Eating Disorders & Disordered Eating

Orthorexia: When eating “clean” gets toxic

November 14, 2023

Written by Chandana (Chandy) Balasubramanian

Medically reviewed by Rita Faycurry, RD

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Contents
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Key Points

  • Orthorexia is an obsession with eating “healthy”
  • People with orthorexia struggle with obsessive thoughts about food
  • Orthorexia can lead to health issues
  • Dietitians who specialize in eating disorders can help you heal from orthorexia

We follow hashtags like #WhatIEatInADay, #WeightLoss, or #CleanEating to improve our health. For many of us, detoxes, cleanses, and green juices are a part of our everyday vocabulary. But, can “clean eating” lead to an eating disorder? Experts say yes. People with orthorexia have an obsession with eating healthy; it’s making them sick.

How do you know if you or a loved one may have orthorexia? The best way is to learn about orthorexia, the signs of orthorexia, and options for orthorexia recovery.

What is orthorexia?

Orthorexia or orthorexia nervosa (ON) means an ‘obsession with healthful eating’, according to the National Eating Disorders Association (NEDA). It is not officially recognized as an eating disorder, but dietitians are drawing attention to it in recent years.

As per NEDA, warning signs of orthorexia include:

  • Compulsive checking of nutritional labels
  • Increasing worry about the health of ingredients
  • Cutting out more food groups, like not eating any sugar, all carbs, or dairy
  • Spending hours a day obsessing about food
  • Getting very distressed when “safe” or “pure” foods are not available
  • Obsessively following clean eating and healthy eating influencers on social media
  • Unusual interest in what other people are eating
  • Trouble being flexible about food choices and mealtime.

NEDA notes that many people with orthorexia also have obsessive-compulsive disorder.

Rita Faycurry, an experienced Registered Dietitian Nutritionist, elaborates, “On the surface, people with orthorexia may look healthy. In our toxic diet culture, they may even be praised for always eating healthy. But, on the inside, they often suffer from obsessive thoughts and high anxiety surrounding food. They may also have health issues similar to anorexia, like malnutrition, fatigue, and hair loss. Females may experience hormonal issues and missed periods.”

If you would like to talk to someone about orthorexia, Fay can help you find an expert registered dietitian nutritionist to help you learn more.

Orthorexia or healthy eating—what’s the difference?

Some of you may say, “What’s wrong with trying to eat healthy?”

or

“My family has a history of diabetes, so I like to eat clean. Why is that bad?”

The main difference between orthorexia and healthy eating is not exactly what you eat but how your food makes you feel.

Many people with orthorexia are consumed by thoughts about food. They often experience high levels of anxiety over social interactions because of the fear of not having ‘safe’ foods available. Some may plan their next meal while eating their current one.

It may be overwhelming to shop for groceries because they analyze food labels in detail and calculate the nutritional value of each food item. As with other disorders, constant thoughts and compulsive behaviors begin to take over their lives, affecting their health and relationships.

Faycurry explains, “Disordered eating is an inside job. It is characterized by how obsessive a person’s thoughts are about food. People with orthorexia often have a voice in their head that constantly warns, evaluates, and plans food intake. Orthorexia can make you very fearful about foods considered bad, unhealthy, or unsafe. In contrast, people without an eating disorder can balance their meals without compulsive thoughts or stress associated with food.”

Fay can help you find a registered dietitian to help you with orthorexia recovery, covered by your insurance.

Health effects of orthorexia

Ironically, while people with orthorexia are obsessed with eating healthy, they may often suffer from nutritional deficiencies and other issues.

Health issues due to orthorexia include:

  • Malnutrition
  • Vitamin or mineral deficiencies
  • Poor gut microbiome or gut health
  • Hair loss
  • Females may experience low estrogen and missed periods
  • Brain fog and low concentration

Similarities between orthorexia and anorexia

Orthorexia shares many similarities with anorexia, particularly compulsive thoughts about eating and needing to control lives by controlling food. People with orthorexia may spend a lot of time planning and preparing their meals and may experience social isolation due to their anxiety about food.

Additionally, people with eating disorders may associate morality and tie their self-worth to their control over food, leading to another parallel between orthorexia and anorexia.

Differences between orthorexia and anorexia

Despite the similarities, there are notable differences between people with orthorexia and anorexia.

People with orthorexia:

  • Are more focused on the quality of their food, not the quantity
  • Do not skip meals (unless they are on a fast)
  • Obsess about self-improvement; their weight may not be the priority
  • May or may not be underweight. Anorexia is characterized by low physical weight.

Challenges with orthorexia diagnosis

Orthorexia can develop from seemingly harmless lifestyle changes. For instance, a person may cut out certain foods and begin to feel better and look healthier. Unfortunately, in our wellness and diet-obsessed culture, they may be overly praised for their controlled diet. For some people, this type of validation can lead to disordered eating, and they may not realize they have a problem.

People with orthorexia may feel superior to others for their “self-control” and tie their self-worth to their ability to follow their diet. Although they may experience a boost in self-esteem in the short term, over time, obsessive and perfectionist thoughts will cause high levels of distress. Another challenge with identifying people with orthorexia is that they may look healthy on the outside even though they struggle inside.

Can you recover from orthorexia?

Orthorexia treatment is often multi-faceted and begins with therapy. When necessary, medication to treat depression, anxiety, or other health issues may be prescribed. Additionally, a dietitian with expertise in eating disorders can help guide you through your journey. 

If you suffer from orthorexia, you may have a voice in your head that tries to control your food intake and can make you feel a lot of guilt, shame, and fear over ‘slipping’ up. A dietitian who specializes in eating disorders can offer support and help with battling and defusing this self-critical voice.  

If you suspect you have orthorexia, Fay can help you find a registered dietitian, covered by your insurance, who specializes in eating disorder recovery.



The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.


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Chandana (Chandy) Balasubramanian

Written by Chandana (Chandy) Balasubramanian

Chandana Balasubramanian is an experienced healthcare executive who writes on the intersection of healthcare and technology. She is the President of Global Insight Advisory Network and has a Master’s degree in Biomedical Engineering from the University of Wisconsin-Madison, USA.

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Rita Faycurry, RD

Medically Reviewed by Rita Faycurry, RD

Rita Faycurry, RD is a board-certified Registered Dietitian Nutritionist specializing in clinical nutrition for chronic conditions. Her approach to health is centered around the idea that the mind and body are intimately connected, and that true healing requires an evidence-based and integrative approach that addresses the root cause of disease. In her books and articles, Rita offers practical tips and insights on how to care for your body, mind, and spirit to achieve optimal health and wellness.

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