
Orthorexia: When Clean Eating Turns Dirty
By Sarabeth Lowe, MPH Ms. Lowe is a Communication Specialist at the University of Delaware Disaster Research Center. Sound nutrition advice is rarely trendy. Often, the most basic guidelines set the stage for a healthy, long-lasting life. Social media, however, may convince some people to think otherwise. Enter some of the latest diet fads: sea moss, beef tallow, chia seed pudding, raw milk, colostrum supplements, apple cider vinegar detoxes, and charcoal cleanses.1–3 The concept of clean eating has become pervasive in society, especially because of the rise of diet culture on social media. Videos linked to #Diet, #DietTips, and #WhatIEatInADay have become some of the most popular health-related searches on TikTok, boasting more than 36 billion views.1 Countless companies have tapped into this phenomenon by employing influencer marketing to promote their wellness products, a trend that reflects a growing societal emphasis on pursuing healthier lifestyles and making more mindful dietary choices.1–3 It’s all too easy to get lost in a nutrition rabbit hole and become hyperfixated on finding the healthiest diet.1,4 Ironically, this well-intentioned endeavor can be harmful. Such a fixation on food choices can blur the lines between healthy eating and an unhealthy obsession and ultimately spiral into orthorexia, a lesser-known eating disorder characterized by an exaggerated focus on healthy eating and optimal nutrition.4–6 Though it is not officially recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), this disorder is becoming increasingly acknowledged by the medical and mental health community.5,7–11 With the wellness industry only expected to continue to increase in size and influence, it’s crucial to understand the difference between a mindful, balanced approach to nourishment and a harmful obsession with nutrition.4,9,12,13 Here is what you need to know about orthorexia. What Is Orthorexia? American physician and holistic medical practitioner Steve Bratman coined the term “orthorexia” in 1997 to describe patients who were inadvertently harming themselves psychologically through an excessive focus on food—intended to improve health and physical well-being—that led to unintentional malnutrition and/or impairment of daily functioning.4,5,8,14 However, he also identified two stages of this condition. Healthy orthorexia, with an interest in healthy eating with no pathological features, and orthorexia nervosa, with an obsessive focus on healthy eating.4,14 The name is derived from the Greek words orthos and orexis, meaning “correct” and “appetite,” respectively, and the Latin word nervosa, which translates to “nervous” or “pertaining to the nerves.” 4–7,15–17 There is a fine line between eating disorders and disordered eating, and the same applies to the difference between orthorexia and orthorexia nervosa.18,19 In many cases, the latter two begin as a righteous, innocent desire to improve health. Unlike other eating disorders, where the motivation for behaviors often centers around body image, size, and weight, orthorexia places value on the perceived “purity” or “cleanliness” of foods.3–9,16 For example, people with the condition might choose to only eat organic foods or abstain from certain additives, preservatives, or food coloring. When these eating patterns and behaviors spiral into harmful habits and overly-restrictive rules that interfere with daily functioning, they can spiral into orthorexia nervosa. This is a more severe and clinically significant form of the disorder, characterized by intense anxiety, distress, and impairments in daily functioning resulting from extreme dietary restrictions.6–9,14–23 Clean Eating and Other Buzz Words In the last 30 years, Bratman’s diagnosis has gained more recognition as an informal term to describe a pathological obsession with pure and healthy foods among researchers, health professionals, dietitians, and similar experts.4,10,11,20 At the same time, there has been a noticeable increase in interest in clean eating. Much of this phenomenon can be attributed to social media, which has facilitated the dissemination of dietary trends and fostered a culture that glorifies specific eating patterns and demonizes others.1–3,7,20 These platforms have also become a de facto news and information source for some people, especially among younger generations. Lack of regulation and fact-checking has allowed health misinformation to proliferate more easily, which might also contribute to the pseudoscientific claims around nutrition and clean eating.1–3,7,20,21 The ambiguity of clean eating, which has no scientifically-accepted definition, may have also contributed to the rise of orthorexia. The lack of clarity surrounding this catch-all term, which loosely describes foods that are natural, wholesome, and free from additives, preservatives, and refined and processed ingredients, leaves it open to interpretation.3,20,26 This vagueness means that some people might take their pursuit of wellness too far, allowing their behaviors to progress from healthy orthorexia to orthorexia nervosa.3,5,7,26,27 Prevalence Research on the prevalence of orthorexia remains limited and inconclusive.20 This is largely due to its exclusion from the Diagnostic and Statistical Manual of Mental Disorders, the handbook used by many health care professionals as the authoritative guide to standardize, classify, and diagnose mental health conditions.5,11,28 Lack of formal diagnostic criteria and a single standardized screening tool makes it exceedingly difficult to get an estimate on precisely how many people have orthorexia and whether it’s a stand-alone eating disorder, like anorexia or bulimia.28 Current estimates of orthorexia range widely. Some studies suggest that 6.9 percent of the general population struggles with this disorder; studies on more specific populations, however, have shown rates as high as 35 to 57.8 percent in high-risk groups.4,23,30–32 There has been conflicting research on whether orthorexia is more common in certain populations. For example, some studies show that rates of the disorder are higher in women than men or vice versa. Others find that rates are comparable among both genders as well as age and body mass index.23 However, a growing body of research points to one likely trend: rates of orthorexia will continue to rise.30–34 Risk Factors Disordered eating and eating disorders do not discriminate; they can affect anyone regardless of health history, gender, age, socioeconomic status, and cultural background. Research on the exact causes of orthorexia nervosa is limited, but studies suggest that a combination of factors are at play.4–8,20,23 Biological. Having an individual or family history of dieting, body dissatisfaction, disordered eating, or type I diabetes can contribute to a higher likelihood of