When You Eat Too Healthy, or Everything You Should Know about Orthorexia

What is orthorexia?

Orthorexia is, simply put, an obsession with healthy eating and healthy food. It mainly manifests itself in strict control of the diet in order to avoid disease or achieve optimal health or figure. The name orthorexia (orthorexia nervosa) comes from a combination of two Greek words: ortho – correct, proper; and orexis – appetite. Orthorexia has not yet been officially classified as a disease, but it is considered to belong to the spectrum of eating disorders.

Orthorexia may be associated with anorexia (mental anorexia nervosa), a mental disorder associated with deliberate abstinence from food. However, these are different disorders. For people with anorexia, what matters most is the portion and calorie content of the food consumed. In the case of people with orthorexia, the quality of food in particular is strictly controlled. In both disorders, there are often problems with acceptance of one’s own body, low self-esteem and a desire to regain control of one’s life by regulating one’s diet.

The term “orthorexia” was first proposed in the 1990s by Steven Bratman, an American physician and author of the book “Health Food Junkies: Orthorexia Nervosa: Overcoming the Obsession with Healthful Eating”, who suffered from various allergies since childhood, causing his parents to limit the range of foods he consumed. Bratman thus perpetuated the belief that food could harm him, and composing menus began to take more and more of his time and energy. As a result, his family, professional and social life suffered. The turnaround came only when he became seriously ill due to nutritional deficiencies. His own experience was the impulse for him to coin the term “orthorexia”.

What symptoms might indicate orthorexia?

Orthorexia occurs when an obsession with healthy food begins to interfere with normal daily functioning and significantly affects responsibilities and routines. Innocent “adherence to a healthy diet” can turn into a disorder the moment food becomes merely a means to a figure or health goal, and thus ceases to serve any other function, such as being a background for social gatherings or a source of pleasure.

Here are symptoms that may indicate orthorexia:

1. Planning all meals in advance and paying close attention to this activity. When assumptions are not met, stress and frustration ensue.
2. Persistent checking of:

• origin of food,
• extent of its processing,
• micronutrients,
• exact method of preparation,
• preservative content,
• presence of food additives,
• presence of pesticides, heavy metals,
• type of materials used for food packaging.

3. Accurate weighing and measuring of portions designated for consumption, with a low tolerance for rounding. Considering household measures (tablespoon/teaspoon/glass) as “not accurate enough”.
4. Intrusive thoughts about food and its effect on health, as well as on the appearance of the body.
5. Buying food only from places deemed “safe”, such as certified organic or healthy food shops.
6. Avoiding eating at restaurants or diners due to fear of inaccurate macronutrient estimates or consuming food from an uncertain source.
7. Judging others by the food they eat.
8. Excessive focus on dietary health. Looking for the cause of many health problems in poor nutrition.
9. Using radical dietary regimes that require avoiding eating the main nutrients, such as completely giving up carbohydrates.
10. Not deviating from the diet even in unusual situations and under special circumstances (such as refusing to eat a piece of birthday cake).
11. Complete abandonment of a meal when a product from the “safe list” is not available. A given person would rather eat nothing for a long time than eat a product that does not meet their quality standards.
12. Continuously lengthening the list of “unhealthy products”.
13. Placing great importance on how the meal is prepared. Any dish prepared in violation of the rules is considered “inedible”.

Due to orthorexia, many people isolate themselves from their surroundings and withdraw from social life. Orthorexia is also often associated with ongoing feelings of guilt, anxiety or self-contempt. Everything is caused by the belief that “I don’t eat healthy enough”. It is not uncommon for people with orthorexia to also impose penalties on themselves for not adhering to the menu. In extreme cases, they would rather eat nothing than consume products that are not on their list of “healthy and safe products”. Orthorexia can develop into other eating disorders with more serious consequences, such as anorexia or bulimia.

Where does healthy eating end and orthorexia begin?

Orthorexia usually begins mildly and innocently, with an interest in healthy eating or taking steps to eliminate bad eating habits. However, it is often difficult to pinpoint the moment at which a person “exaggerates” with following healthy eating rules. The tendency to remove entire food groups from the menu can be dangerous, but the line between the desire to take care of one’s health and the beginnings of orthorexia is blurred.

Thus, orthorexia is considered to begin when the inability to consume “desirable” food (subjectively considered valuable by the person) causes bad mood, remorse or persistent thoughts. The obsession with healthy food begins to disrupt the rhythm of the day and affect functioning in the society.

If you generally eat healthy and follow the rules of healthy eating, but once in a while allow yourself to eat something “unhealthy” and don’t feel bad about it, the problem of orthorexia is unlikely to affect you. This is because it is extremely important to find balance and flexibility in following the guidelines.

Setting exact boundaries and identifying specific behaviours that fall within the “norm” and those that will be considered obsessive is not easy. As with other eating disorders, orthorexia is a certain spectrum of symptoms. Because it is not recognised as a disease, there are no uniform diagnostic criteria. However, some specialists use the ORTO-15 questionnaire, which includes 15 questions to help estimate the risk of developing orthorexia. Here are some questions from the questionnaire:

• Do you feel confused at the grocery store?
• Are the food choices you make determined by health concerns?
• Are you willing to spend more money to stock up on healthy foods?
• Do you think healthy eating affects your lifestyle (frequency of going out to restaurants, to see friends)?
• Do you have feelings of guilt when you deviate from the set dietary rules?

Depending on the answers given and the scores assigned, a propensity for orthorexia can be indicated through the questionnaire.

