Orthorexia: Where to Draw the Line Between Healthy Eating and Obsession?

Dr. Steven Bratman created the term orthorexia (“right appetite”) more than twenty years ago to explain what takes place when health-conscious diet plans go too far.

Although it still hasn’t been accepted as a main medical diagnosis, orthorexia nervosa is a proposed consuming condition that includes a severe fascination with consuming a “correct” diet plan. Individuals with orthorexia nervosa make every effort to consume just foods they think about healthy and strictly prevent foods they consider to be unhealthy or impure. Their fascination with consuming a healthy diet plan takes control of their lives, ultimately hindering their psychological, social, and even physical wellness.

The subject of orthorexia is questionable within health circles. On the surface area, it can be difficult to compare folks who are merely health-conscious and those who have actually crossed the line into disordered consuming. Any diet plan—even reasonably traditional ones like Mediterranean or paleo—might divert into orthorexia depending upon the person.

Individuals who raise issues about orthorexia typically get implicated of “fit-shaming.” Then the straw guy arguments start: “Oh, so I guess it’s healthier just to eat Twinkies and Big Macs, then?” No, undoubtedly not. Orthorexia begins with food guidelines or following diet plans, however it’s a lot more than that.

To be clear: Wishing to be healthy is not orthorexic. Neither is thinking that some foods are healthier or more healthy than others. Eliminating particular foods, tracking macronutrients, or following a particular diet plan is not naturally bothersome.

Nevertheless, those habits can be stepping stones to orthorexia, so this is a discussion we require to be going to have.

What is Orthorexia Nervosa?

Orthorexia nervosa is a fixation with healthy consuming that eventually interferes with health and wellness.

The very first phase includes setting guidelines and constraints around what foods you will and will not consume. Particular guidelines differ from individual to individual. A private may prevent gluten, food ingredients, GMOs, dairy, animal items, nightshades, sugar, sweetening agents, grains, or whatever they consider to be unhealthy.

Prior to you get protective, comprehend that food guidelines are only action one. They are needed however not adequate for establishing orthorexia nervosa. Many individuals follow set diet plans or limit particular food groups without establishing orthorexia. Diet plan habits don’t cross the line into orthorexia nervosa up until they begin to interfere with lifestyle.

Meaning of Orthorexia Nervosa

Consuming conditions and other psychological health conditions each have a set of diagnostic requirements. These resemble lists that assist medical professionals and therapists choose when a specific medical diagnosis is required. Presently, orthorexia nervosa is not acknowledged as an eating condition in the Diagnostic and Analytical Handbook of Mental Illness (DSM-V). That suggests there are no agreed-upon diagnostic requirements.

However, scientists and specialists require to be able to distinguish an ardent healthy-eating lover from somebody who has actually crossed the line into disordered consuming. Professionals have actually proposed numerous methods of specifying orthorexia nervosa. While the specifics deviate rather, they share typical functions:

  1. Habits: Compulsive fixation with consuming just foods one considers “healthy.” Stringent avoidance of foods considered “unhealthy.”
  2. Unfavorable result on psychological health or wellness: Habits and/or ideas around food cause tension, distress, worry, or stress and anxiety.
  3. Unfavorable effect on social relationships or work: Fixation with diet plan diminishes one’s capability to participate in normal social relationships or do one’s job effectively

Immediately, you can see that orthorexia nervosa surpasses simple dieting. Somebody can have intricate, stiff, even relatively illogical food guidelines on their own, however as long as they don’t considerably affect their wellness, those habits wouldn’t be thought about orthorexic. Orthorexia nervosa needs both dieting and unfavorable psychosocial effects.

Normally, even the strictest consuming habits are ruled out disordered in individuals who follow their diet plan for spiritual factors, since they have food allergic reactions or level of sensitivities, or since it has actually been recommended by a medical professional to deal with a medical condition.

