Orthorexia: the slippery slope of “healthy eating”
This blog entry is written by someone who’s personally experienced orthorexia, this is written from the perspective of their reflection and personal experience.
It all starts innocently enough. You hit the gym, feel great about your progress, and think “what better way to support this than with a wholesome diet?” Then you start learning about nutrition labels and how to split your macros. Those long ingredient lists filled with unpronounceable words makes you question everything.
As you dig deeper into “clean eating”, the “do not eat” list grows and meal planning becomes essential. Going out to eat feels daunting, and there is constant worry about hidden ingredients and bad oils. It’s safer to cook at home, especially since a delicious buffalo chicken pizza might make you lose control.
Eating clean felt amazing - digestion has improved, and you could almost feel the benefit of all those vitamins and minerals coursing through your veins. Why isn’t everyone else on board? How could they still enjoy beers and wings every Friday? Maybe cooking for them is a good start. If they could just experience the benefits of clean eating, they might see the light too!
The reality of orthorexia
At the time, I had no idea, but those thoughts were leading me to orthorexia nervosa. When I first heard the term and looked it up, I was shocked. How could trying to eat healthy be a disorder?
But…was it really healthy?
The best way to summarize orthorexia is an obsession with healthy eating associated with restrictive behaviours. This attempt to attain “optimum health” may actually lead to malnourishment, loss of relationships and poor quality of life (2). The very opposite outcome these behaviors have claimed to attain in the first place.
It sneaks up on you. For those who may already be vulnerable to eating disorders due to biological, social, or psychological factors, a desire to “eat healthy” can quickly spiral into something harmful. Foods start getting labeled as “good” or “bad”. There is no shortage of diets or influencers telling us which foods to avoid for “ultimate health” or weight loss. Fad diets are rampant online, and it is easy to absorb this information and apply restrictions to your own diet all in the name of being “healthy”.
How many times have you heard how a carnivore diet can reduce inflammation and improve energy? Videos like this one on TikTok talks about how “it is important to cut out refined sugars and carbs because they drive inflammation, belly fat, feed cancer cells etc”. Oats are called out for being full of phytic acid that prevents your body from absorbing essential minerals such as magnesium zinc and calcium. Grapes are deemed “sugar bombs” and “might as well have a hershey's chocolate bar” instead. There are videos of people saying apples raise glycemic index and that high carb fruits like bananas should also be avoided. The number of “safe” foods dwindles by the day as these restrictive messages pile up.
In today’s world, cutting out food groups has become a trendy way to be “healthy”. Social media platforms play a pivotal role in disseminating these trends, promoting harmful dietary practices and fostering a sense of social comparison (1). What distinguishes orthorexia from other eating disorders is often there is an absence of concerns over body shape or weight (1). The anxieties and avoidance behaviours in the context of eating are linked to an intense, and probably tunnel-visioned, focus on health. But as I learned, obsessing over health can actually undermine it.
One of my last “unsafe” foods was gluten. I remember telling my brother I thought I had a gluten intolerance. He gave me the most perplexed reaction, but I was totally convinced and began to explain how I’d notice bloating and abdominal discomfort every time I ate bread. From then on, I avoided bread, pizza and basically any flour-based carbohydrate to the point where I’d even fill up on vegetables before going out to dinner, just to avoid them. I eventually stopped going to restaurants with friends and family to stay “safe.” This didn’t lead to my optimum health by any means, but it did impact my social life and relationships negatively.
Certain individuals may be more prone to developing orthorexia due to specific personality traits. People exhibiting perfectionism, high levels of neuroticism and a tendency towards obsessive-compulsive traits tend to be more predisposed to engage in rigid and extreme dietary behaviours (1) than individuals who are not.
What are some of the most common symptoms of orthorexia?
Having critical, judgemental thoughts of others who do not follow healthy, pure eating plans (6).
Pursuing “clean eating” and rigid dietary rules as a strong sense of identity and purpose, offering a way to define oneself within a “health-conscious” community (1).
Cutting entire food groups in the diet (3) depending on what is popular in the media at the time. Commonly carbohydrate-rich foods, sugary foods, red meat and gluten are restricted.
Fixating over the quality of food (3). People with orothorexia are highly obsessive over the quality of the food item. Is it composed of ingredients that can be pronounced? Is it organic/inorganic, raw, whole etc.? There is often compulsive checking of ingredient lists and nutrition labels (4).
Obsessive food research that exacerbates rigid food beliefs. There is growing anxiety regarding health concerns, avoidance behaviours, and strict rules that impair social life (5).
Spending an excessive amount of time planning, obtaining, preparing and/or eating one’s food (5).
Anxiety around eating any meals outside the home, eating socially or meals cooked by other people.
How can orthorexia be diagnosed?
Since orthorexia is not yet officially recognized in the Diagnostic and Statistical Manual of Mental Disorders (the American Psychiatric Association's standard guide for diagnosing mental health conditions), it can be more challenging to diagnose. Speaking to a healthcare practitioner is a good first step in getting diagnosed and treated for orthorexia. Sometimes for an individual themselves, it can be hard to see the negative effects of orthorexia as it can be viewed as just living a healthy life.
NEDIC’s helpline and live chat provide confidential support and information for individuals affected by eating disorders, as well as for families, friends, and healthcare providers seeking guidance. The toll-free helpline and online chat are staffed by trained volunteers who offer compassionate, non-judgmental listening, practical information, and referrals to eating disorder services across Canada.
How can orthorexia be treated?
The key is to recognize we’re fallen off balance with our relationship with food, especially when it has started cause more harm than good. Even though there has been limited studies on treatment options for orthorexia, there are suggestions for best practices. This involves working with an interdisplinary team of professionals including a physician, a dietitian, and a psychotherapist (8).
Since orthorexia involves disordered eating, working with a specialized team—including a dietitian and therapist—is important. A dietitian can provide proper nutrition support, challenge unhelpful nutrition beliefs, reverse dysregulated eating behaviors, and support healing the relationship with food.
Additional therapy from a therapist can also be important to explore concerns outside of nutrition, such as underlying emotional root causes that may have contributed to the development of orthorexia, and to provide therapeutic skills that are supportive of recovery. Methods like cognitive behavioral therapy and dialectical behavior therapy are commonly used (7).
Ultimately it is a real condition that is treatable. And just because diet culture has normalized orthorexia, it doesn’t mean we have to as well.
Disclaimer: the information provided is not intended as medical advice or to diagnose or treat a medical disease. It is strictly for informational purposes. Consult with your medical provider such as a dietitian before implementing any dietary changes, the information provided does not replace medical advice provided by your healthcare provider.
Written by Elaine Chan
Reviewed & edited by Abby Hsiao, RD
—————————————————————————————————————————————————————————————————————————————
Work Cited
1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10490497/
2: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6370446/
3: https://www.waldeneatingdisorders.com/blog/8-warning-signs-of-orthorexia/
4: https://www.nationaleatingdisorders.org/orthorexia/
5: https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-024-00988-z
6: https://www.healthcentral.com/article/orthorexia-eating-disorder-risk-factors
7:https://www.waldeneatingdisorders.com/what-we-treat/orthorexia/orthorexia-diagnosis-treatment/
8:https://pmc.ncbi.nlm.nih.gov/articles/PMC4340368/#:~:text=To%20date%2C%20there%20are%20no,best%20practices%20have%20been%20offered.
