The Intersection of Orthorexia and Cancer

Key points: Orthorexia nervosa, or the obsession with nutritional eating, can be especially triggered in cancer patients who need to manage anxiety and feel more control over their diagnosis. To avoid this, dietary changes should be approached carefully.

In honor of Eating Disorder Awareness Week, the last week of February (22-28), I want to draw attention to orthorexia nervosa and highlight the intersection of orthorexia and cancer.

Orthorexia is a pathological obsession with eating proper nutrition. Official diagnostic criteria do not exist, as orthorexia nervosa is not recognized officially in the 5th edition of the Diagnostic and Statistical Manual. Debate exists on whether orthorexia is a distinct eating disorder, part of another eating disorder, or related to obsessive-compulsive disorder.

Research is ongoing to better conceptualize and define orthorexia nervosa, but clinical evidence suggests orthorexia broadly includes a pattern of eating a restrictive diet and avoidance of foods considered impure that leads to negative consequences such as nutritional deficiencies, medical issues, and lowered overall well-being. People struggling with orthorexia may feel guilty for eating foods considered impure, spend an excessive amount of time each day preparing food or thinking about food, and purchase foods deemed higher quality despite causing financial hardships.

Becoming more aware of eating healthier foods and limiting foods with lower nutritional value is not uncommon for people diagnosed with cancer. Cancer survivors may alter their diet as a way to influence their prognosis, chance of recurrence, or quality of life. Altering their diet also provides cancer survivors with a sense of perceived control in a situation where they may feel helpless, anxious, and afraid.

However, risks exist in the pursuit of a healthier diet, especially for cancer survivors. A recent article published in Psycho-Oncology describes a case study of a patient who took healthy eating to the extreme resulting in adverse health and psychological reactions.

In the article, a patient diagnosed with acute lymphoblastic leukemia (ALL) underwent chemotherapy and a stem cell transplant. Three months following treatment no signs of ALL were present but weight and BMI were low and a dietary history revealed the patient was consuming less than 50% of the daily recommended caloric and protein intake. The patient was juicing and eating one meal per day. Medical side effects at the one-year and 18-month post-transplant follow-up were present but responded well to treatment. The patient was an elite athlete who focused on healthy eating for performance prior to the cancer diagnosis. Throughout treatment and follow-up, the patient denied a desire to lose weight while caloric intake remained limited and physical, emotional, and relational complications continued.

Why should cancer patients be aware of eating disorders like orthorexia nervosa?

A cancer diagnosis and the journey throughout treatment and survivorship can trigger changes in eating behaviors that lead to significant medical and psychiatric complications. Well-intentioned wellness warriors in our culture may encourage cancer patients to adopt particular diets thought to improve prognosis, reduce recurrence, or cure cancer; however, the risk for developing orthorexia nervosa could complicate medical and psychological outcomes related to cancer.

Eating disorders have one of the highest mortality rates among psychiatric illnesses and the physical and emotional stressors of cancer could exacerbate pre-existing concerns. Conversely, a desire to do something and take action within one’s own control following a cancer diagnosis, along with underlying anxiety, could create a fertile ground for developing orthorexia nervosa.

What should you do if you are diagnosed with cancer and want to improve your eating habits?

1. Educate yourself about orthorexia nervosa. This post calls attention to orthorexia nervosa but more detailed information exists. Look for articles and resources to learn more about the signs and symptoms of orthorexia. Healthy eating can be an important part of feeling good, but learn when healthy eating potentially crosses the line and becomes dangerous.

2. Consult with your oncologist for referrals to an oncology dietician. Most cancer centers offer support services including dieticians; however, if you need a referral, consult with your oncologist to find a dietician who specializes in oncology. Working with an oncology dietician can help you maintain the nutritional balance needed in all phases of your cancer journey.

3. Consider seeking help from a clinical mental health counselor. A cancer diagnosis is life-changing for many people and anxiety, depression, fear, a lack of control, relational issues, and existential concerns are some of the psychological issues associated with cancer. Talking with a clinical mental health professional may be helpful in managing psychological triggers that could lead to an unhealthy obsession with food.

In summary, many cancer patients alter their diets after diagnosis with the goal of improving health. However, due to the anxiety-provoking nature of a serious medical illness, some patients may be at increased risk of developing orthorexia nervosa, which could lead to lower quality of life, nutritional deficiencies, and complications in cancer outcomes. Seeking professional guidance may help cancer patients make helpful changes to their diet and improve their overall quality of life.