The Troubling Rise of Orthorexia, Or When Healthy Eating Becomes an Obsession

Young woman getting having her green smoothie after training

Sandwiched between sessions on reducing cardiovascular disease risk, boosting brain health and treating childhood obesity at the recent Food and Nutrition Conference and Expo in Boston, was a different type of presentation about the harms of taking healthy eating to an extreme – and the room was packed.

In a cavernous convention hall, an estimated 4,000 registered dietitians listened intently to three experts discuss orthorexia nervosa, a term coined by one of the panelists Dr. Steven Bratman to describe an unhealthy obsession with healthy eating. The condition, not yet classified as a full-fledged eating disorder (although Bratman has proposed diagnostic criteria), is increasingly on the radar of health care professionals. It clearly struck a chord with the audience.

During the 90-minute panel, the topic was trending on Twitter, and it became one of the most talked about sessions at the conference.  Orthorexia was the topic of my latest column for U.S. News & World Report  How To Tell if You Have Orthorexia.  And I’ve been thrilled to see it get picked up by Yahoo,  MSN and SmartBrief.

The condition differs from anorexia nervosa, in which people’s distorted self-image causes them to severely restrict calories for fear of becoming fat . With orthorexia nervosa, or more commonly referred to as simply “orthorexia” (“ortho” means right; “orexia” means  hunger), the goal isn’t necessarily thinness, but a desire to be pure, clean and healthy. In his presentation, Bratman described orthorexia as a “disease in search of a virtue.”

It’s about good intentions that have gone too far. It’s when a desire to eat right totally takes over someone’s life – leading to anxiety, guilt, self-judgment and often social isolation.

“Your identity should not depend on you being the healthiest eater in the room,” said co-panelist Marci Evans, a registered dietitian, eating disorders specialist and body image expert who owns a private practice in Cambridge, Massachusetts.  The third panelist was Jessica Setnick, a registered dietitian and eating disorders expert in Dallas, Texas.


Jessica Setnick, Steven Bratman, Marci Evans

“Unfortunately, it’s become socially acceptable to be obsessive about food,” Evans told me for my U.S. News article.

So why are we seeing a rise in orthorexia?  Many factors are at play.  First, there’s no shortage of trendy wellness bloggers who espouse an “eat like me, look like me” approach.  I’ve written about this issue in the past.  Just because certain bloggers are photogenic and have a large Instagram following, it does not mean they’re doling out good advice.  So often their focus is on what to avoid.  Or they make it seem like there’s only a very narrow range of foods that are permitted if you want to “eat clean.”

Evans said people’s tendency to bucket foods into good and bad categories – and their eating into good and bad days – may be adding to the problem. Even our society’s laser-focus on health without emphasizing the pleasures and enjoyment of food, and the hero-worshipping of certain “miracle” foods, are contributing factors , too.

Of course, just because you’ve decided to become vegan, go paleo, try a detox cleanse or follow a strict eating regimen, doesn’t mean you have orthorexia.  The problem is when your eating becomes increasingly restrictive and it starts to negatively impact your self-worth, happiness and well-being.

If you’re wondering if your healthy eating has become unhealthy, Evans suggests asking yourself these questions:

  • Are you spending more time thinking about your food choices than you wish you were?
  • Do you find that the main barometer of how you feel about yourself on any given day is based on how you’ve eaten?
  • Do you tend to demonize certain foods and think you cannot eat the foods you enjoy?
  • Are you flooded with anxiety, shame, guilt or negative physical sensations when you eat something that is not on your list of permitted foods?
  • Do you feel like your eating has become compulsive instead of an active choice?
  • Are you increasingly eliminating more foods and adding to your list of food rules to try and achieve the same health benefit?
  • As you cut out more foods and try to eat healthier, has your fear of disease gotten worse?
  • Does your eating regimen make it hard for you to interact with friends, family or colleagues?
  • Are you likely to stay home from a social event over a fear of what type of food would be served?
  • Is your eating adding to your overall stress?
  • Has a medical professional told you that you’re experiencing negative health symptoms because of your strict diet?

