Written by: Chase Cleary, MA
Primary Therapist at The Renfrew Center of Nashville
Eating well is good for you, period. But what happens when healthy habits become damaging obsessions? That is where orthorexia and orthorexia nervosa come in.
Both terms describe a fixation on eating “pure” or “healthy” foods, but there is an important difference:
- Orthorexia is an obsessive focus on food quality and cleanliness, often involves rigid rules, the elimination of certain food groups, and meticulous attention to where food comes from and how it is prepared.
- Orthorexia nervosa is a more severe and clinically significant form of this obsession. It is marked by intense anxiety, distress, and impairments in daily functioning – impacting emotional, social, and sometimes physical well-being.
Both revolve around the idea of food purity, but orthorexia nervosa stands out because of the level of distress and dysfunction it causes.
A Modern Phenomenon with Roots in the 90s
The term orthorexia was coined in 1997 by Dr. Steven Bratman, who observed that some of his patients were so fixated on eating “pure” foods that their health and relationships suffered.
At the same time, American culture entered a period with a growing interest in wellness. Nutrition books, TV health segments, and the explosion of the internet along with social media, made it easier than ever to access and share diet trends, “superfood” lists, and celebrity meal plans.
In this environment, “clean eating” ideals flourished. For some, this was empowering. But for some, it became a rigid, fear-driven practice that demonized certain foods or entire food groups, leaving little room for flexibility or joy.
Ideals vs. Rules
Clean eating can be a positive lifestyle choice: focusing on whole foods while minimizing processed ingredients. Many people find this energizing and health-promoting. However, it becomes problematic when food ideals become strict rules. Inflexible, rule-based eating can:
- Promote unrealistic body standards.
- Stigmatize certain foods.
- Encourage black-and-white thinking about nutrition.
- Feed into perfectionism, which often underlies orthorexia.
LISTEN NOW: All Bodies. All Foods. Episode 19: Lesser-Known Eating Disorders
How the Wellness Industry Fuels the Fire
Today’s wellness industry, worth trillions of dollars, often capitalizes on people’s desire for self-improvement, blurring the line between genuine health promotion and unrealistic perfectionism. It can unintentionally, or sometimes deliberately, reinforce orthorexic thinking through:
- Moralizing Food: Labeling foods as “good” or “bad,” which can foster guilt and shame.
- Selling Control: Suggesting that perfect eating can prevent all illnesses or guarantee peak performance.
- Shifting Standards: Constantly moving goalpost with ever-changing diet trends.
- Social Media Pressure: Highly curated images of “perfect” bodies and meals that set unrealistic expectations.
A Public Health Concern
Disordered eating behaviors, including those associated with orthorexia, are a major public health concern, and for good reason. They can seriously affect physical, psychological, and social well-being.
Physically, long-term restrictive eating can lead to:
- Nutritional deficiencies
- Electrolyte imbalances
- Disruptions to metabolic function
Mentally, they can contribute to:
- Mood disorders, like anxiety and depression
- Body Dysmorphic Disorder
- Social withdrawal and isolation
Disordered eating behaviors can also harm relationships, reduce quality of life, and interfere with work, school, or family engagement.
READ MORE: Orthorexia & Kids: How to Identify When “Healthy” Eating in Children Goes too Far
How Common Is Orthorexia?
The exact prevalence of orthorexia and orthorexia nervosa is unknown, as there are no official diagnostic criteria yet and research tools vary.
However, some studies involving high-risk groups like athletes, dietetics students, and wellness influencers have found orthorexic tendencies in up to 90% of participants. Orthorexia nervosa is thought to be less common, though it is likely underreported and still concerns clinicians.
Warning Signs: How Do I Know?
You may be struggling with orthorexic tendencies if you:
- Feel anxious or guilty after eating certain foods.
- Avoid social gatherings because of the food served.
- Spend hours each day planning, sourcing, and preparing meals.
- Have an ever-growing list of “off-limits” foods.
- Find following eating rules is more important than enjoying your meals.
Achieving Balance
If you see yourself in some of these signs, you are not alone. Here are some steps you can take toward a healthier relationship with food:
- Challenge food morality: Replace “good/bad” with more neutral terms like “everyday/sometimes.”
- Loosen the rules: Let yourself enjoy “sometimes” foods without guilt.
- Seek reliable sources: Follow advice from registered dietitians, not influencers.
- Reclaim joy in eating: Share meals, try new recipes, and eat for pleasure as well as health.
- Ask for help: A therapist or dietitian trained in eating disorders can offer guidance.
Treatment for orthorexia nervosa often includes a multidisciplinary approach, combining psychoeducation, traditional psychotherapy, nutritional counseling, and mindfulness-based strategies.
READ MORE: 5 Pivotal Ways Registered Dietitians Aid Eating Disorder Recovery
Conclusion:
Recognizing the signs is an essential first step toward healing. At The Renfrew Center, we believe that all foods can play a role in a balanced, nourishing meal plan. Our approach encourages individuals and families to rediscover the joy of eating while unpacking the socially constructed beliefs that tie food, weight, and size to the idea of “health.” Regardless of any diagnostic label, if your relationship with food or your body is causing distress or interfering with daily life, seeking professional support may be the most important step toward recovery.
If you or a loved one is struggling, The Renfrew Center is here to help. With the right support, healing and progress are possible – every step forward is meaningful, and hope is always within reach. The Renfrew Center provides compassionate care for all bodies. Contact us today to get started.
If you, a loved one, or a patient is experiencing an eating disorder, help is available. Contact The Renfrew Center’s team by phone at 1-(800) 736-3739 or complete our online form.
