A woman in a large kitchen making dinner with fresh and healthy ingredients to represent the topic of the article - Orthorexia, The Hidden Eating Disorder Linked To Healthy Eating

Orthorexia, The Hidden Eating Disorder Linked To Healthy Eating

There’s an eating disorder that isn’t well known, can be easily hidden, and often unwittingly gets a lot of praise. Now I know that sounds confusing, but it’s not the disorder that getting the praise, but rather the perceived results of this eating disorder. The eating disorder I’m talking about is orthorexia.

 

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What Is Orthorexia?

 

Orthorexia is a common co-occurring eating disorder characterised by a need to only eat healthy foods, to avoid “bad” foods and food groups (Eating Disorder Hope). This need for “clean” and healthy eating can easily escalate into an obsession to eat clean and healthy, causing some overlap with OCD, although it isn’t on the obsessive-compulsive spectrum (Psychology Today).

 

A study by Bartel, Sherry, Farthing, and Stewart (2020) sort to classify if orthorexia was an eating disorder or on the obsessive-compulsive spectrum using 512 participants. The study concluded that orthorexia was far more connected to an eating disorder than an obsessive-compulsive disorder, thus supporting the idea of orthorexia being classified as a new clinical eating disorder.

 

A more concise definition of orthorexia nervosa comes from Koven and Abry (2015), who defined orthorexia as a pathological obsession with proper nutrition that often comes with a restrictive diet, avoiding “dirty” unhealthy foods, and ritualised patterns of eating.

 

However, according to Beat and Koven and Abry (2015), orthorexia isn’t recognised as an eating disorder in a clinical setting, even though it has a name, you won’t find it in the DSM V (National Eating Disorders). Nevertheless, most eating disorder organisations, like Beat, will have information on this eating disorder.

 

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Orthorexia’s Connection To Other Eating Disorders

 

One way to develop orthorexia could be due to recovering from another eating disorder, whereby someone in recovery might transition from focusing on weight loss and body image to eating healthy foods obsessively instead (Psychology Today).

 

Support for the recovery causing orthorexia comes from Segura-Garcia et al. (2015), who studied orthorexia in female participants with diagnoses of anorexia and bulimia. The study comprised of two groups, one group’s participants came from an outpatients service for eating disorders and the other group came from high school and college students (control group), with 32 participants coming from each. The results of this study were that orthorexia was highly prevalent among the anorexia and bulimia sample and tended to increase after treatment for their diagnosed eating disorder. This study also backups the claim made by Eating Disorder Hope, that orthorexia commonly co-occurs with other eating disorders

 

The picture is split in two with the top image being of a woman preparing a meal with fresh and healthy ingredients and the bottom image being of a healthy vegetable meal on a small table al fresco style. The two images are separated by the article title - Orthorexia, The Hidden Eating Disorder Linked To Healthy Eating

 

How Diets And Clean Eating Can Hide Eating Disorders

 

Because society has tricked us into thinking that being ultra-thin is equated with beauty, dieting has become a common and normalised behaviour in our society. In fact, this has become so normalised, that children between the ages of nine and eleven are dieting at worrying rates (Eating Disorder Hope). The problem is, diets don’t even work, no matter how much time and money you invest into them, diets fail because they’re unsustainable. We don’t need diets, we need lifestyle changes.

 

Food fads can also play into orthorexia as sufferers try to live a so-called “clean” and healthy lifestyle. Juicing has been a fad that often comes back again and again, but is it actually healthy? No, the fibres found in whole fruits are no longer intact when it’s juiced and the fructose that was once contained in the fruit’s cells are now free and count as regular sugar, speeding up absorption (BBC). Normally, this process of absorbing fructose is slowed down by the presence of the fruit’s fibres. Thus, you’re better off eating fruit than juicing it to drink, although you still need to be careful of your fruit consumption, as fructose is still sugar. Hence, why we’re always told to eat a balanced diet.

 

Another example of a food fad that could be incorporated into an orthorexia sufferers “clean eating” is giving up gluten. The majority of people have no issues with gluten. Yes, there are people with celiac disease and those people should avoid gluten, but someone out there saw a chance to make a buck and turned this issue into a “clean” eating issue even though there are no proven health benefits from avoiding this protein (HealthPartners).

