Orthorexia Nervosa: The Obsession With Healthy Eating

Eating Disorders

Jun 4

Written By Anna S.

It’s important we care about what we put in our bodies. At the end of the day, we all want to be healthy, right?

But what happens when the desire to be healthy turns into an obsession with so-called “healthy” and “clean” eating? What if the idea of eating something “unhealthy” makes you so anxious that you would rather spend hours upon hours in the kitchen, meal-prepping food for days and days to come? What if the desire for “clean eating” starts consuming your every thought and stops you from enjoying time with your friends and loved ones?

Note: Please keep in mind that I am not a dietitian, and I’ve used different resources when researching this article and the podcast episode. All resources all linked at the end of this article.

What is Orthorexia?

The term "orthorexia nervosa" was first introduced by Steven Bratman in the Yoga Journal article back in 1997.

If you're wondering what the term "orthorexia" actually means (like me), the word "orthorexia" comes from the Greek word "ortho," meaning "correct," and "orexis," meaning "appetite".

Jonathan R. Scarff defines orthorexia as “an obsession with healthy eating with associated restrictive behaviors" in the Orthorexia Nervosa: An Obsession With Healthy Eating article.

An article on orthorexia at BeatEatingDisorders.org.uk refers to orthorexia as an "unhealthy obsession with eating "pure" food. Food considered "pure" or "impure" can vary from person to person."

Generally speaking, orthorexia nervosa is an unhealthy obsession with healthy food.

However, orthorexia nervosa isn't recognized as a separate eating disorder. It is classified as an unspecified feeding and eating disorder in the Diagnostic and Statistical Manual of Mental Disorders 5th edition, also known as the (DSM-5).

The DSM-5 is a diagnostic tool published by the American Psychiatric Association used as a guide to diagnosing mental disorders, including eating disorders.

So, what does it mean in practice that orthorexia isn't recognized as a separate eating disorder? It means you can't get officially diagnosed with orthorexia, and there also isn't any official set of criteria for diagnosing orthorexia.

But that doesn't mean that orthorexia isn't a problem, and it doesn't mean it's not something that people suffer from. Orthorexia surely is a form of disordered eating.

When trying to take a closer look at the prevalence of orthorexia among the population, it's not clear how many people suffer from it. An article in TheRecoveryVillage.com from 2023 estimates the prevalence is somewhere between 1-7%. That’s quite a broad range that may not reflect the reality - mostly because orthorexia nervosa isn't a separately recognized eating disorder; therefore, it cannot be diagnosed and tracked.

Glass of smoothie — Photography by: Element5 Digital: https://www.pexels.com/cs-cz/foto/775030/

Signs and Symptoms of Orthorexia

Let's take a closer look at some of the symptoms of orthorexia nervosa - just keep in mind that there isn't any officially approved list of criteria and symptoms.

Based on an article in Institute for Optimum Health, orthorexia nervosa often starts as a desire to cut out foods from your diet that you consider unhealthy. Those foods can be highly processed foods, sugar, fried foods, etc.

But what may start as a desire to improve your health may quickly turn into an obsession with so-called "clean" food, gradually cutting out more and more food groups.

Some of the signs that are typical for people suffering from orthorexia nervosa are:

paying too much attention to nutritional value and the quality of food one consumes
obsessing about the relationship and consequences of eating food and its direct impact on your health
fixation on health, purity of food, and eating "clean"
excluding certain foods and food groups from your diet, which can lead to a lack of nutrients, drastic weight loss, and other health-related problems
a significant amount of time spent thinking about food, planning food, and preparing food
avoiding social situations and avoiding eating out because one wouldn't have control over how the food was prepared
labeling food as "good," "healthy," and "clean" versus "unhealthy"
feelings of distress and anxiety when the "healthy" food option isn't available (for example, at a family gathering or other social event)
following a set of strict rules; breaking those rules can cause distress and anxiety
food rules have a direct link to one’s self-esteem; breaking those rules can have a negative impact on one's self-esteem
increased consumption of supplements; including cleanses, detoxes, and fasting into one's routine
desire to prevent diseases by eating "clean"

Some of those signs you just read aren't wrong in and of themselves. Meal prepping, for example, is an important part of many people’s routines, and there’s absolutely nothing wrong with that. The problem appears when food becomes an obsession controlling your life.

What's also interesting to mention is that unlike anorexia nervosa or binge eating disorder, the primary focus of orthorexia nervosa isn't on the quantity of food but on the quality of it. Similarly, weight loss often isn't the main motivator for people jumping on the “clean eating “train, but it’s rather a consequence of malnutrition and cutting out food groups from their diet.

Consequences of Orthorexia

Orthorexia, like any other form of disordered eating or an eating disorder, stops you from enjoying your life and living your life in the way that you want.