If you answered yes to any of these questions, it may be a red flag. Evans recommends reaching out to a registered dietitian – and potentially a mental health counselor – so you can be evaluated for orthorexia. Your food choices should not be a reflection of your morality or value, she says. A registered dietitian can help reduce these food fears and create an approach to eating that is flexible, less rigid and pleasurable.


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Trendspotting at FNCE: 7 Hot Food Trends from the Academy of Nutrition and Dietetics’ 2016 Food & Nutrition Conference & Expo

I just returned from Boston where I attended the Academy of Nutrition and Dietetics’ 2016 Food and Nutrition Conference and Expo (FNCE). I was there with 10,000+ registered dietitian nutritionists from the U.S. and across the globe.  The annual meeting is always an ideal venue for trend tracking.

Digestive health was a major theme — from the fermented, probiotic-studded and FODMAP-friendly products at the expo to the education sessions focused on feeding your microbiome and influencing the gut-brain highway.

In all the years I’ve attended this conference, I’ve never seen more attention paid to our gastrointestinal tract. There was an entire Healthy Gut Pavilion on the exhibit floor, which was probably the greatest indication of just how big the trend was this year.

The natural and organic section on the exhibit floor seemed bigger than ever, and many companies highlighted their commitments to sustainability, transparency and responsible sourcing. Protein was spotted in many aisles, including protein bars, shakes, chips and even water.  There were multiple sugar substitutes, meal replacement drinks, fancy waters, and better-for-you snacks.  Here’s a closer look at seven trends I spotted this year at FNCE:


Low-FODMAP foods.

Could low-FODMAP foods be the new gluten-free? Although, neither should be considered a fad.  Just like gluten-free is vital for individuals with celiac disease, foods that are low in FODMAPs (types of short-chain carbohydrates that may be poorly absorbed) are part of the treatment for people with irritable bowel syndrome and other digestive conditions.  FODMAP  (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols)  was the focal point of  a range of new products, from salsa and pasta sauce to protein bars and drinks.  Monash University in Australia created a certification program and app to make it easier to identify low-FODMAP foods. Similar to the certified gluten-free stamp, you can now find this low-FODMAP certified stamp on a growing number of food products.


Flavorful fermentation.  

A California-based company called Farmhouse Culture served up Gut Shots, bottled probiotic drinks made from fermented cabbage and other vegetables. The bold, savory flavors included smoked jalapeno, garlic dill pickle, ginger beet and kimchi.  I also sampled the company’s fresh kraut, which is definitely not your mother’s sauerkraut.  Sold in unique “ferment-o-vent” pouches designed to keep the active cultures alive, the krauts came in flavors like horseradish leek, classic caraway and smoked jalapeno – perfect for adding to sandwiches, tacos, quesadillas, power bowls and other dishes. The flavored krauts were served up on gluten-free crackers for sampling.


Plant-forward meals.

Eating more plants does not mean forgoing meat altogether. The Mushroom Council promoted a “Blended Burger” that swaps in some finely chopped mushrooms for part of the ground meat. It was a delicious combination that helped cut down on calories and fat, but left the enjoyment of a full burger experience.  Eating less meat also doesn’t mean simply switching to meat substitutes (such as soy burgers designed to taste like meat).  Several exhibitors sampled products that were plant-forward without screaming “vegetarian,” such as the new power bowls from Luvo Hawaiian Un-Fried Rice and Great Karma Coconut Curry.  Pulses (beans, peas and lentils) were popping up in several booths — after all, 2016 is the International Year of Pulses.


Convenient whole grains.

I found several products that will allow you to eat whole grains on the go – in a portable pack, pouch and cup. GF Harvest created a unique GoPack for oatmeal. All you do is tear the pack open at the top, add hot water and turn the pack into a bowl.  A company called Munk Pack sampled Oatmeal Fruit Squeeze – pouches of ready-to-eat oatmeal in flavors such as maple pear quinoa, blueberry acai flax, and raspberry coconut.   Beyond breakfast, it’s now easier to eat quinoa with Q Cups.  Simply add hot water to the microwaveable paper cup and the quinoa is ready in 5 minutes.  The varieties include Southwestern Barbeque and Savory Garlic and Mushroom.