How Orthorexia Nervosa Compares to Other Consuming Conditions

There’s some argument about whether orthorexia nervosa is an eating condition by itself or whether it’s a version of anorexia. The 2 share typical functions:

  • Limiting food
  • Fixation with food guidelines
  • Structuring one’s life around one’s diet plan
  • Obtaining some mental gain from being certified

Nevertheless, there are likewise clear differences. Weight and body image issues are main to anorexia, whereas orthorexia is primarily about health or pureness. Both conditions might lead to weight reduction due to food limitation, however that isn’t the main objective with orthorexia. Likewise, individuals with anorexia normally conceal their food constraints, while individuals with orthorexia tend to be open about them. They may even try to recruit others to their way of eating.

Orthorexia nervosa also shares features with another eating disorder called Avoidant Restrictive Food Intake Disorder, or ARFID. Folks with ARFID eat an extremely limited number of foods too, but it’s because they find eating to be frightening or discomforting. They aren’t motivated by health or purity concerns.

Warning Signs that Your Healthy Eating Might Be Sliding Toward Orthorexia Nervosa

Many people, probably most people, can try different diets and eliminate specific foods or food groups without ever going down this path. However, for some people, it’s a slippery slope. Some potential red flags include:

  • Food rules get stricter over time, so there are fewer and fewer foods you can eat “safely.”
  • Spending excessive time and/or money preparing food. Planning and preparing food starts to crowd out other activities.
  • Self-esteem becomes wrapped up in diet and how well you adhere to your rules. You may start to feel morally superior to others who don’t eat like you.
  • Extreme anxiety or inability to eat food that you didn’t prepare because you can’t be sure it’s clean.
  • Fear, anxiety, or guilt following diet transgressions, perhaps followed by compensatory behaviors like fasting.
  • Strong belief that you can control your current and future health by eating correctly (beyond what would generally be considered reasonable).

Again, let me stress that these behaviors exist on a spectrum. You may see glimpses of yourself here, but that doesn’t mean you have an eating disorder. With orthorexia nervosa, your diet and food beliefs significantly impact other areas of your life for the worse.

Who Is at Risk for Orthorexia Nervosa?

Orthorexia shares certain features with obsessive-compulsive and anxiety disorders. Individuals with one of these issues may be at greater risk for developing orthorexia nervosa. Perfectionism and narcissism may also contribute to orthorexic tendencies. More research is needed in each of these areas.

It’s not clear whether orthorexia nervosa is related to gender, age, or BMI. Studies have found high rates of orthorexic behaviors among folks like yoga teachers, dieticians, gym-goers, and athletes—sometimes exceeding 80 percent of people studied. However, most of these studies used an instrument called ORTO-15 to measure orthorexia. Other researchers have widely criticized this scale for measuring the behavioral component of orthorexia only. We’d expect these folks to prioritize healthy eating, but that doesn’t necessarily mean their beliefs or behaviors are problematic.

Healthy Orthorexia Versus Orthorexia Nervosa

Although the concept of orthorexia is more than two decades old at this point, researchers and clinicians are still trying to draw a clear line between healthy and unhealthy concerns about food. In 2018, researchers from two Spanish universities proposed a new tool called the Teruel Orthorexia Scale to separately measure “healthy orthorexia” and orthorexia nervosa.

Healthy orthorexia is meant to capture a “non-pathological interest in healthy eating.” Scale items for healthy orthorexia include:

  • I mainly eat foods that I consider to be healthy
  • I don’t mind spending more money on food if I think it is healthier
  • I’d rather eat a healthy food that is not very tasty than a good tasting food that isn’t healthy
  • I try to convince people from my environment to follow my healthy eating habits

As you can see, people who score highly on this dimension care about their food quality more than the average person, but their behavior isn’t maladaptive (though their friends and partners might not love it).

