There is a global trend towards healthy living and eating. The term ‘clean eating’ is often used in the health and wellness as well as fitness spaces and is often touted as ‘the ideal way to get healthy AND achieve the physique you’ve always wanted’.
For some, eating clean is a goal, for others a way of life. Then there are those who become obsessed with clean eating to the point that it becomes harmful to their health and well-being. While it may seem counterintuitive and even ridiculous that clean, healthy eating, even when taken to an extreme could harm a person, this is in fact that case and can lead to both physical and social impairment. When this occurs, the condition is referred to as 'orthorexia nervosa1', which, when literally translated from the Greek means ‘proper appetite’2.
While the term is not currently mentioned in the standard Diagnostic and Statistical Manual (DSM) used by healthcare professionals, awareness of this disorder has been on the rise since it was first identified by American Physician, Dr Steven Bratman in 1997.
Delving into Orthorexia Nervosa research
In a recent study aimed at addressing the limited research on orthorexia nervosa (ON), researchers from York University’s Faculty of Health conducted a comprehensive review of the psychosocial risk factors associated with the disorder3. In this review, they examined all studies published on the subject in two popular databases until the end of 2018. From the existing data they established the psychosocial risk factors that predisposed individuals or made them more vulnerable to developing the condition.
What they found was that unlike individuals suffering from anorexia who restrict caloric intake in order to achieve and maintain an exceptionally low body weight, people with orthorexia nervosa fixate on the quality of food eaten and how it is prepared rather on its caloric value. As the disorder progresses, sufferers spend more and more time and effort planning, purchasing and preparing healthy meals. At the height of condition, these practices become increasingly obsessive and all-consuming which interferes with various aspects of the sufferer's social life and results in weight loss.
Risk factors in the development of orthorexia
The study found that existing literature indicated that those who suffered from the following were also more likely to develop orthorexia:
- Preoccupation with appearance
- Poor body image
- Drive to be thin
- Obsessive-compulsive traits
- An existing or previous eating disorder
Research shows that while eating disorders like anorexia and bulimia affect both sexes, they are more common in young women4. Studies on orthorexia show that it affects both genders equally, placing both men and women with the above-mentioned traits at risk.
Findings on the correlation between the development of orthorexia and the following factors were mixed, and studies to further investigate whether precise links exist are required:
- Socioeconomic status
- Body Mass Index (BMI)
- Working or belonging to a health-related field
- Exercise engagement
- Vegetarianism or veganism (although preliminary evidence in existing studies show that lacto-vegetarians – those who don’t eat meat or eggs but do consume dairy – are at higher risk of developing orthorexia)
- Body dissatisfaction
- Alcohol, tobacco and drug use
Where to from here?
According to the Department of Psychology’s associate professor and senior author on the study, Jennifer Mills, further high quality studies are required in order to develop a consistent definition of orthorexia nervosa. This, in turn, will enable health researchers to develop more reliable measures and provide improved diagnosis and treatment which will allow for more reliable conclusions to be drawn about the true prevalence of the disorder as well as its risk factors.
She adds that the study’s findings will raise awareness and increase the recognition of orthorexia nervosa amongst both healthcare professionals and the greater public, making them aware of the fact that healthy eating, when taken to extremes, can be unhealthy. This is because it can result in a number of issues including:
- Difficulty in socialising, especially in settings where meals or eating is involved
- Cost in term of both time and money as obsessive healthy eating can not only be expensive but also requires large amounts of time for food preparation.
She concludes that people should understand that when taken to the extreme, obsessive clean eating is not just about food, but can be an indication that the orthorexia sufferer is struggling to manage their mental health.
What to do if you find yourself becoming obsessed with clean eating
If your endeavours to eat clean have become an obsession and you find that you’re increasingly spending time and money on accommodating these dietary practices, while withdrawing from social events that may involve eating, and feel guilty or ashamed if/when you don’t stick to your ‘eating plan’ you could have a problem. Body image concerns may or may not be present.
Two of the main concerns that sufferers of orthorexia face are health issues due to malnourishment (which can lead to a variety of ailments including heart problems) and disruption to social life.
Warning signs include2:
- Compulsively examining ingredients lists, nutritional labels and phoning ahead to get nutritional information at restaurants.
- Spending large amounts of time investigating the source of foods – could they have been exposed to pesticides? Are they derived from hormone-supplemented cows?
- Obsessing about the way in which foods were prepared or are packaged.
- Finding yourself becoming increasingly concerned about whether ingredients are healthy.
- Consuming a nutritionally unbalanced diet to the elimination of increasing numbers of foods or food groups, for example, all carbs, all meat, all dairy, all sugar.
- Only eating limited foods that are considered 'healthy', 'clean' or 'pure' and never deviating from this under any circumstance.
- Avoiding foods due to food allergies that have not been diagnosed by a medical professional.
- Spending hours planning and preparing meals.
- Worrying about what food may be served at social events you've agreed to attend and trying to get of these in case the food served interferes with your eating plan.
- Avoiding social interactions that may involve eating.
- Expressing unusual interest in what others are eating and evaluating whether or not it’s healthy.
- Feeling anxious or distressed when the foods that you feel are 'clean', 'healthy' or 'safe to eat' are not available.
- Significantly increasing the consumption of herbal and natural supplements and/or probiotics that are thought to have healthy effects on the body.
- Obsessively following health and wellness trends, fitness advice, blogs and influencers on social media.
While eating a healthy, balanced diet is good for both your mental and physical wellbeing, if you find yourself obsessing, becoming anxious or completely avoiding the people you love or situations that involve food just to stick to your diet, this may be a sign that it's time to seek help.
While orthorexia nervosa is not currently listed in the manuals that mental health and medical professionals use, any mental or healthcare professional that deals with eating disorders will be able to assist you in determining whether clean eating has become a problem for you and help you to overcome it.
Some of the following questions may be asked during a session when seeking to make a diagnosis:
- How many hours a day to you spend thinking about food?
- Do you wish you spent less time thinking about food and more time doing other things?
- Do you question whether food is unhealthy for you and spend time investigating its source, preparation and/or packaging?
- Do you feel happy and in control when you eat the way you’re supposed to?
- Have you planned tomorrow’s menu?
- Can you eat a meal prepared by someone else?
- Does your diet affect your social life? Do you find you see less of your friends or family?
- How do you feel about people who don’t eat healthy like you do?
- Do you feel that your quality of life has been affected as the quality of your diet changes?
- Are you strict with yourself about everything?
- Have you cut out foods you once enjoyed in order to ‘eat clean’?
- How do you feel when you can’t eat the way you’ve planned?
How is orthorexia treated?
The treatment of orthorexia usually involves psychotherapy and occasionally the administration of anti-anxiety and/or anti-depressant medication if this is deemed necessary by the treating professional.
Psychotherapy is a type of cognitive behaviour therapy and teaches a person to change their thought and behaviour patterns. This can reduce the anxiety and obsessive behaviours associated with the condition.
1. National Eating Disorders Association. https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia. Accessed May 16, 2019.
2. Koven N, Abry A. The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatr Dis Treat. 2015:385. doi:10.2147/ndt.s61665
3. McComb S, Mills J. Orthorexia nervosa: A review of psychosocial risk factors. Appetite. 2019;140:50-75. doi:10.1016/j.appet.2019.05.005
4. Striegel-Moore R, Rosselli F, Perrin N et al. Gender difference in the prevalence of eating disorder symptoms. International Journal of Eating Disorders. 2009;42(5):471-474.doi:10.1002/eat.20625