When Does Healthy Eating Lead to Orthorexia?
When Healthy Eating Can Lead to Disordered Eating
As a nutritionist, I am constantly confronted with information about the impact that food has on the body. I remember my first year of graduate school, being surrounded by other "soon to be" nutritionists, and feeling like I needed to show up with "perfect meals." I also remember being bombarded with nutrition information and trying to apply every concept to myself regardless of whether that was really best for me...so much so that my meals became very monotonous, isolated, and frankly boring.
How Does Orthorexia Start?
So what happens when our eating becomes dominated by efforts to eat “clean,” “toxin-free,” “organic,” or “anti-inflammatory?” We may be struggling with orthorexia.
This eating disorder is showing up more and more, and will likely be added to the next version of the reference book for mental health disorders. Orthorexia is essentially the preoccupation on eating for health and/or purity. The National Eating Disorder Association describes this well:
"Orthorexia starts out as an innocent attempt to eat more healthfully, but orthorexics become fixated on food quality and purity. They become consumed with what and how much to eat, and how to deal with “slip-ups.” An iron-clad will is needed to maintain this rigid eating style. Every day is a chance to eat right, be “good,” rise above others in dietary prowess, and self-punish if temptation wins (usually through stricter eating, fasts and exercise). Self-esteem becomes wrapped up in the purity of orthorexics’ diet and they sometimes feel superior to others, especially in regard to food intake."
We often forget that as human beings we are made to enjoy food and find pleasure in eating. We also forget that our bodies are incredible systems built to handle variety.
What is the Primary Motivator of Orthorexia Nervosa?
Simply put, the primary motivator for orthorexia is health. While orthorexia can sit within other eating disorders like anorexia, orthorexia is about being “pure” and “eating clean.” This obsession can reach into other aspects of non-food life as well. For instance, fears of skin care or body care products that aren’t fully “non-toxic,” as well.
Like all eating disorders, though, the obsessions with health and purity are only the tip of the iceberg. Below the surface of “clean eating” are more complex emotional and life experiences that lead to feeling the need to control or find an escape etc.
What do Orthoexics Eat: Orthorexia Diet Example
Typically people struggling with orthorexia eat foods advertised as organic, free of “additives,” very low in processed or packaged foods, and often low sugar or other food categories that diet culture likes to throw shade at.
It’s not uncommon for orthorexics to eat very simple foods, odd combinations of foods or ingredients, or to eat in a very ritualistic way.
What they allow themselves to eat can also be related to how food is cooked– for example people can be afraid of cooking at certain heat levels for fear of oil becoming rancid or more carcinogenic. They might also insist on cooking with ingredients they deem “healthier” to the point where they won’t eat dishes served to them if the ingredients are unknown or known but categorized as “unhealthy.”
What are the Five Warning Signs of Orthorexics?
A progressive reduction in the categories of foods deemed “healthy” or “safe.”
Being very preoccupied with “clean/healthy eating” to the point where they are spending a lot of time or money to ensure everything they consume is “clean.” This often includes time spent researching and acquiring the “right” food.
Socializing over food or eating with others is extremely challenging and may become rare because the food they are able to consume becomes so specific.
Negative impacts to health, lack of nutrition despite focus on it, and impacts to other areas of life like relationships and work/school.
Frustration, anxiety or distress when the food routine or “safe” foods are not available or these beliefs are questioned.
Orthorexia vs Anorexia
Orthorexia is often thought to be anorexia, but the biggest difference is that in orthorexia there is not a big focus on weight. In anorexia, a person struggles with a phobic level of fear towards weight gain and body fat. In orthorexia (without anorexia), the fear is on unhealthy or unclean foods.
Tips to Help Recover from Orthorexia
To recover from orthorexia a person must:
Expose themselves (aka eat) the foods they have deemed “unsafe” or unhealthy”
Re-introduce all food groups including carbs, proteins, and fats
Explore what foods and cooking they enjoyed before their orthorexia really took hold
Explore non-food related contributors to orthorexia like childhood trauma, untreated anxiety and depression, or other conditions/issues like OCD and perfectionism.
It’s important to remember that not all eating disorders including orthorexia look the same. It is also not uncommon for orthorexia to be a part of other eating disorders like anorexia or ARFID (avoidant restrictive food intake disorder), so sometimes treating orthorexia is just a part of treating other issues with eating. Let’s say a person is afraid of eating carbs because they are nervous about weight gain. Orthorexia within anorexia would be this person also refusing to eat non-organic or non-gmo wheat because it’s “less healthy.” Therefore the treatment would encompass both reducing fear around eating this type of wheat, as well as increasing carbohydrates and managing fears of weight gain.
Resources:
Koven, N. S., & Abry, A. W. (2015). The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatric disease and treatment, 11, 385–394. https://doi.org/10.2147/NDT.S61665
