Orthorexia: When Healthy Eating Goes Too Far

By Web Behrens

The celebrity news world lit up in February after David Beckham revealed in a podcast that his wife, Victoria Beckham, had eaten the same dinner for 25 years. That meal? Grilled fish with steamed veggies, a seemingly healthy choice for the former Spice Girl and longtime pescatarian.

“Since I met Victoria, she only eats grilled fish, steamed vegetables,” David said in the River Cafe Table 4 podcast. “She will very rarely deviate away from that.”

Victoria has spoken openly in the past about her meal choices. The fashion designer and performer discussed her history with eating disorders in her 2001 memoir, Learning to Fly, and in 2021 revealed in a podcast that her favorite comfort food is whole-grain toast sprinkled with a bit of salt. She also admitted to being a “very fussy eater,” preferring her food cooked without any fat or sauces, even when eating out at a restaurant.

While there’s nothing wrong with her meal choices, what may ring an alarm bell is the extreme nature of the choices, and how such extreme healthy eating is becoming more commonplace since the pandemic (and not without its hidden burdens).  Behaviors such as this sometimes falls into the realm of an eating disorder called orthorexia.

If you’re wondering what orthorexia is, and whether someone in your life may be taking their healthy eating too far, read on. Below, we delve into the definitions of orthorexia, signs of the eating disorder and what to do if you think someone has orthorexia.

What is Orthorexia?

Orthorexia is when people take healthy eating to an extreme, to the degree where their behaviors paradoxically become unhealthy. Some behavioral examples of active orthorexia include:

  • Being unwilling to eat a meal prepared by someone else
  • Limiting social activities, such as skipping a loved one’s party, in order to maintain a stricter eating regimen
  • Spending exorbitant amounts of time planning meals.

There are other signs and symptoms, too, which we’ll discuss further in a moment.

The term orthorexia nervosa was first coined by Dr. Steven Bratman in the late 1990s. Similar to anorexia nervosa, which describes a different eating disorder, this new appellation comes from the Greek ortho, meaning correct, and orexi, meaning appetite.

While anorexia nervosa, bulimia nervosa and other specified feeding and eating disorders are recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), orthorexia does not have a specific category. But the disorder is captured under the Avoidant/Restrictive Food Intake Disorder (ARFID), which is a broad diagnostic category of eating and feeding disturbances.

The difference with orthorexia is that it does not include “a negative evaluation of one’s body influenced by weight, shape or fear of gaining weight,” writes Dr. Susan L. Bennett, PhD, CEDS, a clinical advisor at the Gaudiani Clinic, which focuses on medical care for eating disorders. “In other words, in the case of orthorexia, the individual is losing weight due to food choices, but not due to a drive to be thin.”

What Are the Signs of Orthorexia?

To gain further insight into orthorexia, Nutritious Life interviewed Victoria Kupiec, RD, LDN, CEDS, the Director of Nutrition and Eating Disorders Services at Timberline Knolls, a residential treatment center for women and girls in the Chicago suburbs.

Orthorexia can be a tricky condition to contend with, in part because it’s not yet recognized by all medical professionals as a clinical diagnosis. Moreover, “orthorexia can fly under the radar, because a lot of the symptoms are validated by diet culture,” Kupiec explains. “Symptoms are often minimized by both the individual and their peers. They classify (orthorexia behavior) as a quest for health rather than a disorder.”

But for individuals whose commitment to healthy eating becomes extreme, individual choices and behaviors that once signified a positive change in life descend into obsession. In addition to the indications listed above, Kupiec shares a detailed list of further signs that a person might have developed orthorexia, which include:

  • Cutting out specific foods or entire food groups, followed by significant weight loss and/or nutritional deficiencies as a result of that change in diet;
  • Attaching morality to food, which leads to feeling guilty after eating “bad” foods, or a sense of pride after eating “good” or “clean” foods;
  • Judging other people’s eating habits, or attempting to get others to eat the way they do;
  • Struggling to concentrate or handle daily activities, because being a perfect meal planner and eater consumes most of their time and mental energy.

What To Do If You Think Someone Has Orthorexia

Don’t make assumptions

To begin with, don’t make any assumptions about who might struggle with eating in a healthy way, based on their age, sex or race. While research on various kinds of eating disorders has historically focused on women, it appears that teenage boys and men increasingly face these challenges too, driven partly by social media pressures to look a certain way. (It’s also worth noting that among the myriad shock waves unleashed by the COVID-19 pandemic, eating disorders have increased since early 2020.)

When it comes to orthorexia specifically, “We need more research to determine any trends in demographics,” Kupiec says. “But it’s important to distinguish that body image is typically not an underlying cause in the development of orthorexia, (compared to) an emphasis on purity to achieve ‘ideal health.’ Given that healthy eating is heavily emphasized and valued in our culture, I am sure we will continue to see an increase in incidence in various demographics.”

Lead with compassion

Because of the cultural stigma that accompanies eating disorders, if you have concerns about someone’s relationship with food, it’s important to discuss your questions and observations with compassion, not judgment. A gentle approach—thereby “decreasing some of that guilt and shame they carry around struggling with eating disorder behaviors,” as Kupiec says—can be a critical first step for someone to seek professional help.

Aim for early intervention when possible

Early intervention can be helpful in reducing the severity of the illness, too. “Many variables influence what someone’s journey to recovery looks like,” Kupiec notes. Those variables include the length, severity and frequency of symptoms. Of course, access to support and care is also a huge factor. Once a person finds a program that’s right for them (Timberline Knolls’ in-patient program is just one example), therapists and nutritionists can begin treatment, which can last many weeks or months, depending on severity of symptoms.

If you or someone you love is struggling with disordered eating, you can contact the NEDA (National Eating Disorders Association) Helpline for support, resources and treatment options.

More Reading

Emotional Eating vs. Eating Disorders: How to Tell the Difference

Do You Suffer From Disordered Eating?

(Image: Shutterstock)

About Web Behrens
Chicago-based writer/editor Web Behrens has spent most of his career covering arts and culture, mostly for the Chicago Tribune and Time Out Chicago. He counts cooking and baking among life's joys, having learned his way around a kitchen from his Bavarian grandmother and from being a strict vegetarian throughout the ’90s and ’00s.

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