Orthorexia: When clean eating becomes problematic

A different type of eating disorder is making the rounds, doctors say

CLEVELAND, Ohio – Many of us head into a new year with goals to clean up our diet. But is it possible to have a good effort spiral into disordered eating?

Orthorexia is a relatively new concept that experts are looking at – one that involves obsessive behaviors or ‘food rules’ about what is healthy and what is not.

“Compared to other eating disorders, orthorexia is more focused on the quality of the food intake, rather than the quantity of the food intake, and there’s a lot of distress or impairment that results from not following a very restrictive diet,” said Kasey Goodpaster, Ph.D., of Cleveland Clinic. 

Dr. Goodpaster said a person might start with good intentions – cutting down on sweets, processed foods or meat – behaviors seen as positive in our society.

But as that person begins to get positive feedback about their behavior, they may seek out other people, perhaps on social media, who follow these same eating habits, which can lead to even more restrictive eating.

“We are bombarded with so many images of food, and there’s so much information out there about nutrition that often isn’t scientifically grounded, and so when viewing all these images, people begin to see them as normal, and they try to get more and more perfection over their food intake in order to match what they see other people doing,” said Goodpaster.

Goodpaster said cutting back on too many food groups can lead to nutritional deficiencies, and in some cases, orthorexia can mirror symptoms of anorexia such as bone loss, anemia and slow heart rate.

But compared to other eating disorders, which are done more in secrecy, she said orthorexia is more out in the open, as people have the tendency to share information about what they’re eating on social media.

Those who are most at risk for disordered eating include people whose careers are focused on health and nutrition, such as health care professionals, athletes, performing artists, and nutritionists, or anyone who is exposed to more health-related advice throughout their careers.

Goodpaster said there are some red flags to look out for if you suspect a loved one may have orthorexia.

“If somebody notices that a loved one is turning down invitations to eat outside of the home; if they’re spending an inordinate amount of time thinking about foods, planning them, preparing them, acquiring them; if their eating becomes more and more restrictive, and if they seem like they’re exhibiting a lot of distress when their eating doesn’t go according to plan, those might be some red flags,” she said. 

If you notice someone who is showing behaviors that mirror orthorexia, Goodpaster recommends gently suggesting that they seek some help for it. She said even though there is not a lot of research available yet, experts with backgrounds in eating disorders and obsessive compulsive disorders can help.