Is it Possible to Take “Clean Eating” Too Far…?

In today’s world, eating “clean” is celebrated. In seconds, we have access to the newest diet trends, body transformation/wellness challenges, and beautifully manicured food posts at the tip of our fingertips. Eliminating processed foods, carbohydrates, sugars, fats, or following a specific diet are all encouraged to achieve physical and mental wellness. But what happens when a commitment to “clean eating” turns into a rigid and harmful obsession? This is where orthorexia comes in – a condition that distorts the line between mindful eating and obsession, often resulting in a decline in physical and mental health.

What is Orthorexia?

Orthorexia, or orthorexia nervosa, is an obsessive and dangerous preoccupation on healthy eating which leads to an extreme concentration on food quality and preparation and adhering to rigorous nutritional standards. Unlike other eating disorders such as anorexia nervosa, bulimia nervosa, or binge eating disorder, which are primarily characterized by quantity of food, orthorexia centers around the quality or “purity” of foods. Orthorexia also shares a symptom profile with obsessive-compulsive disorder (OCD). In orthorexia, patients experience obsessions (e.g., thoughts about food) and compulsions (e.g., preparing foods, weighing foods, reading ingredients), but unlike OCD symptoms which are usually counter to an individuals values, orthorexia symptoms are often largely aligned with a person’s self-image and values and may not be seen as problematic. 

Orthorexia begins as well-intentioned; however, it can quickly turn to extreme dietary restriction that results in fear, guilt, and shame when actual or perceived deviations from clean eating are made.

Orthorexia has no officially accepted definition and is not recognized yet in the DSM-5. Nevertheless, it has a significant negative impact on one’s quality of life.

Signs of Orthorexia

If you are someone with healthy eating habits and unsure if you are at risk or have crossed the line into orthorexia, take a look at these warning signs to see if any resonate with you:

• Extreme Dietary Rules and Restrictions: eliminating entire food groups (e.g., sugar, dairy, carbohydrates) or severely limiting food choices, avoid foods with artificial additives, foods treated with pesticides or certain preservatives. These dietary changes are not medically necessary and are associated with guilt, shame, and embarrassment for eating something “unhealthy.”
• Anxiety Around Food: compulsively checking ingredients, increased concern about health, heightened anxiety and/or avoidance of social events centered around eating, distress related to deviations from dietary standards, high levels of perfectionism.
• Excessive Thinking About Food: Researching, planning, and preparing meals, thinking about healthy foods, spending hours thinking about foods that are served at events.
• Morality About Eating: Feeling “virtuous” for eating “clean” and developing an intolerance for others’ food choices and beliefs.
• Physical Consequences: nutrient deficiencies, unintentional weight loss, and malnutrition are common due to the rigid restriction of foods perceived as "unhealthy." Over time, this can result in weakened bones, hormonal imbalances, cardiovascular issues, and digestive problems, significantly impacting overall health.

‍Why Does Orthorexia Develop?

The rise of orthorexia is closely tied to diet culture, social media, and the wellness industry. Social media has become an integral part of our lives and has changed the way people interact and consume food. Influencers and self-identified health experts promote dietary trends and emphasize a “clean” eating culture, spread harmful messages (e.g., carbs are bad), and share misguided posts (e.g., before and after body pictures, “What I eat in a day”). These tunnel visioned views create food fear and false hope, making people believe they must adhere to restrictive and rigid diets to obtain specific outcomes.

Orthorexia can also be driven by perfectionism, anxiety, and obsessive compulsive tendencies. Although orthorexia is not characterized by a fear of weight gain, individuals with lower self-esteem and body dissatisfaction may try to obtain a higher sense of self-worth by adopting a healthier lifestyle. Lastly, some individuals may have real or medically necessary health concerns (e.g., food sensitivities, insulin resistance) but gradually develop into an unhealthy and rigid preoccupation with food. What starts as a quest for health can lead to nutrient deficiencies, social isolation, and increased anxiety around food.

When Does “Clean Eating” Become a Problem?

There are countless benefits to having a healthy diet but how can you tell the difference between healthy eating and orthorexia?

• Lack of Flexibility: Dietary rigidity is presented as an “all-or-nothing” approach that allows for no deviation from nutritional standards, no variation in foods, and greater chance of overeating and setbacks. Flexible, healthy eaters are able to enjoy a variety of foods in a care-free way.
• Health Promoting vs. Health Obsessed: An individual with orthorexia spends several hours a day thinking about food and behaving in ways to ensure certainty around the “pureness” of their foods. They will think about food preparation, read labels and nutritional facts, and shop at specific places. Their eating behaviors also preoccupy a large percentage of their self worth. 
• Adaptability vs. Avoidance: Those with orthorexia may avoid social events or gatherings where food is involved or cannot control the “cleanliness” of their foods. They may also bring their own food to events and research beforehand. Whereas a health eater can attend events that center around food with enjoyment. 

Recovering from Orthorexia

Many people struggle with orthorexia and recovery is possible. If you or someone you know struggles with symptoms or orthorexia, here are some steps to start the recovery process:

1.  Work with an eating disorder specialist: Working with a therapist who specializes in eating disorders can help you address all the different facets that contribute to orthorexia beyond nutrition and physical health such as perfectionism, anxiety, and obsessive-compulsive disorder. Therapists can also help you address rigid, black-or-white thinking that perpetuates orthorexia.
2. Engaged in Exposure Therapy: Exposure therapy helps individuals gradually confront their fears. Expanding your diet by taking small steps can help reduce fear and increase confidence over time. 
3. Reduce Social Media Usage: Social media is a “hot spot” for diet tips and tricks. Unfollow accounts that promote “clean” eating or restrictive diets.
4. Make Eating Fun: Food has the power to bring people together, create special moments, and is often simply enjoyable. Allowing yourself to enjoy food in a free and flexible manner will help promote a better quality of life and better mental health. 

Final Thoughts

Orthorexia is often overlooked because it disguises itself as “healthy living.” To date there is no standard definition and is not recognized by the DSM-5 which can make detection challenging. If your health journey starts harming your mental, emotional, and physical well-being, it’s a sign that something isn’t right. True wellness includes flexibility, self-compassion, and the ability to enjoy food without fear. If you or someone you know is struggling, you can find the help you need by working with an eating disorder specialist at The Houston Anxiety and Wellness Center. We compassionately and effectively treat individuals of all ages struggling with disordered eating.