Though it’s not formally listed in the Diagnostic and Statistical Manual as an eating disorder, orthorexia is real, it seems to be on the rise, yet many people who have it don’t realize it.

A person can struggle with orthorexia for years, and it may lead to a host of serious physical and mental problems.

With this blogpost, I hope to raise awareness of this misunderstood, often misdiagnosed condition. I’ll discuss the warning signs of orthorexia, and suggest some alternative ways of thinking about food and eating to help people move away from this obsessive mindset.

The basics of orthorexia

The term orthorexia is derived from the Greek orthos meaning “right” and orexia meaning “appetite.” That translates to “righteous eating,” and in practice amounts to an obsession with healthy eating.

People with orthorexia become so fixated on eating only healthy foods that it negatively affects their well-being and overall psychosocial functioning. As orthorexia progresses, people sometimes deny themselves entire nutrient or food groups because they see them as “impure” or “unclean.” Many become severely malnourished.

More broadly, a person’s obsession with healthy eating affects where they buy and eat their food, and who they eat with. Many people give up on eating out altogether, because they can’t control the nutrients and ingredients they consume.

Eating disorder expert Steven Bratman, MD, coined the term “orthorexia” in the late 1990s. Bratman referred to the condition as “a disease disguised as a virtue.” That describes it nicely.

Pay attention to these warning signs

The National Eating Disorders Association (NEDA) offers a helpful list of orthorexia symptoms to watch out for. They include:

• Compulsive checking of ingredient lists and nutritional labels.
• An increase in concern about the health of ingredients.
• Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat).
• An inability to eat anything but a narrow group of foods that are deemed “pure.”
• A feeling of superiority about their nutrition, and intolerance of other people’s food beliefs.
• Spending hours a day thinking about what food might be served at upcoming events.
• Showing high levels of distress when “safe” or “healthy” foods aren’t available.

In my experience as an eating disorder dietitian, the two things that often happen in someone with orthorexia is their healthy eating obsession both limits and interferes with their daily lives. Those are two big red flags: limiting and interfering with.

There’s a better way to live

There tends to be a lot of black and white thinking with people who have orthorexia. Often, a food is seen as either healthy or unhealthy. If you eat the healthy food, that makes you healthy. If you eat the unhealthy food, that makes you unhealthy. There’s a direct correlation between the food they eat and their health.

When I work with people who think this way about food, I try to have them think more broadly about it. I ask them to try and put food in a larger, more nuanced context, and to not just consider its nutritional content.

So things like, how does this food make you feel? How does your body relate to it? Does it taste good? Does it smell good, and look inviting? In what part of the world did this dish come from?

There are also important emotional connections you can have with food that don’t have anything to do with nutritional content, or whether it’s labeled as healthy or unhealthy. For example, if your grandmother makes you your favorite pie that you loved as a child, having a slice of that pie can have a positive impact on your emotional health.

In this situation, food serves as a connection to your grandma, thus nourishing your connection with your family.

Beware of nutritional praise

Because people with orthorexia tend to eat only foods deemed to be healthy (or some other value-based label), it often happens that their family, friends, coworkers, even their doctors will say things to them like “You’re so good!”

That can be dangerous validation for people with this condition. It reinforces their intense desire to be “pure” and “good” in their eating habits. And it gives their eating an added moral dimension (goodness), which may warp their relationship with food and themselves.

Even medical practitioners sometimes miss the clues

Medical practitioners don’t always understand the power of their praise, and how that might be taken on board. Unfortunately, many medical practitioners see health solely through the prism of weight as the problem.

For example, if a person comes into their office and says they have achieved significant and quick weight loss, the practitioner sees weight as the key issue. The negative behaviors that caused the weight loss may be entirely missed.

Or when a patient describes their seemingly healthy eating habits, and they seem physically fine, a medical professional may miss an orthorexia or eating disorder diagnosis altogether. They might even say things like, “You’re so good!” or “You’re doing so well!”

Bottom line is, our healthcare system is not designed to support medical practitioners in assessing a patient holistically, which is vital when it comes to eating disorders. Many don’t have time to ask the right questions, or they don’t have the training or expertise to properly assess their patients for eating disorders or disordered eating.

Those are the times when it’s important for patients to advocate for themselves, and to be honest and direct about what’s going on with their eating. If your medical professional doesn’t get it even in those situations, or they’re not being helpful, consider seeing someone else.

Preferably, you’ll want to find a practitioner with eating disorder expertise who can give you an informed assessment, and refer you to the right level of treatment if that’s needed.

Final thoughts on orthorexia

Obsessing about healthy eating is not healthy. Taking such a narrow, restrictive view of foods—that it’s all about nutritional content, and being “good”—is not sustainable, and it is certainly not joyful. It may also lead to a host of unhealthy mental and physical outcomes.

Last point: If eating was only about nutritional content, macronutrients, and the like, there would be no such thing as cuisine. There would be no culinary arts or ethnic foods. These help make eating a joyful and meaningful experience, and you don’t want to miss out on them.