“Food, no matter how pure, cannot fill the space in your soul that longs for love and spiritual experience. If you are trying to use it for this purpose, you may have gone astray on your journey.” Steven Bratman, MD

Can the pursuit of healthy eating be taken to an unhealthy extreme? Conversations around orthorexia nervosa explore just that. Orthorexia, defined as “a pathological obsession with proper nutrition that is characterized by a restrictive diet, ritualized patterns of eating, and rigid avoidance of foods believed to be unhealthy or impure,” continues to gain attention in the media as well as among health and nutrition professionals. Even so, we lack clear diagnostic tools and standardized treatment protocols for working with clients who struggle with this serious, often debilitating, condition. 

Orthorexia nervosa is not officially recognized as an eating disorder in the Diagnostic Statistical Manual of Mental Disorders (DSM-5), and peer-reviewed research on the topic is lacking. Current treatment recommendations combine best practices for treating Anorexia Nervosa (AN), Obsessive-Compulsive Disorder (OCD), and/or as Avoidant/Restrictive Food Intake Disorder (ARFID). This often includes medications, therapy, neurofeedback, and behavior modification. A multidisciplinary team, including a doctor, therapist, and registered dietitian, is also advised.

How can we, as registered dietitians, best support our clients in recovery from orthorexia? After assessing for possible malnourishment and implementing refeeding strategies as necessary, assisting with behavior modification arises as our most prominent role. Understanding the unique case and situation of each client is crucial here. We must ask ourselves how we can best meet them where they are, adjusting interventions to meet their individual needs. Ultimately, we want to help move our clients toward a flexible, satisfying, and intuitive eating style that frees them from rules, restrictions, and fear. 

Hungry for more? EDRDpro’s members-only June 2019 webinar with Emily Fonnesbeck, Orthorexia Treatment and Strategies, explores goals of treatment, best practices, and missteps to avoid when working with clients with orthorexia. Members can watch the reply of Emily’s webinar at their leisure in EDRDpro’s webinar library. You don’t want to miss this!