When does healthy eating cross the line into behavior that is unhealthy? While eating a predominantly plant-based diet is considered healthy and promotes physical and mental wellbeing and longevity, some people develop such an extreme focus on clean eating, it can cause distress, affect their health, social life, and relationships. Being obsessive about how healthy your food is can become a type of disordered eating called Orthorexia Nervosa, which has similarities to other eating disorders and at its most extreme, may require professional treatment.
Although scientists are still studying the motivations for orthorexia and how it differs from normal healthy eating, there are some basic guidelines that are agreed upon. Let’s look at the facts about orthorexia, risk factors and influences, and diagnostic tools for finding out if your obsession with food is healthy or not.
What is orthorexia?
First coined by physician Steven Bratman over 20 years ago, the term orthorexia is a combination of the Greek words “orthós”–meaning correct–and órexis”–signifying appetite. In its simplest definition, orthorexia is an obsession with proper or healthful eating.
Orthorexia Nervosa (often shortened to orthorexia) which has a similar name to another eating disorder anorexia nervosa, is the medical term for when behaviors motivated by an obsession with healthy food negatively affect someone’s life and health. Anorexia nervosa is characterized by restricting the quantity of food someone eats, but those with orthorexia restrict foods based on their quality (when they are not deemed healthy enough to consume).
How do doctors diagnose orthorexia?
Orthorexia is not formally recognized as a distinct eating disorder and the diagnostic criteria are under debate. For this reason, a doctor may not recognize the condition and someone may require an eating disorder specialist to diagnose them.
Some eating disorder specialists use a diagnostic test devised by Bratman but there are around seven different tools that health professionals can use to diagnose orthorexia nervosa, and none of them are considered to be the gold standard for diagnosing.
Signs and symptoms to watch out for that signal unhealthy orthorexia
The National Eating Disorders Association (NEDA) lists warning signs and symptoms of orthorexia that people can look out for:
- 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 (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 may or may not be present
NEDA advises that orthorexia could lead to malnutrition if someone is restricting the types or amounts of foods they eat. Additionally, someone can try the Bratman test to find out if they may have Orthorexia Nervosa.
Can you have healthy orthorexia and how does it differ from Orthorexia Nervosa?
People can have what experts term ‘healthy orthorexia’. This is when people have an interest in healthy eating and select foods for their positive effects on the body and mind. This differs from Orthorexia Nervosa (unhealthy orthorexia) that is characterized by negative feelings about food such as shame, guilt, and fear, and fixations, compulsions, preoccupations, and overvalued ideas about healthy food. Healthy orthorexia crosses the line into orthorexia Nervosa when it affects someone’s life, social interactions, health, weight, or mental health.
The following examples may help someone decide if they have a healthy attitude to food and a plant-based diet or an unhealthy obsession. It’s important to note that because there are no clear diagnostic criteria for orthorexia, the examples below are simply to help someone consider if their healthy eating has crossed the line.
|Food scenario||Healthy attitude||Unhealthy obsession|
|Everyday meals||Mainly avoiding foods or ingredients that are well-researched and accepted contributors to ill health such as saturated fat, excess salt, processed foods, and added sugars||
|Food preparation||Due care and attention paid to make food safe while not resulting in undue effort||
|Social eating||Choosing menu items or restaurants that serve nourishing, healthy food||
|Grocery shopping||Planning and shopping for meals that are nutrient-dense and healthy||
|Health information||Educating oneself about how to eat a healthy plant-based diet and looking for inspiration for recipes and meal ideas||
Deanne Jade, psychologist and founder and principal of the National Centre for Eating Disorders in the UK told The Beet “Orthorexics begin by eating well and then spiral into an obsession or fixation with goodness, purity, and a certain smugness. At its most extreme, health suffers, other interests diminish, relationships are affected and matters may become dangerous”. Jade also added that some people may become aware of how orthorexia affects them and those around them “I am painfully aware I am a bore even if I strive for it to be a closet bore. I am no less aware that I am a type like many of my ilk, intelligent, city living and more than a tad a control freak” said one patient.
Who is at risk, and how do people develop orthorexia?
Research indicates that orthorexia may overlap with other conditions such as anxiety, anorexia nervosa, obsessive-compulsive disorder (OCD), and obsessive-compulsive personality disorder (OCPD).
