A physician named Steve Bratman created the term “orthorexia” in 1996 as a way to gently challenge some of his patients who seemed obsessed with healthy or “clean” eating. Orthorexia is not a formal psychiatric diagnosis but has gained steam in popular culture as a way to describe people (most typically women) whose concerns about the healthiness of what they’re eating begin to interfere with their well-being. Some argue that orthorexia is distinct from anorexia, because those with anorexia are primarily concerned about potential weight gain, while those with orthorexia are concerned with the purity of what they are eating.
However, new research published in the journal Eating Behaviors suggests that those with orthorexic tendencies prioritize weight loss over health when selecting foods. In other words, obsession with “clean eating” may disguise a more traditional eating disorder.
Anorexia nervosa is an eating disorder that involves intense fear of gaining weight or becoming fat. The official diagnosis of anorexia requires a “significantly low body weight.” Most of those with anorexia also struggle with body image concerns. On the other hand, researchers have argued that orthorexia is more about having one’s life dominated by an obsession with the “rules” of healthy eating than it is about body image concerns or a desire to lose weight. Orthorexia also seems to overlap with obsessive-compulsive disorder, leading some to argue that orthorexia is a version of OCD with obsessions and rituals focused on food.
If orthorexia is distinct from anorexia, we would expect to see the food choices of those with orthorexia motivated by perceived healthiness (or purity). For example, someone with orthorexic tendencies should be less worried about whether a given meal would cause weight gain, and more worried about the nutrients in the food, how it was sourced, or whether it meets any number of rules that guide “healthy eating” for that person. In contrast, someone with anorexia would be concerned primarily about whether a given food could cause weight gain or promote weight loss. In other words, for someone with anorexia, a few M&Ms might be preferable to a bowl of fresh fruit if the M&Ms had fewer calories, whereas the reverse would be true for someone with orthorexia.
A new study led by researchers at Dalhousie University in Canada casts doubt on the claim that orthorexia is about health instead of weight loss. Over 500 subjects completed a survey that contained measures of orthorexia, obsessive-compulsive symptoms, eating disorder symptoms, and motives for food choice. The orthorexia measure asked participants whether concerns about healthy food interfere with other aspects of their lives, whether they feel exceedingly guilty or anxious if they eat any food they believe is unhealthy, and whether their list of “food rules” seems to be growing over time.
The researchers found that orthorexia symptoms were correlated with obsessive-compulsive symptoms. However, this link disappeared when the researchers statistically controlled for eating disorder symptoms. In other words, though people with orthorexic tendencies may also exhibit some of the symptoms of obsessive-compulsive disorder, this is not because orthorexia is on the obsessive-compulsive spectrum.
Instead, the correlation between orthorexia and obsessive-compulsive symptoms simply reflects that those with eating disorders often show some obsessions or compulsions as well. The researchers’ analyses revealed that orthorexia is most accurately conceived of as an eating disorder. Orthorexic tendencies were strongly linked with body image concerns and a preoccupation with weight loss. In fact, among subjects with orthorexic tendencies, food choices were more strongly motivated by concerns about weight control than about the healthiness of the food.
The results of this new study suggest that orthorexia could be thought of as a “sub-threshold” eating disorder. Some individuals may begin by focusing on the perceived “purity” of their food but then shift to focusing on weight loss as their eating becomes more disordered. Someone in recovery from an eating disorder may transition from focusing on how much they are eating to emphasizing “clean” or healthy eating instead. Another possibility is that orthorexia is not a sub-threshold eating disorder, but simply a manifestation of a traditional eating disorder with an added emphasis on healthy eating.
Perhaps because it is more socially acceptable to focus on healthy eating than it is to have an eating disorder, orthorexia may be a way for some to mask or camouflage eating disorder symptoms. For example, skipping meals, fasting, or obsessing over calorie counts can be signs of anorexia. But if you tell people that these behaviors are driven by health concerns, you are less likely to be judged negatively than if you admit to weight loss being your primary goal.
It’s difficult to draw a firm line between a healthy awareness of how best to feed your body and an unhealthy obsession with food purity. The best indicator that you may have moved into a danger zone is if your eating-related behaviors have started to disrupt other areas of your life, like your work or relationships. The good news is that help is available for those struggling with body image or food-related issues. One place to start is the National Eating Disorders Association, which offers a helpline and links to resources. Psychology Today’s Therapist Directory can help you find a therapist near you.