Orthorexia - When Eating Healthy Becomes Unhealthy
Eating healthy and choosing the best quality food available is a good thing, right? At first, our answer as a group of registered dietitians may surprise you – Not always. Orthorexia is an eating disorder where a person has a hyperfixation on extreme “healthy” or “clean” eating, to the point of causing mental and/or physical distress. It can be hard to identify, since it often looks like someone being careful about what they eat or choosing to focus on their health. However, the food restrictions can increase so much that people are omitting certain foods, and even food groups from their diet, which can have the same physical effects on the body as Anorexia Nervosa.
As eating disorder dietitians, we’ve seen how destructive orthorexia can be, and want to provide education around this topic. Read on to learn about orthorexia, what symptoms look like, who is at risk for orthorexia, and what you can do if you suspect that you or a loved one has orthorexia.
What is Orthorexia?
The term ‘orthorexia’ was first introduced in 1996 by Dr. Steven Bratman, a physician, who saw a number of patients become obsessive about eating in certain restrictive ways in the name of health. While orthorexia is not recognized in the DSM-5 as an official eating disorder on its own, it is definitely as dangerous and concerning as the named eating disorders. People with orthorexia may be diagnosed with Unspecified Feeding or Eating Disorder, or they may meet criteria for another eating disorder.
Given our society’s obsession with “clean eating,” exercise, protein, and physique, and from our position as eating disorder dietitians, we believe orthorexia rates may be on the rise. Eating disorders thrive in secrecy and isolation. That’s why people can have an eating disorder for months or years, and loved ones don’t know about it (read our blog about Latent Eating Disorders here.) Orthorexia can be easily missed, given that most people with orthorexia are not pursuing weight loss, but rather, health.
Signs and Symptoms of Orthorexia
Orthorexia can go unnoticed at first, since it so often begins subtly and later develops into disordered tendencies. As always, bringing concerns and observations to an eating disorder informed physician, therapist, and/or dietitian will help you to determine whether these signs are indicative of something deeper going on.
Common signs of orthorexia include:
Obsessing around the quality of food
Someone with orthorexia goes beyond looking for good quality food, and refuses to eat foods that don't fit a specific standard. This standard is often made up in their mind, or based on marketing terms used to describe food.
Creating rigid rules around eating
In orthorexia, someone creates strict rules in their head around what is okay to eat and what isn’t. They will often choose to not eat rather than eat something they deem outside their rules, and if they break their rules, they experience extreme mental distress.
Eliminating entire food groups
People with orthorexia may eliminate entire food groups, without a medical diagnosis indicating a need. People with orthorexia will avoid certain food groups, and place these food groups in their minds as a “no go,” where they would rather go hungry than eat the food.
Anxiety around illness
In orthorexia, the focus is less on weight and size, but rather on preventing illness. This can lead to constant worry that eating a certain food will cause them to immediately develop an illness.
Risk Factors for Orthorexia
In today’s society, it feels as though many people may be primed to develop orthorexia. In general, anyone with a family history of eating disorder, trauma, dieting, substance abuse, or perfectionistic tendencies may develop orthorexia. Additionally, people with anxiety and obsessive compulsive disorder, especially Contamination OCD, are at risk for developing orthorexia as a coping skill for their OCD or health anxiety. People with Type 1 Diabetes, PMOS (formerly PCOS), or kidney disease may be at risk, given that doctors often prescribe restrictive diets to manage their chronic conditions (see how a dietitian can help manage PMOS and kidney disease in our blogs). These are not direct lines to diagnosis, but a general reference as to the type of people who may develop orthorexia.
How to Treat Orthorexia
As with all eating disorders, early detection and treatment can make a huge difference in the outcome of orthorexia. Working with an eating disorder therapist and an eating disorder dietitian can help someone with orthorexia, by working through the psychological restrictions, challenging food and exercise rules, and doing food exposures together in session. Having an eating disorder informed physician on the team can also be a huge asset. Weight stigma is rampant in our current healthcare system (read our blog on Health at Every Size® here), and a physician may inadvertently encourage orthorexia by celebrating someone starting a “clean eating” and extreme fitness journey.
In addition to professional support, cleaning up social media feeds can have a big impact on orthorexia recovery as well. Eliminating exposure to influencers and people who engage in disordered eating or exercise behaviors and finding recipes from sources not focused on making food healthier at the expense of taste can help to reinforce that this type of behavior is not the norm. Know that unfollowing people can be difficult, especially if you’ve followed them for a long time. If you need support in determining who is supporting you versus your eating disorder, you can always ask your therapist or dietitian for help.
At Namaste Nourished, we want you to be healthy, whatever that looks like for you. Orthorexia may feel like it is in pursuit of health, but it’s damaging to your mental and physical health, which is ultimately not what we want for you. A dietitian who specializes in eating disorders can help you find a true healthy balance around food, physically and emotionally. If you have questions or need support, please reach out to us today.
Resources
Cleveland, S. (2024, July 23). The dangers of orthorexia. Ohio State Health & Discovery. https://health.osu.edu/wellness/exercise-and-nutrition/dangers-of-orthorexia
National Alliance for Eating Disorders. (2023, February 6). How to Better Understand the Confusing, Counterintuitive World of Orthorexia. National Alliance for Eating Disorders. https://www.allianceforeatingdisorders.com/how-to-better-understand-the-confusing-counterintuitive-world-of-orthorexia/
Wick, K. (2025, June 30). What is Orthorexia? 8 Warning Signs to Pay Attention To. Monte Nido. https://www.montenido.com/blog/what-is-orthorexia-8-warning-signs
Within Health. (2025, April 8). Orthorexia treatment plan. Within Health. https://withinhealth.com/learn/articles/treatment-of-orthorexia-nervosa