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

Dr. Steven Bratman coined the term orthorexia (“right appetite”) more than two decades ago to describe what happens when health-conscious diets go too far.

Although it still hasn’t been accepted as an official medical diagnosis, orthorexia nervosa is a proposed eating disorder that involves an extreme obsession with eating a “correct” diet. People with orthorexia nervosa strive to eat only foods they consider healthy and strictly avoid foods they deem to be unhealthy or impure. Their obsession with eating a healthy diet takes over their lives, eventually impairing their mental, social, and even physical well-being.

The topic of orthorexia is controversial within health circles. On the surface, it can be hard to distinguish between folks who are simply health-conscious and those who have crossed the line into disordered eating. Any diet—even relatively mainstream ones like Mediterranean or paleo—could veer into orthorexia depending on the individual.

People who raise concerns about orthorexia often get accused of “fit-shaming.” Then the straw man arguments begin: “Oh, so I guess it’s healthier just to eat Twinkies and Big Macs, then?” No, obviously not. Orthorexia starts with food rules or following diets, but it’s much more than that.

To be clear: Wanting to be healthy is not orthorexic. Neither is believing that some foods are healthier or more nutritious than others. Cutting out certain foods, tracking macronutrients, or following a specific diet is not inherently problematic.

However, those behaviors can be stepping stones to orthorexia, so this is a conversation we need to be willing to have.

What is Orthorexia Nervosa?

Orthorexia nervosa is a preoccupation with healthy eating that ultimately interferes with health and well-being.

The first stage involves setting rules and restrictions around what foods you will and will not eat. Specific rules vary from person to person. An individual might avoid gluten, food additives, GMOs, dairy, animal products, nightshades, sugar, artificial sweeteners, grains, or whatever they deem to be unhealthy.

Before you get defensive, understand that food rules are only step one. They are necessary but not sufficient for developing orthorexia nervosa. Many people follow set diets or restrict certain food groups without developing orthorexia. Diet behaviors don’t cross the line into orthorexia nervosa until they start to interfere with quality of life.

Definition of Orthorexia Nervosa

Eating disorders and other mental health disorders each have a set of diagnostic criteria. These are like checklists that help doctors and therapists decide when a particular diagnosis is warranted. Currently, orthorexia nervosa is not recognized as an eating disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). That means there are no agreed-upon diagnostic criteria.

Nevertheless, researchers and practitioners need to be able to differentiate an ardent healthy-eating enthusiast from someone who has crossed the line into disordered eating. Experts have proposed various ways of defining orthorexia nervosa.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340368/‘>² Perfectionism and narcissism may also contribute to orthorexic tendencies.https://pubmed.ncbi.nlm.nih.gov/27756637/‘>⁴ More research is needed in each of these areas.

It’s not clear whether orthorexia nervosa is related to gender, age, or BMI.https://pubmed.ncbi.nlm.nih.gov/26724459/‘>⁶ 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.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0219609‘>⁸ 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.https://etd.ohiolink.edu/apexprod/rws_olink/r/1501/10?clear=10&p10_accession_num=kent1585488932218267‘>¹⁰

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. People 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.

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