Understanding Orthorexia: The Dark Side of Healthy Eating Habits

Jason Wood sat in a restaurant during his vacation with his husband, feeling frustrated because he couldn't substitute pita for fresh vegetables in his hummus plate.

According to Wood, the distress he felt was not exaggerated. It was the result of 20 years of struggling with an eating disorder, along with the anxiety and stress that had built up over time, all coming to a head in that moment.

Wood has a condition called orthorexia, an eating disorder that is not officially recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the guide for diagnosing mental health conditions. However, therapist Jennifer Rollin, who founded The Eating Disorder Center in Rockville, Maryland, has noticed an increase in orthorexia among her patients.

There is little research on eating disorders and semaglutide, experts said.

There is little research on eating disorders and semaglutide, experts said.

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Weight loss medications raise questions among eating disorder experts. Rollin expressed hope that they would be included in the DSM, but acknowledged the slow process of making changes.

Orthorexia is when someone becomes fixated on eating what they consider to be “clean” food, based on certain rules that vary depending on the individual and their environment. According to Dr. Jennifer Gaudiani, a specialist in eating disorders and the founder of the Gaudiani Clinic in Denver, a study from November 2023 revealed that approximately 3 out of 10 people displayed signs of orthorexia.

This condition is often overlooked or not taken seriously because it involves an excessive focus on eating healthily, explained Wood, who is the director of community engagement at the National Association of Anorexia Nervosa and Associated Disorders (ANAD).

Here is what you need to know about orthorexia: The lack of understanding around this condition kept Wood’s friends and family from raising concerns. They sometimes even praised his dedication to strict eating habits. However, this led to him withdrawing from friends and losing so much weight that he struggled to stay warm.

Diet culture in disguise

Focusing on eating healthy sounds like a good thing, right? Not always.

Eating disorders often have similar underpinnings, according to Rollin. A genetic predisposition combined with environmental factors plays a key role in the development of these disorders. Additionally, the disorder typically revolves around strict rules related to calories, meal timing, or food ingredients.

Rollin explained that individuals vulnerable to eating disorders may start by only eating what they perceive as healthy. However, this behavior can quickly escalate from a preference to an obsession.

Wood mentioned that as time passed, the number of foods he deemed unhealthy increased while the list of healthy options decreased. This eventually led to him feeling anxious and even leaving social gatherings because he couldn't find anything suitable to eat.

Black woman biting sandwich

Black woman biting sandwich

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A year of reasons why you should just eat the bagel

For some — but not all — people with orthorexia, their body image may start to hinge on how closely they follow their food rules, Rollin said.

Orthorexia can lead to other disorders like bulimia or anorexia nervosa, according to Gaudiani. She explained that the motivations people with orthorexia have, and the praise they receive from society, may seem like promoting health or preventing disease. However, she pointed out that these motivations are often just a disguise for the "traditional diet culture" that focuses on achieving a specific body shape and size.

Rollin mentioned that some elements of it can resemble diet culture in disguise.

Gaudiani added that even without shame related to weight, orthorexia and the actions taken to follow specific food rules can be costly, overwhelming, and troubling.

“It can also limit one from what one’s sort of greater goals and values are,” she added.

What is healthy anyway?

Another indication that eating guidelines are not solely focused on health is the challenge of determining what exactly is considered healthy. In the 1990s, healthy eating meant following low-fat diets, according to Gaudiani. However, nowadays, the definition of healthy eating has shifted to include high-protein, high-fat, low-carb, and low-sugar foods.

Gaudiani mentioned that some people focus on where their food comes from, like if it's organic, non-GMO, and locally sourced.

Rollin pointed out that there's nothing wrong with choosing to eat a salad, but it becomes an issue when you believe that you can only eat salad.

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It's not just older teenage girls who we need to watch for eating disorders, experts said.

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Everybody is unique, so the healthiest choice of food varies based on individual needs and the situation they are in. According to Rollin, unless there is a specific dietary requirement for a medical condition, the best approach is to pay attention to your body.

When considering health, it is crucial not to focus solely on nutrition, as mentioned by Wood.

Living a healthy life involves having strong social relationships, pursuing passions, engaging in enjoyable physical activity, and finding peace of mind. However, this can be challenging when you spend a lot of time fixating on what you "should" be eating.

According to Gaudiani, following strict rules around food can lead to orthorexia, which can isolate you from others. Turning down opportunities to eat with friends and family who don't follow the same rules can cause your social circle to shrink, making your world smaller.

Rebuilding life during recovery

If you or someone you care about is struggling with orthorexia, the positive news is that the treatment process is similar to the established plans for eating disorders like anorexia or bulimia nervosa. Unfortunately, the downside is that there may be obstacles due to a lack of awareness among the general public.

When seeking therapy for orthorexia, it's important to find a specialist who has experience with this specific eating disorder, according to Rollin. Not all specialists will have this expertise, so it's crucial to do your research and find the right fit.

People dealing with orthorexia may have a treatment team that includes therapists and dietitians, similar to those with other eating disorders, Rollin explained. However, individuals with orthorexia may also need to reexamine their definition of health and make challenging adjustments to their beliefs surrounding it.

The process may also involve working with those around you, Rollin said. More people are becoming aware that it isn’t a good idea to talk about food in terms of weight regularly. However, fewer see talking about “healthy” or “unhealthy” foods as problematic, she said.

“It might take a fair amount of educating friends and family members,” Rollin added, “helping them to have understanding and compassion for why them commenting about the new juice cleanse they’re on is activating.”

Gaudiani emphasized the importance of individuals in recovery showing compassion towards themselves. She noted that nobody engages in harmful behaviors just for fun or without a reason. People may start engaging in these behaviors due to perceived health benefits, societal pressure, or a sense of safety.

Recovery can be tough, but it's worth it, according to Wood. Almost four years ago, he hit rock bottom during a vacation dinner.

"I feel like I'm finally starting to enjoy life again," Wood shared. "Instead of obsessing over food all the time, I can now focus on other parts of my life. It's been really amazing."

Editor's P/S:

This article has shed light on the growing issue of orthorexia, an eating disorder characterized by an excessive focus on consuming "clean" food. The lack of awareness and recognition of orthorexia in the DSM has led to underdiagnosis and delayed treatment. The article highlights the harmful effects of orthorexia, including social isolation, impaired relationships, and a narrow definition of health. The emphasis on healthy eating can mask the underlying motivations of orthorexia, which often stem from societal pressure, perceived health benefits, or a sense of safety.

The article underscores the importance of seeking professional help from specialists experienced in orthorexia. Treatment involves not only addressing the restrictive eating patterns but also challenging the underlying beliefs and values that contribute to the disorder. Recovery from orthorexia requires self-compassion, support from loved ones, and a redefinition of health that encompasses physical, emotional, and social well-being. By raising awareness and providing resources for treatment, we can help individuals struggling with orthorexia regain their lives and enjoy a healthy relationship with food.