Food

The Lowdown on Orthorexia: When Eating Well Becomes an Eating Disorder

Contributing writer and eating disorders therapist Jenny Weinar breaks down the lesser-known eating disorder.


orthorexia

Orthorexia is a lesser-known eating disorder. / Photograph courtesy of Getty Images

Jenny Weinar is a Philly-based body positive psychotherapist and certified yoga teacher who’s passionate about helping clients struggling with disordered eating, chronic dieting, over-exercising, and weight preoccupation find their way home to their bodies. This is the third of a series of posts that will (hopefully!) help our readers do the same. Read Weinar on Be Well every other Tuesday.

Be Well Philly readers are no strangers to the concepts of “clean eating” and wellness, but some might be less familiar with the darker side of these seemingly healthful pursuits. What may start out as a few simple changes to one’s eating habits can progress to a dangerous disorder known as orthorexia nervosa.

“Orthorexia” was coined in 1997 by physician Steven Bratman, from the Greek for “correct diet.” In his essay outlining the phenomenon, Dr. Bratman describes certain patterns he observed as an alternative medicine practitioner, both in his patients and in himself as someone who formerly engaged in such “righteous eating.”

Orthorexia is characterized by an obsession over the perceived purity or quality of one’s food. It is typically driven by a preoccupation with health and the belief that one can control or prevent disease by strictly controlling their food intake. But what exactly does orthorexia look like in real life? Here are some signs and symptoms to look out for.

  1. Eliminating certain food groups for non-medical reasons. One hallmark of orthorexia is cutting out entire food groups without medical necessity, such as carbohydrates, gluten, dairy, processed foods, meat, or sugar.
  2. Moralizing food. For someone with orthorexia, those foods that are eliminated or avoided are designated as “bad” or “dirty,” while those that remain are “good” or “clean.”
  3. Compulsively checking or comparing food labels. People with orthorexia might obsess over ingredients or the difference in grams of sugar or fat, for example. While this does not automatically apply to individuals with legitimate medical conditions, such as celiac disease, food allergies, or religious, ethical or environmental concerns, they might be at a higher risk for developing orthorexia by nature of having to pay closer attention to their food.
  4. Little dietary variety. With such strict rules and limitations around food, someone with orthorexia will often eat the same things repeatedly with little variation or spontaneity.
  5. Significant emotional distress when food rules are broken. Eventually those food rules come to dictate every food choice and can provoke feelings of panic when there isn’t access to those foods that have been deemed safe.
  6. Comparing your food (and yourself) to others. Those suffering with orthorexia tend to judge others’ food and feel superior about their own eating, or conversely to feel shame when someone else is following an even stricter diet.
  7. Becoming increasingly isolated. Someone with orthorexia may publicly espouse the health benefits of their food choices while, privately, they are consumed by thoughts of meal planning, reading menus, or extreme worry around consuming food prepared by others. This may lead to increasing isolation in order to control one’s food intake, and, ultimately, to depression, anxiety, and related disorders.
  8. Possible weight loss. Given all their food restrictions, someone with orthorexia might exhibit weight loss, even though this condition is not primarily motivated by body image concerns. If someone gains weight when they deviate even slightly from their food rules, this is a good indicator that they’re malnourished.

Ironically, the stress caused by trying to adhere to such strict food rules can be damaging to one’s health, and in some cases might induce the symptoms someone with orthorexia is trying to heal through food in the first place. This is also known as the “nocebo effect,” in which the expectation of negative effects from a particular substance can actually produce those very effects. This might serve to exacerbate anxiety around food, which can in turn worsen symptoms.

Orthorexia is not yet formally recognized in the Diagnostic and Statistical Manual of Mental Disorders (the official handbook for diagnosing mental disorders published by the American Psychiatric Association). Nonetheless, it can be just as disruptive to one’s life and mental health and as harmful as other forms of disordered eating. If you’re struggling with any of the symptoms of orthorexia, you should consider seeking help from an eating disorders professional as soon as possible.

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