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Eating Disorders Explained: Orthorexia

Infographic describing the difference between positive nutrition and pathological nutrition

Spend five minutes scrolling through your social feeds and you’re likely to come across a news article, advertisement or influencer touting the health benefits of a new diet. And sometimes, there’s truth to back the claims. Dietary changes can help you maintain a healthy weight, prevent disease and even boost athletic performance.

But while healthy eating is an excellent habit, taking it too far can have dangerous consequences. OhioHealth sports medicine dietitian Dawn Holmes, MS, RD, CSSD, and primary care and sports medicine physician Marguerite Weston, MD, share how in this explanation of orthorexia nervosa, an eating disorder that’s on the rise.

What is orthorexia?

People with orthorexia have a preoccupation with healthy eating that negatively affects their physical, social or psychological health. Anyone can develop orthorexia. It often begins with a positive intention to improve your health, but evolves into rigid rules for eating that take over your life.

What are the symptoms of orthorexia?

People with orthorexia may exhibit different warning signs depending on their unique diet and the severity of their condition.

Some symptoms to watch for include:

  • Assigning food a moral value, for example, good or bad.
  • Obsessive-compulsive behaviors, such as strict meal planning, or creating rules around the ingredients you can eat or how your food needs to be prepared.
  • Eliminating specific foods or entire food groups, without a medical reason.
  • An extreme lack of dietary flexibility. ­
  • Isolating yourself from social situations where food is involved.
  • Feelings of anxiety, guilt or impurity when you deviate from your diet.
  • Judging others for eating what you deem unhealthy.
  • No longer enjoying food you once loved.
  • Disgust when near prohibited foods.
  • An inability to change your diet, even if you know you should increase calories or be more flexible
  • Denial that you have a problem with food.

How does orthorexia affect the body?

Some people with orthorexia become so restrictive with their food choices that they develop a nutritional deficiency. For example, someone who avoids dairy may not get enough calcium.

These restrictions often escalate over time, sometimes involving fasting cleanses or detoxes. This results in weight loss, even though the desire to lose weight may be absent or obscured by the belief what you are doing is best for your health. Orthorexia can even become anorexia, hidden behind the façade of healthy eating.

When significant weight loss occurs, your metabolism will begin to slow to conserve energy, and your muscles will weaken, including your heart. This is very dangerous, especially for athletes.

How is orthorexia diagnosed?

At this time, there is no screening tool specific to orthorexia, but a psychologist may use elements of the SCOFF questionnaire, which is used to diagnose all eating disorders.

They will also evaluate whether patients have:

  • An obsessive focus on healthy eating.
  • Exaggerated emotional distress when eating food considered unhealthy.
  • Compulsive behaviors.
  • Dietary rules they’ve created.
  • Dietary restrictions that escalate over time.

If you are concerned you or someone you know may have orthorexia, start by asking yourself the following questions. If you answer yes to any of them, seek help from a physician.

  • Do you have anxiety when you violate your rules for eating?
  • Is the way you’re eating negatively impacting your health?
  • Are you more anxious than usual?
  • Is the way you eat impacting your relationships with other people?

 How do you treat orthorexia?

As with all eating disorders, the longer symptoms last, the harder the disorder is to treat. Early intervention with a multidisciplinary care team is critical to a successful recovery.

Find a primary care physician who is knowledgeable about eating disorders. They can refer you to a psychologist who will explore your anxiety and compulsions, and help you find ways to cope in ways unrelated to food. A dietitian can teach you which foods are appropriate for your body and in what amount.

Recovery from any eating disorder is challenging, and relapses are not uncommon. Acceptance and recognition of what triggers your disorder are two of the most important elements of treatment. Ultimately, the goal of treatment is to help you find balance, so food is used to nourish your life, not control it.

If you or someone you know needs help with an eating disorder, seek medical care from a physician quickly. You can find primary care physicians and psychologists at OhioHealth.com.