Orthorexia: When “Healthy Eating” Isn’t So Healthy Anymore.

I would like to thank Megan Newnham (Dietetic Intern) for her collaboration on this blog post!

The Spectrum of Eating Behaviours  

Most of us have heard about eating disorders, whether or not we have been personally affected by them. But what you might not realize is that there is a broad spectrum of eating patterns. This spectrum ranges from normal eating —> to disordered eating —> to clinically diagnosed eating disorders. Orthorexia falls on this spectrum, somewhere between disordered eating and clinically diagnosed eating disorders.

Unfortunately, the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) does not formally recognize orthorexia as an eating disorder. Therefore, individuals with orthorexia cannot be officially diagnosed and no current clinical treatments exist specifically for orthorexia.

What is Orthorexia? 

Orthorexia was first coined in the late 1990’s by Dr. Steven Bratman.  

Orthorexia is defined as a pathological obsession with “healthy eating” – or whatever that individual perceives as healthy (because healthy eating is actually subjective, if you think about it). When “healthy eating” becomes an all-encompassing obsession, this is no longer healthy and can have a significant negative impact on that individual’s mental health. 

An individual with orthorexia may be fixated on consuming foods that are more “natural” or “clean” and they might follow restrictive diets, e.g. the “Whole 30” program, which calls itself the “clean eating” plan. What is clean eating?!? This is a catchy phase used by the diet industry to market their programs. It insinuates that whatever way you were eating before was considered “dirty” (this is not true). There is no such thing as “clean” eating.

Individuals with orthorexia may exclude entire food groups from their diet that they perceive to be less healthy. 

How is Orthorexia Different From Other EDs?

Unlike anorexia nervosa, in which individuals restrict how much food they are eating, individuals with orthorexia focus on the specific types of food they allow themselves to eat. Orthorexia is food restriction based on quality rather than quantity. 

A research study from the United Kingdom published in 2017 found that higher Instagram use was associated with an increased tendency of having orthorexia. They surveyed 680 social media users who were following health food accounts. Out of the study population, the prevalence of orthorexia was 49%. The research article concluded that the “healthy eating” community on Instagram has a high prevalence of orthorexia symptoms. This is something for dietitians and mental health professionals to keep in mind, in the context of eating disorder development. 

Common Signs of Orthorexia: 

• Feeling anxious about making food choices 

• Attaching moral labels to foods (e.g. good/bad)

• Following restrictive fad diets (e.g. raw food, no sugar, clean eating, veganism without ethical intentions)

• Avoiding meals prepared by others (e.g. restaurant meals)

• Spending excessive amount of time reading ingredient lists or nutrition labels 

• Excluding entire food groups from a diet (e.g. avoiding grain products)

• Linking self-esteem to dietary intake 

• Judging others based on their food choices

• Preoccupation with food that interrupts day-to-day activities and enjoyment of life 

How is Orthorexia Treated?

Although orthorexia is not formally recognized as an eating disorder in the DSM-V, individuals struggling with orthorexia can work with a team of professionals who specialize in the treatment of eating disorders. 

The three essential components of a treatment team include a medical doctor, psychologist, and a registered dietitian. One of the key strategies is exposure therapy – AKA eating the foods that are anxiety-provoking. With time, the “fear foods” become normalized, and eventually they can be eaten without feelings of anxiety or distress.  

Final Words 

It is difficult to determine when healthy eating has become a pathological obsession, because these extreme behaviours are normalized and even praised in our society. If you are struggling with any of the thoughts or behaviours listed above, I encourage you to reach out for help. 

Having a healthy relationship with food is more important than being a “perfect” eater – because perfect eating doesn’t exist! 

Thanks for reading! Have a great week :)