From the health-impact perspective, it's quite a paradox that the desire to be as healthy as possible can actually lead to the decline of your health - mostly due to cutting out foods and food groups from your diet, not having diversity in your diet, and therefore lacking important nutrients.

Orthorexia can also lead to a dangerous drastic weight loss due to the lack of nutrients and as a consequence of following strict diet rules. Orthorexia can potentially contribute to developing an eating disorder.

Besides physical health, orthorexia has a significant impact on our mental health as well:

one’s diet is about following very strict rules, obsessing over the idea of "healthy," "pure,” and “clean eating"
one is spending so much time thinking about food, worrying about food, and preparing food that they may not have enough time for other activities and focus on other areas of their life
people suffering from orthorexia often avoid eating out, going out with family and friends because they’re scared they won't be able to eat the "healthy" option
one’s self-esteem is directly affected by how well they’re sticking to the strict rules
someone suffering from orthorexia who has tendencies for perfectionism may see restrictions as a form of self-discipline
labeling food as good and as bad, which can contribute to restricting the "bad" food, which can lead to binge eating
eating food from the "bad" category makes people feel "bad" about themselves

All of that contributes to reduced quality of life, continuous stress, and anxiety about food.

There's nothing wrong with caring about what you eat and being mindful of the ingredients in the food you eat. But it should never limit us or stop us from living content lives; we shouldn't become victims of food rules and restrictions.

Healthy baked food — Photography by: Annelies Brouw z Pexels: https://www.pexels.com/cs-cz/foto/jidlo-drevo-cukr-cokolada-3065512/

Tools for Identifying Orthorexia

There are no universally accepted and agreed-upon diagnostic criteria for orthorexia, but since 1997, when orthorexia nervosa was first described, there have been multiple attempts throughout the years to create tools that would help with recognizing orthorexia.

Probably the most well-known tool is called the Bratman test, created by Steven Bratman, who was the first to describe orthorexia nervosa.

The Bratman test was created in the year 2000 in the USA, and it’s a set of 10 Yes/No questions serving as a self-assessment tool that can help you understand wether you might be suffering from orthorexia nervosa.

The test includes questions like:

Do you spend more than 3 hours a day thinking about your diet?
Do you plan your meals several days ahead?
Has the quality of your life decreased as the quality of your diet has increased?

Depending on how many of those questions you answered Yes to, the higher the chance you might be struggling with orthorexia.

Another diagnostic tool, which is based on the Bratman test, is called the Orto-15 questionnaire, created by Donini and others in 2005 in Italy. It’s a set of 15 questions, where eating habits are sorted by 3 main factors - rational, clinical, and emotional factors.

Another tool called the Eating Habits Questionnaire was created in 2003 but wasn't published until 2013. It has 21 questions that are scored using a 4-point scale. Similarly, the Orthorexia Nervosa Inventory, tool created in 2020, is a questionnaire of 24 questions using a scale from 1 to 4 for rating each question.

If you’d like to learn more about the tools designed for recognizing orthorexia nervosa, I’d suggest checking an article published in the International Journal of Environmental Research and Public Health in 2021 called Prevalence of Orthorexia Nervosa and Its Diagnostic Tools—A Literature Review by Antoni Niedzielski and Natalia Kaźmierczak-Wojtaś.

How Orthorexia Is Treated

There is currently no standard clinical treatment plan when it comes to orthorexia nervosa. Based on an article in the National Alliance for Eating Disorders, the treatment of orthorexia is usually a “combination of psychological treatment, mindfulness training, and nutritional education.”

But like in the case of dealing with any other problem, the very first step is to realize and admit to oneself that one might be struggling with orthorexia. That may not be that easy to do as most people are interested in what they feed their bodies with, and we all know that health is important.

Therefore, we have to be very honest with ourselves to determine when the boundary between being mindful of what ingredients food has and what we eat and obsessing about healthy and clean eating has been crossed.

Let's not forget we live in a society that, in a way, glamorizes and praises weight loss and "clean" eating.

We are more and more exposed to different marketing messaging like "clean food," "healthy and diet-friendly recipes," cleanses, and different "-free" diets, e,g, sugar-free, dairy-free, etc. When someone struggles with food allergy or intolerance, there’s no doubt that they have to follow a certain type of diet that their doctor has recommended to them. But the problem is, oftentimes, we see people jumping on a trend of diet solely because they believe they'll be healthier or they’ll lose weight.
Please note that nobody should feel guilty for eating. Nobody should feel like they and their life are controlled by food - whether the "healthy" food or any other food. Everybody should have a chance to live life at peace with their body and mind.

Thank you for reading. 🩷