Healthy Eating vs. Orthorexia

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. They are simply adherents of a dietary theory. The term “orthorexia” only applies when an eating disorder develops around that theory.

I feel a need to clarify the distinction because I have recently begun to encounter news articles on orthorexia that incorrectly apply the term to people who merely follow non-mainstream theories of healthy eating. This incorrect usage is partly my fault, because in my original orthorexia essay I failed to emphasize the distinction

Another contributing factor to the confusion is that the research test used in Europe for studies of orthorexia, the ORTO-15, needs some further refinement; as currently structured, it seems to identify members of healthy eating subcultures rather than those who truly have orthorexia. (Researchers are in dialogue to remedy this.)

There even seem to be people who proudly name themselves “orthorexic” because they choose organic, whole, relatively unprocessed foods, free of preservatives, antibiotics and GMOs. I hate to disappoint you folks, but you need to follow a much more restricted diet than that have a chance at the name!

Enthusiasm for healthy eating doesn’t become “orthorexia” until a tipping point is reached and enthusiasm transforms into obsession.

Orthorexia is an emotionally disturbed, self-punishing relationship with food that involves a progressively shrinking universe of foods deemed acceptable. A gradual constriction of many other dimensions of life occurs so that thinking about healthy food can becomes the central theme of almost every moment of the day, the sword and shield against every kind of anxiety, and the primary source of self-esteem, value and meaning. This may result in social isolation, psychological disturbance and even, possibly, physical harm.

To put it another way, the search for healthy eating has become unhealthy.

 

Diet as Risk Factor

The issues of “theory of healthy diet” and orthorexia are not entirely separate, because it isn’t possible to develop orthorexia without at first adopting a theory of healthy food. However, in many ways, the specific details of the theory are irrelevant. Orthorexia = disordered eating in relationship to [insert any restrictive theory of healthy diet here, even mainstream medical theories.]

As a matter of practical fact, some theories present more risk of orthorexia than others. The more restrictive the diet, the more likely it is to set off the psychological factors that lead to an eating disorder.

The basic “clean eating” diet, which focuses on organic whole foods, free of preservatives, antibiotics and GMOs, barely qualifies as a restrictive theory of healthy eating and only occasionally leads to orthorexia. Going gluten-free is useless for most, but it’s also pretty harmless.

Similarly, the standard paleo diet is quite mild, and regardless of whether one believes the theory makes sense or not (I personally think it is quite absurd) becoming paleo seldom leads orthorexia unless further restrictions follow. Simply remember to take a gentle approach with yourself, as Neil Stephenson advises on his popular Paleoista blog.

Raw foods veganism is on the other extreme, and has a high orthorexic potential. This is a challenging diet to manage safely, and many people who will ultimately develop orthorexia begin as raw foods vegans. Nonetheless, there are also certainly many people who adopt the raw food vegan lifestyle and do not become orthorexic.

A truly extreme diet like fruitarianism is orthorexic almost by definition — it does not provide nutrition compatible with health, and in order to become a fruitarian a person must have already gone pretty far afield on the path of obsession. But with a nutritionally sound diet, what matters is not whether the theory is wrong or right, scientific or unscientific. It’s how it impacts you as a person.

People who get in trouble with theories of healthy eating often have an underlying predilection toward going overboard. As Jordan Younger writes in her excellent piece on Refinery29,  “Those of us who have a tendency toward extremes in other areas are more susceptible to developing it [orthorexia] — especially once we start cutting out entire food groups.“

To clarify, it IS possible to cut out an entire food group without being orthorexic — but a restriction so sweeping as that definitely puts one at risk.

 

The Tipping Point

Healthy diet turns into orthorexia when a boundary is crossed and a person’s relationship with food begins to impair various essential dimensions of human life. There is no bright line to mark this transition, but it can be recognized as a situation in which the search for a healthy diet has taken on a life of its own and no longer serves the goal of improving health.

Jaime A. Heidel captures this tipping point in her essay “Are you TOO Obsessed with Healthy Eating?” She began following theories of healthy eating in order to address certain personal health conditions. From a physical perspective, she found this effective. However, “somewhere along the line, my desire to keep my conditions under control developed into an obsession of the more questionable variety.”

She describes how “healthy” diet began to take over her life. “My diet became increasingly strict and I found myself feeling agitated and anxious whenever I couldn’t find organic or natural foods.“

Ultimately, she decided she should loosen up a little. “If your desire to eat healthily and avoid chronic disease begins to interfere with your daily living, social activities, and relationships, it may be time to take a step back.” Her conclusion: “While you’re in the process of improving and prolonging your life, don’t forget to live it.”

