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What is Orthorexia? Is there really something wrong with “healthy eating”?

shutterstock_272048915There has been a lot of talk around the term “Orthorexia Nervosa”. It is defined by Steven Bratman, MD, as, “an unhealthy obsession with eating healthy food”. While this disorder is not officially part of the DSM-V as an official Eating Disorder, it still produces a great deal of pain for those who suffer from it and is worth the attention of the mental health community.

As a therapist who specializes in the treatment of Eating Disorders, this condition is not new to me. I have been seeing it for years, it only now has a name attached to it. I believe it is vital for our culture to start looking more critically at what it means to be “healthy”. Many people develop some kind of disordered eating habits or full-fledged eating disorders with the intention of being “healthy”. Somewhere along the way, things take a turn and these good intentions become harmful behaviors, but the intention is almost always coming from a place of wanting to be healthier or improve oneself. I want to look at Orthorexia through this compassionate lens.

The key to understanding what makes this a disorder different from “healthy eating” is a person’s rigidity of thinking and the level of distress that one experiences when deviations from that diet are made. Making solid efforts to eat healthy food is not what makes Orthorexia a disorder. One person could eat the exact same organic kale salad and it isn’t necessarily the food choice itself but the thoughts and anxiety behind it that make it a disorder. If a person is not able to be flexible with food choices, a serious red flag goes up for me in thinking that this person is at high risk for some kind of Eating Disorder. We deal with many unexpected events in the course of our lives, from life-changing, traumatic disruptions to smaller but still significant disruptions in our everyday routine. Allowing our brains to accept this uncertainty and be able to adapt to new circumstances is a huge part of being an emotionally healthy person. For a person with Orthorexia, deviations from his/her routine that are food related are met with intense guilt, anxiety, and self-criticism. Being at a party and being “forced” to eat outside of his/her comfort zone is not something that is acceptable to a person with Orthorexia. The focus of everyday life is about maintaining the “purity” of his/her diet and removes the person from fully being present. Planning meals for the day begins to take up more and more time. A person starts saying no to social engagements or travel because they are unsure of the food that will be available. When a person must deviate from the food plan, the level of anxiety that it triggers is painful. This is much more than a simple, “Oh wow, I think I overate at that party, I’ll just balance things out tomorrow”. The thoughts are more focused on personal weakness or “what damage has been done”.  Weight loss is not the main goal for the person with Orthorexia, the focus is on food purity.

What makes this such a difficult issue to address is the good intentions of the person suffering from the disorder and how difficult it is for others to understand why this is a problem. Maybe the person is focused on eliminating carcinogens to avoid cancer, or eliminate chemicals from their diets. These goals start off well, but the time involved to succeed at them becomes more than a person can realistically commit to. It also becomes tied to a person’s self-esteem. Food is important and it can bring up a lot of emotions for us, but it is not tied to our self-worth. A person with Orthorexia often judges him/herself based on their food choices. That organic kale salad goes from being a simple lunch choice becoming a source of personal validation. When the person “falls off the wagon”, the shame is so intense that it furthers a tendency to isolate and become disengaged with life outside of the world of Food. It can also have physical consequences, including nutritional deficiencies and illness.

When I read articles on Orthorexia on social media sites, I am often struck with the backlash that I read from people who are outraged that “healthy eating is now a disorder”. I hope we can expand our dialogue here. This is an opportunity to have an honest look at what “good health” means. I hope that we can acknowledge that we are allowed to choose how we spend our time. We are allowed to spend time fostering relationships, working on our careers and finding joy in our lives.  The purity of our food choices does not have to take priority over all of these other things. We are allowed to listen to our bodies and make intuitive food choices based on our healthy hunger cues. We are not “weak” or “bad” when we don’t execute these diets perfectly. There is a big difference between “eating perfectly” and having a balanced life that is focused on flourishing. I hope we can continue to strive for this and support others who are struggling to do so through their eating disorders.

For more information on Orthorexia, please visit:

National Eating Disorder Association: https://www.nationaleatingdisorders.org/orthorexia-nervosa

Steven Bratman, MD, MPH (the person who coined the term “Orthorexia”): http://www.orthorexia.com

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