*Homework assignment written by Misti Blu Day McDermott for Epidemiology
Orthorexia Nervosa: A Lifestyle Syndrome
Anorexia nervosa, dating back to the 1600s, is a psychological and potentially life-threatening eating disorder. The complications from anorexia nervosa can be fatal. Many people have heard of this disorder or know someone who has suffered from anorexia. On the other end of the spectrum, over-eating is also a disorder known as binge eating disorder. Several recent studies in the US have developed broader definitions of eating disorders to more accurately represent the wide range of disorders (Keski-Rahkonen, 2007). Orthorexia nervosa, known as a lifestyle syndrome, is not well recognized and wasn’t proposed until the late 1980s.
Excessive exercise plays a role in orthorexic behaviors. Orthorexia is defined as “a fixation on eating healthy food.” Though the desire to eat healthy is a beneficial habit that can improve one’s health, it can be considered a behavioral addiction or an extreme dietary habit in excess (Håman, 2015). Healthism is a social perspective of health, a dominant view of ideology emphasized by the individual based on popular media and Western societies. Healthism considers a lean body to be healthy, though ideal health is much deeper than one’s body shape. According to nationaleatingdisorders.org, this obsession with healthy eating has several warning signs: compulsive checking of labels and ingredients, cutting out an increasing number of food groups (sugar, carbs, dairy, fats), inability to eat anything besides a narrow group of foods that are deemed “healthy,” unusual interest in what other people are eating, obsessively thinking about upcoming meals, high levels of distress when “safe” food is not present, and body image concerns.
Similar to anorexia nervosa, orthorexia involves restriction of the amount of food intake and limited variety of foods. Both make malnutrition likely and share many of the same physical consequences. Because orthorexia is still considered a new disorder, coined in 1998, there are no current studies on the disorder. Anorexia nervosa and bulimia nervosa are the more severe eating disorders, linked to high premature mortality and suicidal risk, as well as severe medical complications. In a fixed Swedish study by Yao et al., heritability of clinically diagnosed anorexia and bulimia was estimated at 43% and 41% (with a 95% confidence interval). The study encourages further molecular genetic research on the behavioral disorders.
Secondary to chronic malnutrition, anemia, leukopenia, and thrombocytopenia are all hematological complications of anorexia. Abnormal liver function, cardiac arrhythmias, effects on bone density, insulin sensitivity, and psychiatric disorders are also major complications involved. In a 2019 systemic literature search by Giovianazzo et al., cardiac abnormalities were presented and identified. QT interval prolongation, bradycardia, Torsades des Pointes, and ventricular fibrillation are common cardiac consequences of anorexia due to severe deficiencies. Many of the cardiac complications are severe and can result in sudden cardiac death. The danger isn’t only in the lack of eating but also in refeeding syndrome. During the first few days of refeeding, acute, life-threatening cardiac complications are an increased risk (Giovianazzo, 2019).
Because orthorexia nervosa and anorexia nervosa have overlapping complications, it is important to raise awareness on orthorexia. Moderation and balance are important for maintaining homeostasis. Anything in excess can be dangerous, including healthy habits.
Giovinazzo, S., Sukkar, S. G., Rosa, G. M., Zappi, A., Bezante, G. P., Balbi, M., & Brunelli, C. (2019). Anorexia nervosa and heart disease: a systematic review. Eating and weight disorders : EWD, 24(2), 199–207. https://doi.org/10.1007/s40519-018-0567-1
Håman, L., Barker-Ruchti, N., Patriksson, G., & Lindgren, E. C. (2015). Orthorexia nervosa: An integrative literature review of a lifestyle syndrome. International journal of qualitative studies on health and well-being, 10, 26799. https://doi.org/10.3402/qhw.v10.26799
Keski-Rahkonen A, Hoek HW, Susser ES, Linna MS, Sihvola E, Raevuori A, …, and Rissanen A. (2007).Epidemiology and course of anorexia nervosa in the community.American Journal of Psychiatry, 164(8):1259-65. doi: 10.1176/appi. ajp.2007.06081388.
Yao, S., Larsson, H., Norring, C., Birgegård, A., Lichtenstein, P., DʼOnofrio, B. M., Almqvist, C., Thornton, L. M., Bulik, C. M., & Kuja-Halkola, R. (2019). Genetic and environmental contributions to diagnostic fluctuation in anorexia nervosa and bulimia nervosa. Psychological medicine, 1–8. Advance online publication. https://doi.org/10.1017/S0033291719002976