Orthorexia: when healthy eating becomes an obsession

What is orthorexia?

Orthorexia is the name given to a rigid preoccupation with the quality or supposed purity of what we eat. Eating starts to be governed by rules that become harder and harder to relax. Choosing food takes up time, causes distress and can pull the person away from their social life [1].

The term describes a pattern that deserves assessment. It is not a diagnosis in its own right in the DSM-5-TR or the ICD-11, the two main reference classifications [1]. An international consensus proposed criteria to study it, but its authors call for more research before those criteria can be considered definitive [1].

That is why a list found online cannot tell you whether you “have orthorexia”.

If you want to understand the wider picture, read our guide to eating disorders. Orthorexia revolves around food considered “healthy”. When the preoccupation centres on muscle, body or training, we are talking about a different problem, muscle dysmorphia.

Orthorexia or eating healthily: where is the limit?

Looking after what you eat lets you choose, adapt and share a meal without every change becoming a threat. Rigidity appears when a personal criterion turns into a constant obligation. Breaking a rule can trigger guilt or anxiety [1].

A useful question is whether you can still decide calmly when plans change. Do you avoid get-togethers because you cannot control what will be served? Do you spend much of the day checking or anticipating choices? Distress and the deterioration of everyday life matter more than putting a name to the problem [1][2].

Eating in a way that looks after you should also leave you room to live.

No number of rules or hours can, on its own, separate an interest in nutrition from a problem. The tools used in many studies do not distinguish well between the two [2]. If you have lost freedom, it makes sense to ask for help.

Which signs go beyond “eating carefully”?

Isolation can appear. You stop accepting plans because eating without following your rules causes you anxiety [1]. NICE also considers social withdrawal when assessing a suspected eating disorder [3]. Later, planning spreads to shopping, timetables and meetings. Flexibility decreases, and the effort to feel safe ends up taking more time [1].

Is there a profile of a person with orthorexia?

The proposed criteria still need research. The consensus did not reach agreement on a specific age or gender profile [1]. That is why it is worth talking about the distress and what has changed in your life, without deducing a problem from your job or the way you shop.

What role does food play, and what role does it not play?

In an assessment, the team checks whether restriction has stopped you eating enough and has affected your physical health. If an eating disorder is suspected, the specialist team assesses the psychological, medical and nutritional support needed [3].

Offering yet another list of rules as a first response can reinforce the same mechanism that keeps the distress going. That is why we avoid turning this problem into a plan for “eating even better”. Expert consensus recognises that treatment studies specific to orthorexia are still lacking [1].

If an eating disorder is suspected, NICE recommends prompt referral for specialist assessment [3].

We do not suggest testing your limits on your own or changing abruptly what you eat. If you are eating very little or have physical symptoms, a medical professional should first assess the risk [3][4]. The next steps depend on that assessment.

How is it approached?

The first step is a specialist assessment that listens to how your relationship with food has changed. It should also look at the effect on your health and your relationships. The assessment makes it possible to tell this pattern apart from other problems that need a different approach [1][3].

If an eating disorder is suspected, the clinical guideline recommends prompt referral to a specialist service [3]. There, it is decided what psychological, medical and nutritional support you need. Nutrition does not replace psychotherapy or the review of possible physical complications.

The goal is agreed with you and adapted to your circumstances. It may include getting back to shared meals or reducing the anxiety caused by change, always with appropriate support. There is no single plan and no promised timeframe for orthorexia. Expert consensus recognises that specific evidence on its treatments is still lacking [1].

What we see in the clinic

“I need a more precise menu” is a question we can review in the clinic. Perhaps keeping to that menu’s rules already feels exhausting. That request makes sense: rules can give a momentary sense of safety. The conversation changes when we ask what happens when you do not follow them.

Positive comments about discipline can leave out how you feel. A compliment on how you eat does not measure your wellbeing. If you turn down plans, feel guilty or need to check everything, tell us at the assessment. It is useful information, without judgement.

If you are also worried about your body image, tell us at the assessment. Explain which thoughts come up and how they affect your meals or plans. You do not need to decide beforehand whether both difficulties have the same cause.

If you are worried about someone close to you

Talk about the changes you notice, such as distress at a shared meal or giving up plans. Listen to how they are experiencing it. A debate about whether their food choices are right may leave out what they most need to say.

You can offer to help them find an assessment, without demanding an immediate explanation. If the warning signs in the alarm section appear, follow the urgency it indicates. The clinical guideline includes family and close people in the assessment and support when appropriate [3].

If the person is still a minor, their family can take part in specialist care according to their age and situation [3]. It is preferable for the team to also assess their physical health before discussing changes to eating at home.

OCD, orthorexia or ED: how do they differ?

Food rules can look alike from the outside, but a single behaviour is not enough to tell problems apart. Orthorexia describes a rigid preoccupation with eating in a way considered “healthy” or “pure”. Its proposed criteria are still under study and it can overlap with other disorders [1].

In obsessive-compulsive disorder (OCD), intrusive thoughts and checking or rituals that cause distress can appear. The clinical guideline recommends exploring those experiences and their impact on everyday life [5]. Tell us which rituals appear around food and how much time they take up.

An eating disorder (ED) can include restriction, weight changes or intense concern about body shape, among other signs. No single sign confirms or rules out an ED: the assessment takes into account physical health, context and other problems that may coexist [3].

If you avoid foods or need to check labels, do not try to put a diagnostic label on yourself using this comparison. Raise it in a specialist assessment. If an ED is suspected, prompt referral is recommended [3].