Orthorexia Nervosa: When Striving for "Health" May Go Too Far
What can it look like to be overly focused on health and nutrition? The answer to this question may surprise you since we live in a society that prioritizes and praises the notion of “health.” Read on as we break down orthorexia nervosa and explore what it means to have an “unhealthy obsession” with being “healthy.”
What is Orthorexia Nervosa?
The term orthorexia nervosa (further referred to as orthorexia in this blog) was coined by Dr. Steven Bratman in 1997 to describe situations when pursuing a healthy diet intensifies to the point of obsession and impaired daily functioning (1). Dr. Bratman has since noted orthorexia to be an “obsessive focus on ‘healthy' eating, as defined by a dietary theory or set of beliefs whose specific details may vary; marked by exaggerated emotional distress in relationship to food choices perceived as unhealthy"(2). More simply put, we might think of orthorexia as a fixation with being “healthy.” Over time, the concept of orthorexia has evolved and expanded beyond just food choices. It is now commonly found in association with excessive exercise (3). While orthorexia is not an officially recognized diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), it can have clinically significant mental and physical consequences and is worthy of professional support.
One of the complexities of orthorexia is that it often starts out with intentions to “be healthy” or take care of oneself through food and exercise. Orthorexia can be hard to spot in our diet- and health-centric society. In fact, it’s not uncommon for individuals with orthorexia to be praised for being “health conscious” or “healthy.” Because there has been a sharp rise in interest in nutrition and wellness in popular culture over the past few decades, diet culture is everywhere. The wellness industry has been estimated to be worth 4 trillion dollars (4). Social media is filled with food photos, “healthified” recipes, and people promoting supplements, superfoods, and fad diets. We are inundated with health and nutrition messaging from governmental authorities, schools, health care institutions/providers, and mainstream media telling us what we “should” eat. It may feel like you are getting nutrition advice from every possible outlet, and while it is often well-intentioned, the underlying message places an undue amount of pressure on one to maintain a “healthy diet.” This type of messaging is an oversimplified approach to health and may contribute to disordered eating behaviors, like those present in the case of orthorexia.
Possible Signs of Orthorexia
With that in mind, how can we differentiate between a general interest in health and orthorexia? As we mentioned in our most recent blog, it may be helpful to conceptualize disordered eating and eating disorders along a spectrum, with differences lying in the frequency and intensity of symptoms. This same concept can be applied to orthorexia. Dr. Bratman states, “Interest in healthy eating does not become pathological until a further progression takes place. In this second stage, obsessive thinking, compulsive behavior, self-punishment, escalating restriction and all the other dynamics of conventional eating disorders begin to take hold"(3). Let’s consider what that might look like. Here are some possible warning signs for orthorexia:
Fixating on the quality of food. Individuals with orthorexia often zero in on the quality of food consumed. Some might focus on the “purity” of food and where it comes from, with a strong preference for organic food, locally grown food, fresh/raw food, etc. Individuals with orthorexia may avoid foods with genetically modified ingredients (GMOs) or foods that they deem to be “overly processed,” and are more likely to use food labels such as “good/bad foods” or “clean ingredients"(5). These labels add an unhelpful layer of morality to food choices and show the ways in which some people may see “healthy eating” as a fundamental virtue (3).
Cutting out food groups. It’s not uncommon for individuals with orthorexia to cut out entire food groups from their diet, such as carbohydrates and/or gluten-containing foods or dairy products. Such foods are often eliminated due to purported health/wellness benefits or pseudoscientific “evidence” rather than true medical necessity. As noted above, food groups may also be eliminated based on perceptions that they are less nutritious, or are produced in ways that do not align with one’s standards (6,7).
Maintaining inflexible eating patterns and experiencing emotional distress around eating. Some people create food rules or have strong dietary preferences that they feel need to be maintained at all costs. In situations when food rules are broken, one may experience intense feelings of guilt, shame, self-loathing, or fear. This type of inflexibility with eating behaviors and related emotional distress is a hallmark of disordered eating and typically serves as an indicator that one’s quality of life has been impacted due to inflexibility and obsessive thoughts around food (8).
Experiencing social isolation due to preoccupation with food. Fear or anxiety around eating out at restaurants or away from home may lead to avoidance of social gatherings and subsequent isolation. Additionally, individuals with orthorexia may spend a disproportionate amount of time thinking and talking about food, shopping for food, and preparing food. As a result, they may (knowingly or unknowingly) push their true hobbies/interests to the background in order to pursue “a healthy lifestyle”(5). Individuals with orthorexia are more likely to encourage their friends/family to pursue a “healthy diet,” which may also contribute to social isolation (9).
Obsessively focusing on health status. Certain dietary/lifestyle changes may be pursued due to a belief that they will benefit health. Some people with orthorexia may constantly worry about getting sick and some may experience health anxiety. This can be accompanied by an overemphasis of the role that diet and physical activity play in one’s health, which contributes to an excessive focus on diet and exercise routines at the expense of mental health, social connections, and other important aspects of a full and vibrant life.
A Note on "Health"
While it may be tempting to want to “control” our health through various lifestyle factors, it’s important to note that there is much more to health than diet and physical activity. In reality, research demonstrates that the social determinants of health (e.g. social, economic, and environmental factors like income, access to stable housing, food security, etc.) can play a larger role in health and well-being compared to individual lifestyle factors like diet and exercise (10,11). Furthermore, the definition of “health” varies for each person and not everyone has the opportunity or desire to be "healthy.”
How to Move Forward
Orthorexia is an evolving concept with many complexities and the above list of warning signs is not meant to be exhaustive. Like any other condition, orthorexia may show up in different ways depending on each person’s unique circumstances. Any food, body, or movement-related stressors are valid and worth additional support. If this blog brought up questions or concerns for you or someone in your life, know that you are deserving of support and we are here to offer assistance as needed.
Bratman S. Health Food Junkie. Yoga Journal. Published October 1997:42-50.
Pratt VB, Hill AP, Madigan DJ. A longitudinal study of perfectionism and orthorexia in exercisers. Appetite. Published online January 2023:106455. doi:10.1016/j.appet.2023.106455
Bratman S. Orthorexia vs. theories of healthy eating. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. 2017;22(3):381-385. doi:10.1007/s40519-017-0417-6
Harrison C. The Wellness Trap. Little, Brown Spark; 2023.
Rogowska AM, Kwaśnicka A, Ochnik D. Development and Validation of the Test of Orthorexia Nervosa (TON-17). Journal of Clinical Medicine. 2021;10(8):1637. doi:10.3390/jcm10081637
Wick K. 8 Warning Signs of Orthorexia. Accessed May 20, 2023. https://www.waldeneatingdisorders.com/blog/8-warning-signs-of-orthorexia/
Warning Signs of Orthorexia Nervosa. Accessed May 20, 2023. https://centerfordiscovery.com/blog/more-orthorexia-nervosa-warning-signs/
Scarff JR. Orthorexia Nervosa: An Obsession With Healthy Eating. Federal practitioner: for the health care professionals of the VA, DoD, and PHS. 2017;34(6):36-39. https://pubmed.ncbi.nlm.nih.gov/30766283/
Varga M, Thege BK, Dukay-Szabó S, Túry F, van Furth EF. When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry. 2014;14(1). doi:10.1186/1471-244x-14-59
Kinavey H, Sturtevant D. Reclaiming Body Trust. Penguin; 2022.
World Health Organization. Social Determinants of Health. World Health Organisation. Published 2023. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1