It was also great to see an old-school grain making a comeback:  sorghum.  This whole grain, described as “nature’s super grain,” comes in a variety of forms to easily incorporate into meals — from grain bowls and salads to casseroles and stir-fries.


Better noodles.

While I love pasta and I don’t think it needs to be banned from anyone’s diet, many people are looking for ways to cut back on refined grains. That’s why we’ve seen the explosive popularity of spiralized vegetable noodles and cauliflower rice.  I spotted several exhibitors, including Banza and Explore Cuisine, touting new and improved noodles, including chickpea rotini, red lentil penne, green lentil lasagna noodles, edamame and mung bean fettuccine and black bean spaghetti (touted as gluten-free and higher in protein and fiber).  A company called Miracle Noodle created shirataki pasta and rice made from glucomannan, a soluble fiber extracted from the root of a Japanese plant called Konnyaku Imo.  The pasta is so full of water that’s it’s promoted as a zero calorie noodle.  Keep in mind that it’s virtually nutrient–free, too (except the fiber).  So that’s a downside. Plus, I’m biased against any product calling itself a “miracle” or “guilt-free.”  No food should evoke guilt, even real pasta.


Veggies in new forms.

We still fail to eat enough vegetables, but there’s never been more creative ways to try and change that. I sampled beet chips, frozen vegetable and fruit blends for smoothies, and veggie fries made from potatoes combined with carrots, broccoli, kale, chickpeas and red pepper.  Several salad kits were on display, including creative combinations with kale, shredded Brussels sprouts, beet greens, chard and sliced broccoli stalks.  Tasty toppings, such as dried fruit and nuts, along with packets of dressing, were all packaged together.


A company called Kuli Kuli is trying to give kale some new superfood competition by introducing moringa —  a leafy green from a tree grown in Haiti, parts of Latin America and Africa.  In fact, the Wall Street Journal just included moringa in an article about the next hot trends in food (along with jackfruit, new plant waters like cactus water, and spirulina).   Kuli Kuli is selling powdered moringa, green energy shots and bars.  Although give me a kale salad anytime — even if the kale craze has peaked.


Seeds in spotlight.

Seeds may be the new nuts — although nuts are still riding high.  Many of the new snack bars on display featured seeds, including 88 Acres, a company named after the 88-acre organic farm in Massachusetts where the founder grew up.  They make craft seed bars, including varieties with pumpkin seeds, sunflower seeds and flax seeds.  Thrive by GoMacro sampled a variety of ancient seeds superfood nut bars, including blueberry lavender, ginger lemon and caramel coconut.   Mediterranean-inspired bars from Mediterra included kale and pumpkin seeds, and sesame seeds with pistachio and honey.  (I also loved their savory bars with olives.)   Go Raw sampled bags of sprouted seeds, including watermelon, pumpkin and sunflower seeds.  Seed butters are also surging. I stopped by Betsy’s Best and chatted with the founder Betsy, a registered dietitian, who was sampling her sunflower seed butter with chia seeds.  Just love it when I see dietitians creating their own products!

Here’s a look at some other FNCE trendspotters:

Food Navigator

Meal Makeover Moms’ Kitchen

Huffington Post

Rebecca Scritchfield

Guiding Stars

Mom’s Kitchen Handbook

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Grocery Shopping on a Sunday Morning

I love grocery shopping.  I really do.  Sure, sometimes it seems like a chore.  But I mostly enjoy the process.  In Chicago, I have a great pick of places to shop, including Trader Joe’s and Plum Market.  I don’t go to either place every week (Mariano’s and Whole Foods are in my rotation too).  But when I do, I always find something new.

There’s been a lot written about the cult following of Trader Joe’s and the fan favorites, including recent posts by What’s Gaby Cooking, Refinery29, Popsugar, BonAppetit and Thrillist.  Believe me.  People are obsessed with this store.

