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Orthorexia: When Healthy Eating Turns Obsessive

When diet dedication always wins over killer weekend plans, it might be a sign that too much of a good thing can actually be bad. Meet Orthorexia, a form of disordered eating that might <em>seem</em> like an innocent obsession.
Orthorexia: When Healthy Eating Turns Obsessive

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Going vegan, eating organic, or simply counting calories can all result in leaner, happier bodies. But it turns out being too healthy can actually be unhealthy. When a diet crosses the line from careful plan to Spartan obsession, it may be a sign of “orthorexia nervosa,” an increasingly common disorder demanding attention from the medical community.

Dinner Dateless — Why It Matters

Photo by Dan Zimmer  

Orthorexia is an obsession with eating a “pure” diet, which usually entails avoiding foods with artificial colors, flavors or preservatives, unhealthy fats, added sugar or salt, and genetic modification [1] [2]. And while it’s smart to care about what exactly goes into your body, it can become a serious problem if such strict food rules lead to social isolation. Orthorexics will often turn down social invitations, fearing that “healthy” food won’t be available, or — if they opt to risk it — will refuse to touch even a morsel of impure food, even despite hunger pangs. They may also spend inordinate amounts of time shopping for specific groceries and preparing meals, or hide their habits from friends and family to avoid criticism [2].

Though they sound similar, orthorexia is markedly different from anorexia: The goal is not necessarily to lose weight, but instead to attain “perfect” physical health. An anorexic person might avoid healthy fats found in oils and nuts like the plague, fearing their high calorie count and potential for causing weight gain — but an orthorexic person would be more likely to acknowledge fat’s health benefits and carefully portion out their organic almonds and expeller-pressed oils. They would not fear weight gain so much as eating an imbalanced — and therefore imperfect — diet.

Depending on the extremity of the diet, some health-food addicts can still fall prey to chronic hunger and rapid weight loss as they continue to blacklist “unhealthy” foods. And lets just be clear before criticizing those picky-eater friends: The term also does not apply to people with medical conditions that absolutely forbid certain food groups, such as those with celiac disease, lactose intolerance, or food allergies.

Going Health Nuts — The Answer/Debate

Orthorexia has not been accepted as an official medical condition and remains unknown by many doctors, dietitians, and therapists. Unlike anorexia or bulimia, orthorexia may have less to do with poor body image or self-esteem, and more to do with a fear of illness and bad health [3]. Some classify it as a form of OCD, or when a person satisfies unreasonable obsessions (like, say, eating a completely pure diet) with ritualistic behavior (meticulous calorie counting and nutrient tracking, refusal to eat certain foods, etc.) [4] [5]. In this case, someone with orthorexia might undergo cognitive behavioral therapy (CBT) to address and resist rituals attached to their grocery shopping, food prep, and eating habits. Some psychologists think a combination of CBT and “mindfulness” — increasing awareness and acceptance of uncomfortable sensations — can train orthorexic patients to overcome anxiety related to their health. Others also call for the involvement of physicians and dietitians, and even the use of drugs that help to control mood by inhibiting serotonin receptors [2]. But because it is not an accepted medical term, there is no definitive classification, diagnosis, or treatment for the disorder.

But before trying to diagnose every health-fanatic friend, realize there’s also a fine line between what makes someone health-conscious or health-obsessed. The distinguishing factor seems to be whether or not the behavior interferes with other obligations (especially social life). Warning signs might also include other health-related obsessive behavior, like exercise addiction. Previous struggles with anorexia or bulimia could also predispose someone to orthorexia. Keep an eye out for abnormal overall mental happiness, too. A health conscious person cares about their body; a health obsessed person freaks out over it. If not in complete control of their diet, an orthorexic person could have increased anxiety — a sign of a true disorder.

Experts' Take:

Dr. Sherry Pagoto, Clinical Psychologist:

“If a behavior is so disruptive that it interferes with work and personal relationships, it could be a sign of a psychological disorder. Social life is a huge factor in health because it’s a buffer for stress. Lack of social support can mean less ability to cope with stress.

People with OCD have a lot of anxiety, and perform rituals or compulsions to relieve that anxiety. [In the case of someone with orthorexia], they may have some underlying anxiety issues that are triggered by an interest in health or by all the conflicting news concerning nutrition. Maybe there’s an underlying fear of death or disease. Whether it is actually a disorder I think depends on the individual’s personality traits; they may just be a perfectionist.”

Liza Moskovtiz, RD:

"As a dietitian, a majority of my profession is spent helping people learn how to eat healthier diets — whether by teaching how to plan meals better, choosing healthier menu options, portioning out calories, or adding more nutrient-dense foods  to enhance energy levels and help fight stress. A condition like Orthorexia, on the other hand, requires an entirely different approach and treatment plan from what I normally practice. And while it may not be as dangerous as other serious eating disorders like anorexia and bulimia, it can certainly still have negative implications on a person’s nutritional status.

From a nutrition standpoint, my biggest concern would be total caloric intake. The questions to ask? Is the patient at risk of not consuming enough calories throughout the day? Are they deficient in any nutrients (and having regular blood tests to avoid these deficiencies)? Have they experienced any issues with energy levels, immunity, or concentration? Has the function of  their digestive system been affected?

A constant obsession, or fear of eating certain foods, no matter what the individual's motive — to maintain low body weight, eat a vegan diet, deal with food allergies/intolerances, or in this case, fear of an unhealthy diet — will almost always result in some form of calorie restriction. Short-term calorie deprivation may lead to increased anxiety, difficulty concentrating, digestion issues, dehydration and fatigue. Long-term semi-starvation results in more serious issues such as osteoporosis, anemia, physical injuries, impaired immunity and hormonal disruptions such as infertility."

The Takeaway

Orthorexia is an obsession with eating only “pure” foods. While the pure foods themselves are for the body, orthorexia can lead to an unhealthy relationship with food and empty social calendar. Even for the sake of “perfect” health, social interaction shouldn’t be limited to talking to organic homegrown tomato plants. Cutting out junk food is great, but moderation is key to achieving both physical and mental health.

When it comes to healthy eating, do you think there can be too much of a good thing? Tell us how you feel in the comments section below.

Originally posted June 2012. Updated February 2013. 

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Works Cited +

  1. Orthorexia nervosa. A new eating behavior disorder? Catalina Zamora ML, Bote Bonaechea B, García Sánchez F, Ríos Rial B. Actas Esp Psiquiatr. 2005 Jan-Feb;33(1):66-8.
  2. Orthorexia or when a healthy diet becomes an obsession. Bartrina JA. Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, España. Arch Latinoam Nutr. 2007 Dec;57(4):313-5.
  3. What is the association between obsessive-compulsive disorder and eating disorders? Altman S.E., Shankman S.A. Department of Psychology, University of Illinois-Chicago, Clinical Psychology Review, .2009 Nov;29(7):638-46.
  4. What is the association between obsessive-compulsive disorder and eating disorders? Altman S.E., Shankman S.A. Department of Psychology, University of Illinois-Chicago, Clinical Psychology Review, 2009 Nov;29(7):638-46.
  5. Morbidity risk for obsessive-compulsive spectrum disorders in first-degree relatives of patients with eating disorders. Bellodi L., Cavallini M.C., Bertelli S., Chiapparino D., Riboldi C., Smeraldi E. Istituto Scientifico H. San Raffaele, Department of Neuropsychiatric Sciences, University of Milan School of Medicine, American Journal of Psychiatry. 2001 Apr;158(4):563-9.