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Orthorexia: When Does Healthy Eating Become Too Much?

By Amber Young MS, RD, LDN

It’s no secret that eating a healthy diet is highly valued and emphasized in our society. Making gentle dietary modifications to assist in managing a chronic health condition or improve sports performance are just a few ways eating healthy can have an impact on our lives. But when does this begin to become a problem? Many are familiar with serious eating disorders such as anorexia nervosa or bulimia nervosa, both diagnoses in the Diagnostic and Statistical Manual of

Mental Disorders (DSM-V) from the American Psychiatric Association (APA); but most haven’t heard of orthorexia nervosa, another prevalent eating disorder.


In this blog post, we take a deep dive into what this eating disorder is, warning signs and symptoms, and how to treat the condition. Let’s get started!



What is Orthorexia?


The term orthorexia came about in the late 1990’s and is defined as “an obsession with proper or ‘healthful’ eating.” This disorder stems from a preoccupation with eating foods deemed as pure or of high-quality forms, and fuels the individual’s obsession with being “healthy.” This fixation begins to interfere with the individual's life: increasing stress and anxiety around meals; excluding important nutrients in the diet; and compromising their overall mental and physical well-being.


Orthorexia can often start with a seemingly harmless diet and intentions to lead a healthier lifestyle, but can rapidly escalate into a much larger problem. Over time, the “dieter” may receive praise from others for their discipline or healthy eating habits which may fuel the restriction further. It is common to see a decrease in energy intake and variety over time as the list of “acceptable” foods begins to dwindle. This can put the individual at risk for malnutrition, nutritional deficiencies, decreased metabolic function, slowed digestion, and higher risk of mortality. Individuals with orthorexia experience a decreased quality of life as their relationship with food begins to interrupt other aspects of their life. For example, they may find that they are no longer able to enjoy their favorite restaurant on a night out or attend a friend’s birthday party due to the anxiety of not feeling able to eat the food available.


Warning Signs & Symptoms

According to NEDA.org, orthorexia is typically accompanied by the following warning signs and symptoms:

Compulsive checking of ingredient lists and nutritional labels

Increased concern about the health of ingredients

Cutting out an increasing number of food groups (all sugar, all carbs, all meat etc.)

An inability to eat anything but a narrow group of foods that are deemed “healthy”

Following a strict, increasingly restrictive diet

Decreased variety of foods eaten

Unusual interest in the health of what others are eating

Spending hours per day thinking about what food might be served at upcoming events

Showing high levels of distress when “safe” or “healthy” foods aren’t available

Obsessive following of food and “healthy lifestyle” accounts on social media

Weight loss



How Common is Orthorexia?


Since orthorexia is not yet an official diagnosis in the DSM-V, there aren’t formal diagnostic criteria, which can make it challenging to diagnose. Unfortunately, to the untrained eye, individuals with orthorexia may not receive a diagnosis as it often gets mislabeled as “healthy or disciplined eating.” Because of this, it is difficult to collect accurate statistics. However, studies published in the peer-reviewed journal Eating and Weight Disorders in 2011 found that rates of orthorexia may be twice as high among women as among men, and estimated that between 21% – 57.6% of the general population have eating behaviors that are characteristic of orthorexia.


Nutrition HealthWorks & Treating Orthorexia


To date, there aren’t any evidence-based treatments for orthorexia, but many eating disorder clinicians have found that individuals respond well to Exposure and Response Prevention (ERP), which involves repeated exposures to avoided foods to slowly expand food preferences and return to a more balanced eating pattern. Since some behaviors and compulsions of orthorexia can resemble characteristics of anorexia and obsessive-compulsive disorder (OCD), a combination of treatment modalities may be preferred.


When seeking treatment for orthorexia or any eating disorder, it is important to work with a treatment team consisting of an eating disorder informed physician, therapist, and dietitian. Meeting with a skilled dietitian is a great first step to getting help and they can assist you in the process of forming a treatment team. Recovery is possible and you deserve a life outside of your eating disorder. If you feel you have orthorexia or are suffering from another eating disorder, the skilled dietitians at Nutrition HealthWorks have the team available to help you on your wellness journey. Our staff will help you regain confidence in your eating habits, allowing you to live a healthy lifestyle that lets you look and feel your best. Get in touch with our team to schedule an appointment with our dietitians today.



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