Updated: Oct 11, 2022
This post was adapted from episode 14: "Definition of Orthorexia... What is it?"
of the Nourished & Free podcast.
Orthorexia is a term that is up and coming in the eating disorder community. Today, I want to go through the definition of orthorexia, what it means, who's at risk, if you're showing signs of orthorexia, the consequences of orthorexia, and what you can do to both avoid it AND heal from it.
Definition of Orthorexia
Orthorexia is essentially an unhealthy obsession of what's in our food. Those who are showing signs of orthorexia are highly preoccupied by healthy eating. This preoccupation may affect quality of life, the ability to eat with others, and the foods available to that individual.
A proposed diagnostic criteria for the definition of orthorexia nervosa is:
(a) obsessional or pathological preoccupation with healthy nutrition;
(b) emotional consequences (e.g. distress, anxieties) of non-adherence to self-imposed nutritional rules;
(c) psychosocial impairments in relevant areas of life as well as malnutrition and weight loss.
Is Orthorexia in the DSM?
In order to know if orthorexia is an eating disorder, we have to look at the DSM (the Diagnostic and Statistical Manual, aka the manual providers go through to see if you meet criteria for a disorder). Currently, the DSM-5 does not include orthorexia, so it is not an eating disorder (officially). However, that does not mean you shouldn’t be concerned if you are showing signs of orthorexia.
It has been proposed as an addition to the DSM-5 because orthorexia is very real and it has been shown to be dangerous for our health. It can get to a point where it's quite unhealthy. It is very similar to the manifestations we see in anorexia nervosa (very little intake, obsessive thinking, black and white mentality around food, low body weight, etc).
A lot of times, clinicians will treat Orthorexia just like they do anorexia, because if somebody is obsessive about how good, healthy, and pure their food is then they are going to end up being restrictive in their eating.
Which begs the question,
How is orthorexia different from anorexia?
In the table below, I show the diagnostic criteria for anorexia nervosa. I want to note that the two can certainly be seen together, and orthorexia can lead to anorexia. However, the key features of orthorexia (on the right side of the table) are unique from the diagnostic criteria for anorexia (on the left).
Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
An inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’, not necessarily calorie content.
Intense fear of gaining weight or becoming fat, even though underweight.
Unusual interest in the health of what others are eating.
Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
Body image concerns may or may not be present.
The Difference Between Orthorexia and Healthy Eating
I do want to pause and take a minute here to remind you: It's okay to make sure you're incorporating things in your diet because you know they can help your body feel and function well. That's healthy, and that's normal. We want that. That is not automatically orthorexia, you may just be mindful (and I encourage that!)
Orthorexia is on a new side of the spectrum for healthy eating: it’s completely overboard obsession about healthy eating. If you feel like this describes you, here are some things to consider if you are wondering, “do I have orthorexia?”
Symptoms of Orthorexia
In discussing the definition of orthorexia, it’s important to also look at the signs and symptoms of orthorexia.
Some symptoms of orthorexia include:
· Thinking about food constantly
· Always checking ingredients
· Making sure that everything is non GMO or organic
· Requiring the ability to pronounce every ingredient on the label
· Looking into the manufacturing of how the food was made...
· Requiring foods to be “chemical free” or “nontoxic”
· No flexibility around food
· Inability to eat food spontaneously
· Eliminating food groups
· Eating vegan for non-ethical reasons
· Distressed over food
These are not normal things. Rather, they are some telltale signs of orthorexia.
How to Avoid Orthorexia
Let’s talk about what causes orthorexia. Interestingly, Instagram use is linked to increased symptoms of orthorexia nervosa. This is certainly not the only cause of orthorexia, but I do want to highlight it today. What I propose when we consider how to avoid orthorexia is to not pay attention to the people who tell you to pour over the ingredients in your food.
Let me tell you a story. I came across a reel once from a health coach that had no legitimate certifications (read: nothing that would take longer than a month to earn). She had posted something on Instagram a reel all about these ingredients that you have to avoid. She literally listed 20 different things.
