Orthorexia: Are You Obsessed With Eating the Right Foods?

October 11, 2024

In today’s health-conscious world, many people strive to eat a clean, balanced diet. However, for some, this pursuit of healthy eating can morph into an unhealthy obsession known as orthorexia nervosa.

While eating healthy is essential for overall well-being, orthorexia takes it to a concerning extreme.

Over the past several years, there’s been a shift among Americans in our attitudes toward food. Slowly but surely, more of us are choosing wholesome foods and paying closer attention to what we’re consuming in what’s been dubbed the “clean eating movement.”

That’s terrific news. Focusing on a clean eating meal plan that includes fresh foods and eliminating highly processed ingredients can lead to reduced inflammation, a lowered risk of diabetes and certain types of cancers, and an overall happier, healthier feeling.

But what begins for many as a genuine desire to feel better about themselves and the foods they put into their bodies has the potential to become a dangerous fixation, often propelled by social media. Meet orthorexia, a new cousin to anorexia nervosa, bulimia nervosa and other eating disorders.

What is orthorexia?

Orthorexia describes an obsession with eating foods that one considers healthy. While healthy eating is beneficial, orthorexia crosses the line into an unhealthy preoccupation with food quality and purity.

Individuals with orthorexia develop rigid dietary rules and restrictions, often eliminating entire food groups they deem unhealthy. Their focus shifts from enjoying nutritious food to a relentless pursuit of dietary perfection.

“Orthorexia nervosa” was named by Dr. Steven Bratman in 1996. While seeing patients in his alternative medicine practice, he noticed an increasing amount of them were fixated on eating healthy.

He coined the phrase as a way to help a particular patient work through her extremist attitude about food.

As Dr. Bratman describes, “It is formed in analogy to anorexia nervosa, but using orthro, meaning ‘right,’ to indicate an obsession with eating the right foods.”

But what began as a tongue-in-cheek way to work through a patient’s troubled relationship with food and getting “overly obsessed health foodists to take a look at themselves” has evolved into a term that describes a real eating disorder that some young women and men are finding themselves all too familiar with.

While eating clean, reading labels and being cognizant of the foods we consume (mindful eating or intuitive eating) aren’t bad things — particularly in a society that’s seeing increasingly high rates of obesity — for some, it becomes an unhealthy obsession with otherwise healthy eating.

While social media isn’t to blame for orthorexia — after all, the phrase came about in the ’90s, years before Instagram, Snapchat, TikTok and Pinterest even existed — experts agree that easy access to all those pretty photos of kale smoothies and meticulously arranged salads makes it easier to feel the pressure to eat clean.

The 24/7 access we have to popular food feeds and celebrity accounts means comparing diets or “outdoing” someone else’s (“She’s vegetarian? I can go vegan!”) is always at our fingertips.

Is orthorexia a genuine eating disorder?

While many people, mainly young white women, identify as having orthorexia, mention the term to a doctor and you might get a blank look. That’s because orthorexia isn’t yet considered an official, individual eating disorder.

It’s not included in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) that’s published by the American Psychiatric Association and considered the “bible” of disorders.

Some experts believe that orthorexia is not different enough from other existing disorders, like anorexia or obsessive compulsive disorder (OCD), to warrant its own definition. Similar to anorexics, individuals with orthorexia become fixated on food and their bodies, though the preoccupation is not on calories or weight, but on what types of food are being eaten.

For those struggling with orthorexia, there are constant feelings of being “unclean” or having their bodies marred by the foods they’re eating, no matter how “healthy” their diets are.

According to Dr. Bratman, recovering anorexics sometimes shift or “graduate” to orthorexia. These people keep their disordered eating habits but focus on purity, rather than losing weight.

Like people with OCD, orthorexics use their eating habits as a way to gain control. For some, the fact that these people are obsessing over something — not what they are obsessing over — means orthorexia is a type of OCD.

Of course, that theory might be self-prophesying, as more research on orthorexia as a unique eating disorder is needed.

As Dr. Cynthia Bulik, professor of eating disorders at the University of North Carolina, Chapel Hill, told The Guardian, diagnosing orthorexia can be a vicious cycle.

“It is not a bona fide diagnosis, so there is no research on it; however, since there is no research on it, we know very little about whether it actually should be a disorder,” she said.

Eventually, however, “orthorexia” might officially enter the medical lexicon. That’s because of the way eating disorder evolution tends to occur.

After bulimia was recognized as a disorder in 1979, for example, doctors started recognizing that some patients were first binge eating and then purging their food, or just binge eating altogether. But it wasn’t until 2013 that binge eating disorder was added to the DSM-5.

In orthorexia’s case, when Dr. Bratman first came up with the name, most of his clients were fixated on cleanses, the popular healthy eating fad at the time. Today, it’s cutting out gluten, eliminating dairy or nixing entire food groups.

While these might be positive, healthy changes for some people — like if you have celiac disease or lactose intolerance — for some people, the obsession with eliminating certain “bad” foods becomes all-consuming.

Signs and symptoms

Is reading restaurant menus before meeting friends for dinner or cutting cheese out from your diet orthorexia? Not necessarily.

Empowering yourself to make healthy choices or restricting foods that truly don’t work for your particular body because they make you sick or contribute to health issues is not a bad thing.

That’s what makes recognizing orthorexia especially tricky. Eating clean and choosing healthy foods are, in general, positive things.

It’s much more difficult to identify the problem because it’s cloaked in a “healthy” disguise.

If you plan your day and social activities around food, attach your self-esteem to how well you can stick to your diet, or find yourself restricting more and more foods, it could be time to seek help. When clean eating becomes a fixation that’s dominating your life, there is a problem.

Dr. Bratman and his colleagues released formal criteria to diagnose orthorexia. It includes two sets of criteria.

Criterion A comprises an obsessive focus on “healthy eating;” an exaggerated fear of disease; a sense of personal impurity, anxiety and shame if an individual violates self-imposed dietary rules; and increasing dietary restrictions over time.

In Criterion B, the compulsive behavior leads to malnutrition from a restricted diet; impairment of social, academic or vocational functions because of healthy diet behavior; and a positive sense of self-worth being excessively dependent on a person’s self-defined “healthy” eating behavior.

Remember, choosing good-for-you foods isn’t a bad thing — just like enjoying a pizza or nibbling on chocolate now and again isn’t the end of the world.

With orthorexia, though, there’s really no longer a choice when it comes to eating “healthy.” Food has become a psychological obsession.

Here are some signs and symptoms of orthorexia:

Obsessive preoccupation with healthy eating: People with orthorexia spend excessive time planning meals, researching healthy foods and worrying about the purity of their ingredients.
Rigid dietary rules and restrictions: They may create elaborate rules around food preparation, consumption and source. Any deviation from these self-imposed rules can cause significant anxiety and distress.
Elimination of entire food groups: Orthorexic individuals often restrict or eliminate entire food groups they perceive as unhealthy, even if these foods are part of a balanced diet.
Increasingly restricted diet: The “safe” food options become narrower over time.
Increasing social isolation: The fear of consuming anything deemed unhealthy can lead to social isolation as individuals with orthorexia avoid social gatherings or restaurants where they cannot control the ingredients. It can also manifest in feeling superior to others based on dietary habits.
Deteriorating mental and physical health: The relentless pursuit of dietary perfection can lead to malnutrition, anxiety, depression and a negative self-image.

Causes

The exact cause of orthorexia is unknown, but several factors may contribute to its development, including:

Obsessive personality traits: Individuals with perfectionist tendencies or a history of OCD may be more prone to developing orthorexia.
Social media influence: The constant bombardment of unrealistic body image standards and extreme diet trends on social media can fuel unhealthy obsessions with food and physique.
Low self-esteem: People struggling with low self-esteem may latch on to healthy eating as a way to feel control and improve their self-worth.
History of dieting: Individuals with a history of yo-yo dieting or restrictive eating patterns may be more susceptible to orthorexia.
History of eating disorders: Individuals with a history of anorexia or bulimia may be more at risk. Past eating disorders can shift focus to food purity.
Focus on health: A genuine interest in healthy eating and a desire for control over health can morph into an unhealthy obsession.

It also appears being a student with a health-related major is a risk factor, with several studies showcasing many dietetics and nutrition students deal with orthorexia.

How common is it?

The prevalence of orthorexia is not well-documented due to its lack of recognition as a distinct disorder. However, it’s becoming more noticeable with the rise of health-focused dietary movements.

Since it is a relatively new eating disorder, there’s no established data on its prevalence. Experts believe it’s becoming increasingly common, particularly among athletes, fitness enthusiasts, and individuals with a strong focus on health and wellness.

Vegetarians and vegans also seem to have higher rates, according to available research.

Overall, the best estimates reveal that less than 1 percent of people in U.S. fit the criteria for orthorexia, which coincides with several other eating disorders.

Diagnosis

Diagnosing orthorexia involves assessing dietary habits and their impact on mental and physical health. Criteria include an obsessive focus on healthy eating, significant dietary restrictions, and resulting malnutrition or social/occupational impairment.

Healthcare professionals may diagnose orthorexia based on symptoms such as:

Preoccupation with healthy eating that disrupts daily life
Rigid dietary rules and restrictions
Anxiety or distress associated with not adhering to self-imposed dietary rules
Evidence of malnutrition or weight loss

This might involve a physical examination, blood tests and a psychological evaluation. The following questionnaires may be used to diagnose the condition:

Negative health effects

While the pursuit of healthy eating is commendable, orthorexia can have several negative health consequences, including:

1. Malnutrition

By eliminating entire food groups or strictly limiting food intake, individuals with orthorexia may deprive their bodies of essential nutrients, leading to malnutrition and health complications. Restricting food groups can lead to deficiencies in essential vitamins, minerals and macronutrients.

2. Social isolation

The fear of consuming unhealthy foods can lead to social isolation as individuals avoid social gatherings or restaurants. Avoiding social gatherings due to food concerns, in turn, can lead to loneliness and depression.

3. Anxiety and depression

The constant stress and anxiety around food choices can contribute to the development of anxiety and depression.

4. Negative self-image

The relentless pursuit of dietary perfection can result in a negative body image and low self-esteem.

5. Weakened immune system

Malnutrition from restrictive eating can weaken the immune system and increase susceptibility to illness. In addition, it may result in issues such as slowed heart rate, general weakness, digestive issues, metabolic acidosis, hormonal and electrolyte imbalances, and more.

6. Damage to digestive system

Excessive focus on “clean” foods can disrupt gut health and lead to digestive issues. In addition, chronic purging or laxative abuse in some cases of orthorexia can damage the digestive system.

How to treat

Treatment for orthorexia typically involves a combination of psychotherapy and nutritional counseling.

Psychotherapy can help individuals with orthorexia address the underlying psychological factors that contribute to their obsession with healthy eating, such as anxiety, perfectionism or low self-esteem.

Nutritional counseling can help them develop a more balanced and flexible approach to eating that meets their nutritional needs while promoting a healthy relationship with food.

Here is more on the multipronged approach to treating this form of disordered eating:

Nutritional counseling: A registered dietitian can help develop a balanced and flexible eating plan.
Cognitive behavioral therapy (CBT): CBT can help identify and modify negative thoughts and behaviors related to food.
Support groups: Connecting with others who understand the challenges of orthorexia can be invaluable and help manage underlying mental health issues.
Gradual exposure to feared foods: Slowly start reintroducing certain foods to reduce anxiety around eating.

Do you have orthorexia?

Do you believe you might be suffering from orthorexia?

Consider these questions provided by the National Eating Disorders Association. The more questions you answer “yes” to, the likelier it is you might have orthorexia.

Do you wish that occasionally you could just eat and not worry about food quality?
Do you ever wish you could spend less time on food and more time living and loving?
Does it seem beyond your ability to eat a meal prepared with love by someone else — one single meal — and not try to control what is served?
Are you constantly looking for ways foods are unhealthy for you?
Do love, joy, play and creativity take a back seat to following the perfect diet?
Do you feel guilt or self-loathing when you stray from your diet?
Do you feel in control when you stick to the “correct” diet?
Have you put yourself on a nutritional pedestal and wonder how others can possibly eat the foods they eat?

If you believe you might have a problem with orthorexia, it’s important to reach out for help. Working with a professional who specializes in eating disorders can help you rethink your relationship with food and address the underlying issues that contribute to orthorexia.

While eating clean and focusing on a healthy lifestyle are great, they’re just part of our lives. Food is a way to nourish our bodies, enjoy time with friends and family, and feel good — not an enemy.

Orthorexia: Are You Obsessed With Eating the Right Foods?