When “Healthy” Goes Too Far: Meet Orthorexia
Let’s begin with a little game of association here. When you hear the word healthy, what comes to your mind?
Images or phrases such as gluten-free, juice cleanse, abs, dairy-free, paleo, keto, whole30, dewy skin, and ________ [insert any other #trendingnow idea] may have come to mind. As you can see, the term “healthy” is pretty loaded these days.
Over the last decade, we have seen increased interest in nutrition and fitness, which is great, don’t get me wrong. I love that people are thinking about how food makes them feel, and how it impacts their daily lives.
But is there such a thing as being too healthy?
Yes. Yes, there is. There is this little thing called “Diet Culture.” This term refers to a culture of dieting, cleansing, clean eating, detoxing, macro-counting, and eliminating. It is of the idea that you should change your body to meet society’s “norms”, and it isn’t new. The wild thing is that none of these trends are new, they are re-washed, re-mixed versions of disordered eating. The “low-carb” diet was initially introduced in the mid-1800s and the government’s first recommendations on protein, carb, and fat balance were introduced in the early 1900s. But in our current age of instant gratification and social media, these ideas have hijacked our lives, our bodies, and our relationship to food and body. Diet culture is something that we, unfortunately, don’t get to opt into, we are born into it.
Food is so much more than fuel. It is our comfort, culture, connection, joy, and…oh yeah energy and nutrients. Think about it like this: When you smell your mom’s cookies (or any other favorite childhood food), what does it remind you of? Coming home from school, Christmas, or your birthday? Okay, so now you have a location. What do they taste like? What do they feel like? These emotions about food are deep-rooted, and Diet Culture doesn’t just tell us to eat cookies less often. Instead, it tells us that cookies are dirty, scandalous, worthy of guilt and shame and that you have “let yourself go” if you partake. And that’s simply untrue.
Our culture’s normalization with the obsession with “detoxing”, “cleansing”, and “clean eating” has warped our relationship to food, our bodies, and is a topic of serious concern.
So what is orthorexia?
Orthorexia is a fixation on righteous eating. It is not yet recognized as a clinical eating disorder in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), but it is seriously disordered and any level of disordered eating is a problem. Eating disorders have specific criteria that must be met in order to be diagnosed. Some of these diagnosis include anorexia nervosa and bulimia nervosa. Both of which are highly restrictive, weight and body-image focused, and often have compensatory behaviors such as vomiting or over-exercising. But just because you don’t meet these criteria, that doesn’t mean that you don’t have a disordered relationship with food.
Orthorexia is the extreme of “healthy” eating. It is when your food choices impact your normal life and ability to adapt to your environment and a variety of circumstances. I often see orthorexic tendencies start when someone decides to eliminate a group of food for either “health” or “environmental” reason. This may start with wanting to eat more plant-based, or decreasing their added sugar intake. Neither of these is inherently bad, but this process can lead to a hyper-vigilant attitude towards food and food ingredients. For most people, things stop there. But for others, the elimination spiral continues in a way that can become problematic.
Instead of restricting food quantity like anorexia, orthorexia is overly restricting food due to quality or emphasizing food morality such as “good” foods vs “bad” foods. Here are some of the signs and symptoms:
Rigidity: Sure, we all have our quirks. I don’t eat candy daily, but that doesn’t mean I won’t get down on some Skittles or Hi-Chews every now and again. However, someone who has orthorexic tendencies will struggle with flexibility around food. Anything that is deemed to be “bad” or “unhealthy” based on their self-imposed food rules will be avoided at all costs and cause increased anxiety when encourntering these foods.
Ask yourself this: Do you often avoid eating out or choose to go hungry in social situations because you may not know what is in the food that is offered, or where it comes from?
Fixation on quality: Yes, food quality food matters. But, please note that IT IS A PRIVILEGE to care about where our food comes from, how it is grown, and how it is prepared. You can do whatever you want with your wallet and your mouth. But when someone absolutely won’t eat something because it is not organic, whole, raw/vegan, or any other label, we have a problem.