But even this advice will raise concerns for some people. In a post titled “Is Healthy Eating Doing us More Harm than Good?” popular blogger Kelly at Mummywrites says the same thing, but with a caveat: ” Life is too short to live on extreme diets, stressing about every morsel, but then life really will be short if we don’t look after ourselves!” [my italics]

Perhaps here it is worthwhile gently pointing out that the modern world is so chockful of chemicals that the trace quantity of pesticides and other chemicals in a serving of non-organic food simply doesn’t amount to disaster? The evidence suggesting potential harms caused by pesticides in food indicates at most a tiny fractional percent of an increase in the risk of health problems even when eating non-organic foods day in and day out. If you are afraid that occasionally straying off your perfect diet will give you cancer you might as well cower at home under your blankets.

A friend of mine is afraid of going to Italy because she thinks the leftover radiation from Chernobyl will kill her; in fact, the amount of radiation exposure on the plane trip to Italy is orders of magnitudes higher.

So let’s keep a sense of proportion: If you prefer to eat mostly organic, preservative- chemical- and antiobiotic-free foods (as I do!) and think that many overly processed foods are not foods at all (as I do!) it still doesn’t mean you have to follow those principles 100% of the time. That’s just perfectionism, obsession, orthorexia.

Trying to be perfect will make you crazy, in diet as elsewhere in life.

Lighten up a little. Be gentler with yourself.

To quote Jaime again: While you’re in the process of improving and prolonging your life, don’t forget to live it!

Steven Bratman, MD, MPH

 

 

 

22 thoughts on “Healthy Eating vs. Orthorexia

  1. These posts have been very helpful and informative. My 30-year old daughter has this illness….she started out as a vegetarian then a vegan then the raw foods route and now this totally “unhealthy obsession with healthy food.” Combine this with her latest fad of the cross-fit cult and there’s a lot of scary things going on… I want to help her but she doesn’t see there is a problem and of course nothing can change with that kind of thinking…it is so very sad yet I am determined to move mountains to help her.

  2. When you know someone like this how do you help them? and what would you suggest doing if there need for control extends to having their children on highly restrictive diets?
    I don’t think their health is in immediate danger, unless it gets more restrictive but I am concerned of the long term effect, they are being given the message, all day long, that their bodies are sick and need gut healing and that food makes them unwell/is dangerous. There is no deviation from protocol, and no end of the protocol insight, and it restricts their lives socially.

    1. As with most addictions, it is very difficult to effect change from without; the person has to recognize a problem and begin to seek health. When children are involved it is particularly poignant, but even harder to touch. You could try showing them “Health Food Junkies.”

  3. This has been the most helpful article I’ve read about the difference between eating healthfully vs orthorexia. I’m concerned that my teenage daughter’s healthy eating habits are becoming unhealthy as she continues to reduce the foods she deems healthy to eat. Would a nutritionist be able to help her or do you suggest seeing a psychologist? Thank you!

    1. Thank you for your kind words. I would recommend she see an eating disorders specialist who understands orthorexia. It could either be an RD or a psychologist, though even better it should be both (they are likely to work together.) But they have to understand orthorexia. If you go to someone who does not, they will likely go off in the wrong direction. I will email you separately.

      1. Hi Stephen,
        I’m also concerned about my 17 year old daughters eating habits. She eats fruits, veggies and meats but refuses and other foods. By adopting this life style she has lost 13lbs – and everyone who comes in contact with her think there is something wrong. I’m concerned and have been looking into nutritionists. Any direction you can point me into would be very appreciated! We live in the suburbs of Philadelphia, PA
        Thank you in advance,
        Kathy

  4. Great ! But yeah, Steven, could you please tell me more on what does the orthorexic’s perception on their physical body?

    1. Great question! As you know, people with anorexia have a body image distortion in which they think they are fat, no matter how much weight they have lost. People with orthorexia tend to look on their body as impure, no matter how strictly they are trying to eat foods they conceive of as pure. Just as a person with anorexia always feels a need to lose more weight, a person with orthorexia always feels a need to make their body more pure.

    1. Your story is really well-presented, and I think it will help many people. My honor to include it! Thanks also for your feedback on the article … it was helpful!

    1. Your perspective is particularly important, because a lot of people with orthorexia describe being “primed” for it by their parents’ obsessiveness with food. This was a factor in my own personal orthorexia history. It’s great that you clarify these issues for your readers!

      1. When I was a out patient RD, working with children was always difficult. Either their parents were obese, so that following any recommendations was futile, or the patients had themselves been overweight once, and so were pushing all their anxieties onto their children.
        To this day I have no idea what to tell parents with overweight children, except to move more. I fear for their mental and physical health.

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