Almost everywhere we turn, we are bombarded with messages about what to eat, or rather, what not to eat. Perhaps you have heard from well-intended family members that you should avoid sugar because it is toxic, or you were warned on a talk show about how certain ingredients in packaged foods are unsafe. Maybe your favorite influencer follows a strict diet and you are tempted to try it; or maybe you are looking for new ways to eat healthy and have heard that “clean eating” is the best way to do so (p.s. it’s not). Whether it’s warnings about sugar, fat, carbs, fruits, nightshades or ingredients we can’t pronounce, it seems that there is a lot to be anxious about when it comes to making food choices.

Given our social and media environment, it makes sense that we would think certain foods are good and others are bad. It also makes sense that we want to do what we can to prevent disease. If you stop and think, the anxiety many of us experience around food makes lot of sense.

We hear so many rules, beliefs and ideas about food from family members, strangers on the internet or celebrities, it can be a lot to take in: and often what we have heard is not based in science or the nuance that nutritious eating requires. For some, the desire to be healthy, coupled with disordered food beliefs and other life challenges, can lead to an unhealthy obsession with eating healthy.

Enter orthorexia.

What is Orthorexia?

According to the National Eating Disorders Association, orthorexia nervosa is a fixation on proper or healthful eating. Individuals struggling with orthorexia may experience an obsession with pure eating that is so strong it harms their physical and psychological status. It has not yet been officially classified as an eating disorder by the Diagnostic and Statistical Manual of Mental Disorders (DSM), however orthorexia is a serious problem that often requires treatment from health professionals.

For a person suffering from orthorexia, meals are something to control rather than to enjoy. Orthorexia is typically driven by a desire to eat healthy, which often masks worry that cannot be solved by food and overshadows many other areas of a person’s life. Due to the rigid nature of the eating patterns of someone struggling with orthorexia, the disorder can result in malnutrition, serious nutrient deficiencies and other life-threatening consequences such as anemia, osteoporosis, hormone imbalances and an abnormally slow heart rate.

Additionally, people suffering from orthorexia have serious misconceptions about nutrition, some which may exclude entire food groups or specific foods and nutrients, e.g., grains, fats or dairy from their diet because they have concluded they are unhealthy and/or harmful.

A desire to eat more healthfully and prevent disease is not inherently pathological; however, it becomes dangerous when this desire develops into a very unhealthy view of, and relationship with food that affects many other parts of one’s life.

How Do You Know if Your Desire for Healthful Eating Has Gone Too Far?

The National Eating Disorders Association (NEDA) states the following as the warning signs and symptoms of orthorexia:

• Compulsive checking of ingredient lists and nutritional labels.
• An increase in concern about the health of ingredients.
• Cutting out an increasing number of food groups (I.e., all sugar, all carbs, all dairy, all meat, all animal products).
• An inability to eat anything but a narrow group of foods that are deemed healthy or ‘pure.’
• Unusual interest in the health of what others are eating.
• Spending hours per day thinking about what food might be served at upcoming events.
• Showing high levels of distress when ‘safe’ or healthy foods aren’t available.
• Obsessive following of food and healthy lifestyle blogs on Twitter and Instagram.
• Body image concerns that may or may not be present.

While the prevalence of orthorexia is not known, the topic is increasingly the focus of published articles in peer-reviewed literature. This increase appears to coincide with society’s growing fascination with “clean eating,” (cited as a top diet since 2019 in IFIC’s 2021 Food and Health Survey) and thinness, yet there are many factors that play into the development of a disordered eating pattern or eating disorder. Genetics, gender, environment, stress and trauma can all contribute to developing orthorexia or another type of eating disorder.

Treatment

There is not currently a clinical treatment for orthorexia, but those struggling with this condition often work with a multidisciplinary team, including but not limited to a therapist, registered dietitian and doctor. From a nutrition standpoint, the goals are to deconstruct false food beliefs – including redefining “healthy”, decrease the belief in the magical food mentality, (i.e., that certain foods can solve and/or save us from disease or challenges) and increase exposure to all kinds of foods. When appropriate, weight restoration is part of treatment as well.

Orthorexia is an important reminder that the information we consume matters, and nutrition is much more nuanced than what is boiled down in the media. Remember, there is no such thing as a perfect diet, and food is just one piece of what contributes to our well-being.

For more information on orthorexia, visit the National Eating Disorder Association (NEDA) or the Academy of Nutrition and Dietetics websites.

If you think you might be suffering from an eating disorder, please call the NEDA Helpline at 1-800-931-2237.