Tamara Pryor executive director of clinical and research and adjunct associate professor and Eating Disorder Care and director at NEDA told The Beet “Orthorexia does appear to be related to, and exhibit features of, OCD when it evolves from ‘health foodism’ and becomes pathological. At this stage, the individual expresses obsessive thinking, compulsive behavior, self-punishment through deprivation and escalating restriction.
Over time individuals express phobic avoidance of foods perceived to be unhealthy, severe emotional distress, persistent failure to meet nutritional needs, and marked interference with social functioning. Traits of perfectionism, OCD, and extremism are risk factors for the development of Orthorexia.”
Pryor said it’s difficult to know the prevalence of orthorexia because there is no thoroughly vetted measure but using the Bratman test estimates a huge range from 6.9 percent to 57.6 percent in the general population.
Sportspeople seem particularly susceptible “30 percent of men and 28 percent of women in a variety of sports, such as running, swimming and basketball were found to have orthorexia. It has recently been found to be fairly common in the climbing/bouldering community. Athletes may be more susceptible because of a desire to achieve optimal sports performance” said Pryor.
Is a plant-based diet linked to eating disorders?
Some people think that plant-based diets are linked to eating disorders. A review suggested that a plant-based diet is not a cause of someone developing an eating disorder, instead, people may adopt a plant-based diet when they already have an eating disorder, as a way to restrict food further.
Registered dietitian Taylor Wolfram said in an interview that this is a stereotype that prevents vegans from securing treatment, as many eating disorder centers wouldn’t accept vegan clients unless they agree to eat animal products “I come across the stereotype about vegans having eating disorders more so among my fellow health-care professionals than I do the public” said Wolfram.
The influence of social media and health information
It comes into question what role online health information plays in the development of orthorexia. Certainly, orthorexics may have an unhealthy interest or obsession in collecting facts about food and nutrition that can perpetuate their condition. However, credible online health information enables people to make decisions about their health and gain valuable knowledge about nutrition and this is a positive step for many people, helping them to adopt healthier lifestyles. Conversely, unscientific information may do harm “nutrition information that is not scientifically based and inaccurate is constantly circulating. This misinformation may not be causative but can certainly contribute to the development of orthorexia and other disordered eating” said Pryor.
Pryor believes that health media should be aware of promoting rules around eating that categorize foods into good, bad, or clean, and encourage certain diets to achieve higher purification or status. Instead, she said they should promote the development of a healthy, joyful relationship with food.
How is orthorexia treated?
Although a doctor may not initially diagnose orthorexia, as it progresses it may require treatment from a practitioner who specializes in eating disorders. Pryor explains that a health professional can help someone plan a balanced diet and use dietetic science to reassure them about their food fears. Pryor says “Also, complicating treatment is the fact that motivation behind orthorexia is multifaceted.
First, the orthorexic must admit there is a problem and then identify what caused the obsession (i.e. childhood illness involving diet or digestive issues, fear of disease, parents who place undue importance on healthy food, etc…). They must also become more flexible and less dogmatic about eating. Working through underlying emotional issues being expressed via their rigid eating patterns will make the transition to more balanced eating easier”.
NEDA advises that psychotherapy may be needed to increase the variety of foods eaten and exposure to anxiety-provoking or feared foods and Jade adds “the answer is not medical, it is psychological”
Recovered orthorexics may still eat healthily but will have a different understanding of what healthy eating is, notes Pryor “They will realize that food will not make them a better person and that basing their self-esteem on the quality of their diet is irrational. They will need to discover that while food is important, it is one small aspect of life and that often other things are more important”.
Where to find help
Someone who thinks they may have orthorexia should discuss this with a health professional if they are worried about the consequences to their health, mental wellbeing, or everyday life. They can also contact NEDA, or the NCFED if based in the UK, who will be able to offer help, advice, and someone to speak to.
The Bottom Line: Orthorexia is an obsession with healthy eating
When it crosses the line into behaviors and thoughts that negatively affect wellbeing, health, and everyday life healthy eating may become orthorexia and require treatment from an expert.
Certain groups of people such as competitive athletes, and those eating a plant-based diet, and people who have an existing mental health condition such as anxiety or OCD are more susceptible. Treatment is available using therapy and education about meal planning. If someone has orthorexia they should seek help from their doctor or a therapist.