Relevance of orthorexic eating behavior in nutrition counseling and nutrition therapy

Results of a nationwide survey among German nutritionists

Introduction

In recent years, orthorexic eating behavior has gained more attention in the general population as well as in the field of scientific research. However, this potentially new variant of disordered eating behavior is not classified in the ICD-10 nor in the DSM-5. Orthorexic eating behavior is defined as a fixation on only eating food considered healthy according to subjective criteria [1, 2]. In 1997, Steven Bratman, a US-American practitioner of alternative medicine, was the first to describe orthorexic eating behavior [3, 4]. The current state of research suggests that orthorexic eating behavior is associated with a cognitive fixation on healthy eating and rigid adherence to self-imposed nutritional rules [1, 5].

While the other eating disorders are mainly characterized by a focus on the consumed quantity of food, individuals with orthorexic eating behavior worry about the quality of their food [6]. The persistent search for the perfect and healthiest diet may lead to increasing restrictions in eating behavior because more and more food is considered unhealthy [4]. Hence, orthorexic eating behavior deviates progressively from general recommendations for healthy eating habits, for example from those published by the German Nutrition Society [7]. Recent studies suggest several similarities between anorexic and orthorexic eating behavior, which is why orthorexia is discussed as another variant of disordered eating behavior [8].

Abstract

Orthorexic eating behavior is defined as a potentially pathological fixation on only eating food that is considered healthy according to subjective criteria. In the German population, approximately 1–7% are affected. However, it is still an open question whether these individuals make use of professional help. Aim of the present study was to evaluate the relevance of orthorexic eating behavior in the field of nutrition counseling and nutrition therapy. For this purpose, 290 German nutritionists were surveyed regarding the number and sociodemographic characteristics of affected individuals that made use of nutrition counseling. 70% of the participants reported that individuals with orthorexic eating behavior consulted them in the past 12 months. Half of them displayed orthorexic eating behavior as a main feature. In the remaining cases, orthorexia was reported to occur in combination with other eating disorders or obsessive-compulsive disorders. For the treatment of orthorexic eating behavior, participants recommended psychotherapy and nutrition counseling.

Keywords: Orthorexia, orthorexic eating behavior, nutritionists, survey, eating disorder

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