Rosemary Ann Ogilvie


Intro: It’s wonderful to see healthy eating take centre stage at long last, with blogs and a raft of new healthy-eating cookbooks featuring amazing, flavour-packed recipes. It’s also great to see people’s new-found passion for healthy food. But sometimes that passion can go to extremes – and this article looks at the warning signs that it may be morphing into an eating disorder.


Suddenly healthy eating is right on-trend. After decades of being the culinary poor relation, something you did only as a last resort because healthy food was considered bland and lacking in flavour, people have developed a passion for clean eating, plant foods, raw food, Paleo, vegetarian and vegan regimens.

Social media has been a major driver in healthy eating becoming mainstream, thanks to numerous popular bloggers extolling its benefits through clever prose, enticing Instagram pix of every meal, and imaginative, flavour-packed recipes. Many have gone on to write best-selling recipe books that further highlight just how delicious healthy meals can be.


Coupled with this is a growing awareness of the harm a diet of highly processed foods loaded with chemical additives does to our health – without question, it’s a major contributor to the obesity epidemic – and also the health of our planet, what with the energy consumed in that processing, and the plastics and other materials used to package these products.

Seek Professional Advice

Certainly, some of the currently popular diets won’t appeal to everyone (a life devoid of cheese? Sorry, that’s a sentence, not a life!) but they can deliver health benefits such as fat loss and a reduction in the risks for chronic diseases such diabetes, cardiovascular disease, and some cancers. And contrary to some opinions, these healthy diets are perfectly safe if followed correctly – and “correctly” includes eating as wide a variety of foods as possible to guard against nutrient deficiencies. For this reason, before embarking on any restrictive eating it’s always wise to seek the advice of a qualified naturopath or nutritionist to ensure you eat the right foods – and enough of them – to supply all the necessary nutrients, for example protein and calcium for those eschewing meat and dairy (see sidebars).

Sometimes, though, there can be too much of a good thing, with the desire to eat healthy foods intensifying into an unhealthy obsession where people become positively evangelical about the benefits and healthy eating, and/or totally fixated on the quality and purity of their food, berating themselves on those inevitable occasions when they slip up and break their strict self-imposed rules.

Tease Therapy

Steven Bratman MD tagged this condition in 1996 as a “tease therapy” for his overly diet-obsessed patients. As he tells it, one patient at the start of every consultation would always ask what food she should give up. Bratman believed what she really needed to do was “relax the grip of her mind and live a little”. However, knowing from his own experience as a vegan how difficult this would be for her, he used the “devious therapeutic technique” – as he describes it – of standing her virtue on its head by calling it a disease. He named it orthorexia nervosa, a riff on anorexia nervosa, but using “ortho” – meaning “right” – to indicate an obsession with eating the right foods. His response to this patient’s question became “we need to work on your orthorexia”, which made her laugh and enabled her to relax.

It was only after the publication of his 2004 book Health Food Junkies in which he shared advice on identifying and treating orthorexia that Bratman recognised the term identified a genuine eating problem, which – to his shock – actually led to the deaths of some people as a result of malnutrition.

Expert Attention

Still, once Bratman identified the condition, health experts started giving it their attention – primarily in European medical journals. Orthorexia nervosa is currently not an officially recognised disorder by the DSM-5, or the American Psychiatric Society, although some experts believe it has similarities to other eating disorders: people with anorexia nervosa or bulimia nervosa obsess about quantity of food, while those with orthorexia nervosa obsess about the quality of food.

In April this year, Bratman and psychologist Thomas Dunn, PhD, Clinical Instructor of Psychiatry at University of Colorado School of Medicine, published a review of literature on the orthorexia, along with proposed treatment criteria to help health professionals identify and diagnose the condition.


The reality is many people really struggle with the symptoms associated with the condition. Apart from extreme preoccupation with quality of the food, these symptoms include:


  • A feeling of superiority due to the self-control exercised over food choices.
  • Feeling in control when sticking to the “correct” way of eating.
  • Wondering how others following less healthy diets can possibly eat those foods.
  • Suffering guilt with even the most minor deviation or slip up.
  • Longing sometimes to be able to eat without giving a thought to the quality of the food.
  • Experiencing social isolation, or issues with friends and family arising as a result of eating habits.
  • The person’s sense of self-worth, satisfaction, and identity are dependent on extreme, self-imposed “healthy” eating habits.
  • Extreme limitations in food choices, for example eliminating entire food groups such as fats or carbohydrates. This is particularly serious as the consequences may potentially lead to malnutrition, extreme weight loss, loss of bone density or even cardiac complications

Professional Help

In the instance where strict and obsessive eating behaviour focussed on purity of foods leads serious health issues, it’s essential to consult a qualified nutritionist and a psychologist who have proven track records in dealing with eating disorders.

The psychologist will work to identify and resolve or eliminate underlying issues and behaviours that contribute to the condition of orthorexia. Known risk factors include obsessive-compulsive tendencies, and past or current eating disorders. Some studies indicate people who are focused on health for their career – healthcare workers, sportspeople and those in the performing arts – may have a higher risk of developing orthorexia.

While scientific studies demonstrating the treatments that may be most effective for this condition are lacking, psychologists may use cognitive-behavioural-therapy (CBT) strategies such as targeting distorted beliefs, for example the need for perfection and the perceived harm of occasionally indulging in certain foods. Another strategy is graduated exposure to feared foods.

A final word: it’s important to stress that following a healthy eating regimen – whatever name it goes by – is not an eating disorder as some have misinterpreted orthorexia. Only when eating nutritionally sound food becomes an obsession does the risk of orthorexia arise.