What Is Orthorexia?

I trace the source and legitimacy of a disorder purporting to describe an “unhealthy obsession with healthy eating.” 

Orthorexia nervosa is described as “a fixation on the virtue of food or unhealthy obsession with healthy eating.” Orthorexia has been styled as a type of “self-righteous eating” or “as ‘clean eating’ by those who are involved in these behaviors.” Hold on. Let’s take a step back. First of all, while this phenomenon “has been described in the scientific literature, it is not formally recognized as an official psychiatric diagnosis.” Furthermore, orthorexia doesn’t even have an accepted definition nor validated diagnostic criteria, and if you can’t validly diagnose it or even define it, what good is it? Where did this concept even come from? As I discuss in my video Is Orthorexia a Real Eating Disorder?, it didn’t come from a scholarly source, but from a popular press article called “Confessions of a Health Food Junkie” in a magazine called Yoga Journal. 

Let’s explore its “scientific legitimacy.” Evidently, it looks like orthorexics obsessively avoid processed foods, unhealthy fats, and foods with too much salt or too much sugar. But, by definition, we should avoid unhealthy fats—they’re unhealthy! And anything that has too much salt or sugar has too much salt or sugar. Is a nonsmoker who “obsessively” avoids cigarettes an orthospirexic? Someone obsessed with “right” breathing? “In many cases, parents strictly limit their children’s sugar intake or try to feed them only organic foods.” The horror! Off to the institution they go! 

Orthorexics “make the nutritional value of [a] meal more important than the pleasure of eating it.” If you didn’t do that just a little, wouldn’t you just eat donuts all day? If pleasure trumps health, should we all just start shooting heroin? Absurd. 

One of the proposed criteria is an “unusual concern about one’s own health.” What does that mean? Do you have a mental illness if you decide to hold the bacon on your double cheeseburger? That could be seen as an unusual level of concern in a standard American diet. 

“People with orthorexia pay excessive attention to the quality of consumed food; they also rather do not eat unhealthy food.” I bet they wear their seatbelts, too! “Experts” recommend we reprogram their unhealthy healthy thoughts with cognitive behavioral therapy combined, of course, with drugs, maybe SSRIs, such as Zoloft, Prozac, and Paxil.

Regarding psychotropic medication, SSRIs may help, but you may have to dip into the atypical antipsychotics as well. There may often be a concession, like: “Of course, from a clinical and public health perspective it would not be reasonable to suggest that individuals who follow a strict healthy diet are endangering their health.” It only reaches “‘clinical significance’…when health-directed eating” starts causing problems in relationships or impairs an individual’s social life. But, if someone asks their spouse not to smoke around them and the kids, that “health-directed” behavior could cause “interpersonal distress” in the relationship. Should you just keep quiet then? Or should you yourself keep smoking so you don’t create waves with your smoking spouse? And social-life-wise, do you have mental illness if you tell your date you’d rather not go to the steak house or the smoking lounge? 

“The problem…is when the behavior begins to hinder a person’s ability to take part in everyday society…They might start bringing their own food to…dinner parties.” Maybe I’ve just gone to too many potlucks, but bringing a healthy dish to share with others doesn’t sound like a druggable psychiatric offense to me. 

Then there’s Instagram. Think of “the implications social media can have on psychological well-being…[of] hundreds of thousands of individuals.” Did you know that “healthy food posts tend to receive more support from users than less healthy images, indicating a positive attitude towards healthy foods and healthy eating”? Soon, everyone might be taking pictures of broccoli. Quick, get out the straitjackets! 

In his decades of medical practice, Dr. Dean Ornish says he’s never seen a case of “orthorexia.” “Most people,” he says, “have the opposite problem; they don’t care enough about what they eat.”