Is healthy eating becoming your unhealthy obsession? It could be orthorexia

Orthorexia is a common eating disorder, but identifying it is not as easy. Here’s all you need to know.
Orthorexia can be dealt with, if it is recognized in time. Image courtesy: Shutterstock
Dr Jalpa Bhuta Published: 12 Oct 2021, 07:00 am IST
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Proper nutrition and diet enhance wellness and health. However, in case “healthy” eating becomes an unhealthy fixation in quest of a ‘pure’ and ‘super healthy ‘ diet (and exclusion of everything else), it is a form of disordered eating.

Orthorexia nervosa (ON) is derived from the Greek ortho, meaning correct, and orexic, meaning appetite (Steven Bratman 1997). Anorexia nervosa (AN) and bulimia nervosa (BN) are well known eating disorders. Orthorexia nervosa is a form of disordered eating, which is still relatively unknown with no uniform diagnostic criteria. 

orthorexia starts off as being a genuine desire to eat healthy and live a better lifestyle. Image Courtesy: Shutterstock

It  is an extreme preoccupation with healthy eating, with self-made criteria for how ‘pure and clean ‘the food should be, associated with restrictive behaviours due to the same. There may be some overlap with obsessive compulsive disorder (OCD), and anorexia nervosa (AN), and yet there are many differences.

How do you recognize it?
  • There is extreme focus on food quality, not on quantity.
  • Refusal to eat anything deemed ‘unhealthy” or ‘impure’ food, containing salt, sugar, preservatives, sugar, dairy, GMO etc
  • This leads to elimination of several foods and food groups from the diet
  • 3-5 hours spent in daily researching and sourcing ingredients, planning and preparation of food
  • Significant shame when a ‘slip up’ occurs
  • Refusal to meet friends outside for dinners, meals or insists on carrying own food
  • Look down upon others who eat meat/ fast food.
  • Strong belief and fear that any error in dietary habit will lead to illness

Also, take this quiz: Tell us your eating habits with this quiz, and we’ll tell you if you’re eating well-balanced meals

How is orthorexia caused?

There are certain risk factors.

  • If there is a tendency for preoccupation with being overweight, a parental history of eating disorders, fearful and dismissive attachment style etc.
  • Certain traits are also found to be more common, i.e. usually persons suffering from orthorexia are more anxious, have a strong need to control, chase perfection, and may have excessive concern about their appearance.
  • Neurocognitive deficits are similar to those with AN or OCD. There is a deficit in flexible problem solving, external attention and working memory. Also, neuroimaging in OCD has cortico-striato-thalamo-cortical pathways implicated.
  • In AN, there is dysregulation of dopamine transmission in reward circuitry of ventral striatum, and food regulatory mechanism in the hypothalamus.
Unlike other eating disorders, orthorexia mostly revolves around food quality, not quantity. Image courtesy: Shutterstock
How does orthorexia nervosa affect our health?

Although most people with orthorexia have a normal to low normal body weight, if symptoms are severe leading to restriction of several food groups and calories, it may lead to malnourishment and physical complications and hospitalization. Moreover, it also affects their mental health. It leads to guilt, anxiety, social avoidance, preoccupation with nutrition of ‘pure’ foods, mood swings and depression, obsessive compulsive behaviours etc.

Also, read: Science says eating 5 servings of fruits and veggies daily can help you live a long and healthy life

What is the treatment for orthorexia nervosa?

In this, there is a danger of symptoms being easily missed/ unnoticed and a ‘healthy lifestyle’ can mask underlying issues and obsessive behavior. Moreover, those with ON may not consider themselves ill. They think they are on the path to perfect health. This may create a resistance to initiating treatment. The first step is for them to accept that they need help and have a goal of healthy eating, with no obsession.

Once there is acceptance, ON is easily amenable, given their pursuit of wellness. There should be a multidisciplinary team approach, consisting of a physician, psychotherapist and nutritionist. 

Also, read: These 8 signs and symptoms are hints that you aren’t eating well

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Physical examination and blood tests should rule out any medical complications. Cognitive behavior therapy addresses perfectionism and cognitive distortions. Exposure and response prevention helps with obsessive and compulsive behaviours. On the other hand, relaxation therapy helps with meal time anxiety.

If you think you have an unhealthy relationship with eating, your doctor may suggest mindful eating strategies. Image courtesy: Shutterstock

ON patients may refuse medications, deeming them to be ‘unnatural’ substances. SSRIs may be useful for obsessive tendencies.

Psychoeducation by the nutritionist is important to correct accurate beliefs about food groups, purity and preparation.

The last word

Orthorexia nervosa is an obsession with healthy eating with associated restrictive behaviours. It is an attempt to obtain optimum health through ‘pure’ diets, which may impact the overall physical and mental health, relationships and quality of life. It is little understood with imprecise etiology, and diagnostic criteria. Its prevalence is not yet accurately known. ON characteristics vary from normal to pathological, and relies mainly on clinical judgement.

More research is required to determine if in our society, healthy behaviours are becoming pathologically unhealthy.

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About the Author

Dr Jalpa Bhuta, Consultant Psychiatrist at Global Hospital, Mumbai ...Read More

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