Orthorexia Nervosa: The Eating Disorder You May Not Know

orthorexia nervosa

Everyone wants to be more conscious of their eating habits and try to improve their diet. Yet, what happens when that desire to eat only healthy foods becomes an obsession? There’s a name for this infatuation with constantly eating healthy– orthorexia nervosa. 

If you’re asking yourself, “isn’t eating healthy a good idea?” You’re not alone. And the answer is, of course, eating a healthy diet is essential for a healthy lifestyle. However, when it becomes an obsession that prevents you from daily activities, it has less to do with eating healthy and more to do with obsessing over how “clean” your food is. 

For example, you might spend hours researching the sources of your food, meticulously checking labels and ingredients, and avoiding any food that doesn’t meet their strict criteria. This intense focus on food purity can lead to a restricted diet, social isolation, and even malnutrition. You may avoid entire food groups or limit their calorie intake to maintain your strict dietary standards.

Since it’s National Eating Disorders Awareness Week, I decided to shed light on this surprisingly common, yet not as well-known, eating disorder, orthorexia nervosa. 

Table of Contents

What is Orthorexia Nervosa?

The word orthorexia was first coined in 1997 by Dr. Steven Bartman, a physician in California.[1]https://pubmed.ncbi.nlm.nih.gov/26724459/ The definition of orthorexia is righteous eating or the right appetite. As with most eating disorders, studies suggest obsessive-compulsive behaviors cause orthorexia.[2]https://www.ncbi.nlm.nih.gov/pubmed/18791881

However, the causes of eating disorders are complex and vary from person to person and could be from social factors, hormonal imbalances, pressure to conform to beauty standards, trauma, abuse, or psychological factors such as anxiety, depression, low self-esteem, and perfectionism. 

It is important to note that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not recognize orthorexia nervosa as a formal diagnosis. Yet, experts specializing in eating disorders do recognize orthorexia as a distinct eating disorder. 

If someone has orthorexia, they become preoccupied with the quality and purity of their food and may spend excessive time planning, purchasing, and preparing their meals.

While the desire to eat healthily is considered a positive thing, individuals with orthorexia nervosa take this to an extreme that can negatively impact their physical and mental health. There are many risk factors associated with these obsessive behaviors. Let’s talk about them. 

Risk Factors of Orthorexia Nervosa

While a commitment to a healthy diet is not a bad thing, an excessive focus on “clean” eating can lead to significant health risks. Some potential health risks of orthorexia include:[3]https://www.montecatinieatingdisorder.com/eating-disorders/orthorexia/symptoms-signs/


Individuals with orthorexia may avoid entire food groups, such as red meat or processed foods, to make their diet clean. Everyone should remove processed foods from their diet. Meat is a good source of protein, which gets used for cellular growth and muscle development; meat also contains vitamin B12 and iron. 

People with orthorexia may also cut out fats and other foods they perceive as unhealthy. When you cut out food groups and do not replace them or the nutrients those food groups provide, nutritional deficiencies happen. 

Physical Health Problems

Orthorexia has several similarities to anorexia. One of those similarities is its impact on your kidneys. Salt is a common spice that people restrict from their diet. However, salt contains sodium, an essential mineral that is an electrolyte. An electrolyte imbalance can lead to dehydration and exhaust your kidneys, leading to kidney failure.[4]https://pubmed.ncbi.nlm.nih.gov/3317287/

A lack of nutrients can also lead to hormonal imbalances, irregular periods in women, low bone density, loss of muscle mass or muscle fatigue, anemia (low iron), and digestion problems such as gas, bloating, vomiting, and diarrhea. 

Social Isolation

An obsession with clean eating may cause you to isolate yourself from friends and family or avoid social situations where food will be present. This behavior is shared among all eating disorders. 

Individuals with orthorexia can also push away friends and loved ones by being overcritical of their eating habits. Furthermore, going to an event with food can cause enormous stress and cause you to isolate yourself from friends or loved ones.

Mental Health Problems

Orthorexia can lead to anxiety, depression, obsessive-compulsive disorder (OCD), and body dysmorphia. It can also affect your concentration, energy levels, memory, and problem-solving ability. 

Moreover, orthorexia can lead to other eating disorders or behaviors that mimic other eating disorders, such as anorexia nervosa or bulimia nervosa. If you believe that you or someone you know has an eating disorder, it is vital to get help from a professional health provider that specializes in eating disorders and can provide appropriate treatment and support to help address the underlying psychological and physical health concerns.

Let’s discuss some of the signs of orthorexia nervosa.  

Signs of Orthorexia Nervosa

You’ll likely be able to recognize some signs immediately, such as obsession with body image or how many calories they burn a day. Other signs may be more subtle. 

Those with orthorexia nervosa are constantly obsessed with what they eat and not so much about how much they eat. They may feel guilt or anxiety if they eat anything that does not fit within their rigid dietary guidelines. Some signs and symptoms of orthorexia nervosa may include:[5]https://www.webmd.com/mental-health/eating-disorders/what-is-orthorexia

Obsession with healthy eating

People with orthorexia may spend excessive time thinking about food and dietary habits. They may also spend significant amounts of time meal planning, reading food labels, and researching nutrition information about their food.

