When it comes to health, you can have too much of a good thing.
Orthorexia is an obsession with eating healthy food. For people who develop the eating disorder, the intention to eat nutritious food turns into a fixation. Instead of generally striving to eat more healthy foods, people with orthorexia cut out entire food groups they feel aren’t healthy, which can result in nutritional deficiencies, mental health challenges, and social isolation.
The signs of orthorexia can also be very difficult to identify, says Sadi Fox, PhD, a licensed psychotherapist who has been working with people with eating disorders for 10 years. Since eating healthy is generally perceived as a good thing, people with orthorexia might be praised for their disorder, not know they have a problem, and not end up getting the help they need—which is the case for some patients who work with Fox. “A lot of people are just like, ‘Whoa, I didn’t even realize how deep [into my eating disorder] I was,’” she says.
People with orthorexia might make food choices based on different approaches they see on social media, but that doesn’t necessarily mean it’s backed by science, says Fox. Narrowing down the foods you eat, especially based on misinformation, is a “slippery slope” for other disordered behaviors, she adds.
Meet the experts: Sadi Fox, PhD, is a psychotherapist specializing in eating disorders at Flourish Psychology, a Brooklyn-based private psychotherapy practice. Kelli Rugless, PsyD, is a clinical psychologist and eating disorder specialist at the virtual talk therapy practice Flourish Psychology. Emily Van Eck, RD, is a dietitian and intuitive eating counselor at Emily Van Eck Nutrition.
Most importantly, orthorexia can often go unnoticed. Since eating healthy is a good thing, behaviors related to orthorexia can often be encouraged. It’s important to know the signs and symptoms—and even more important to turn to experts when it comes to determining what goes into a well-balanced diet.
Orthorexia is not officially recognized in the DSM-5 (the handbook for diagnosing mental disorders), but it’s an eating disorder that has risen significantly over the past few years, according to the experts who treat it. Without formal diagnostic criteria, it’s challenging to determine exactly how many people in the U.S. struggle with orthorexia, per the National Eating Disorders Association—but prevalence varies across countries and populations, ranging from 6.9% in the Italian population to 88.7% in Brazil, per a 2021 review in the International journal of environmental research and public health. Other studies suggest orthorexia might be more common in Instagram users (49% prevalence) nutrition students (72% prevalence), and populations that exercise (55% prevalence). Plus, athletes and endurance athletes (runners especially) have higher symptom severity when it comes to orthorexia, according to a 2023 study in Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity.
Here’s what you need to know about recognizing orthorexia.
What is orthorexia?
Orthorexia is when eating healthy goes from a goal to an obsession, and it has both physical and mental drawbacks.
With orthorexia, you become so focused on avoiding foods you think are harmful that you end up depriving your body of the nutrition it needs, says Kelli Rugless, PsyD, a clinical psychologist and eating disorder specialist at the private therapy practice Flourish Psychology. Because their diets can become so restrictive, people who are orthorexic might lack key nutrients, not get sufficient calories for normal bodily functions, and have digestive issues like constipation, says Emily Van Eck, RD, a nutritionist who works with patients with eating disorders.
Beyond the physical complications that come with orthorexia, the eating disorder is also associated with mental and emotional challenges, including dealing with shame, guilt, fear, and social isolation when it comes to food, says Rugless. “Their relationship with food becomes obsessive,” says Rugless. They might avoid social situations where they can’t control what they eat. Plus, the stress that comes with an eating disorder can ruin your quality of life, says Van Eck.
Compared to eating disorders like anorexia and bulimia, in which a person’s primary motivation might be to change the look of their body, orthorexia typically starts with the goal to eat the healthiest foods possible, says Rugless. This goal doesn’t happen in a vacuum, though. “It’s diet culture’s newest attack,” says Fox. Media and social media’s support of things like “clean eating,” different harmful dietary practices, and general health misinformation may contribute to fears about “toxic” foods and could be supporting this uptick in orthorexia, per a 2023 study in Nutrients. Basically, social media is playing a role in the increase of this eating disorder, which can have serious consequences on someone’s health.
