The Troubling Rise of Orthorexia, Or When Healthy Eating Becomes an Obsession

Young woman getting having her green smoothie after training

Sandwiched between sessions on reducing cardiovascular disease risk, boosting brain health and treating childhood obesity at the recent Food and Nutrition Conference and Expo in Boston, was a different type of presentation about the harms of taking healthy eating to an extreme – and the room was packed.

In a cavernous convention hall, an estimated 4,000 registered dietitians listened intently to three experts discuss orthorexia nervosa, a term coined by one of the panelists Dr. Steven Bratman to describe an unhealthy obsession with healthy eating. The condition, not yet classified as a full-fledged eating disorder (although Bratman has proposed diagnostic criteria), is increasingly on the radar of health care professionals. It clearly struck a chord with the audience.

During the 90-minute panel, the topic was trending on Twitter, and it became one of the most talked about sessions at the conference.  Orthorexia was the topic of my latest column for U.S. News & World Report  How To Tell if You Have Orthorexia.  And I’ve been thrilled to see it get picked up by Yahoo,  MSN and SmartBrief.

The condition differs from anorexia nervosa, in which people’s distorted self-image causes them to severely restrict calories for fear of becoming fat . With orthorexia nervosa, or more commonly referred to as simply “orthorexia” (“ortho” means right; “orexia” means  hunger), the goal isn’t necessarily thinness, but a desire to be pure, clean and healthy. In his presentation, Bratman described orthorexia as a “disease in search of a virtue.”

It’s about good intentions that have gone too far. It’s when a desire to eat right totally takes over someone’s life – leading to anxiety, guilt, self-judgment and often social isolation.

“Your identity should not depend on you being the healthiest eater in the room,” said co-panelist Marci Evans, a registered dietitian, eating disorders specialist and body image expert who owns a private practice in Cambridge, Massachusetts.  The third panelist was Jessica Setnick, a registered dietitian and eating disorders expert in Dallas, Texas.


Jessica Setnick, Steven Bratman, Marci Evans

“Unfortunately, it’s become socially acceptable to be obsessive about food,” Evans told me for my U.S. News article.

So why are we seeing a rise in orthorexia?  Many factors are at play.  First, there’s no shortage of trendy wellness bloggers who espouse an “eat like me, look like me” approach.  I’ve written about this issue in the past.  Just because certain bloggers are photogenic and have a large Instagram following, it does not mean they’re doling out good advice.  So often their focus is on what to avoid.  Or they make it seem like there’s only a very narrow range of foods that are permitted if you want to “eat clean.”

Evans said people’s tendency to bucket foods into good and bad categories – and their eating into good and bad days – may be adding to the problem. Even our society’s laser-focus on health without emphasizing the pleasures and enjoyment of food, and the hero-worshipping of certain “miracle” foods, are contributing factors , too.

Of course, just because you’ve decided to become vegan, go paleo, try a detox cleanse or follow a strict eating regimen, doesn’t mean you have orthorexia.  The problem is when your eating becomes increasingly restrictive and it starts to negatively impact your self-worth, happiness and well-being.

If you’re wondering if your healthy eating has become unhealthy, Evans suggests asking yourself these questions:

  • Are you spending more time thinking about your food choices than you wish you were?
  • Do you find that the main barometer of how you feel about yourself on any given day is based on how you’ve eaten?
  • Do you tend to demonize certain foods and think you cannot eat the foods you enjoy?
  • Are you flooded with anxiety, shame, guilt or negative physical sensations when you eat something that is not on your list of permitted foods?
  • Do you feel like your eating has become compulsive instead of an active choice?
  • Are you increasingly eliminating more foods and adding to your list of food rules to try and achieve the same health benefit?
  • As you cut out more foods and try to eat healthier, has your fear of disease gotten worse?
  • Does your eating regimen make it hard for you to interact with friends, family or colleagues?
  • Are you likely to stay home from a social event over a fear of what type of food would be served?
  • Is your eating adding to your overall stress?
  • Has a medical professional told you that you’re experiencing negative health symptoms because of your strict diet?

If you answered yes to any of these questions, it may be a red flag. Evans recommends reaching out to a registered dietitian – and potentially a mental health counselor – so you can be evaluated for orthorexia. Your food choices should not be a reflection of your morality or value, she says. A registered dietitian can help reduce these food fears and create an approach to eating that is flexible, less rigid and pleasurable.


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