When healthy eating becomes bad for our health: Identifying orthorexia nervosa

What resembles a healthy focus on food and nutrition may be a debilitating mental health disorder.

Colorful fruit and herb smoothie bowl.
Photo: Pexels/Jane Trang Doan.

Taking time to learn about, select and prepare food can lead to a diet that supports a healthy lifestyle. However, what may appear as a healthy interest in food and nutrition, can sometimes be harmful and disordered behavior. An obsession with healthy eating is the main sign of a mental health condition called orthorexia nervosa, or orthorexia. Individuals with orthorexia severely restrict the foods they eat based on how healthy they perceive them to be, and this perception of healthy food may or may not be based on accurate nutrition information.

For individuals with orthorexia, the emphasis on only consuming healthy food often results in a very controlled and precise diet. According to the National Eating Disorders Association, some foods that are often avoided by individuals with orthorexia are processed foods, foods with dairy or foods with added sugars. These kinds of diet choices can be a reasonable, healthy choice for some people. However, individuals with orthorexia become so concerned with the health quality of their food, that it is damaging to their physical and mental health.

The consequences of untreated orthorexia nervosa

Orthorexia creates a constant source of stress in an individual’s life. A person with orthorexia may be concerned about accidentally eating foods that they feel are unhealthy. Often, intense fear and anxiety may develop at the idea of eating food that is perceived to be unhealthy. Additionally, they may feel intense guilt and shame after eating such food. This can translate to anxiety about what food will be available when they are not at home and do not know exactly what is in their food, where it came from or how it was prepared. Due to an intense fixation over food choices, a person with orthorexia may spend a lot of time researching food and increasingly restrict their diet over time. This can lead to financial, social and physical problems.

A person’s finances may be jeopardized due to orthorexia. A person with orthorexia may only accept foods that are organic, fresh or non-GMO. These kinds of foods tend to be more expensive than other foods. The person may also spend more money traveling to stores further away or pay shipping fees to order food from specialty stores. These costs add up quickly and can become a major financial burden.

Orthorexia can quickly put a strain on relationships as well. A person struggling with orthorexia may avoid visits with friends or family because of an unpredictable and uncontrollable food environment. Similarly, the person may not attend social gatherings for holidays and other celebrations because the food that is served does not meet the person’s strict rules. Additionally, a person with orthorexia may spend a lot of time focused on acquiring and preparing food, which takes time and attention away from loved ones. Family dynamics can also be strained because shopping and mealtimes may be harder to manage, when the person with orthorexia requires food that is different than what other people in the household eat. In many cases, individuals with orthorexia find it easier to isolate themselves from loved ones rather than engage in uncontrollable, anxiety-inducing food scenarios.

The extreme restriction accompanying orthorexia can often lead to malnutrition. Malnutrition is when a person is not getting enough energy or nutrients for their body to function. Depending on what foods the person eats, essential nutrients or enough calories may be missing in the diet. Malnutrition can affect many parts of the body. A few signs of malnutrition are weight loss or gain; low energy; hair loss; loss of muscle mass, including heart muscle; decreased bone density, which can lead to osteoporosis and fractures and skin conditions.

Orthorexia nervosa and other restrictive food behaviors

It is important to recognize that there are reasons why an individual might have a specific diet that is not the result of an eating disorder. Behaviors that resemble signs of orthorexia but might not be related to it include:

  • Excluding certain food groups or not eating at certain times for religious or cultural reasons.
  • Avoiding foods based on a doctor’s instructions due to physical health conditions like pregnancy, food allergies, diabetes or bowel-related diseases.
  • Excluding foods due to personal beliefs, like animal rights or environmental reasons.
  • Avoiding foods due to personal taste, such as not enjoying spicy foods.
  • Limiting consumption of expensive foods or not eating a variety of foods due to budget constraints and food access.

In these cases, the person may still experience some negative consequences from restricting specific foods or whole food groups. Additionally, some of these situations, like having a severe food allergy or intolerance, can be a risk factor for developing orthorexia. However, these scenarios differ from the experience of orthorexia in that, with orthorexia, the obsession with healthy eating drives the decision to restrict and limit the intake of certain foods.

Orthorexia can also resemble other eating disorders and mental health challenges. Some examples of this would be someone with autism who has texture, scent, taste or visual sensitivities related to food, a person with avoidant-restrictive food intake disorder or a person with anorexia nervosa.   

Orthorexia can be treated

If you suspect that you or someone you know is experiencing orthorexia or another type of eating disorder, it is important to talk to a healthcare provider. Eating disorders and other mental health conditions should not be self-diagnosed or diagnosed by someone without appropriate licensure or certification. Professionals — such as medical doctors, mental health counselors and registered dietitians — can all help a person with an eating disorder like orthorexia. These professionals can assess signs and symptoms to provide an accurate diagnosis, aid in creating a diet and lifestyle plan to support overall health and well-being, and treat disordered behaviors and thoughts about food and body image. Orthorexia, like other eating disorders, is treatable with support from professionals and loved ones.

MSU Extension also provides many programs and materials that may be helpful for someone who is experiencing or supporting someone with an eating disorder. Mental Health First Aid (MHFA) teaches adults how to approach and support people in their lives who may be struggling with a mental health challenge. MSU Extension also has programs that can boost resilience and teach skills to manage mental, emotional and social well-being.

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