We live in a wellness-obsessed culture. Dieting is commonplace, strenuous exercise is a way of life for many people, and it’s not uncommon to spend lots of time and money “eating clean” or “detoxing.” But just because these things are popular, doesn’t make them healthy or worthwhile. Orthorexia is a type of disordered eating that can seriously impact your quality of life.
As a dietitian who helps clients overcome orthorexia, I’m all too familiar with how insidious this particular disorder can be. And as someone who has lived with orthorexia in the past, I know how hard it is to even recognize your own orthorexic tendencies in the first place. Here, I’ll answer a few common questions: What is orthorexia? How do I know if I have orthorexia? (Hint, there’s an orthorexia quiz for that!) How can I work towards orthorexia recovery? What does a healthy relationship with food actually look like?
What is orthorexia?
Orthorexia is characterized by an unhealthy and disruptive obsession with “healthy” or “clean” eating. While it’s not recognized by the current Diagnostic and Statistical Manual (DSM5), many experts consider it an eating disorder. Unfortunately, because dieting and food restriction are so normalized (even praised!) in our culture, orthorexia can be tough to spot.
Someone with orthorexia fixates not just on the quantity of food they eat (like a traditional dieter), but also on its perceived quality. Typically, they severely restrict or eliminate food groups or types of food (i.e. dairy, sugar, processed food, gluten-containing food). This very limited way of eating becomes a fixation, something they put lots of time and energy into. Ultimately, it leads to a worsened quality of life overall.
Where does the term come from?
The term was coined in 1997 by physician Stephen Bratman, MD, who first used it in an article for Yoga Journal. Since then, it’s made its way into the mainstream. It comes from two Greek words: “orthos” (which means “right”) and “rexia” (which means “hunger”). So, it translates to “righteous hunger.” Usually, it manifests as extreme “clean eating,” or an obsession with only eating foods that someone deems “natural” or “pure.” Of course, there’s no standard definition or understanding of what this actually means. Typically, that leads people to become more and more restrictive about their food intake over time.
Many eating disorder experts, myself included, treat it as a unique type of eating disorder or disordered eating. While it might manifest alongside another eating disorder, like anorexia nervosa or bulimia nervosa, orthorexia is specific. Someone with orthorexia is primarily obsessed with “healthy” eating and fixates on only eating foods that are “clean” or “healthy.” Unlike with many other eating disorders, they may not be fixated on weight and body image (although often, they are).
How does clean eating lead to orthorexia?
For many of my clients with orthorexia, things started out with a seemingly innocent interest in “clean eating.” (I always, always put this term in quotes. There’s really no such thing as “eating clean,” unless you’re referring to washing dirt off of your food.) I relate to this, too. Early in my career as a journalist and recipe developer, I wrote “clean eating” meal plans that now make me cringe.
“Clean eating” is all about avoiding foods that are processed and therefore deemed “bad” or unhealthy. But usually, it doesn’t stop there. “Clean” eaters might also start excluding:
– Gluten, a naturally occurring protein found in wheat and some other grains)
– Sugar and other sweeteners, all of which are derived from plants, although their level of processing varies
– Dairy, which comes naturally from animals and is often minimally processed (pasteurized milk, cream, butter, most cheeses)
– Grains, which in their whole grain forms are barely processed
….and so much more
Plus, there’s lots of grey area in the “clean eating” realm about what types of processed foods are OK. For example, many “clean eaters” avoid packaged snacks like crackers and cereal, but are fine eating packaged snacks that market themselves as “clean,” like RXBars and beef jerky. It’s also common to avoid processed grain foods like whole wheat bread, which is full of nutrients, but be perfectly fine with supplement powders that have been made in a lab and undergo no formal testing. In other words, it doesn’t quite make sense.
For many people, “clean eating” turns into an incredibly restrictive diet that includes mostly fruits, vegetables, meats, nuts, and seeds. Is it possible to get adequate nutrients this way? Yes. But it’s extremely expensive, time-consuming, and isolating. It’s nearly impossible to eat out when you eat this way, and convenience foods are hard to come by.
This is where “clean eating” becomes orthorexia. When you’re forgoing most foods, skipping out on dinner invitations, and obsessing about cooking everything from scratch. At this point, you’re probably moralizing food as “good” or “bad,” and internalizing those judgements when you eat certain foods.
How do I know if I have orthorexia?
Because an obsession with health and wellness is normalized in our culture, many people struggle with orthorexia without realizing that it’s a legitimate, treatable problem. Often, clients come to me thinking that their problem is binge eating or constantly thinking about food, when in fact the root cause of these things is orthorexia.
It’s important to note here that you don’t need a quiz to tell you whether or not you have a problem. If food and eating are extremely stressful for you, or if you’re constantly obsessing about food and weight, it’s a good idea to seek help. A qualified therapist can help you work through any trauma that you have around food. And a dietitian who specializes in eating disorders and non-diet nutrition can help you heal your relationship with food. (You can read more about my nutrition counseling services here.)
The orthorexia quiz.
If you’re looking for a quick way to know if the struggle you’re experiencing is orthorexia, there’s a quiz that can help guide you.
In his book Health Food Junkies, Bratman outlined a 10-question test for orthorexia, based on his experiences as a clinician. It’s simple to take: Just pull out a piece of paper and write “yes” or “no” to the questions below:
Do you spend more than 3 hours a day thinking about your diet?
