Orthorexia: righteous eating or health food addiction

[Guest guest]

February 26, 2009

What's Eating Our Kids? Fears About `Bad' Foods

By ABBY ELLIN

SODIUM — that's what worries Greye Dunn. He thinks about calories,

too, and whether he's getting enough vitamins. But it's the sodium

that really scares him.

" Sodium makes your heart beat faster, so it can create something

really serious, " said Greye, who is 8 years old and lives in Mays

Landing, N.J.

Greye's mother, Beth Dunn, the president of a multimedia company, is

proud of her son's nutritional awareness and encourages it by

serving organic food and helping Greye read labels on cereal boxes

and cans.

" He wants to be healthy, " she says.

Ms. Dunn is among the legions of parents who are vigilant about

their children's consumption of sugar, processed foods and trans

fats. Many try to stick to an organic diet. In general, their

concern does not stem from a fear of obesity — although that may

figure into the equation — but from a desire to protect their

families from conditions like hyperactivity, diabetes and heart

disease, which they believe can be avoided, or at least managed, by

careful eating.

While scarcely any expert would criticize parents for paying

attention to children's diets, many doctors, dietitians and eating

disorder specialists worry that some parents are becoming

overzealous, even obsessive, in efforts to engender good eating

habits in children. With the best of intentions, these parents may

be creating an unhealthy aura around food.

" We're seeing a lot of anxiety in these kids, " said Cynthia Bulik,

the director of the eating disorders program at the University of

North Carolina at Chapel Hill. " They go to birthday parties, and if

it's not a granola cake they feel like they can't eat it. The

culture has led both them and their parents to take the public

health messages to an extreme. "

Tiffany Rush-Wilson, an eating disorder counselor in Pepper Pike,

Ohio, has seen the same thing. " I have lots of children or

adolescent clients or young adults who complain about how their

parents micromanage their eating based on their own health standards

and beliefs, " she said. " The kids' eating became very restrictive,

and that's how they came to me. "

Certainly, not all parents who enforce rules about healthy food — or

any dietary plan — are setting their children up for an eating

disorder. Clinical disorders like anorexia nervosa and bulimia,

which have been diagnosed in increasing numbers of adolescents and

young people in the last two decades, are thought by researchers to

have a variety of causes — including genetics, the influence of mass

media and social pressure.

To date, there have been no formal studies on whether parents'

obsession with health food can lead to eating disorders. Some

experts say an extreme obsession with health food is merely a

symptom, not a cause, of an eating disorder.

But even without firm numbers, anecdotal reports from specialists

suggest that a preoccupation with avoiding " bad " foods is an issue

for many young people who seek help.

Dr. James Greenblatt, the chief medical officer at Walden Behavioral

Care, a hospital specializing in child and adult eating disorders in

Waltham, Mass., estimates that he has recently seen about a 15

percent rise in the number of his young patients who eat only

organic foods to avoid pesticides.

" A lot of the patients we have seen over the last six years limited

refined sugar and high fat foods because of concerns about gaining

weight, " he said. " But now, these worries are often expressed in

terms of health concerns. "

Lisa Dorfman, a registered dietitian and the director of sports

nutrition and performance at the University of Miami, says that she

often sees children who are terrified of foods that are deemed " bad "

by parents. " It's almost a fear of dying, a fear of illness, like a

delusional view of foods in general, " she said. " I see kids whose

parents have hypnotized them. I have 5-year-olds that speak like 40-

year-olds. They can't eat an Oreo cookie without being concerned

about trans fats. "

Dr. Steven Bratman of Denver has come up with a term to describe

people obsessed with health food: orthorexia. Orthorexic patients,

he says, are fixated on " righteous eating " (the word stems from the

Greek word ortho, meaning straight and correct).

" I would tell them, `You're addicted to health food.' It was my way

of having them not take themselves so seriously, " said Dr. Bratman,

who published a book on the subject, " Health Food Junkies, " in 2001.

The condition, he says, may begin in homes where there is a

preoccupation with " health foods. "

Many eating disorder experts dispute the concept. They say that

orthorexia, which is not considered a clinical diagnosis, is merely

a form of anorexia nervosa or obsessive compulsive disorder.

