Orthorexia - is healthy eating ruling your life? | Level Up Nutrition | Brighton
Brighton based Registered Dietitian Nutritionist.
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Orthorexia – when does healthy eating become disordered eating?

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Orthorexia – when does healthy eating become disordered eating?

Image by Gabrielle Henderson on Unsplash

Updated 10th June 2020

Have you heard the word before? Not quite sure what it meant? It’s something I’m asked about regularly so I thought I’d focus in on what exactly orthorexia is, what some symptoms may be and why it might be so prevalent these days.

What is it?
Coined by Steven Bratman in the late 90’s – orthorexia is when an interest in eating only ‘healthy’, clean or ‘pure’ food becomes a fixation. People affected may only eat the foods that they deem healthy foods and avoid foods they deem as impure or healthy.

It’s not the same as say, just trying to change up your diet to eat more fruit and veg or cutting out a bit of saturated fat. People affected may feel extremely anxious around certain foods – believing that eating them will damage their health. This can have a knock-on effect on their social life – avoiding certain situations and causing distress when certain foods are present – creating a cumulative negative affect on mental health.

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How can it manifest?
Let’s meet Jane. Jane wanted to do her best to look after her health and started reading up on the perfect diet. She picked certain nutrients that she’d heard were important and changed up her cooking and eating routine to include more of these foods and less of the ones that she’d read were unhealthy. Jane spent a lot of her time reading food labels and checked out the menu of every restaurant she went to with her friends.

If it wasn’t organic or it had preservatives added, she didn’t allow herself to eat it. Over time, the list of foods that she felt were okay got smaller and smaller – now she’d cut out sugar, dairy and meat as well. When there wasn’t anything that was on her ‘safe’ list available, Jane cancelled her plans with friends.

She felt guilty if she ever had one of the foods from her unhealthy list and couldn’t let herself attend events were there were going to be a lot of these foods. Jane felt tired and low a lot of the time and had lost a lot of weight, though she hadn’t intended to.

This is just an example of how easy it might be to start off with the best intentions, only for them to cross over into something more harmful.

When can it be harmful?
An obsession with measuring and tracking nutrients and even completely excluding certain food groups in the pursuit of health can be harmful psychologically and physically.

Though it might sound suspiciously similar to many restrictive diets, concerns arise when these changes begin to impact on how you live your life and how food may make you feel emotionally – ie, guilty or ‘dirty’. General emotional wellbeing may be completely tied to food in someone who’s affected by orthorexia.

One big problem for health is that cutting out these food groups can actually be damaging – as it severely restricts overall nutrient intake. It can eventually lead to people losing a lot of weight unintentionally or to experience other signs of malnutrition like amenorrhea (loss of periods), mood swings or even damage to bone density.

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Similarities with anorexia
Orthorexia isn’t classified as an eating disorder in clinical terms – so, it’s not classified like anorexia nervosa or bulimia nervosa. This means that treatment isn’t currently offered specifically for orthorexia.

There are many similarities between orthorexia and anorexia though – and those with symptoms of orthorexia may be diagnosed and treated as having anorexia or ‘other specified feeding or eating disorder’ (OSFED). One difference is that whereas those with anorexia nervosa may be concerned with weight and energy balances, someone with orthorexia may be unconcerned about weight.

As with any disordered eating, those affected need help and psychological support for treatment going forward.

Why the sudden rise in orthorexia?
As the rise of diet tribes and clean eating has continued exponentially, many more people are seeing foods classified as simply ‘good’ or ‘bad, ‘clean’ or ‘unclean’. Our culture has an unhealthy obsession with being slim and the pursuit of health – at the expense of pretty much everything else…. ironically, including our health.

The ability to find things online that will undoubtedly support your own ideas from potentially unqualified (no matter how well-meaning) sources can confuse matters further. The internet is awash with people purveying their ‘perfect’ diets and lifestyle in a way that can seem very real – and achievable.

The thing is, no food is inherently good or bad in terms of nutrition – and (unless you haven’t washed it!) no food is ‘unclean’. The language of ‘clean’ eating has been co-opted by food manufacturers and unqualified influencers with gusto – giving rise to a whole host of ‘dirty’ burger recipes and clean eating meals to find online or in shops and restaurants.

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Super appealing
It’s easy to see why this black and white thinking is so appealing – on the surface it appears that nutrition and health can be mega-simple and straightforward: Don’t eat this, do eat this… and you’ll be sorted. Sounds amazing, I’m all in.

There’s a problem though… that’s BS. Nutrition is never black and white – it’s pretty darn grey and it’s one of the most complicated bioscience subjects there is to study. What could be healthy for one person, say – a slice of wholemeal bread to get some energy and gut-loving fibre in, could be pretty damaging to someone who has coeliac disease and so can’t eat gluten.

One person’s nutritional needs and preferences are very different to another person’s. Sure there are some basics that can be useful to all of us – but there are no hard and fast rules on what works for everyone, all of the time.

Does any of this ring true for you?
NEDA – the National Eating Disorders Association lists signs and symptoms of orthorexia on their site as:


  • Compulsive checking of ingredient lists and nutritional labels
  • An increase in concern about the health of ingredients
  • Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
  • An inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
  • Unusual interest in the health of what others are eating
  • Spending hours per day thinking about what food might be served at upcoming events
  • Showing high levels of distress when ‘safe’ or ‘healthy’ foods aren’t available
  • Obsessive following of food and ‘healthy lifestyle’ blogs on Twitter and Instagram
  • Body image concerns may or may not be present”

Source: NEDA (accessed 20/06/2019)

If you recognise these symptoms in yourself, speak to your GP who can refer you on for specialist treatment if needed. You can also find out more information and support for eating disorders at Beat Charity and the NHS website. You can also find trained, eating disorder specialist registered dietitians through the Freelance Dietitians website – who’ll be able to help and advise you as appropriate.

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