Orthorexia: Can "Clean Eating" Become an Eating Disorder?
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For a long time, Equip Peer Mentor Rachel Myers had struggled with what she calls “health anxiety.” The fear of getting sick or developing a chronic illness consumed her, leading her down a rabbit hole of solutions for staving off sickness. That’s how she first discovered veganism. While some adopt veganism for ethical or environmental purposes, for others like Myers, the lifestyle choice was a slippery slope into an obsession with healthy eating known as orthorexia.

While orthorexia isn’t a diagnosable eating disorder, it can be just as dangerous. Many people with orthorexia also fit the criteria for Other Specified Feeding and Eating Disorder (OSFED), or go on to develop other eating disorders, like anorexia or binge eating disorder. Learn more about what orthorexia is, how it's connected to disordered eating, and how to get help.

What is orthorexia?

The term “orthorexia” stems from a literal translation of the Greek words “ortho” (“correct”) and “orexi” (appetite), and refers to an overwhelming focus on “healthy” eating (you might also hear it referred to as "clean eating disorder"). There is, of course, a lot of variability in what constitutes “healthy” food, but the condition is typically characterized by some form of food restriction, a fixation on the quality or “pureness” of ingredients, and distress when preferred foods aren’t available.

“When we talk about orthorexia, we’re referring to the state of being rigidly obsessed with 'clean' eating patterns in a way that obstructs normal functioning and daily life,” says Equip Dietitian Gabriela Cohen. “I would say it's on the rise because of the immense popularity of ‘wellness trends,’ which often end up doing the opposite of providing wellness.”

While the reported prevalence of orthorexia varies from study to study, the condition is estimated to affect up to 7% of the population. Those who are immersed in the health and wellness world may be more prone to developing orthorexia. Orthorexia can be an especially prevalent form of disordered eating among adults, who are targeted by “wellness” marketing.

Signs of orthorexia

Here are some of the most common signs of orthorexia, according to Cohen, and Equip Therapist Ashley Isenhower:

  • Being extremely health-conscious or obsessed with “clean eating”
  • Having very rigid rules about when you can eat (this includes intermittent fasting) or how much you need to exercise
  • Saying things like “I don't want to be thin, I want to be fit,” or “strong is the new skinny.”
  • Having to measure and count everything you eat
  • Being stressed to travel or go out to restaurants
  • Having an intense fear of contamination or health side effects from eating “impure” foods

It’s also worth noting that someone with orthorexia may have a "normal" body mass index (BMI) and appear healthy. You can’t always tell from someone’s appearance if they are struggling with orthorexia — or any other form of disordered eating for that matter.

Is orthorexia an eating disorder?

Despite its prevalence and negative impacts on physical and psychological health, orthorexia isn’t considered a clinically diagnosable disorder and isn't recognized in the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). While many experts have argued for the classification of orthorexia as a clinical disorder, no standard set of diagnostic criteria has yet been established. However, that doesn’t mean orthorexia can’t have devastating effects on those who experience it, or initiate a slippery slope toward a diagnosable disorder.

“When asked 'is orthorexia an eating disorder,' I answer that I see orthorexia as a combination of different disordered eating patterns,” Cohen says. “Over a very short period of time, it can easily turn into an eating disorder such as anorexia or binge eating disorder (BED) if the patterns increase to the point that the individual isn’t eating enough or becomes so distressed that they start binge eating.”

Isenhower disagrees with the absence of orthorexia from diagnostic literature and says omitting it could result in serious consequences. “Not only do I believe orthorexia is and should be a classified eating disorder, I think it's probably the most dangerous one,” she says. “It’s the embodiment of diet culture and anti-fat bias. It’s so incredibly praised and glorified — many fitness instructors, nutritionists, and social media influencers are essentially just selling orthorexia. And they get away with it because they proclaim to be ‘all about health.’”