 

Calling foods “clean” and “dirty” is just dieting by another name, a trick that has caused so-called “clean eating” to grow in popularity (National Eating Disorders), causing fixations on fad foods and diets that take potentially healthy eating to unhealthy levels.

 

Someone with orthorexia might start eating “clean” and healthy, but later shift towards weight loss as the obsession with “clean” eating starts to dominate their life (Psychology Today). Thus, if you or someone you know are seeking out new fad foods and diets, then you might be at risk of developing orthorexia because following such food plans can become obsessive, fast.

 

The problem is, the diet industry is largely unchecked by any scientific regulatory processes, meaning people can make wild and incorrect claims which then get amplified by social media and news companies (Koven and Abry, 2015). And such misleading information puts people’s lives at risk.

 

The big risk of “clean eating” fads and diets is that it can become pathological, leading to the development of orthorexia. As such, ironically, the person with orthorexia can suffer from nutritional deficiencies, causing medical complications, and a poor quality of life (Koven and Abry, 2015).

 

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My Brush With Orthorexia

 

I experienced an episode of orthorexia when I tried cutting out carbs and going keto. I became obsessed with cutting out all carbs. Every label was checked, and I only ate antipasti with meat, had soya milkshakes with no carb protein powders, and for a treat, I made keto mug cakes (which just weren’t the same). My life was consumed by making sure I didn’t eat carbs, and it was completely soul-destroying. I lost weight, but I couldn’t live being consumed by my need to avoid carbs. I just couldn’t enjoy myself. Then the pandemic hit and I lost access to the foods I need to maintain a keto diet, so I gave up on it. I have since tried to return to keto several times because I did lose weight, but even though I bought the foods to do it, I couldn’t start it. I just couldn’t bring myself to live through that nightmare again.

 

Besides the weight loss, there was also another benefit of me going keto. While on the keto diet, just before I was forced to give it up by world events, I’d stopped getting my hypo symptoms, which was nice. For the longest time, the starving issues caused by my eating disorder were dealt with by my hypos, because my symptoms are so unbearable that I’d have to eat. However, without those hypo symptoms, I returned to starving myself and was only eating once every three days by the time the pandemic hit.

 

This one diet, which was recommended to me by my doctors even though I told them I have an eating disorder, in a relatively short time, turbocharged my eating disorder. And although it was nice not having my hypo symptoms for the first time in years, having my eating disorder go out of control like that just isn’t a price I’m willing to pay.

Signs And Symptoms Of Orthorexia

 

  • Self-esteem comes from healthy eating.
  • You compulsively and obsessively check ingredient lists and nutritional labels.
  • You avoid eating out due to fear of not being able to find the food you can eat.
  • You have a growing concern about what ingredients are in food.
  • Feeling of guilt and/or shame bombard you when you don’t meet your dietary standards.
  • An inability to eat foods outside of your accepted healthy and “clean” foods group.
  • Being consumed with thoughts about what food options will be available at events.
  • Getting stressed out when your sanctioned foods aren’t available.
  • Cutting out a growing list of food groups, such as carbs, meat, and gluten.
  • An unhealthy interest in what others eat.
  • Experience anxiety around your meal times and food planning.
  • Becoming obsessed with joining healthy lifestyle groups and following healthy lifestyle blogs and social media accounts.
  • Developing less than favourable opinions of others who don’t follow your kind of “clean eating”.

 

Interestingly, body image may not be present as a symptom of orthorexia.

 

The Bratman Orthorexia Self-Test

 

The self-test is made up of a few statement questions that Steven Bratman outlines on his website for exploring if you have orthorexia, so you can seek support and make adjustments. If you’re keen on healthy living and diet fads, this small test might be useful to you to avoid health complications further down the line. Thus, if you answer yes to any of the following six statements, then you may be at risk of developing orthorexia.

 

  • I spend too much of my life thinking about, choosing, and preparing healthy food that it interferes with other aspects of my life, such as work, school, social activities, and relationships.