Who most often struggles with orthorexia?

Certain groups of people are more prone to orthorexia than others. Here are some predisposing factors:

• feeling a strong need to control yourself and your life,
• strong ambition and the need to succeed,
• striving to achieve a flawless image associated with, for example, a slim figure,
• the belief that achieving a dream figure goal will help get rid of problems and gain many benefits, such as finding the perfect partner or advancing one’s career.

The disorder is more likely to occur in the following persons:

• Athletes (amateurs, semi-professionals and professionals) – a well-chosen diet undoubtedly supports performance, but the ambition of athletes sometimes causes all advice (coming from a coach or dietitian, for example) to be followed 100%, without any flexibility. Such an approach can cause more harm than good in the long run, such as when skipping a meal or having to eat something outside the strict schedule is associated with stress or reduced recovery time. Allowing oneself to deviate and plan to deal with various life situations (such as a trip during which one does not have access to one’s own kitchen) can relieve pressure and support the athlete. It is worth discussing with an authority (such as a sports dietitian or trainer) the degree of flexibility in your dietary approach that will allow you to maintain the objectives of your diet plan and achieve results, while allowing for other activities.
• Dietitians and dietetics students, as well as other healthcare professionals – these individuals are more likely to be overly restrictive in enforcing healthy eating rules due to peer pressure and the desire to set an example for future patients.
• People trying to lose weight on their own, choosing “miracle diets” – adherence to a restrictive (and often fashionable) diet, such as the Dukan diet, Copenhagen diet or the southern beach diet disrupts the relationship with food. Many fad diets impose rigid rules and principles to ensure the fastest possible results. These diets are not tailored to the realities of everyday life and rarely have a long-lasting effect. Even small deviations from a restrictive menu are considered a “lack of strong willpower” and a “failure”. Unfortunately, similar methods of “weight loss” very often end in compulsive overeating, the yoyo effect, or giving up and deciding that “healthy eating is not for me”. People who undertake “miracle diets” often function in cycles in which they follow a strict diet for a while, notice results, and a small deviation causes a cascade of negative behaviour to return. It is also a kind of orthorexia.
• People on elimination diets without indications – choosing restrictive elimination diets, such as gluten-free, dairy-free or extremely low-carbohydrate diets without specific health indications can upset the relationship with food. This results in behaviours indicative of orthorexia, such as overanalysing ingredients and avoiding eating at restaurants or social gatherings for fear of not having access to “safe food”. While all of the aforementioned diets may be applicable and justified in some cases, their use without health indications unnecessarily exposes one to nutritional deficiencies and disorders.

Side effects of orthorexia

Orthorexia can have varying degrees of severity and health consequences. When it is associated with strong dietary restrictions and abstention (e.g. due to lack of access to “acceptable” foods), it leads to deficiencies in minerals, vitamins and other nutrients. The consequences of such deficiencies can manifest themselves in a variety of ways – carbohydrate deficiencies upset the thyroid and endocrine system, a dairy-free diet can cause calcium deficiencies, osteoporosis and tooth decay, and general under-eating can lead to loss of muscle mass. In severe cases, orthorexia can cause an expansion of symptoms and even lead to bulimia or anorexia.

Orthorexia indicates a disturbed relationship with food and with the perception of one’s own body. Getting back on the “right track” in your relationship with food is often a long process – so from the very beginning of your adventure with healthier eating, it is worth remembering to be flexible and strike the right balance in following the “ideal diet”.

How to proceed when you suspect orthorexia in yourself or a loved one?

Orthorexia is an unclassified disorder, but the symptoms should not be ignored as they can develop into other (potentially more dangerous) disorders. It is worth seeking help from a specialist – a dietitian, psychodietitian or psychologist. Depending on the severity of orthorexia, the help of a doctor and/or psychiatrist may also be necessary, as well as psychotherapy.

The primary intervention and recommendation in orthorexia is to implement a balanced diet to compensate for any nutritional deficiencies caused by the exclusion of certain food groups.

A good specialist will point the right way and help to more accurately establish rules for healthy eating that will not interfere with daily responsibilities, while allowing you to take care of yourself. This will teach responsiveness in following the rules of healthy eating and modifying them so that they do not hinder life, but bring the desired results.

Here are some techniques to combat orthorexia that a specialist can recommend or implement:

• Stop counting calories and switch to intuitive eating. This frees you from obsessively following the perfect macronutrients.
• Adhering to an 80/20 diet – 80% of the food consumed should be “healthy and balanced”, while 20% of the food consumed may have another purpose, such as satisfying a taste sensation.
• Intentionally including small portions of ingredients considered “unhealthy” in balanced and healthy meals. A piece of chocolate for oatmeal, a small sweet as a complement to a second breakfast, or cheese as a sprinkle for a vegetable casserole – all of the listed ingredients can be part of a balanced diet. These products will be different for everyone, so the exact recommendations to support the therapy will also vary.
• Embracing a strategy of “healthier choices” of products instead of a strategy of “healthy choices”. It involves flexibly composing meals to support the building of healthier eating habits, without an all-or-nothing approach. This will make it easier to accept that the diet will not be 100% perfect, but it may be “good enough”.
• A review of authority figures and people followed on social media. The pressure to achieve the perfect figure or ideal health results often comes from comparing oneself to others. In social media culture, many people project themselves as experts who always eat balanced meals and never skip a workout. This causes pressure and drives unrealistic expectations. So it is worth choosing carefully the people you surround yourself with, including in the virtual world.

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