Myers’ experience is a clear example of this. She says, “My life revolved around being ‘healthy,’ but I was constantly getting sick because I was not eating enough to sustain my energy needs, I lost my menstrual cycle for many years because of the imbalances I caused in my body, and orthorexia made me avoid getting help because I feared doctors would try to contaminate me even further with medicine or chemicals.”

What are the risks of orthorexia?

While orthorexia doesn’t have the deadly reputation that disorders like anorexia and bulimia do, it doesn’t take much for an obsession with “clean” eating to spiral into a full-blown illness.

Side effects from “health products”

Orthorexia can trigger the use of potentially harmful substances that cause unpleasant side effects. As Myers puts it, “During my orthorexia, I was constantly trying out new, unregulated supplements and herbs because I believed I was deficient in vitamins and minerals but they caused stomach problems, headaches, and vitamin imbalances.” Myers advises, “It’s always best to talk to a doctor and dietitian before taking any supplements to see if you actually need them, and if there are any interactions with other medications.”

Mental health consequences

Aside from the physical risks, orthorexia can have a particularly negative effect on someone’s mental health. “There is an intense fear of what may happen if their meal isn't macro-friendly or if they can't work out exactly to their liking,” Isenhower says. “When we diagnose any mental illness, we're looking at the level of distress it causes the individual—how is this disorder impacting their daily functioning? With orthorexia, people are often severely impacted. That alone should qualify it for an official diagnosis.”

Medical distrust

“My orthorexia made me really mistrust my own medical provider,” Myers says. “Instead of opting for medications to help with my chronic illness and mental health symptoms, I was determined to use diet, exercise, and supplements to manage them. I believed it wasn’t good to have anything 'artificial' in my body."

Getting help for orthorexia

Seeking help for orthorexia or offering support to someone you believe is struggling can be tricky, especially because the symptoms of this condition can often be deemed praise-worthy in diet culture. But Isenhower says swift action is necessary to stop the progression of orthorexia and improve the chances of recovery. Here are a few steps you can take.

Initiate a conversation

Broaching the subject with a loved one can be difficult, but coming from a place of concern and empathy can help make the discussion easier. You can let them know what is orthorexia, and that you're concerned. “If you feel comfortable, I would try to talk to them or to their support system,” Cohen says. “A lot of the time people who engage in this type of behavior don't realize what they are doing because it’s so normalized in society. People think that they are engaging in ‘healthy eating’ while in reality it’s an ‘unhealthy way to eat healthy.’”

Cohen says that any time she’s concerned about a loved one, she asks them some specific questions to initiate a thoughtful, nonjudgmental conversation:

  • I’ve been noticing some new behaviors, are they actually promoting health to you?
  • Are you feeling at peace? What is the balance between your mental and physical health like right now?
  • Could the anxiety that you have surrounding eating actually be impacting your health (which goes beyond physical looks) in a negative way?

Avoid reinforcing harmful beliefs

Another seemingly obvious but often overlooked tip for those observing orthorexia symptoms in a loved one: avoid reinforcing or idolizing their problematic behaviors, even unintentionally. “I would often get comments like, ‘I wish I was like you, I wish I could eat that healthily’ when it was actually driven out of fear for my health and wellbeing,” Myers says. I would suggest that you express genuine concern with that person and talk to them about getting professional help.”

Seek treatment

“I truly cannot emphasize how harmful and serious orthorexia is,” Isenhower says. “It can be just as dangerous and just as fatal as any eating disorder. In order to get treatment covered, it may be helpful to seek a diagnosis of Other Specified Feeding and Eating Disorder (OSFED), which can usually apply to someone who’s exhibiting symptoms of orthorexia.”

If you or someone you love might be showing signs of orthorexia, remember that support is out there. Equip provides tailored eating disorder treatment that includes a coordinated care team and mentors who have been through similar experiences. In treatment, trained clinicians can help you or your loved one unpack long-held beliefs about what is and isn’t “healthy,” and create space to live a life free from rigid restrictions. Schedule a free consultation to learn more.

Michelle Konstantinovsky, MJ
Equip Contributing Editor
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