In contrast, orthorexia nervosa is characterized by items like:

  • Thoughts about healthy eating do not let me concentrate on other tasks
  • I feel overwhelmed or sad if I eat food that I consider unhealthy
  • If, at some point, I eat something that I consider unhealthy, I punish myself for it
  • I avoid eating with people who do not share my ideas about healthy eating

A 2019 follow-up study showed that healthy orthorexia is associated with experiencing more positive and fewer negative emotions in everyday life, while the opposite is true for orthorexia nervosa. Because this is a new measure, we’ll have to wait for more studies to provide insight into this vital distinction.

Conclusion

At its core, orthorexia is “clean eating” taken too far.

Hopefully it’s clear that orthorexia is about much more than simply being health-conscious. As Dr. Bratman explains:

“Adopting a theory of healthy eating is NOT orthorexia. A theory may be conventional or unconventional, extreme or lax, sensible or totally wacky, but, regardless of the details, followers of the theory do not necessarily have orthorexia. …Enthusiasm for healthy eating doesn’t become ‘orthorexia’ until a tipping point is reached and enthusiasm transforms into obsession [sic].”

You can believe that diet profoundly impacts health, avoid specific foods, weigh and track all your food, and still go about your merry way without developing orthorexia nervosa.

But, if you feel your diet taking over your life, or if the thought of eating something off-plan makes you break into a cold sweat, it’s a good idea to seek help. Even though it’s not an officially recognized mental health disorder, many eating disorder specialists focus on treating individuals with orthorexia nervosa. The National Eating Disorders Association (NEDA) hotline is a good place to start.

Orthorexia Nervosa FAQs

Is orthorexia an obsession with healthy eating?

“Orthorexia” means wanting to eat “correctly.” The term may be used to describe disordered eating, as in orthorexia nervosa. That is an obsession or preoccupation with eating only specific foods that you consider healthy and avoiding foods you think are unhealthy.

What are the main warning signs or symptoms of orthorexia nervosa?

The defining characteristics are: (1) having strict food rules about what you will and will not eat based on your definition of “healthy,” and (2) those rules negatively impact your psychological, social, and/or physical well-being. Truly healthy diets should enhance, not detract from, your quality of life.

How common is orthorexia nervosa?

No one really knows because of problems with how orthorexia nervosa has been measured in the past. Estimates range from as few as 3 percent of people in the general population to more than 80 percent in health-focused communities, but those numbers may not be reliable.

Is fasting or eating only one meal a day the same as orthorexia?

Orthorexia nervosa has to do with beliefs about food quality and eating only “healthy” foods. Individuals may also use fasting to try to achieve health, but that isn’t the same as orthorexia. The same goes for excessive exercise. Both can co-occur with orthorexia, but they aren’t themselves orthorexic.

Is my ______ diet orthorexic?

No diet is inherently orthorexic, no matter how restrictive it is. Context always matters. You can’t decide if someone’s diet is orthorexic without knowing why they are following it and how it is impacting their emotional health, physical health, social relationships, occupation, and overall quality of life.

Primal Kitchen Buffalo


About the Author

Lindsay Taylor, Ph.D., is a senior writer and community manager for Primal Nutrition, a certified Primal Health Coach, and the co-author of three keto cookbooks.

As a writer for Mark’s Daily Apple and the leader of the thriving Keto Reset and Primal Endurance communities, Lindsay’s job is to help individuals learn the whats, whys, and hows of leading a health-focused life. Before joining the Primal team, she earned her master’s and Ph.D. in Social and Personality Psychology from the University of California, Berkeley, where she likewise worked as a researcher and instructor.

Lindsay lives in Northern California with her husband and two sports-obsessed sons. In her free time, she enjoys ultra running, triathlon, camping, and game nights. Follow along on Instagram @theusefuldish as Lindsay attempts to juggle work, family, and endurance training, all while maintaining a healthy balance and, the majority of all, having a good time in life. For more details, go to lindsaytaylor.co.

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Jobber Wiki author Frank Long contributed to this report.