Here’s a look at my weekend stop at Trader Joe’s. I started off picking up riced cauliflower.  You know the cauliflower trend has hit it big when you can find ready-made riced cauliflower that can be used as a substitute for rice and pasta, or turned into pizza crust (which I did later that night.)  I bought this fresh version and the frozen below.



You can find lots of conveniently packaged vegetables, like these seasoned brussels sprouts that are already for roasting.


I picked up these rainbow carrots, which we’ve enjoyed raw and roasted with a bit of olive oil, maple syrup and sea salt.

IMG_2486We love pomegranate, and how handy to have the seeds ready to toss into salads or to top vegetables — like this Ottolenghi eggplant dish that I’m dying to make.

I didn’t buy these, but intrigued by Green Plumcots, a cross between a plum and apricot.  Has anyone tried these?IMG_2496

I didn’t buy these either, but intrigued by all the freeze dried vegetables that were packaged as snacks.


I liked this whole wheat pizza dough…


And picked up this 10-minute farro, which has become one of my favorite whole grains.  You must try Charlie Bird’s farro salad.


I ended up buying some plain boneless chicken breasts (conveniently packaged in individual portions), but I thought this spatchcocked lemon rosemary chicken was fun.  I’m wanting to do my own spatchcocking very soon!

I like to make my own hummus whenever possible, but this sriracha version was tasty.  Anything sriracha is good to me.
And who doesn’t love cookie butter?  It’s a Trader Joe’s classic.  These chocolate bars are filled with cookie butter, which is an incredible concoction make with Speculoos cookies.  Ah-ma-zing. IMG_2497

Do you have any favorites from Trader Joe’s?













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Food Trends Unveiled at Institute of Food Technologists’ Annual Meeting

Chicago was host to the Institute of Food Technologists’ annual meeting and food expo — an ideal venue for tracking trends and learning about new product innovations.  Analysts from two market intelligence agencies, Mintel and Innova Market Insights, discussed the food and flavor trends they’ve been noticing—and the buzzworthy ingredients they think will take off.  Here are some of the highlights.

Soursop or guanabana, the new salted caramel

Soursop or Guanabana on white background

fage yogurtThis tropical fruit is described as a combination of strawberry and pineapple, with notes of sour citrus and a creaminess similar to that of coconut or banana.  Part of the appeal of guanabana is that the tree is native to Mexico and Cuba, countries that are on the minds of many American consumers.  You can find the fruit in Fage Total 0% mango-guanabana Greek yogurt and Vitamin Water Zero strawberry-guanoabana enhanced water — but expect it to be popping up in even more new products. Similarly, salted caramel products are booming, featured in breakfast cereals, dairy, snacks, desserts and drinks.

Harissa, the next sriracha

Spoonful of harissa chili pepper spice mix. Traditional mix from Northern Africa. Shallow DOF.

harissa hummus

I absolutely adore harissa, a staple in North African and Middle Eastern cooking that combines hot chili peppers, garlic, cumin, coriander, caraway and mint.  Most of the new products featuring harissa are sold in Europe, but Lynn Dornblaser from Mintel said several North American launches have taken the flavor beyond its primary category of sauces into hummus, frozen entrees, and chips.

Jackfruit, the next superfruit

Green jackfruit on the tree

jackfruitI’ve written about jackfruit in the past.  This Southeast Asian tree fruit has been a standout in lots of recent trade shows, and several brands have introduced innovative products featuring jackfruit, such as Upton’s Naturals, the Jackfruit Co., and Yves Veggie Cuisine.  Jackfruit is often dressed in savory sauces to replace meat in tacos or sandwiches.


Fabanaise970Yes, it’s simply the liquid from cooked chickpeas, but somehow aquafaba has been generating lots of buzz.  The protein-laden liquid has egg-like properties so you’ll find lots of vegan recipes using the liquid from canned chickpeas, including baked goods and desserts.  One new product on the market using the trendy ingredient is Sir Kensington’s Fabanaise, a vegan mayo.  The company describes aquafaba as “chickpeas’ greatest gift since hummus.”  Ha.  Love that.

