they have misidentified the origins of their feelings and attributed the origins to something other than what it actually is.

    I’m here also thinking about dog meat. In just this past month, there have been a few articles about South Korea and dog meat and how during the Olympics in Seoul that dog meat as banned from public sale because South Korea wanted to project an image of itself that was more in alignment with the Western world. In America, for sure, the general public thinks of eating dog meat as just too horrifying. But like my friend noted above, they have not properly identified their source of horror. I would say that probably what they have found disgusting is simply because most Americans view dogs as pets and therefore a taboo for making meat out of them. But consider that we can also have chickens as pets, or rabbits as pets, or lamb as pets, so why not be equally horrified when we know that many Americans eat chickens, rabbits, and lamb?

    So probably it’s a good idea not to take such an overly firm stance on one’s food choices and from time to time give in a bit to see what it is that our morals are aligning with (and why) and reassess, and even take a walk on the wild side every now and then and eat what we usually don’t eat.

    When I was in Africa and my friend (the one noted above) came to visit, she was often squeamish about the local foods there. I would keep telling her this: look, you’re here to experience another culture and you don’t want to be rude to the people around you. If they can eat that stuff so too can you. They’re just as human as you.

    This isn’t to say she should just throw away her own personal morals. It is to say, this whole food thing is a push and pull and tug affair, and we certainly shouldn’t hold such a harsh black and white idea over our own food boundaries.

  • Thib

    One more thing,

    the Chinese have a saying that goes something like this, “Even a little poison from time to time can’t kill.” The saying is often said in the context around food when someone absolutely refuses to take any more food or some such. I think within reason, the saying is a good one to take in mind. Even moderation itself needs to be taken in moderation! 🙂

  • One thing I have found by following many experts on Twitter and blogs: They often seek perfection (it doesn’t exist) and are quick to admonish even the slightest imperfection. Many also equate it to other problems: climate change, working conditions, etc.

    It can be overwhelming and make you very anxious.

    I’ve learned to filter out many of the so-called experts.

    Ken Leebow

  • I actually think that Orthorexia Nervosa is a real disease. It is an anxiety disorder. BUT…healthy eating is NOT Orthorexia Nervosa. There is a huge difference. Unhealthy eaters are looking for any opportunity to slam those of us who have begun to take care of ourselves.

  • Btwomey

    I often encounter people who are obsessed with healthy eating. As a vegetarian for 25 years some would consider me one of them. However, I am also a professional chef and taste and cook everything including meat. I believe in moderation-which includes the occasional ingestion of “unhealthy” foods. Food and life should be enjoyed and celebrated- what I have seen in the health obsessed is anxiety and fear about ingesting anything “bad” for fear of possible future health repercussions. This is not, as others have mentioned, an emotionally or psychologically healthy way in which to live.
    I’d also like to say that many of the obsessed healthy eaters I have met are basing their decisions about what to eat on the latest fads and not on sound nutritional principles as you yourself Ms. Nestle have written extensively about (and thank you for your work!).

  • Marion,

    “If your health food-obsessed friends are adults and their diets are reasonably varied, balanced, and moderate, they are probably doing just fine and don’t need an intervention. If they aren’t, and you think their dietary obsessions are harmful and causing them to lose too much weight, you can try an approach along the lines of “I love you and I want you to be healthy” and see if you can get them some professional help.”

    Respectfully, as an RD who counsels clients in healthy weight management through positive lifestyles, a fan of “health at every size” movement, and someone who treats people struggling with the spectrum of eating disorders, including binge eating disorder (which is estimated 30% of people seeking weight loss treatment have). I have come across my fair share of people who have an unhealthy obsession — and frankly lots of misdirection and confusion over what is “good food” and “bad food”. I kid you not, very well educated CEOs, lawyers, doctors, members of Congress, nurses, school teachers, moms of young kids, and even high school students (boys and girls) frequent my office. None of them had an “unhealthy” low or high weight… (as you mention as the indicator.) But nevertheless, they are indeed majorly struggling.

    – food fears
    – frequent food thoughts
    – “It’s a constant battle to choose what to eat”
    – “Is a balance bar healthier than a twix bar”
    – food is too hard to resist, I love bread but don’t let myself have it because it is too processed
    – should I avoid carrots because of the sugar

    The list goes on and on. I come in contact with people all the time where the pressure to be “perfectly” healthy has taken up way too much of their brain power and mental energy. It gets in the way of their quality of life. Pleasure (as you say a reason we eat – we are so lucky) for them is greatly diminished because of the “evil” food can do.

    So that’s just my two cents. I agree that we can’t really say “orthoexia” is real, but the struggles people have are real and it is not just people with a diagnosable mental health issue. And weight can not be the indicator we use to determine if someone needs a dose of reality.


  • Anthro

    The question is kind of silly to begin with. What constitutes an “unhealthy obsession” anyway? I eat healthy food, prepare most of it myself and obtain most of it locally. People who live on fast food and deli food might find me “obsessed” with “healthy eating”. It’s really a matter of perspective.

    The questions people have as noted by Rebecca are really a matter of ignorance, rather than obsession. The answers could be found with a bit of research.

    Most of the people who find my eating habits “extreme”, “odd”, or perhaps “obsessive” are either fat or the sort of people who are almost totally uninterested in food and nibble at whatever comes their way.

    I think people who will not ingest a bite of something not labeled “organic” or “non GMO” might be called obsessive, but not in the clinical sense. They are annoying to have lunch with, but probably not in need of treatment.

  • Anthro — everyone is ignorant? Really? How can you judge whether or not someone’s food fears is getting in the way of their quality of life?


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  • Emilie

    The problem with becoming obsessed with “healthy eating” is that it can eventually lead to believing almost all foods are not acceptable to consume. Not only does this obsession lead to awkward and uncomfortable situations in social settings but also can lead to not enough calories or nutrients in one’s diet. If someone has “orthorexia” or seems constantly obsessed with eating healthfully and thinking about every piece of food that goes into his body, it may be the start of anorexia.

    I’m speaking from personal experience. I started to become so obsessed with eating properly – no processed foods, junk food, etc. that soon my body and habits formed around this eating style so that I no longer enjoy the taste of anything unhealthy. Unfortunately this has lead me down a path of severe weight loss from lack of caloric intake, and now with the help of doctors and friends, I am on a long struggle trying to recover. I believe that this new so-called disease “orthorexia” is just a way for people to create a more socially acceptable name for anorexia. If eventually this obsession with eating healthy becomes unhealthy it is important to seek help no matter the name of the diagnosis.

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