Healthy eating is an excellent goal, but when taken to an extreme, pursuing the so-called “perfect” diet can actually become an unhealthy obsession. When people become fixated on eating “right” to the detriment of their mental health or overall wellness, they may be diagnosed with an eating disorder known as orthorexia nervosa—sometimes simply called orthorexia.
Nine percent of the general population (28.8 million Americans) will have an eating disorder in their lifetime. Orthorexia is a relatively new disorder in scientific literature, so it’s difficult to say how many people suffer from it. But that doesn’t mean there aren’t resources for understanding and treating this condition.
What Is Orthorexia Nervosa?
Orthorexia nervosa is characterized by an extreme fixation on healthy or “clean” eating. (Its name comes from the Greek “ortho,” meaning “correct” and “orexi,” meaning “appetite.”) This focus may lead people to adopt ritualistic eating behaviors, only eat a small number of approved foods, or avoid eating in social situations, as they may believe they must rigidly control which foods are acceptable for their health. An obsession with the “correct” diet may even crowd out other interests, taking over a person’s thought life.
Extreme tunnel vision on approved foods can lead to harmful consequences. For example, someone with orthorexia nervosa might feel unable to eat foods family or friends have prepared for them, or unable to dine out at restaurants, since they can’t be sure of the ingredients used in each food. People with orthorexia might also lose an unhealthy amount of weight by avoiding entire groups of foods.
Despite its known hallmarks, orthorexia has not been researched as thoroughly as many other eating disorders. In fact, orthorexia is not found in the DSM-5, the manual that serves as a gold standard for mental health diagnoses. That said, it is possible to receive a diagnosis of orthorexia nervosa from a qualified practitioner—and, often, people with orthorexia overlap with other eating disorders that are more easily diagnosed. Many people with orthorexia may fit the diagnostic criteria for other specified feeding and eating disorder (OSFED), which is an official diagnosis outlined in the DSM-5.
Signs of Orthorexia
The signs of orthorexia may look different from person to person. According to the National Eating Disorders Association, some indicators of orthorexia may include:
- Increased concern over the healthfulness of ingredients in foods
- Obsession with reading labels and ingredient lists
- Cutting out large groups of foods, sometimes in progression (such as all carbohydrates, all grains, all dairy, all meat, all sugar, etc.)
- Distinct interest in what others are eating and whether or not it’s healthy
- High stress levels when approved foods are not available
- Fixation on which foods may be served at an event or gathering
- Inability to eat in social situations
- Devotedly following certain social media wellness accounts or health “experts”
While it’s only natural to feel concerned about the healthfulness of food (especially if you’re pursuing a specific wellness goal or are eating to manage a health condition), orthorexia is distinguished by its level of extremity. Someone with orthorexia might spend exorbitant amounts of time curating their meals, consuming media related to their chosen diet, or scouring menus before dining out. For some people, the condition also involves linking their self-worth with what they eat.
Causes of Orthorexia
Like all disordered eating patterns, orthorexia likely stems from a variety of factors, both personal and cultural.
The authors of a 2020 investigation found that the factors influencing orthorexia include personal beliefs about food and health, past trauma, perfectionism, and the way food and bodies are talked about by parents and social groups (particularly fitness or health-related groups. According to a 2021 review, orthorexia typically does not appear overnight but develops slowly—often beginning as a well-intentioned desire to pursue a healthy diet that evolves into an obsession.
The review found that demographic markers of individuals who may struggle with orthorexia often include being female, having an intermediate-to-high level of education, and having an active lifestyle.
It’s important to note that larger societal forces might be behind an uptick in orthorexia cases. Given that the social and digital environment plays a significant role in how individuals think about food, they’re a likely culprit in orthorexia development. Whether online or in-person, friend groups can easily turn into echo chambers of belief. Many people who struggle with orthorexia are surrounded by others with similarly black-and-white beliefs about food and healthy eating.
Evidence-based nutrition education from a registered dietitian can help people with orthorexia to let go of false beliefs about the healthiness (or unhealthiness) of certain foods. A huge part of orthorexia treatment is helping the patient unravel their orthorexic beliefs about food. That might mean going over certain aspects of nutrition science to make it clear that our bodies were made to eat all kinds of different foods, or explaining how and why most so-called ‘toxic’ ingredients are actually completely safe to eat in normal amounts.
Diet Culture and Orthorexia
In recent years, you’ve probably heard the term “diet culture” tossed around in the media. This term refers to the glorification of dieting—and, specifically, losing weight—often at the cost of other aspects of health. Diet culture invokes all-or-nothing thinking about food, labeling certain foods “good” and others “bad.”
It’s not surprising, then, that experts have speculated that diet culture has pushed many people toward orthorexic beliefs.
In diet and wellness culture, there’s so much fear-mongering about food. It’s common to see foods described as good or bad, healthy or unhealthy, which just feeds orthorexic thinking. In reality, no one food will make or break your health. Food doesn’t have moral value—you’re not a better or worse person because of what you eat.
It’s often difficult to admit having a problem with food obsessions, especially when you suspect people may judge you harshly. But if the description of orthorexia sounds familiar to you and you are wondering if your relationship to food could be problematic, speak to a qualified professional, such as a registered dietitian or psychologist.