Too much of a good thing
There comes a point when eating healthy becomes an obsession that's not healthy at all - and I say this from first-hand experience.
It began a few months ago during my second pregnancy, when I was all about eating foods free of gluten, dairy, sugar and soy. They had to be wholefood - organic, vegan and with no artificial additives, preservatives or processing.
As a holistic nutrition consultant, I would also experiment with elements of various dietary theories: avoiding nightshade vegetables like tomatoes and eggplants (nightshades are thought to contain compounds that can cause chronic joint, muscle and nerve pain); avoiding common allergens such as nuts; incorporating at least 50 per cent raw food into my diet, as well as 'superfoods' such as royal jelly and cacao.
I no longer enjoyed eating at restaurants, as I would wonder where the food came from and how it was prepared. I'd visit various health stores regularly to buy the right foods. At supermarkets, I stared in shock at others' shopping baskets, wondering how their health was.
It turns out there's a name for this sort of obsessive-compulsive behaviour with food: orthorexia nervosa. The term was coined in 1997 by Dr Steven Bratman, an alternative medicine consultant from the United States. It's derived from the Greek 'ortho', which means 'correct' or 'right', and 'orexis', which means 'appetite', and is intended as a parallel with anorexia nervosa ('without appetite').
Bratman, who claims to have had the condition himself, describes orthorexia as an unhealthy fixation with healthy eating and claims that, in rare cases, this focus may turn into an obsession so extreme that it can harm personal relationships and emotional well-being, and lead to severe malnutrition and even death.
I contacted the Hong Kong Eating Disorders Association for advice, but the people there could not provide me with any information.
'Since we mainly deal with the cases of anorexia nervosa and bulimia nervosa, we are not familiar with orthorexia,' the e-mail response said.
While orthorexia nervosa is not a formal medical condition, the Eating Disorders Coalition in Washington, which represents more than 35 eating disorder organisations in the US, thinks it should be considered a separate psychiatric illness, to explain a growing health phenomenon and enable patients get treatment. Yet the lack of knowledge about the syndrome and clinical acceptance results in most doctors not making a diagnosis.
Hong Kong-based counselling psychologist Catriona Rogers, who has seen two cases of orthorexia, says she would resort to tools such as counselling, cognitive behavioural therapy and the emotional freedom technique to treat the condition - and more importantly understand the deeper roots. 'Orthorexia may often provide a sense of superiority and being in control, as a spin-off effect to deeper causes such as low self-esteem,' she says.
She adds that new media trends on the need to be healthy are creating a similar pressure to the need to be thin. 'You end up with a lot of fear-based communication telling you that if you don't buy this product or the other you won't feel this great sense of well-being,' she says.
Dr Donald Li Kwok-tung, a practitioner in family medicine, believes the key word is moderation. 'These people consider their eating habits almost as a religion, which leads to antisocial behaviour,' he says. 'A clinical psychologist will be required to uncover the underlying reasons.'
Dr Michael Cheng, another general practitioner, says it's not only advertising trends promoting images of health, but also the consensus among the community on what is considered healthy that creates peer pressure. 'There's no scientific evidence behind some of these health products,' he says.
Registered dietitian Kendy Tam sees a fine line between diet and disorder. She says: 'As long as the person can eat healthily and follow a daily balanced diet with a normal level of flexibility, it's fine.'
A healthy obsession
Here are some symptoms that may indicate you have orthorexia:
You care more about the virtue of what you eat than the pleasure you derive from eating it.
You skip food you once enjoyed in order to eat the 'right' food.
You have become much stricter with yourself.
You plan tomorrow's menu today.
You find it difficult to eat anywhere but at home.
Your diet isolates you socially.
You feel in total control when you eat the way you're supposed to.
You boost your self-esteem by eating healthy food.
You look down on others who don't eat the same way.
You feel guilt or self-loathing when you stray from your diet.
You spend more than three hours a day thinking about healthy food.
Your quality of life has decreased as the quality of the food you consume has increased.