What is Orthorexia Nervosa? When Eating Healthy Becomes Unhealthy
By: Katherine Metzelaar, MSN, RDN, CD
Orthorexia is often described as an unhealthy obsession with healthy eating.
While it isn't currently recognized as its own diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the struggles experienced by people with orthorexia are very real. Most people don't set out to develop orthorexia. More often, it begins with a genuine desire to take care of your health. Over time, those healthy intentions can gradually turn into rigid food rules, anxiety around eating, and a relationship with food that feels increasingly stressful instead of supportive.
What Is Orthorexia?
People with orthorexia often become increasingly focused on eating in a way they believe is healthy, clean, “pure” or "correct." Food quality, ingredients, and purity may begin to feel more important than flexibility, enjoyment, or listening to their body's needs. Over time, food choices become driven less by nourishment and more by fear, certainty, or the desire to avoid making the "wrong" choice.
Signs and symptoms of orthorexia:
Cutting out foods or food groups (common ones are sugar, dairy, gluten, and meat) leading to limited variety in the diet
Focusing on food cleanliness and purity. Examples include “clean eating,” “whole foods” or only organic
Constantly reading nutrition facts and ingredient lists
Deep concern for food’s health and nutrient density (consumed by them and others around them)
Dedicating unusual amounts of time to meal planning and cooking foods that comply with their dietary restrictions
Anxiety at social events where food is served and/or refusing to go to these events because of the food served
Getting really stressed out when “safe” or “healthy” foods are not available
Heightened interest in the health quality of food of others
Hard time eating anything but a limited list of specific foods
A worry, concern and/or deep fear about the ingredients in food products
Allowing food to revolve around your daily schedule
Isolation from others including family and friends
Eating only fruits and veggies or only consuming organic foods
Strict behaviors around preparation of food and meals
Most of us have been told the importance of “healthy eating” in one way or another, whether it was in schools, doctors’ offices, online, or in our social circles. Today’s diet culture promotes various wellness lifestyles (a.k.a. diets) as the pathway to longevity, boundless energy, and the pinnacle of health. Health-centric marketing messages are everywhere to mask an emphasis on weight loss in the diet industry. If you feel stuck in orthorexia-like eating disorder behaviors, please know you didn’t cause your disordered eating. The culture you live in breeds this kind of thinking and is part of what makes orthorexia so hard to spot and know that you’re suffering from it.
This is the culture you’re swimming in, so no wonder you internalize the dominant culture’s narrative that you should achieve “optimal health” through food. So, orthorexia is particularly difficult to address because modern-day diet culture not only normalizes but actively promotes orthorexic behaviors. Additionally, orthorexia has series health consequences and is just as damaging as other eating disorders.
When Does Healthy Eating Become Unhealthy?
There is nothing inherently wrong with wanting to eat in a way that supports your health. Wanting to feel your best, manage a medical condition, or learn more about nutrition are all understandable goals.The difference is often found in your relationship with food.
Healthy eating tends to support your life while still leaving room for flexibility, spontaneity, and enjoyment. Orthorexia often has the opposite effect. Food rules become increasingly rigid, anxiety grows, and eating begins to take up more mental space. Meals become stressful instead of nourishing, and life starts revolving around avoiding the "wrong" foods rather than enjoying the moments food is meant to support.
Healthy eating should support your life, not become your life.
How do you know if you might be suffering from orthorexia?
Food Fear and Anxiety. In orthorexia, the food choices are made from a place of external influence, fear mongering, and thinking about food as “good” versus “bad.” Your food rules and patterns prevent you from connecting with your body, honoring internal desires, and making choices from a place of peace and authenticity. Consequently, if you have orthorexic behaviors you likely have a lot of emotions related to food. Some common emotions are fear, perfectionism, stress, or anxiety. You might also experience uneasiness and self-criticism as you try to craft the “perfect” diet. Tuning into the food thoughts and emotions you notice can provide insight into how your eating patterns are affecting your well-being.
Flexibility versus Control. Another element to consider are your reactions to the food environment. If you are struggling with orthorexia you might experience distress when you do not have full control over the menu. Social events or travel are particularly challenging because the foods accessible to you likely won’t meet the criteria for the foods you deem healthy enough to eat. The stress of the unknown combined with the additional food labor to prepare acceptable foods interfere with your ability to be spontaneous and enjoy foods in the moment. Your rigidity and commitment to your eating patterns might be detrimental to your relationship with food.
When Food Takes Up Too Much Mental Space: With orthorexia, as in all disordered eating, a common theme is that food takes up lots of headspace. Reading the latest wellness articles, shopping for safe foods, meal planning among a narrow list of foods, daily cooking and preparation, researching restaurant and menu items all time up a lot of your time. if you are caught in orthorexic behaviors your food to-do list is never ending. As food takes up more mental space, there is often less room for everything else. Relationships, hobbies, travel, celebrations, and everyday moments can slowly become overshadowed by planning meals, researching ingredients, and worrying about whether you've made the "right" choice. One of the goals of recovery is helping food return to the role it was always meant to have: supporting your life rather than becoming the center of it.
Orthorexia can be difficult to recognize because many of the behaviors are praised by our culture. We often celebrate discipline around food without asking whether those habits are actually supporting someone's well-being. If healthy eating has started creating more anxiety than peace, or if food has begun taking up more space in your mind than you'd like, you don't have to wait for things to get worse before asking for help. Healing doesn't mean caring less about your health. It means building a relationship with food that supports both your physical and mental well-being while leaving room for the rest of your life.
Looking for Orthorexia?
If you're wondering whether your relationship with food has become more stressful than supportive, you don't have to figure it out alone. I provide nutrition counseling for adults recovering from orthorexia, eating disorders, disordered eating and chronic dieting. Together, we'll work toward building a relationship with food that feels flexible, nourishing, and no longer driven by fear.
Want to learn more? Visit my Orthorexia Treatment & Recovery page for a more in-depth look at the signs of orthorexia, what recovery can look like, and how nutrition counseling can help.
If you're ready to take the next step, I'd be honored to support you.