Do you plan your meals several days ahead?
Is the nutritional value of your meal more important than the pleasure of eating it?
Has the quality of your life decreased as the quality of your diet has increased?
Have you become stricter with yourself lately?
Does your self-esteem get a boost from eating healthily?
Have you given up foods you used to enjoy in order to eat the ‘right’ foods?
Does your diet make it difficult for you to eat out, distancing you from family and friends?
Do you feel guilty when you stray from your diet?
Do you feel at peace with yourself and in total control when you eat healthily?
To score the Bratman Orthorexia Test:
According to Bratman, answering “yes” to four or five of the above questions means that you may have orthorexia nervosa, and that you should try to improve your relationship with food.
Answering “yes” to six or more means that you’re almost certainly struggling with orthorexia and an obsession with healthy eating.
Again, I’ll reiterate that you don’t need a quiz to prove that you’re struggling. If you feel obsessed with food and your body, it’s time to seek help.
What are the signs and symptoms of orthorexia?
It can also be helpful to understand a bit more about the signs and symptoms of orthorexia. Learning how and why the below symptoms might signal orthorexia can help you spot it in yourself or someone close to you.
1. Fixating on the quality or “cleanliness” of food
This is the key feature of orthorexia. A fixation on the quality of your food becomes obsessive. You might only eat organic, local, and “whole” foods. You might only eat things that are raw or vegan. Generally, this perceived quality is more important than how much you eat.
2. No flexibility in your eating habits
In the case of orthorexia, people are generally completely rigid about their food rules. You might go out of your way to avoid “bad” foods, going as far as avoiding restaurants or social gatherings, and making all of your food from scratch.
3. Extreme feelings of guilt
If someone with orthorexia eats something that doesn’t meet their standards of quality, they’ll probably feel incredibly guilty. They might experience extreme shame, and believe that they’re a “bad” or “weak” person because they ate a “bad” food. Or, they might think of themselves as an “emotional eater.” Someone who prioritizes nutrition but doesn’t struggle with orthorexia would be able to eat a Krispy Kreme donut (or any other food deemed “bad”) and move on. Someone with orthorexia would likely feel guilty for a long time afterwards, and might try to “repent” somehow (through exercise, or a “detox). They might even experience some depression.
4. Anxiety in the presence of “bad” foods
Often, people with orthorexia not only experience guilt after eating a “bad” food. They might also feel guilty or anxious just being around it. If you get anxious or uncomfortable when you’re around food that you deem “bad,” that’s a pretty clear sign of orthorexia
5. Eliminating entire food groups
There’s no definition of what “clean” or “pure” food actually is, which means that orthorexic eating habits vary from person to person. But often, orthorexia includes eliminating entire food groups. It’s common for people with orthorexia to eliminate gluten, grains, dairy, processed foods, sugar, preservatives, and meat.
5. Constant health anxiety
Orthorexia usually extends beyond just anxiety about food. Because those with orthorexia tend to buy into the myth that food is the end-all, be-all when it comes to health and disease, they’re often incredibly worried about their own health. They might believe that a single slip-up in their rigid food behaviors might lead to disease.
6. Weight loss
Orthorexia can exist without weight loss, since it’s more about the quality of food than the quantity. But often, weight loss is a side effect. Someone’s eating habits may become so restrictive that they lose significant weight and/or become malnourished.
How to start recovering from orthorexia
As is the case for all types of eating disorders, orthorexia recovery can be difficult, and it will take time. The first step is recognizing that your obsession with “healthy eating” is not healthy. The second step is reaching out for help.
In my nutrition counseling for orthorexia, I work with clients to figure out where their orthorexic beliefs come from. We talk about what they hoped to gain from their rigid eating habits. We even talk about the ways that they might have benefited from these rigid eating habits in the past. Then, we take a look at all the ways that these extreme beliefs around food have been (and continue to be) harmful. While orthorexia ultimately harms you and diminishes your quality of life, you no doubt had reasons for starting down this path. Getting a full picture of how your disordered behaviors and beliefs took shape is crucial.
Once you understand and accept how and why your eating disorder came to be, you can start working towards a healthier relationship with food.
What does a healthy relationship with food actually look like?
Some people call it intuitive eating. Others call it food freedom. Many people simply refer to it as food peace. Ultimately, all of these philosophies describe a state in which you’re able to nourish your body without constantly worrying about food.
If you’d like to learn more about intuitive eating, I outline the 10 principles here. If you’re trying to stop obsessing about food but don’t know where to start, here are some actionable steps to take. Since body acceptance is also key to recovery, I also recommend learning more about it here.
To overcome orthorexia, you must start challenging your own internalized food rules. Realize that the things you’ve been led to believe about food — that “bad” foods will ruin your health and “good” ones make you superior — are false, and harmful. Start eating regular meals and snacks, and expand the variety of foods that you eat.
If you’re struggling with orthorexia, I can help. I’m a dietitian who specializes in eating disorders and disordered eating. I take a weight-inclusive, gender-affirming, patient-centered approach. Learn more about my nutrition counseling, offered to clients in several states. If you’re not ready to commit to counseling but want more information about the anti-diet approach, subscribe to my weekly newsletter.