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I spend too much of my life thinking about, choosing, and preparing healthy food that it interferes with other aspects of my life, such as work, school, social activities, and relationships
I spend too much of my life thinking about, choosing, and preparing healthy food that it interferes with other aspects of my life, such as work, school, social activities, and relationships
I spend too much of my life thinking about, choosing, and preparing healthy food that it interferes with other aspects of my life, such as work, school, social activities, and relationships

 

  • I feel anxious, guilty, impure, unclean, and/or defiled when I eat any food I regard to be unhealthy; even being near such foods disturbs me, and I feel judgmental of others who eat such foods.

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I feel anxious, guilty, impure, unclean, and/or defiled when I eat any food I regard to be unhealthy; even being near such foods disturbs me, and I feel judgmental of others who eat such foods.
I feel anxious, guilty, impure, unclean, and/or defiled when I eat any food I regard to be unhealthy; even being near such foods disturbs me, and I feel judgmental of others who eat such foods.
I feel anxious, guilty, impure, unclean, and/or defiled when I eat any food I regard to be unhealthy; even being near such foods disturbs me, and I feel judgmental of others who eat such foods.

 

  • My sense of happiness, joy, peace, safety, and self-esteem is excessively dependent on the purity and rightness of what I eat.

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My personal sense of happiness, joy, peace, safety, and self-esteem is excessively dependent on the purity and rightness of what I eat
My personal sense of happiness, joy, peace, safety, and self-esteem is excessively dependent on the purity and rightness of what I eat
My personal sense of happiness, joy, peace, safety, and self-esteem is excessively dependent on the purity and rightness of what I eat

 

  • Sometimes I would like to relax my self-imposed “good food” rules for a special occasion like a wedding or a meal with my loved ones, but I’m unable to bring myself to do so. (Note: If you have a medical condition in which it is unsafe for you to make ANY exception to your diet, then this item does not apply).

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Sometimes I would like to relax my self-imposed “good food” rules for a special occasion like a wedding or a meal with my loved ones, but I'm unable to bring myself to do so
Sometimes I would like to relax my self-imposed “good food” rules for a special occasion like a wedding or a meal with my loved ones, but I'm unable to bring myself to do so
Sometimes I would like to relax my self-imposed “good food” rules for a special occasion like a wedding or a meal with my loved ones, but I'm unable to bring myself to do so

 

  • Over time, I’ve steadily eliminated more foods and expanded my list of food rules in an attempt to maintain or enhance health benefits; sometimes, I may take an existing food theory and add to it with beliefs of my own.

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Over time I've steadily eliminated more foods and expanded my list of food rules in an attempt to maintain or enhance health benefits; sometimes, I may take an existing food theory and add to it with beliefs of my own
Over time I've steadily eliminated more foods and expanded my list of food rules in an attempt to maintain or enhance health benefits; sometimes, I may take an existing food theory and add to it with beliefs of my own
Over time I've steadily eliminated more foods and expanded my list of food rules in an attempt to maintain or enhance health benefits; sometimes, I may take an existing food theory and add to it with beliefs of my own

 

  • Following my theory of healthy eating has resulted in me losing more weight than most people would say is good for me, or has caused other signs of malnutrition such as hair loss, loss of menstruation, or skin problems.

Coming Soon
Following my theory of healthy eating has resulted in me losing more weight than most people would say is good for me, or has caused other signs of malnutrition such as hair loss, loss of menstruation, or skin problems
Following my theory of healthy eating has resulted in me losing more weight than most people would say is good for me, or has caused other signs of malnutrition such as hair loss, loss of menstruation, or skin problems
Following my theory of healthy eating has resulted in me losing more weight than most people would say is good for me, or has caused other signs of malnutrition such as hair loss, loss of menstruation, or skin problems

 

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Orthorexia Treatments

 

According to Koven and Abry (2015), no studies currently confirm any effective treatments for orthorexia. So currently there is no peer-reviewed clinical treatment for orthorexia. However, that doesn’t stop eating disorder organisations like Beat from offering you advice and support. Thus, please reach out to your GP or an eating disorder service if you think you may have orthorexia or any eating disorder.

 

As always, leave your feedback in the comments section below. Also, feel free to share your experiences with orthorexia and eating disorders in the comments section below as well. Don’t forget to bookmark my site and if you want to stay up-to-date with my blog, then sign up for my newsletter below. Alternatively, get push notifications for new articles by clicking the red bell icon in the bottom right corner.

