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education Orthorexia Nervosa From Virtuous to Vicious By Ruth Werner This article is a bit of a departure from the typical Pathology Perspectives column. It is focused on a phenomenon, not yet fully accepted as a freestanding disorder, called orthorexia: a pathologic obsession with eating healthfully. The obsession is so extreme that people with this condition can literally "health themselves to death." I offer it partly because massage therapy may have a role to play for clients dealing with orthorexia, but mainly because health-care providers—that's us—turn out to be unusually susceptible to some of the problems this condition can bring about. And because our clients look to us as role models for wellness, it is worth taking a close look at our attitudes about food, eating, and health. PATHOLOGY PERSPECTIVES THE CHALLENGE OF FOOD Food is a glorious necessity. We need food—a wide variety, with the right ratios of all the essential ingredients, or we get sick and die. Somehow in the process of our evolution, humans have figured out how to derive a usable balance of nutrients, minerals, and vitamins from our surroundings. Our haphazard intake of calories allows us to grow, fight disease, reproduce, and engage in all the activities that characterize being alive. It would seem that in our millennia of experience as food-consuming organisms, our nutritional intake would become less haphazard, and we would develop a reasonably solid, widely applicable, predictable, and functional recommendation for eating that people would be willing to follow. Nothing fancy, just some simple guidelines about what to eat, where to get it, how to prepare it, and how much to have. But as we all know, diet science is far from fixed, and human appetites don't always follow best practices. A brief look at food culture in the United States dating from the 1950s shows distinctive cycles in our approach to food. We have swung from a primarily farm-and-garden culture of the '40s and '50s to the drive-through restaurants, artificial sweeteners, processed cheese food slices, and never-stale snack cakes of the '60s. The '70s brought us macrobiotics and the natural foods movement, where we rediscovered the virtues of brown rice, soaked beans, and the use of carob as a sad, sad substitute for chocolate. The '80s brought us Pritiken, and the '90s delivered Atkins, super low-carb diets (and clients with truly awesome flatulence), and—my personal favorite—the cabbage soup regimen. The '00s were all about South Beach and the Mediterranean 44 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 5 diet. Now we are bombarded with messages about going gluten-free, the advantages of the paleo diet, and the dangers of nonorganic, GMO-enhanced "Frankenfoods." Today's eater has a harder task than ever before. How is it possible to make sense of all the messaging we receive about food and health? Where, in the bombardment of our senses through television, the Internet, and even billboards on the streets, can we find some kind of truth about healthy eating? This is an especially challenging issue for massage therapists and other health-care professionals. We are better educated than many about nutrition and healthful eating, and we want to take responsibility for being good examples. But with so many conflicting messages being hurled around us through every medium, how do we settle on the "right" diet? Does such a thing even exist? HISTORY OF ORTHOREXIA NERVOSA In 1997, after having been an organic farmer, a cook at a commune, and a holistic medical specialist in nutritional healing, Stephen Bratman, MD, coined the term orthorexia nervosa to describe a pathologic pattern of "righteous appetite." He based this description partly on his observations with his patients, but also on his own experiences as he struggled with the challenges of eating healthfully. He wrote a book on the topic: Health Food Junkies: Overcoming the Obsession with Healthful Eating. 1 Bratman reflects on his experience with orthorexia: