Does that sound like you? You value healthy eating, then you spend a lot of time and effort making sure your diet has the perfect combination of macronutrients and micronutrients.
You feel more secure when you make your own meals (and know exactly what they contain) and you don’t understand why your friends get upset when you won’t go out to eat with them.
You also don’t understand why your colleagues think you’re stuck you never come to office birthday celebrations.
And you had no answer when your sister asked because you only ate the turkey and salad you brought when you hosted Thanksgiving. (“It’s not like you have a food allergy or celiac disease, for Pete’s sake,” she said the next day over the phone.)
It’s true that eating nutritious foods helps support health, but when taken to extremes, the pursuit of a “healthy” diet can become unhealthy. Almost 30 years ago, Dr. Steven Bratman coined the phrase “orthorexia,” which generally translates to an unhealthy obsession with eating healthy foods. (He went on to write the 2000 book “Health Food Junkies.”).
When Bratman first coined the term orthorexia, it was mostly found among people heavily involved in alternative medicine. Today, with the increased interest in healthy eating among a wider segment of the public—driven in part by social media—it appears that orthorexia has become more common.
So at what point does prioritizing healthy eating become unhealthy? While there is a fine line between healthy eating and orthorexia, there is a line. Although orthorexia is not an “official” eating disorder like eating disorders, it can damage both physical and mental well-being. This is because orthorexia can lead to diets so strict that they have health-related consequences such as malnutrition, social isolation and severe psychological distress.
The slippery slope to orthorexia
Bratman has pointed this out Orthorexia has two stages. The first is simply choosing a healthy diet. In itself, this is not harmful (obviously). It is the second stage – the “intensification of this pursuit into an unhealthy obsession” – that tips the balance.
This means that simply adopting an alternative diet—even if it’s based on evidence—doesn’t mean someone has orthorexia. What matters is how one responds to the diet one has chosen. Healthy eating doesn’t become unhealthy until it becomes entangled with obsessive thinking, compulsive and ritualistic behavior, and self-punishment.
People with orthorexia often use their diet to achieve a feeling of perfection, purity or superiorityand may feel judgmental of those who do not follow a healthy diet. They can spend an inordinate amount of time researching and planning meals around “pure” or “pure” foods. All of these interfere with participation in normal social activities and interactions – such as dinner with friends, office birthday cake, enjoying traditional holiday foods together.
It’s one thing to generally try to eat organic or to eat whole grains instead of refined grains. It’s another for someone to become so fixated on avoiding pesticides, GMOs or white flour that their diet becomes rigid, they refuse to go out to restaurants, they don’t let others cook for them.
For some, crash diets are the slippery slope that leads to orthorexia. Someone I interviewed told me this:
“I felt worse and worse, but I kept chasing that magical unicorn of the ‘perfect diet.’ The anxiety I felt about food was suffocating and completely took over most other parts of my life. I was afraid to eat out or travel or—worse—have a regular meal with my family. I had to have absolute control over everything I ate.”
Why is orthorexia not considered an eating disorder?
It is not clear whether orthorexia can be characterized as a unique eating disorderor if it is a variant — or precursor — of anorexia nervosa or obsessive-compulsive disorder (OCD). Orthorexia, anorexia and OCD share rigid and perfectionistic personality traits.
What orthorexia has in common with anorexia is a sense of control and predictability—you can’t control life, but you can control your food—and that obsessing over food can be a way of avoiding negative emotions. The downside is that when control breaks down and someone eats a forbidden food, feelings of failure, guilt and self-hatred often follow.
Orthorexia and anorexia have many other similarities, including:
- Preoccupation with food and eating
- Restrictive eating habits
- Food rituals
- Magical beliefs about food
- Intense anxiety and fear about certain foods
- An excessive need for self-care and protection
Unlike anorexia, orthorexia is generally not aimed at weight loss. The focus is on the quality of the food, not the quantity. One can start out with a desire to be healthier, but take it to an unhealthy, even dangerous level.
However, orthorexia has the potential to transform into anorexia, especially if the list of foods to avoid grows too long.
Although health rather than weight loss is the primary motivation, this is a difficult distinction to make since ideals of health are often conflated with body weight and/or body composition.
In fact, orthorexia is often considered a variant of “healthy”. Hygienism is a belief system that makes personal health a primary goal for well-being. It also emphasizes personal responsibility for achieving health and preventing disease. The current trends of life extension and biohacking are newer manifestations of hygiene that could lead to orthorexia.
How common is orthorexia?
We don’t know for sure how common orthorexia is. One reason is that there is no commonly accepted definition of orthorexia or a validated assessment tool.
(A validated assessment tool is generally a set of questions that have been studied to see if they do a good job of correctly identifying people with a particular problem without misidentifying people who do not have that problem.)
A set of suggested criteria that I like include 1) an obsessive focus on healthy eating that includes compulsive behavior and mental preoccupation, anxiety and distress when self-imposed dietary rules are violated, and 2) dietary restrictions that escalate over time, along with one of the following:
- Malnutrition, severe weight loss, or other medical complications from the restricted diet.
- That is, mental distress or impairment of social, academic or work functioning secondary to the individual’s dietary beliefs or behaviors.
- Positive body image, self-esteem, identity, and/or satisfaction are overly dependent on conforming to self-imposed rules of “healthy” eating.
Having helped clients with a wide range of eating disorders and/or symptoms,* I can honestly say that while orthorexia MAY be less likely to lead to medical complications, the psychological distress and impact on daily life is just as real. As with “official” eating disorders, orthorexia makes your world smaller.
*While I’ve helped people who clearly have anorexia or bulimia or binge eating disorder or ARFID, I’ve had many more clients whose symptoms and behaviors don’t fit neatly into one of those boxes, or who clearly had anorexia earlier in life but now have binge eating disorder, for example.
I’ve heard people say things like, “Well, it is just orthorexia.” There is no such thing as “right.” If something you just read hits a little too close to home, ask for help. Trying to “fix” disordered eating on your own only delays recovery.
Not sure if you’ve reached an unhealthy tipping point with your “healthy” diet? Click here to schedule a free 20-minute Discovery Call to talk about your concerns and whether you would benefit from nutritional therapy.
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Disclaimer: All information provided here is general in nature and provided for educational purposes only. This information should not be taken as medical or other health advice related to an individual’s specific health or medical condition. You agree that use of this information is at your own risk.
Hi, I’m Carrie Dennett, MPH, RDN, a weight that includes registered dietitian, nutritionist and body image consultant. I offer compassionate, personalized care for adults of all ages, shapes, sizes and genders who want to break free from eating disorders, disordered eating or years of dieting. If you need to learn how to management of IBS symptoms with food, or improve your eating and lifestyle habits to help manage a current health concern or just supporting your overall health and wellness, helping people with that too.
Need 1-on-1 help with your nutrition, food or body image concerns? Schedule a free 20-minute Discovery Call let’s talk about how I can help you and explore if we’re a good fit! I am in network with Regence BCBS, FirstChoice Health and Providence Health Plan and can bill Blue Cross and/or Blue Shield insurance in many states. If I don’t get your insurance, I can help you claim compensation yourself. To learn more, explore our insurance and service areas page.
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