 

Lastly, if you’d like to support my blog, then you can make a donation of any size below as well. Until next time, Unwanted Life readers.

 

 

 

References

 

Bartel, S. J., Sherry, S. B., Farthing, G. R., & Stewart, S. H. (2020). Classification of Orthorexia Nervosa: Further evidence for placement within the eating disorders spectrum. Eating Behaviors, 38, 101406. Retrieved from https://doi.org/10.1016/j.eatbeh.2020.101406.

Koven, N. S., & Abry, A. W. (2015). The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatric Disease and Treatment, 11, 385–394. Retrieved from https://doi.org/10.2147/NDT.S61665.

Segura-Garcia, C., Ramacciotti, C., Rania, M., Aloi, M., Caroleo, M., Bruni, A., Gazzarrini, D., Sinopoli, F., & De Fazio, P. (2015). The prevalence of orthorexia nervosa among eating disorder patients after treatment. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity20(2), 161-166. Retrieved from https://www.researchgate.net/profile/Cristina-Segura-Garcia/publication/270220344_The_prevalence_of_orthorexia_nervosa_among_eating_disorder_patients_after_treatment/links/5ac4fab9aca27239edb8d959/The-prevalence-of-orthorexia-nervosa-among-eating-disorder-patients-after-treatment.pdf, https://pubmed.ncbi.nlm.nih.gov/25543324, and https://doi.org/10.1007/s40519-014-0171-y.

 

Support

 

Beat UK

The National Eating Disorders Association US

53 thoughts on “Orthorexia, The Hidden Eating Disorder Linked To Healthy Eating

  1. I hadn’t heard of this before but I can see how it could be the start of a slippery slope and if someone already tends towards control through eating it must be even more risky. I know lots of people who advocate eating only this set of foods or that one – it never seemed balanced to me. But then, apart from 20 years vegetarian before having kids, I’ve always eaten a wide range of foods and have a big appetite (apparently, my mother in law says I “put it away” but I think she restricts her portions a lot). Thanks so much much sharing, and I love that you always do proper research and provide references to published, peer-reviewed journals.

    • Lot’s of people love to advocate one style of eating or a diet, but they rarely know the health risks that might come with it. Like with everything in life, balance is where it’s at

  2. I’ve heard of orthorexia but I didn’t know that much about it. It must be hard to spot sometimes, so it’s great that you’ve drawn attention to it here

  3. The best thing here in this article is the information, you have a very good way in informing as i learned so much from reading this article, hope you have a good day!

  4. I’d never heard of Orthorexia before, albeit I know people can become obsessed with eating ‘clean’, I’d never have thought it as an eating disorder. Thank you for explaining about it, definitely learned something new today!

  5. This is a really under-talked about eating disorder – because it’s about “healthy eating” people often overlook the fact that it’s still an obsessive way of thinking about food.

    • That’s likely because it’s not in the DSM V nor been accepted as a clinical disorder yet, even though the vast majority of eating disorder services and mental health organisations do

  6. Thank you for sharing this information. I’m so glad you bought out the importance of recognizing when a dietary change can turn into an eating disorder. So many are doing the keto diet but this information is so important Thank you for sharing. It would be wonderful if you could share this on other platforms honestly.

    Pastor Natalie
    Letstakeamoment.com

  7. I’ve never heard of Orthorexia before. This is so interesting! I’ve always had a problem with my weight for as long as I can remember. I think in the last year or two I’ve started eating a better balance between healthy foods and those that I really enjoy, but it’s hard. Thanks for sharing!

  8. I had heard of orthorexia in one of the previous posts, but it was very interesting to get to know more about it and the symptoms! I have never been one for excluding different kind of foods, but having a light intolerance to gluten, I had to check labels more often than not in the last few years! Thanks for sharing x

    • Funny you should say that, I wrote this along side another article that mentioned it, and even linked to this very article, I then forgot to publish it ha ha ha. So the article you’re likely thinking of linked to an article I though I’d published, but hadn’t until now

  9. I believe I might now someone who is suffering with orthorexia. Its say how people can have an eating disorder and no one can recognize it. I have seen people who only eat certain foods and constantly desire to be thin. Being thin is not everything. I wish more people knew this.