Related Stories
Signs And Symptoms Of Orthorexia
How can you tell if someone is simply eating healthy or dealing with an eating disorder? Look for rigidity, says Rugless. If a friend is dividing foods into black and white categories (like “good” and “bad”) and cutting out entire food groups aside from allergies or religious and cultural traditions, that’s a sign they could be dealing with something deeper. They also might avoid certain restaurants, bring their own food, or refuse to eat altogether if they can’t access a food they’re okay with. They may also spend a lot of time researching food or spending money on health foods they can’t afford, adds Fox.
People who struggle with orthorexia tend to focus on not eating anything “harmful,” “damaging,” or “bad,” Rugless says. Instead, they consume foods they believe are “pure,” or “clean.”
“People are a bit moralistic about it,” says Fox. If you have a friend who feels particularly judgy about food—or even about what you eat—that also might be a sign of an unhealthy relationship with food.
If you think you or a loved one might be struggling with orthorexic behaviors, it’s always a good idea to talk to a therapist. If you’re not sure, here are some questions Fox tends to ask patients.
Is your diet representative of the different food groups?How does your diet make you feel?Does thinking about eating and food take up a lot of time in your life?Does what you eat cost an appropriate amount of money?Are you able to enjoy social gatherings around food? Related stories
How is orthorexia diagnosed and treated?
Orthorexia is not an official diagnosis in the DSM, so as of right now, there isn’t a set of clear clinical criteria to determine whether a person has it or not. However, if you’re exhibiting any of the above behaviors—like consistently fixating on food that you perceive to be “harmful,” avoiding restaurants, focusing on foods that you feel are “clean,” or any of the other behaviors mentioned, it’s likely a sign that you could be dealing with orthorexia.
Working with a licensed therapist and a dietitian can help you navigate this eating disorder, Fox and Rugless say.
Therapists might use cognitive behavioral therapy (CBT)—a type of psychotherapy focused on disrupting unhelpful thought patterns—to help you get back to the basics, make sure all food groups are represented in your diet and work on breaking down some of the ideas you might have about what makes something “healthy.” A dietitian can help make sure you’re adequately nourishing your body, all while helping you fight misinformation you might have inherited about food.
Related Stories
When To See A Doctor
If you think you may be struggling with orthorexia or any other eating disorder, it’s always a good idea to check in with an eating disorder specialist—they can help you, no matter how far along you are. To find one, you can look for therapists who mention specializing in eating disorders in their bios or for a Certified Eating Disorders Specialist (CEDS) or Certified Eating Disorders Registered Dietitian (CEDRD) credential. You can find more resources and get connected with a provider via the National Eating Disorders Association (NEDA) or head to findEDhelp.com, hosted by the National Alliance for Eating Disorders.
If you’re experiencing any of the below, Fox and Rugless recommend you reach out to a professional for help.
Anxiety or fear around foodOthers remarking on your eating habitsCutting out entire food groupsLacking energy, motivation, or interestFatigue or trouble sleepingFeeling obsessive about eatingOnly thinking about eating and/or making decisions around itExtreme hungerBinge episodes
In addition to talking with a therapist, if you are experiencing any physical issues, check in with your doctor to make sure you’re getting the vitamins and nutrients you need.
Olivia Luppino is an editorial assistant at Women’s Health where she covers health and fitness. She previously wrote for The Cut, POPSUGAR, and Salon and has written about everything from New York Fashion Week to dating app trends to the United States Women’s National Soccer team (a.k.a. her heroes). When she isn’t writing, Olivia is likely catching up on Bravo shows or running late to barre class.
Sadi Fox, PhD is a psychologist and founder of Flourish Psychology, a private psychotherapy practice.
