Healthy eating is an important staple of wellness, yet with fads centered around “clean eating” and the number of diets claiming their way is the best way, it can be a challenge to know what is healthy. Is it possible to take clean eating too far?
While not officially recognized as an eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, orthorexia shares many of the hallmark signs of a disordered relationship with food.
What is Orthorexia?
The term orthorexia was first coined by physician Dr. Steven Bratman in 1997 and defined as an obsession with foods' nutritional quality and purity. While the definition is still under debate, a 2015 paper by Koven and Abry defined orthorexia as: “a pathological obsession with proper nutrition that is characterized by a restrictive diet, ritualized patterns of eating, and rigid avoidance of foods believed to be unhealthy or impure.”
Koven and Abry go on to describe that while the underlying intention is to prioritize health, orthorexia eating patterns can lead to nutritional deficiencies, medical problems, and a lower quality of life. That lower quality of life is partly due to ruminating about food, decreased pleasure from eating and while around others eating, and limited social interactions due to the challenge of finding foods that meet the individual’s rigid standards.
You might be wondering how someone who prioritizes healthy eating could be nutritionally deficient or develop medical problems. That’s because some diets that prioritize “eating clean” can leave out important macro and micronutrients, affecting health.
Take for example the conventional healthy eating patterns of the later 20th century. Beginning in the 1950s there was an epidemic of heart disease in middle-aged American men. Doctors and researchers sought to explain why so many men were having heart attacks. They came to blame the increased fat in their diets while ignoring the increases in trauma and stress from the wars of previous decades, high alcohol consumption, and high rates of smoking all of which are associated with increased risk of cardiovascular disease.
Those doctors, researchers, and eventually the US Government began to promote a low-fat diet, which we now know deprives the body of an essential macronutrient necessary for healthy hormones, mucus membranes, cell walls, and of the ability to absorb fat-soluble vitamins.
There are many examples today of fad diets that eliminate whole food groups, macronutrients, or other staples of a balanced diet in the name of “clean eating.” When taken too far they can cause harm to the body, psychology, emotional well-being, and relationships.
Signs of orthorexia
Because research into orthorexia is ongoing and mental and physical health professionals are still debating its definition, there are no clearly defined parameters for what constitutes orthorexia. However, there are some key themes to be aware of:
• Spending excessive amounts of time researching or engaging with content trying to clarify what foods are “healthy” or “clean”. You’ll know this is happening when you forego things you enjoy or shirk responsibilities to prioritize your research. Similarly, find yourself absorbed in social media posts about food.
• If you find a sense of importance, personal value, or special identity in the cleanliness, quality, or other aspects of your food. This is especially true if you value or judge others who do not eat the way that you do. That type of judgment is a sign you’re creating an identity around your diet.
• Developing restrictive or extreme food rules and relating to foods as “good” or “bad”. This can relate not only to the foods themselves but also to value judgments about yourself or whomever else eats those foods. For example, judging someone you perceive as having had “bad” food.
• Anxiety or other emotional distress around what is in each food and how the food you eat is prepared. For example, spending hours planning and preparing food, so it meets cleanliness or purity standards, then being afraid you’ll make a mistake. This might result in feeling ashamed if you’d eating something outside the plan.
• Food fixations or food rules affect social interactions. Whether judging someone for eating a food deemed “unclean,” out of fear that the “right” foods won't be available, or because you’re spending so much time thinking about, planning, and preparing food that you isolate yourself.
There are three important factors related to the above themes.
First, many of the themes above are true of other forms of disordered eating and if you or someone you work with is experiencing them you may want to consider professional guidance.
Second, that orthorexia is distinctly different than restricted eating due to a medical diagnosis or other health problem. Not eating gluten due to having celiac’ s disease or avoiding lactose because you’re intolerant is not a sign or orthorexia.
Third, you might read that list and wonder “what’s wrong with wanting to eat healthy or have standards?” While nothing is wrong with wanting to be healthy, you may want to consider when the focus on healthfulness can become harmful.
Wellness Practices to Mitigate Orthorexia
Because Orthorexia is not formally recognized as an eating disorder there is not currently a clear treatment, however a study by Rodgers, White, & Berry published in December of 2021 found that women who practiced the foundational behaviors of intuitive eating showed less orthorexia behavior. This is the most effective and positive finding so far in the treatment of orthorexia. The four foundational pillars they measured are:
• Unconditional permission to eat: that foods are not good or bad and the person does not experience shame, blame, or guilt regardless of what they are eating.
• Eating for physical reasons rather than emotional: the individual eats when they are hungry, stops when they are full, and does not either restrict or eat due to emotional motivations.
• Reliance on hunger and satiety cues: instead of using tracking apps, food rules, scheduling timing, or other motivations around when and how much to eat.
• Recognizing that foods have many roles in one’s life: NASM’s Certified Wellness Coaching course lists nutrition, taste, energy, & enjoyment and well as cultural and personal expression.
Getting Support for an Eating Disorder
Disordered eating is a complex psychological issue and one that should be treated with care. If you believe you are experiencing any of the signs of disordered eating you can find resources and help at the National Eating Disorder Association helpline.
If you’re a professional working in fitness and/or wellness such as a personal trainer or wellness coach, you might consider how your current practices affect the long-term eating behaviors of your clients. While a client’s results matter to you and them, the tools, language, and techniques you use to support behavior change can have lasting impacts on your client’s beliefs about nutrition and themselves. Restrictive eating and rhetoric about “clean” foods may leave your clients obsessing, and confused, and diminish their wellness.
Dunn, T. M., & Bratman, S. (2016). On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eating behaviors, 21, 11-17.
Koven, N. S., & Abry, A. W. (2015). The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatric disease and treatment, 11, 385.
Rodgers, R. F., White, M., & Berry, R. (2021). Orthorexia nervosa, intuitive eating, and eating competence in female and male college students. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 26(8), 2625-2632.