Angelique A. Sallas, a clinical psychologist in Chicago, says the

idea of a " health food disorder " is practically meaningless. " I

don't think the symptoms are significantly different enough from

bulimia or anorexia that it deserves a special diagnostic category, "

Dr. Sallas said. " It's an obsessive-compulsive problem. The object

of the obsession is less relevant than the fact that they are

engaging in obsessive behavior. "

Dr. David Hahn, the assistant medical director at the Renfrew

Center, an eating disorders clinic in Philadelphia, also thinks that

orthorexics are anorexics in disguise. " I see many patients that are

overly concerned with the quality of their food, and that's the way

they express their eating disorder, " he said.

But whatever the behavior is called, those who have lived through a

disorder fueled by an obsession with healthful eating say that the

experience can be agonizing. Kristie Rutzel, a 26-year-old marketing

coordinator in Richmond, Va., began eliminating carbohydrates,

meats, refined sugars and processed foods from her diet at 18. She

became so fixated on eating only " pure " foods, she said, that she

slashed her daily calorie intake to 500. Eventually, her weight fell

to 68 pounds and she was repeatedly hospitalized for anorexia.

Today Ms. Rutzel, who said she is normal weight, often talks to

young girls in schools and churches about the perils of becoming

health-food obsessed.

Laura Collins, a writer who lives in Virginia, was once a parent who

was always " moralizing about good and bad foods, " she said. " We

didn't serve candy, my kids didn't have soda. " Ms. Collins's

daughter, Olympia, became rigid in her eating, fearing food that she

worried would make her unhealthy. By age 14, Olympia developed

anorexia, her mother said. To help her recover, the family had to

rethink its entire approach to food.

Some experts are quick to point out that it is not only parents who

may contribute to children's food anxieties. They cite nutritional

programs in schools that may go overboard. " I see younger kids who

have an eating disorder precipitated by a nutrition lesson in

school, " said Dr. Leslie Sanders, medical director of the eating

disorders program at Atlantic Health Overlook Hospital in Summit,

N.J.

Over the last five years, Dr. Sanders said, she has seen a rise in

the number of children who are fixated on the way they eat: " Some

educators categorize food into `good' and `bad.' The kids come home

and say `Don't eat French fries' instead of talking about

moderation. "

The problem, according to some nutritional experts, is that many

teachers don't understand nutrition well. " We're driving our kids

absolutely crazy, " said Katie Wilson, president of the School

Nutrition Association. " All the stuff about preservatives and

pesticides. All an 8-year-old kid should know is that he or she

should eat a variety of colors, and don't supersize anything but

your water jug. "

Nina Planck, author of " Real Food: What to Eat and Why, " said that

it's a " total cop out " to lay blame on schools and parents for

children's eating disorders. " The eating disorder comes out of a

disordered psyche, " she said. " You can't blame the information for

causing the eating disorders. "

But Jessica Setnick, a dietitian in Dallas and author of " The Eating

Disorders Clinical Pocket Guide, " tells a story that suggests

parents' attitudes can affect children. She recalled a mother who

brought in her preteen, apparently bulimic daughter. As Ms. Setnick

discovered, the girl was not trying to lose weight. " Her mother only

served brown rice, but she didn't like it, " Ms. Setnick said. " She

did like white rice. And while I'm not going to tell anyone what

they can bring into their own home, we discussed that when the

family went out, it would be O.K. to get white rice. "

When the girl told her mother what Ms. Setnick said, the mother was

furious, according to Ms. Setnick. " She said, `Don't you know white

rice is just like sugar?' "

" My heart broke for that girl, " Ms. Setnick said. " She was telling

her mother what she needed, and the mother wasn't listening. "

Ms. Collins, the author of " Eating with Your Anorexic, " a book about

her daughter's struggle with anorexia, and director of the nonprofit

organization Feast (Families Empowered and Supporting Treatment of

Eating Disorders), offers some perspective.

" It's a tragedy that we've developed this moralistic, restrictive

and unhappy relationship " with eating, she said. " I think it is

making kids nutty, it's sucking the life out of our relationship

with food. "

http://www.nytimes.com/2009/02/26/health/nutrition/26food.html?

th & emc=th