Orthorexia - an obsession with clean eating?

What Is Orthorexia?

Orthorexia, is an eating disorder characterised by an obsessive focus on healthy or "clean" eating. Unlike other eating disorders, orthorexia is primarily driven by an extreme preoccupation with the quality and purity of food, as opposed to weight & body image preoccupation. It may be confusing to understand how a focus on 'health' can be considered an illness, but the obsessive nature of orthorexia, means eating patterns can become highly restrictive, resulting in potential serious physical and psychological health consequences.

When Was Orthorexia Discovered?

The term "orthorexia" was first introduced in 1997 by Dr. Steven Bratman, an American physician who noticed that some of his patients were developing an unhealthy obsession with healthy eating. The word itself is derived from the Greek words "ortho" (meaning "right" or "correct") and "orexia" (meaning "appetite"). While orthorexia is not yet formally recognised as a eating disorder in diagnostic manuals like the DSM-5, it is widely acknowledged by eating disorder specialists as a serious and growing concern. Particularly due to the rise in power of the wellness industry and the accessibility of nutrition misinformation through social media channels.

How Is Orthorexia Diagnosed?

As Orthorexia cannot be given as an official diagnosis, there is no standardised diagnostic criteria. However, experts, including Dr. Bratman, have proposed guidelines to help identify orthorexic tendencies. A diagnosis typically involves assessing:

The level of distress and anxiety associated with food choices.
The extent to which dietary restrictions impact daily life, relationships, and overall well-being.
Whether the fixation on healthy eating has led to nutritional deficiencies or physical health issues.
If the behaviour is driven by a need for control rather than genuine medical necessity (e.g., food allergies or medical conditions requiring dietary adjustments) or within the context of another eating disorder such as anorexia nervosa.

A couple of tools which may be used to assess symptoms are the ORTO-15 questionnaire and BOT (Bratman Orthorexia Test).

Signs, Symptoms, and Warning Signs of Orthorexia

Physical Signs:

Unintentional weight loss due to extreme dietary restrictions.
Micronutrient deficiencies
Hair loss, poor wound healing, poor nail & skin health
Gastrointestinal symptoms including early satiety, constipation & bloating.
Weakened immune function and increased susceptibility to illness.
Hormonal imbalances, potentially leading to menstrual irregularities and/or low libido.

Psychological Signs:

Intense fear of consuming foods perceived as "impure" or "unhealthy."
Feelings of guilt or shame after eating foods outside of strict dietary rules.
Anxiety or distress when "safe" foods are unavailable.
An extreme need for control over food choices and preparation.
Low self-esteem tied to adherence to a self-imposed diet.
Feeling a level of moral superiority compared to others & their food choices.

Behavioural Signs:

Spending excessive amounts of time researching food quality, ingredients, and sourcing.
Avoiding social events involving food due to fear of "unhealthy" options.
Rigid eating habits that become increasingly restrictive over time.
Judging others' food choices and urges to lecture/inform others of nutrition information.
Justifying extreme dietary restrictions as being "for health" while ignoring the negative impact on well-being.
Excessive intake of supplements and vitamins
Spending large amounts of time preparing food

How does orthorexia compare to other disorders?

While orthorexia shares similarities with anorexia nervosa and obsessive-compulsive disorder (OCD), there are key differences:

Anorexia Nervosa vs. Orthorexia: Although weight loss may occur in orthorexia due to the difficulty in meeting energy needs with such a restrictive diet, this is not the primary driving factor as in anorexia nervosa. Someone with orthorexia is likely to be more focused on food purity as opposed to calories for example. Case studies have indicated that the initial onset of orthorexia is often a specific physical illness or symptom, inducing a level of distress, that an individual tries to control through their dietary choices e.g. acne, which is quite different to what we know about the underlying causes of anorexia. There can however, very much be a cross-over, with many individuals with anorexia presenting with orthorexic traits.
OCD vs. Orthorexia: Both conditions involve obsessive behaviours, but OCD is characterised by compulsions that extend beyond food-related concerns, whereas orthorexia is specifically centred around dietary habits. Another difference is that OCD can be considered an ego-dystonic illness, where individuals recognise that their thoughts and behaviours are irrational & maladaptive, whilst orthorexia is an ego-syntonic disorder, where suffers may struggle to see what is wrong with their behaviours and thought patterns.

Potential Consequences of Orthorexia

If left untreated, orthorexia can have serious consequences for both physical and mental health:

Malnutrition: Eliminating essential nutrients due to strict food rules can lead to deficiencies in vitamins, minerals, and macronutrients.
Social Isolation: Avoiding social events and relationships due to fear of "unclean" food can contribute to loneliness and depression.
Mental Health Decline: Increased anxiety, guilt, and obsessive thoughts around food can significantly impact overall well-being.
Impaired Physical Health: Prolonged nutrient deficiencies can lead to poor bone health, organ damage, and immune system suppression.
Loss of Flexibility and Joy in Eating: Food becomes a source of stress rather than nourishment and enjoyment.

Final Thoughts

Orthorexia is a growing concern in a world that increasingly promotes "clean eating" and diet perfectionism. While making nutritious choices is beneficial, an extreme obsession with food purity can lead to harmful consequences. If you or someone you know is struggling with orthorexia, seeking help from a registered dietitian or eating disorder specialist can be an essential step toward healing.

If you think you may be struggling with some of the symptoms outlined above, please do get in contact to find out how 1:1 dietetic support may be able to help you.