Pea protein


The humble pea is the hot new protein ingredient and it’s showing up in dairy-free beverages, snacks and vegan spreads.  Ripple Foods introduced a “plant-based milk” using pea protein and boasting about eight times the protein of almond milk.  This pea milk is also fortified with omega-3s.

New ‘natural’ processing


No doubt, the concept of processing has gotten a bad rap.  But I think it’s wrong to condemn all “processed food.”  Even so, fermentation, high-pressure processing (HPP), and other processing methods perceived as “natural” are gaining favor among consumers seeking alternatives to artificial preservatives.

Creating a ‘real’ link


Increasingly, people want to know about the people behind the product.  The number of global product launches tracked with an origin claim nearly quadrupled between 2011 and 2015, as more companies feature farmers and use “local” descriptors.

Beyond the athlete

Fruit and Nut Cranberry Almond Cashew

The sports nutrition market has broadened its appeal to mainstream consumers seeking protein and energy ingredients for a healthier lifestyle, according to Lu Ann Williams, director of innovation at Innova Market Insights.  So that means more people are drawn to sports nutrition products, especially because the category now offers more novelty and flavor variety.

The indulgence alibi


Health-conscious consumers are seeking indulgent snacks with wholesome ingredients or smaller portion sizes.  So that means more chocolate-covered fruits and nuts, along with mini-treats.

Tastes for new experiences



New products are featuring more front-of-pack texture claims, like Chobani’s new Simply 100 Crunch.  Other texture claims include velvety, silky, rich and oozy.

Sources:  Food Business News, Top 10 food trends of 2016; Five ingredients to watch, The next big flavor trends   

Images: courtesy of manufacturers and iStock 


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Appearance of Nutrition B.S. at the RNC


So this happened today.

A reporter from The Daily Beast texted me this morning.  Actually, I had just gotten out of the shower.

Turns out, he was investigating a story about one of the newly announced prime-time speakers at the Republic National Convention who is a big player in a multi-level marketing scheme called Youngevity.  This was the same reporter, Tim Mak,  who tracked me down for another story he wrote about the Trump Network, which I wrote about several years ago in a post: Donald Trump You’re Fired! as a Nutritionist.

Well, I guess Trump isn’t trying to distance himself from the criticisms of his own, now defunct multi-level marketing program that was widely panned as a scam (or the pyramid selling lives on, Trump just got out of the business).

Here’s Tim’s article that includes my early morning assessment of Youngevity: Michelle Van Etten, Soon-to-be RNC Star, Peddles Pills That Make Alex Jones ‘Crazed.’

“The whole basis of the products and the claims are pseudoscience,” said Janet Helm, a nutritionist and registered dietitian who writes frequently about diet myths, nutrition trends, and misinformation.”

“Don’t get your health advice from someone to sell you products. These are unproven and potentially dangerous, and they’re very expensive,” Helm told The Daily Beast. “There are a lot of products that are very cringe-worthy… They make a lot of claims: weight loss claims, products for kids that are very troubling to me—supplements and essential oils—they have packaged foods would not be what I consider nutritious meals.”

Do my quotes even make sense?  Seems like I’m talking on and on.  Poor Tim can’t even make a full sentence out of my chatter.

The deal is, I was worked up.  I was actually outraged.  These products are total B.S.  And the more I looked into this company and the claims they make, the more troubling it was to me.

They prey on people with cancer, claiming that products like Tangy Tangerine  will help. They sell weight loss products to cleanse and reduce belly fat.  They even promote questionable, potentially dangerous products for kids.

The founder Joel Wallach and his claims have been widely criticized, here and here.

So look for Michelle Van Etten to speak on Wednesday.  Her appearance as a representative for small-businesses in the U.S. has been  challenged, such as this article in Fortune.

Let’s just hope her “business” is challenged as well.


Visual courtesy of Bill Brooks on flickr.

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