My immediate thought, “Why is this something that somebody is getting attention for, why are people paying her for her advice?” She was basically teaching people to be afraid of food. That's a really classic sign of orthorexia, and now she’s going viral teaching others how to develop it as well.
There is a lot of really scary nutrition advice on TikTok and Instagram. There’s even scary nutrition advice within the walls of our own doctors’ offices. Credentials help us to know that someone has a greater degree of education on certain subject matters, but they shouldn’t automatically be trusted (yes, even RDs!)
Here’s something to ask yourself if you’re wondering whether you should believe a nutrition tip or not that you see on social media or that you hear from a professional: “is this person telling me to completely cut out a food or foods from my diet, even though I’m not allergic to it?” If yes, move on my friend, move on.
Why is Orthorexia Bad?
In theory, it sounds normal to care about what we put in our body. So why shouldn't we pour over ingredients?
This issue is, we are so obsessive about the ingredients in our food as a culture. We're getting obsessive about things that we can't pronounce, or that are a chemical, whether they’re organic or not, and so on. But honestly, all of life is chemicals. Water is chemicals. Every single thing that you can see and touch is at its most basic form… a chemical. Everything breaks down into atoms. And so, in terms of food and nutrition, it's absolutely ridiculous to get so wound up about chemicals in our food because literally everything that we can possibly eat is going to have chemicals, no matter how you spin it.
Things like additives, GMOs, and pesticides get a bad rap, but they are actually there for our safety. Additives there to increase shelf life so that food doesn't spoil on us and we're not eating rotten food. Pesticides are there to keep crops from spoiling. GMO’s are there to help us have access to food during parts of the year we normally wouldn’t.
We end up paying so much money for these things that are “clean”, and it makes absolutely no difference on how our bodies function. It does make a big difference in our mental health because being obsessive over food is going to inhibit quality of life, as well as our health.
Orthorexia Nervosa Effects
The consequences of orthorexia is why I'm talking about the definition of orthorexia in the first place. Orthorexia can lead to really dangerous side effects. When we have a restrictive mindset around food, we may end malnourishing the body. Meaning, not eating enough and missing out on key nutrients. Malnourishment has become a glorified thing in our culture: if we’re cutting carbs or having 1200 calories a day or less, we're doing great. We're getting skinny, and as long as we are skinny then it’s worth it.
The reality is, what orthorexia does to your body is similar to what happens in anorexia nervosa. If you're malnourished, your body starts to break down tissue from your organs and muscles in order to survive. Prolonged restriction and malnourishment may actually shrink your heart down to the size of a 6 year old’s.
As a result of the heart decreasing in size, it will be working so much harder because it is not as strong. This is when we start to see things like arrhythmias, blood pressure issues, and honestly… heart attacks.
Next, our gastrointestinal system (gut health) will decrease in quality if we're cutting out foods (especially things like dairy and fruit); we’re not allowing the body to have healthy probiotics, prebiotics, fiber, etc. We can basically clean out our gut so much that we don't have any good bacteria left. This can lead to irregular bowel, pain and bloating, nausea, vomiting, and more.
Orthorexia can also impact our immune system. If we're deficient in nutrition, your immune system will weaken and it can't do anything for you. Illness is a lot more likely, which is interesting because a lot of times people with orthorexia exhibit signs of OCD as well, and a lot of times those people are really concerned about getting sick. If you think about it, being overly concerned is actually leading them to sickness. Essentially what’s happening is their immune system is not working as well since they are malnourished, to some extent.
Some other symptoms of orthorexia are dry skin, brittle nails, hair falling out, fatigue, anemia, dehydration, organ failure... Our bodies can and will shut down if things like this go on for too long.
What To Do if You Have Orthorexia
If you resonate with the definition of orthorexia and suspect you may have it, I want you to know that there is another way. You absolutely can live a life free from food obsession. A life that is apart from orthorexia the life that is apart from obsessing over food. It is a more full life. It is a life it's more enjoyable.
Learn more about how I can help you through debilitating food guilt, food anxiety, and stress that comes with orthorexia.