Does this sound like you? You value eating healthy, so you spend a lot of time and effort making sure your diet has the perfect blend of macro and micronutrients.
You feel more secure when you make meals yourself (and know exactly what’s in them), and you don’t quite understand why your friends get upset when you won’t go out to dinner with them.
You also don’t quite get why your co-workers think you’re stuck up for never coming to the office birthday celebrations.
And you didn’t have an answer when your sister asked why you only ate the turkey and the salad you brought when she hosted Thanksgiving. (“It’s not like you have a food allergy or celiac disease, for Pete’s sake,” she said the next day on the phone.)
It’s true that eating nutritious food helps support health, but when taken to extremes, the pursuit of a “healthy” diet can become unhealthy. Almost 30 years ago, physician Steven Bratman coined the phrase “orthorexia,” which generally translates to an unhealthy obsession with eating healthy food. (He went on to write the 2000 book “Health Food Junkies.”)
When Bratman first coined the term orthorexia, it was mostly found among people who were heavily into alternative medicine. Today, with increased interest in healthy eating among a broader segment of the public — driven in part by social media — it appears orthorexia has become more common.
So, at what point does prioritizing healthy eating turn unhealthy? While there is a fine line between healthy eating and orthorexia, there is a line. While orthorexia is not an “official” eating disorder, like eating disorders, it can harm both physical and mental well-being. That’s because orthorexia can lead to diets so strict that they have health-related consequences, including malnutrition, social isolation and severe psychological strain.
The slippery slope to orthorexia
Bratman has pointed out that orthorexia has two stages. The first is simply choosing to eat a healthy diet. By itself, that’s not harmful (clearly). It’s the second stage — the “intensification of that pursuit into an unhealthy obsession” — that tips the balance.
This means that simply adopting an alternative diet — even if it’s evidence-based — does not mean someone has orthorexia. It’s how someone responds to their chosen diet that matters. Healthy eating does not become unhealthy until it becomes entangled with obsessive thinking, compulsive and ritualistic behavior, and self-punishment.
Individuals with orthorexia often use their diet to achieve a feeling of perfection, purity or superiority, and may feel judgmental towards those who don’t follow a healthy diet. They may spend excessive amounts of time researching and planning meals around “pure” or “clean” foods. All of that interferes with participation in normal social activities and interactions — like dinner with friends, office birthday cake, the communal enjoyment of traditional holiday foods.
It’s one thing to generally try to eat organic or 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 inflexible, they refuse to go out to restaurants, they won’t let others cook for them.
For some, elimination diets are the slippery slope that leads to orthorexia. Someone I once interviewed told me this:
“I only felt worse and worse but kept chasing this magical unicorn of the ‘perfect diet.’ The anxiety I felt about food was suffocating and totally overwhelmed most other parts of my life. I was afraid to eat out or travel or—the worst of it—to eat a normal meal with my family. I had to have complete control of everything I was eating.”
Why isn’t orthorexia considered an eating disorder?
It’s unclear whether orthorexia might qualify as a unique eating disorder, or whether it is a variant of — or precursor to — anorexia nervosa or obsessive-compulsive disorder (OCD). Orthorexia, anorexia and OCD all 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 about food can be a way of avoiding negative feelings. The downside is that when control cracks and someone eats a forbidden food, feelings of failure, guilt and self-hatred often follow.
Orthorexia and anorexia have several other similarities, including:
- Preoccupation with food and eating
- Restrictive eating habits
- Eating rituals
- Magical beliefs about food
- Intense anxiety and fear regarding certain foods
- An exaggerated need for self-care and protection
Unlike anorexia, orthorexia generally doesn’t have weight loss as a goal. The focus is on the quality of food, not the quantity. Someone may start with wanting to be healthier, but take it to an unhealthy, even dangerous level.
However, orthorexia has the potential to morph into anorexia, especially if the list of foods to avoid grows too long.
Even though health, rather than weight loss, is the primary motivation, that’s a difficult distinction, given that health ideals are often tangled up with body weight and/or body composition.
In fact, orthorexia is often considered a variant of “healthism.” Healthism is a belief system that makes personal health the primary goal for well-being. It also places emphasis on personal responsibility for achieving health and preventing disease. The current trends of life extension and biohacking are newer manifestations of healthism 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 agreed upon definition of orthorexia or 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 at correctly identifying people with a certain problem without incorrectly identifying people who don’t have that problem.)
One set of proposed criteria 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.
- Mental distress or impairment of social, academic or work functioning that is secondary to the person’s dietary beliefs or behaviors.
- Positive body image, self-worth, identity and/or satisfaction is excessively dependent on compliance with self-defined “healthy” eating rules.
Having helped clients with a wide range of eating disorders and/or symptoms,* I can fairly say that while orthorexia MIGHT 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 have helped people who clearly have anorexia or bulimia or binge eating disorder or ARFID, I’m had many more clients whose symptoms and behaviors don’t neatly fit in 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’s just orthorexia.” There is no “just.” If anything you’ve just read hits a little too close to home, please seek help. Trying to “fix” disordered eating on your own just delays recovery.
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Disclaimer: All information provided here is of a general nature and is furnished only for educational purposes. This information is not to be taken as medical or other health advice pertaining to an individual’s specific health or medical condition. You agree that the use of this information is at your own risk.
Until next time,
