The Orthorexia Nervosa Test

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“Orthorexia…is defined as an unhealthy obsession with eating healthy food.” Want to know if you’re orthorexic? “The ORTO-15 is the most widely accepted assessment tool used to screen for orthorexic tendencies.” A score of 40 or lower was considered the best threshold for an orthorexia diagnosis. There are 15 questions, each scored from 1 to 4, so you can end up with a score of 15 to 60, with a score under 40 denoting orthorexia. So getting 1s and 2s and even an occasional 3 on your answers would mean you may have it, so lower scores are worse. Okay, let’s check it out. The first question: “When eating, do you pay attention to the calories of the food?” Always, Often, Sometimes, or Never. According to the test, the healthiest answer is Often, with the orthorexic answers being Always—or Never. I can see how always obsessively worrying about calories could hint at a problem, but if you’re eating healthy enough, a diet centered around whole plant foods, you don’t need to worry about calorie counts or portion control. And the healthiest foods—fruits and vegetables—don’t even have a nutrition label. But, apparently, if you’re never Googling the calories of every apple you eat, you may have a problem.

“When you go [to the grocery store] do you feel confused?” Supposedly, the healthiest answer is Always. You should always be confused, and if you’re not at least often confused, we may end up having to drug you.

Question 3: “In the last 3 months, did the thought of food worry you?” The supposed healthiest answer? Never. The thought of what you’re putting into your body didn’t worry you once. According to the test, it would be healthier if your eating choices were “conditioned” worries about your health, and of course taste should always be “more important than the quality” of your food. I mean, if you think the quality of food is even “sometimes” more important, you may have a mental illness. And if you’re often “willing to spend more money to have healthier food?” Crazy! Are you so delusional that “you think that consuming healthy food might improve your appearance?” My favorite, though, has to be question 14. Do you think that supermarkets also sell “unhealthy food?” You’ve got to be kidding. And then, they like penalize people who live alone.  

If you scored under 40, you are not alone. Using this test, about 50 percent of registered dietitians in the United States are supposedly suffering from a mental illness. “The…prevalence of [orthorexia nervosa] presents as being impossibly high.” I mean, “anorexia and bulimia…are estimated to be no higher than about 2 percent.” And so, it’s kind of “counterintuitive to believe that” there’s some eating disorder out there that has rates as high as nearly 90 percent. No wonder the DSM, the psychiatry profession’s official diagnostic manual, does not include orthorexia “as a psychiatric diagnosis”—and they love turning things into mental illnesses. The latest edition can turn kindergarten temper tantrums into a disorder, too much coffee… or even bad PMS into a mental illness, but they’re still not going to go there with orthorexia. For example: “Researchers had a tendency to pick and choose which questions of the ORTO-15 they used and [come up with] their own cut off scores for diagnosis,” resulting in “[a]n alarmingly erratic use of the ORTO-15 tool [that was] designed to measure [orthorexia].” The bottom line is that the ORTO-15 test “is likely unable to distinguish between healthy eating and pathologically healtful eating,” whatever that is.

Now, more recently, new criteria have been introduced. Given “the impossibly high prevalence rates,” new emphasis is placed on health problems because of diet, such as malnutrition, or medical complications that would, by definition, make it an unhealthy diet. Like this tragic case in which someone had tried to live off a few spoonfuls of rice and vegetables, and ended up bedridden. If that is what you want to call orthorexia, fine, but one wonders if it might have been clouded by some actual psychiatric diagnosis, like OCD, obsessive-compulsive disorder.

If you add in those adverse health criteria, then the prevalence drops to “less than one half of 1%,” which seems a little more reasonable. Interestingly, those eating “vegan” diets had the least pathological scores in the sample—though this may reflect them just being less serious about healthy eating, reaching for the vegan doughnut rather than the lentil soup.

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Image credit: ulleo via pixnio. Image has been modified.

Motion graphics by Avocado Video

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