  10. This is so interesting. I now that eating clean and healthy is almost a compulsion for some but had no clue it had a name and diagnosis. I’m going ot have to keep an eye for this with someone close to me
    Rosie

  11. I can definitely relate to some of these symptoms, thinking back to my eating disorder recovery. When I was 16-18, I went though a phase where I stopped counting calories, but focused on only eating low fat foods (this was way back when low fat was supposed to be ‘healthy’ and no one talked about carbs!) My skin got dry and my energy was low from the diet that I thought was good for me. I eventually stopped and just embraced eating a range of food again, but I can remember feeling a lot of anxiety about food being dirty/clean in terms of its health effects. Thank you for this detailed post and your research – it’s very helpful!

    • That’s the problem with low fat products, they tend to throw in more sugar to replace the fat. But the problem is, even though fat has more calories, fat in can make us feel fuller for longer than sugar, so really, we need the sugar/fat dynamic to be the other way around, because fat is a slow burning fuel so it’s better at maintaining our blood sugar levels

  12. I had never heard of this, but it seems like it is actually quite prevalent. So many people have these rules about food and what they “can or can’t” eat, when often it’s about arbitrary choice. The fact that our society accepts diet mindfulness as normal must just make this worse. Especially when body-image isn’t directly tied in, but rather the desire “to eat healthy”.

    • It’s definitely been made worse by the natural is better than chemical movement, even though everything is chemicals and so called natural is no better or worse than artificial

      • For sure. Organic was pushed so hard for a while, then it slipped to “natural”.
        It’s like everything else though, we need to find balance. That’s where the disorders fit in, that they are unbalanced.
        Our mental and emotional health can be so easily skewed with no regard to environment nor education (although those can influence).
        Thank you for this information today. You opened my eyes to be aware.

  13. Wow I have never heard of this one but it really does make sense as being an eating disorder. The one thing they all have in common is the obsessive compulsive tendencies, I guess. Great post!

  14. Very interesting!! I have heard of this before, it’s interesting how it can be linked to OCD, as I think it can prompt, exacerbate anxiety too x

  15. Great article! Always a pleasure and lots of learning reading your blog. This info is really helpful to watch our for this hidden eating disorder. No extreme diet is good even on being clean! Thanks for sharing!

  16. This is my first time hearing of orthorexia so thank you for such a well-researched introduction to it. It’s not something I’ve experienced but I can’t say I don’t recognize some of this in friends. Hopefully, there will be more awareness of this and people can recognise it more. Great post x

  17. I have heard about orthorexia before but I never really knew what it was. So thank you so much for this informative piece. With what I learnt about anorexia today, I can understand that it’s a topic that’s common. I personally don’t fancy dieting and I feel like it can have adverse effects. It does makes sense to classify this as an eating disorder. I hope more people start to talk about this to create more awareness.

  18. I didn’t know about orthorexia at all, so I’m glad to know about it. I’ve been on a few diets myself, the last one being the Keto diet that I followed from January to July of this year. I found that cutting out an entire food group (carbs) was not a balanced formula and I was not happy with the results either. So I switched to a calorie counter a few weeks ago. It’s good, but I realize that now I worry about every portion I eat, so I really don’t know if it’s better.

    • It’s so easy to fall into obsessive thoughts when it comes to sticking to a diet, but it can be really hard to naturally stick to a healthy balanced life style you can live without having to think about it as well

  19. Wow! This is such an interesting perspective! I’ve definitely changed my lifestyle and that I am making healthier choices in terms of food but there’s definitely guilt associated when every once in a while I “slip” and have some thing a little bit naughty.

  20. Wow, this was a well-written and informative post. I was not aware of “orthorexia” before this. You’re completely right that there are a lot of claims out there about “clean” eating and being gluten-free and it can cause more harm than good when people jump on these diets. I believe in moderation and a well-rounded diet, and, of course, fun! Thanks for making me aware of an issue that I suspected but was not wholly aware of!

  21. There was an increase of eating disorders during the peak of the COVID pandemic perhaps due to lack of control over circumstances. I think that it might have been higher considering that orthorexia could have fallen under the radar as being “healthy.”

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