Ask yourself this: Would you eat something if you didn’t know how it was grown, how it was prepared, or where it came from?
Eliminating entire food groups: Orthorexia may start with going vegetarian, then vegan, and then raw vegan. Then, you eliminate gluten because you read in Women’s Health that it is the devil incarnate. Sugar is next because it’s “addictive” right? Then, you eliminate nuts because, well, lectins. White foods? No thanks. Then it’s the carbs because those are probably causing every ache and pain. And then *POOF* all of the sudden you don’t have anything left to eat and you have eliminated so many foods from your diet that you are malnourished, tired, and fatigued. When in reality, this is actually why you’re tired, feel bloated, and have pain. Because you’re not eating enough. The most inflammatory thing we can do to our body is not providing it with adequate calories and nutrients.
Note, I am not talking about those who eliminate food due to religious reasons or because of a diagnosed medical condition such as celiac disease.
Ask yourself this: Are there things that I have eliminated a rule or a preference? A rule would be something that someone else has decided for you (a diet, cleanse, magazine, protocol, etc). A preference would be something that you don’t eat because you prefer not to. You can easily prefer to not eat cheese, but if you don’t eat cheese because someone has told you that it is “addictive” and causing all of your “issues”, then it’s a rule.
Emotional turmoil: Individuals with orthorexia will often have a heightened emotional response when they are confronted with eating something out of their control or out of their norm. These feelings may include anxiety, guilt, or distress. It can require a lot of dismantling to get to the bottom of these emotions. The best way to do that is with a mental health professional and a Registered Dietitian. Simply eliminating foods is not the answer.
Ask yourself this: Do I feel overly guilty or anxious when I eat something out of the norm?
Typically not driven by body image: Orthorexia is often motivated by health, family health history, poor health, control, avoidance of fears, improving self-esteem, or searching for spirituality through food. With orthorexia, someone’s eliminations become their identity “I’m keto”, “I’m Gluten-Free”. How you choose to eat should be the least interesting thing about you and if this is your only identity, then it may be time to do some soul-searching. Although orthorexia is not always associated with body image, it has recently started shape-shifting due to wellness influencers promising that eating a certain way will result in glowing skin, flat abs, and toned bodies.
Ask yourself this: If I were to write a bio, would I add vegan 🌱, WFPB (whole food, plant-based), or any other food-related descriptor?
If you answered “yes” to any of these questions, I would urge you to think about your relationship with food and think about discussing these thoughts with a Registered Dietitian.
Why it’s good to be dirty
Sure, “clean” eating sounds really nice. Clean things are good and hygienic, of course, we want to be clean individuals. “Clean eating” on the other hand is Diet Culture’s subtle way to push us all to be more restrictive and orthorexic because, on the surface, it seems logical. But, the opposite of clean is dirty. This is where the problem lies. Is dirty the best way to explain your mom’s cookies? No. Just as many things in our life are not binary, neither is food.
There are no “good” or “bad” foods. Foods do not have morality. You shouldn’t feel guilty when enjoying a childhood recipe or your favorite ice cream. When we live within these boxes of “yes” and “no” there is little room for maybe, sometimes, and little flexibility. You can eat food for other reasons than health.
I believe that everyone should find a way of eating that aligns with their ethics, lifestyle, and brings them joy rather than subscribing to some abstract idea of “eating clean”. The best way to eat clean is to wash your produce and cook your food to the proper temperature to kill any harmful bacteria.
Having a truly healthy relationship with food is hard in the culture that we live in. But I will be the first to tell you that it doesn't look like eating only brightly colored fruits and vegetables. It looks like eating when you’re hungry (sometimes when you’re not, hello anxiety), eating in community, finding joy in the food that you eat, being flexible, and eating a variety of foods that make you feel you’re best and support you mentally and physically.
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