February 27, 2020

Orthorexia: Are You Taking Healthy Eating Too Far?

Girl holding apple

Whether it’s cutting back on red meat or limiting processed foods, there’s usually nothing wrong with improving your diet. But when that effort goes too far — when you become so fixated on clean or healthy eating that it affects your well-being and day-to-day functioning — you may have a condition called orthorexia.

“Orthorexia is an unhealthy obsession with healthy eating, which is unique since we all should strive to eat healthy, but at what point does healthy eating turn into an unhealthy relationship with food?” said Andrea Branton, RD, LDN, CSP, a Pediatric Outpatient Dietitian with Mission Children’s Hospital. “Teenagers often are seeking out that perfect diet, not only for health, but for weight control. When your teen starts changing their diet you are likely to be motivating and pleased with their new way of eating.”

Though not officially recognized as a psychiatric diagnosis, orthorexia is a serious disorder that needs professional treatment. As it progresses, it can lead to physical and mental health problems including malnutrition, calorie deficits and anxiety. In worst-case scenarios, it may even become life-threatening.

Understanding Orthorexia

Orthorexia is a relatively new term, coined in the late 1990s. Though awareness of the disorder is growing, there isn’t as much research on it compared to well-known eating disorders, such as anorexia or bulimia. As a result, we’re not sure exactly how many people have orthorexia, for instance, and there aren’t formal guidelines for the diagnosis or a universally shared definition for the condition.

“It may start out as a basic attempt to eat healthy, but can quickly become a fixation on food,” said Branton. Many healthcare providers, however, share a basic understanding of the disorder: People with orthorexia are wholly obsessed with eating foods they consider to be clean, healthy or pure — often, to an unhealthy extent.

“It becomes more concerning if the teen’s self-esteem is tied up in this way of eating to which they may even start to deny themselves food or restrict even healthy foods,” said Branton. “Orthorexia is about correct eating instead of without eating like anorexia. It is a hyper focus on quality of food, not quantity.”

Parental influence can also affect a teens eating behaviors, beliefs and choices. “If the parent hyper focuses on healthy eating and shames or becomes overly obsessed with the food choices of their children/teens then this may in fact start to affect the child’s view on what is healthy,” said Branton.

Often, to maintain a “pure” diet, people with orthorexia severely limit the variety of foods that they eat. They may restrict themselves to raw, local, organic or unprocessed goods, for example, or exclude refined grains, gluten, soy, specific foods or even entire food groups, such as dairy and meat. Doing this can make them feel virtuous and even provide an initial boost to their self-esteem, but it can also lead to a fear of eating certain items.

Warning Signs of Orthorexia

Since there’s no official criteria for diagnosing orthorexia, pinpointing it comes down to recognizing when clean eating morphs into an unhealthy obsession. The following behaviors may be symptoms:

  • Fixating on ingredients, nutrition labels and the content of food in general
  • Spending significant time each day reading, researching, planning and thinking about how, when and what you’re going to eat
  • Avoiding more and more foods because you consider them to be unhealthy
  • Continuously narrowing the number of foods you consider to be healthy or pure
  • Rejecting food at restaurants or social gatherings, or other foods that you did not prepare yourself
  • Becoming anxious when healthy or “acceptable” foods are unavailable
  • Feeling extreme guilt or stress after eating foods classified as unhealthy or impure

It’s Not the Same as Anorexia

These symptoms share similarities to those associated with anorexia nervosa, an eating disorder that causes people to have a distorted view of their body and an intense fear of gaining weight. People with anorexia do not eat enough to maintain health, restricting their caloric intake and eliminating entire food groups or limiting their diet to a few acceptable, low-calorie foods.

But there are key differences. While those with anorexia focus on limiting the quantity of food that they eat, people with orthorexia focus on the quality of their food, restricting their diet to only the foods that they deem “pure” or acceptable.

It’s important to understand that orthorexia is not merely the elimination of food groups. Many special diets involve cutting out certain foods, and they can be perfectly healthy with the right approach. Vegans, for example, exclude all animal products from their meals. Rather, orthorexia is fixating on foods considered to be pure, and excluding those deemed impure to the point that it’s potentially harmful.

The Health Consequences of Orthorexia

“The concern for this type of behavior in adolescents is the potential lack of certain micronutrients for ideal bone health, brain development, immunity and continued growth through puberty,” said Branton. “This population is easily convinced of the so called benefits of certain diets that it’s hard to decipher what is true and accurate from what is a claim.”

Orthorexia can have numerous negative effects on your well-being, similar to that of anorexia, and can include:

  • Malnutrition: Cutting out entire food groups or strictly limiting yourself to certain foods may deprive your body of the fluids and nutrients it needs to thrive.
  • Calorie deficits and weight loss: Restricting food intake means you may not get enough calories to power your body. This can be made worse by compulsive or excessive exercising.
  • Anxiety: When people worry obsessively about the contents of their diet, levels of anxiety and stress tend to increase.
  • Social isolation: The self-imposed pressure to eat clean — and fear of eating something impure — may cause people with orthorexia to avoid social gatherings and events or withdraw from friends.

Treatment for Orthorexia

Orthorexia is a serious condition, and people with symptoms should seek help from a healthcare professional. Orthorexia patients frequently have misconceptions about food, and they may benefit from learning more about nutrition and health from their primary physician or a nutritionist.

It’s also important to address the physical and mental health effects of orthorexia with a mental health professional with experience with obsessive-compulsive disorder, anxiety and depression. If you have symptoms of orthorexia or a related condition, your doctor can help you find a counselor or other healthcare professional who specializes in eating disorders.

Some of this content originally appeared on Sharecare.com.

Andrea Branton, RD, LDN, CSP, is a Pediatric Outpatient Dietitian with Mission Children’s Hospital.

For more information about pediatric specialists at Mission Children’s Hospital, visit missionchildrens.org.