Orthorexia: When a passion for healthy foods turns into an eating disorder

March 23, 2020

Providence Nutrition Team

Orthorexia: When a passion for healthy eating becomes unhealthy

People with orthorexia have an extreme commitment to healthy eating.
They are not driven to lose weight, but rather to eat the “right” way.
Misinformation from “wellness influencers” can make the problem worse.
A series of questions can help you understand your risk of developing this disease.

[5 MIN READ]

You’ve probably been on a healthy eating kick before. Maybe you’re on one now. You’ve cut out processed sugar, or gotten excited about the benefits of kale or found six new ways to cook with quinoa. Whether it was because you gained a few pounds or got inspired by a friend’s dietary regimen, you made a change and you felt good about it.

And that’s great. But for some people, enthusiasm about healthy eating becomes an obsession. They develop an eating disorder called orthorexia, and spend the majority of their time thinking about, obtaining and preparing food that they deem healthy.

Often this disease begins in someone aiming to improve their health. But over time, behaviors grow progressively extreme and develop into disordered eating or an actual eating disorder. This can lead to consequences such as malnutrition, mental distress, social isolation and poor body image.

For some people, enthusiasm about healthy eating becomes an obsession. They develop an eating disorder called orthorexia, and spend the majority of their time thinking about, obtaining and preparing food that they deem healthy.

Why do people develop orthorexia?

“Someone with orthorexia often views food as a source of health but not necessarily pleasure,” says Jason Stone, MD, a psychiatrist with Providence St. Vincent Behavioral Health Program in Portland, Oregon. “Often, they morally judge others based on what they eat. If people with orthorexia eat something they perceive as being unhealthy, they often have an exaggerated fear of the physical consequences.”

People with orthorexia are not primarily driven by a preoccupation with their weight or a desire to lose weight, he adds. They are motivated instead by ideals of health and virtue. Their pursuit of better health ends up harming them.

What are some characteristics of a person with orthorexia?

People with orthorexia are often anxious, and some may exhibit obsessive-compulsive tendencies. “In people with orthorexia, food rules and rituals are often extreme and inflexible,” Dr. Stone says. “These individuals may have an exaggerated faith in the benefits and harms of eating different foods. Another common trait is that they may take food recommendations to an extreme. For example, instead of following the general guideline of eating less sugar or processed foods, the person may eliminate all foods with any added sugar or processed ingredients.”

In people with orthorexia, food rules and rituals are often extreme and inflexible,” Dr. Stone says.

Dr. Stone says that many factors have given rise to this eating disorder in recent years. Examples include the multibillion-dollar diet and wellness industries, in which businesses sometimes push unscientific ideas and products. Other factors are wellness influencers and “clean eating” social media accounts that tell people to eat in specific ways that are not always healthy.

How do you know if you or someone you love has orthorexia?

Dr. Steven Bratman, a physician who coined the term orthorexia in the late 1990s, offers a self-test. If you answer “true” to any of these statements, you may have orthorexia or be at risk of developing it.

I spend so much of my life thinking about, choosing and preparing healthy food that it interferes with other dimensions of my life, such as love, creativity, family, friendship, work and school.
When I eat any food that I regard to be unhealthy, I feel anxious, guilty, impure, unclean and/or defiled. Even to be near such foods disturbs me, and I feel judgmental of others who eat such foods.
My personal sense of peace, happiness, joy, safety and self-esteem is excessively dependent on the purity and rightness of what I eat.
Sometimes I would like to relax my self-imposed “good food” rules for a special occasion, such as a wedding or a meal with family or friends, but I find that I cannot. (Note: If you have a medical condition or food allergy in which it is unsafe for you to make ANY exception to your diet, then this statement does not apply to you.)
Over time, I have steadily eliminated more foods and expanded my list of food rules in an attempt to maintain or enhance health benefits; sometimes, I may take an existing food theory and add to it with beliefs of my own.
Following my theory of healthy eating has caused me to lose more weight than most people would say is good for me, or has caused other signs of malnutrition such as hair loss, menstruation issues or skin problems.

What does a person with orthorexia need in order to heal?

As of now, orthorexia is not an official diagnosis. It does not have well-defined criteria that are universally accepted. But a trained mental health professional can recognize the signs and provide help in the form of counseling. Therapy focuses on helping people expand their flexibility around food. People with orthorexia may need tests to find out if they are malnourished or have a vitamin deficiency. If so, treating those problems and working with a registered dietitian nutritionist will be part of the recovery process.

Find a doctor

If you or someone you love needs help overcoming an eating disorder, talk to your doctor. You can find registered dietitian nutritionists and mental health professionals in our provider directory. Or, you can search for a primary care doctor in your area.

How do you keep a healthy perspective on your diet? Share it with #healthyeating @psjh

Regional resources

Alaska: Outpatient Diabetes and Nutrition Center

California: Nutrition Counseling

Oregon: Providence Nutrition Services

Texas: Covenant Health LifeStyle Centre

Washington: Nutrition Consultations