Orthorexia: When a Commitment to Healthy Eating Goes Too Far

Strict "food rules" can have negative consequences

Orthorexia: When a Commitment to Healthy Eating Goes Too Far

Turning down the donuts a coworker brings to the office and packing a salad for lunch every day demonstrate a solid commitment to healthy eating. Right? Yes, of course. But if even the sight of those donuts causes anxiety, and if eating that salad for lunch becomes an obsessive behavior that causes someone to skip social or work events where there may be other kinds of food, something else might be going on.

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In recent years, psychologists have recognized that people can become overly fixated on healthy eating, to the point where it could become detrimental to their well-being. A new term has emerged for this behavior: Orthorexia nervosa – literally meaning “proper appetite” – describes a pathological obsession with eating “clean” or “healthy” food.

People with orthorexia engage in restrictive or ritualized eating behaviors and avoid certain foods that don’t fall within their definition of “clean” or “healthy.” These diets can be so strict that they impact the physical or mental health of the people who follow them.

An emerging concept

Orthorexia isn’t on the official list of eating disorders and other mental illnesses that psychologists use to make a diagnosis (the Diagnostic and Statistical Manual of Mental Disorders). And there hasn’t been much scientific research on it, especially in the U.S.

But the National Eating Disorders Association has addressed it, and experts like psychologist Kasey Goodpaster, PhD, say the conversation has been building over recent years. “The obsession with healthy or ‘clean’ eating seems to be another manifestation of our ‘diet culture’ in which there is a heavy emphasis on thinness often masked by a desire for health,” Dr. Goodpaster says.

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What exactly is orthorexia?

Orthorexia isn’t just someone who follows a strict vegan diet for ethical reasons or eats gluten-free because it makes them feel better. It’s someone who obsessively follows rules they’ve created about which foods are pure and healthy and which are not. They may also experience feelings of guilt and anxiety associated with foods that don’t fit their rules.

These behaviors share many characteristics with the eating disorder anorexia, like restriction, rigidity and perfectionism, according to Dr. Goodpaster. But orthorexia is more focused on the quality of food, rather than the quantity of food intake.

Since it’s not an official eating disorder, it’s hard to state where exactly the line is drawn. But Dr. Goodpaster explains that the line between a commitment to healthy eating and orthorexia really lies with the ability – or not – to practice moderation, and whether the drive to eat healthily creates distress.

“Eating is so complex that it is downright impossible to be perfect,” she says. “A more sustainable, healthy lifestyle comes from recognizing that deviating from intentions to eat in a particular manner is completely normal and not a sign of personal failure.”

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Why is orthorexia dangerous?

For starters, eliminating entire food groups could cause malnutrition. It could also lead to overeating. “When entire food groups such as sugar are completely eliminated, cravings increase, and when restraint is inevitably broken during a time of stress or change, the guilt and shame can be intense, possibly prompting overeating,” Dr. Goodpaster says.

There’s also a social component. Sharing meals is a universal way that we humans spend quality time with each other, so adhering to stringent eating rules with no flexibility can cause social isolation and emotional distress. Dr. Goodpaster adds that it can also have an impact on a person’s quality of life due to the extreme amount of time spent thinking about and preparing “clean” foods.

Since it’s not yet recognized as an eating disorder, there are no clinical treatments specifically for orthorexia, but experts say that its similarities to anorexia or obsessive compulsive disorder might make psychotherapy a good option.

“The media’s interest in this area might prompt more research, which is much needed before orthorexia could become included in the DSM,” Dr. Goodpaster says.

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