Strict dietary rules

The individual may have strict rules around what they can and cannot eat and may avoid entire food groups or specific types of food. They may also be highly rigid about when and how they eat and may have particular rituals or routines around mealtime.

Anxiety and guilt around food

Individuals may experience significant anxiety or guilt if they eat something not within their dietary guidelines. They may also feel a sense of moral superiority over others who do not eat as “cleanly” as they do.

Social isolation

I discussed this as a risk factor, but it can also be a sign something is wrong. If you or someone you know avoids social situations involving food or refuses to eat with others, this could be a sign of orthorexia nervosa. They may also become socially isolated due to their preoccupation with healthy eating and rigid dietary rules.

Physical symptoms

Orthorexia can lead to physical symptoms such as extreme weight loss, digestive problems, and other health issues such as weakness or tiredness. 

As with any eating disorder, orthorexia is a serious condition that can significantly impact an individual’s physical and mental health. 

How Orthorexia Nervosa Develops

The exact causes of orthorexia nervosa are not fully understood. However, as with most eating disorders, the causes are complex and multifaceted. Several factors may contribute to an eating disorder’s development:[6]https://my.clevelandclinic.org/health/diseases/4152-eating-disorders

  • Diet culture and societal pressure– The internet has no shortage of quick fixes and fad diets. When added to the culture around food and health, it can promote an obsession with clean eating, leading individuals to believe that they must eat perfectly to be healthy and accepted.
  • Perfectionism– People with perfectionistic tendencies may be more prone to developing orthorexia nervosa or any eating disorder. They may strive to maintain complete control over their food choices and feel guilty or anxious if they deviate from strict dietary rules.
  • Anxiety and OCD– Orthorexia nervosa is linked to anxiety and obsessive-compulsive disorder (OCD), which can cause individuals to fixate on their food choices to cope with anxiety or other emotional distress.
  • Trauma– Some individuals may develop orthorexia nervosa to cope with trauma or a sense of powerlessness. That could come from mental abuse, childhood obesity, or an abusive relationship. They may feel a sense of control and empowerment by controlling their food intake.

It’s important to note that while eating a healthy diet is essential to optimal health, it should never become an obsession or interfere with daily life. Let me tell you how to maintain a healthy diet without the restrictions of so-called quick fixes, fad diets, counting calories, or macros. 

The Living Very Well Method™ for Nutrition

The problem with most fad diets is that they are short-term solutions that offer short-term results. Diets should not be restrictive or cut out a specific food group, nor should they cause you stress by worrying about counting calories, protein intake, carbohydrates, or the amount of fat in your diet.

As a sports nutritionist and health coach, I know nutrition isn’t a one-size-fits-all solution. If you are active, your calorie intake needs to be much higher than someone who lives a sedentary lifestyle. However, the universal approach to food should be long-term sustainability and providing your body with enough nutrients and energy to function optimally. I call this The Living Very Well Method™. 

However, there are times when cutting out foods is necessary. Food sensitivities can have an impact on nutrient absorption and your overall health. Anytime I work with a new client, I always start by testing for food sensitivities or an elimination diet. Once we know what foods you are sensitive to, the real work begins. 

What to Eat

The nutrition tier of The Living Very Well Method™ is based on the Paleo diet and focuses on eating whole foods, such as fresh fruits and vegetables, lean protein from chicken and turkey, and whole grains from quinoa, rolled oats, popcorn, and brown rice. I have found that jasmine rice is a healthy grain and can be used as long as you aren’t sensitive to barley or gluten. 

Natural sweeteners such as stevia, honey, and maple syrup are allowed, as are most teas. For fats, olive oil, avocado oil, and coconut oils are allowed, as are some seed oils, such as sesame oil. 

What to Toss

The Living Very Well Method™ eliminates dairy, processed and added sugars, alcohol, artificial sweeteners, whole flour (substitute almond, cassava, or coconut flours). Industrial oils such as vegetable oil, canola oils, and animal lard should also be removed from your diet.

Refined grains, enriched grains, and fortified grains are also not allowed. These aren’t natural grains and often are stripped of their vitamins and minerals. 

Caffeine is a difficult food for some people to give up. If you can eliminate caffeine, then you should. If you find removing caffeine from your diet challenging, it should be severely limited to under 100mg daily, equivalent to one 8-ounce cup of coffee. 

That doesn’t mean if you eat a piece of cake, drink a soda, or have a cocktail, you’re a terrible person or failed at your nutrition. Eat the pizza and the cookie! It’s not the end of the world, and it is okay occasionally. 

Final Thoughts on Orthorexia Nervosa

Eating should never cause you stress or take added effort like counting calories or macros to achieve your goals. As with any eating disorder, orthorexia nervosa is a serious condition that requires medical attention. If you believe you or someone you love has an eating disorder, seek the care of a licensed medical professional.

If you want to learn more about optimizing your nutrition through The Living Very Well Method™ to improve your daily life, let me help. Schedule a free discovery call, and let me help you get on the path of Living Very Well™. 

About Michael
About Michael

Michael is a functional health coach and sports nutritionist based in Austin, Texas. He has a master’s degree in kinesiology from the University of Texas and advanced certification in sports nutrition from the International Society of Sports Nutrition.