What Are the 5 Warning Signs of Orthorexia?

In this article, we share the five warning signs of orthorexia and discuss how "clean eating" can lead to orthorexia.

What is orthorexia?

Orthorexia is a type of disordered eating  that results in a fixation surrounding “healthy” or “clean eating.” Unlike some other eating disorders, those with orthorexia  may or may not experience a preoccupation with their weight and do not necessarily engage in caloric restriction or compulsive eating habits.

Instead, individuals living with orthorexia experience debilitating anxiety when they stray from their newly formed “healthy eating” rules and experience extreme rigidity surrounding food choices stemming from beliefs that certain foods can cause adverse health effects.

Kathryn Johnson, MA, RD/LD, CEDS-S, nutrition director at ERC, explains: “A person with orthorexia may not have specific weight loss goals and may be more focused on the perceived health benefits of ‘clean eating,’ and fear of what may happen if they were to decrease rigidity around their food choices.”

Clean eating: A warning sign for orthorexia?

An extreme focus on "clean eating," including restricting foods perceived as “junk food,” can be a warning sign for orthorexia.  “Clean eating” is often seen as a lifestyle choice to be praised among friends, on social media, and even at the doctor’s office.

“Many of the eating behaviors that are normalized in our culture are actually disordered,” explains Adee Levinstein, MS, RD, LD, CEDS-C, clinical dietitian training specialist at Eating Recovery Center (ERC). “The hyperfixation and attempts to control every aspect of our food intake can lead to distress and disordered eating.”

The 5 warning signs of orthorexia

#1: Obsessing over the quality of ingredients in foods

It is commonly thought that individuals with eating disorders or disordered eating are preoccupied with calories or the quantity of fat or sugar in food. While this can be true, and may be a sign of orthorexia as well, unique to orthorexia is a preoccupation with the quality of the ingredients listed on the food label.

What exactly does this mean? Those living with orthorexia experience an extreme fear of eating ingredients they deem “unhealthy” or “poor quality.” This may mean they restrict themselves to only eating organic, raw, vegan or even “whole” foods.

#2: Avoiding entire food groups

Individuals with orthorexia may eliminate entire food groups when they fear a certain food may negatively impact their health. Examples of foods often avoided by those with orthorexia include:

• Gluten
• Dairy products
• Refined sugars
• Meats
• Processed foods
• Various oils

#3: Being overly preoccupied with one's health

It is no surprise that what we eat can impact our overall health. However, experiencing extreme anxiety surrounding health and the impact food has on our bodies is a red flag. Individuals with orthorexia go to extremes to avoid foods or activities that they believe will cause detrimental health effects. For example, a person may completely avoid added sugars due to fear that consuming it will result in diabetes (this is, of course, untrue).

#4: Fear of eating outside the home

Individuals with orthorexia may also find themselves spending hours a day preparing their own foods and avoiding eating at restaurants or other people’s houses. This stems from a fear about the ingredients used to prepare foods that they may be unaware of. It is also tied to the belief that some foods (or methods of food preparation) are “good,” whereas others are “bad.” When faced with the need to eat outside of one’s comfort zone, someone with orthorexia may choose to avoid eating altogether or make several alterations to a menu item.

#5: Feeling anxious when forced to break rigid eating patterns

Much like other forms of eating disorders or disordered eating, behaviors arise to avoid anxiety or stress. A key difference between “healthy eating” and orthorexia is when an individual experiences emotional distress when unable to follow their plan. When an individual has a healthy relationship with food and their body, they are typically able to practice flexibility and make quick adjustments to their food or exercise plan without anxiety or fear.

This is not a comprehensive list of disordered eating warning signs. Some of the behaviors noted are also characteristic of a diagnosable eating disorder. If you are concerned for yourself or a loved one, call us at 877-825-8584 and we’ll match them with the exact support they need.

Can clean eating be harmful?

Health care professionals often endorse and even praise "clean eating" efforts. The response can be similar among friends and family. For that reason, orthorexia and similar forms of disordered eating often fly under the radar. So how can you tell the difference between mindful dietary changes and the development of disordered eating?

Social media posts and advertisements push the idea of  “clean eating” to help readers reach “peak” health and fitness. Harmful messages like these have become so commonplace in our society that it can be hard to see when dietary changes have become overly rigid and harmful.

With so many different health claims and social media influencers posting about their own efforts to “be healthy,” it can be hard to see when an unhealthy obsession with food is developing -- or to even know what “healthy” really means.

You can probably think of a time when you or a friend assigned moral value to a food, calling it (or yourself) “good” or “bad” when eating it. You may even have avoided certain foods because you believed they could negatively impact your health. These are just a few examples of behaviors that can be red flags for a disordered relationship with food.

So, how can you tell when “clean eating” has become harmful? 

Levinstein shares, “Red flags for ‘clean eating’ include attaching labels to food (good/bad/healthy/unhealthy/clean/toxic), being overly critical or hypervigilant about ingredients in food or how it is prepared, using large amounts of time to grocery shop and prep food every week, and avoiding social situations where the person doesn’t have control over or knowledge about the food sourcing.”

Orthorexia can lead to malnutrition

When the way we think about food results in feelings of guilt or shame, or we find ourselves passing up the opportunity to try something new for fear of how it might impact our overall health, it likely indicates that something is wrong.

Over time, “clean eating” may lead to a complete elimination of certain food groups. This can result in malnutrition and inadequate intake of key vitamins and minerals that our bodies need to thrive. Sudden changes to eating habits in children can be particularly harmful to physiological, physical and emotional development.

Here at ERC, we believe that all foods can be part of a balanced diet and no foods are “good” or “bad.” Providing variety with food allows us to honor our cravings and our bodies at the same time.

Read: Nutritional Rehabilitation for Orthorexia

How to help someone with orthorexia

If a loved one is exhibiting signs of orthorexia, it is important to meet them with compassion and understanding. Recognize that often people make initial changes to their diet and lifestyle with the best of intentions and that sometimes it can develop into disordered eating or an eating disorder, which is a serious mental health condition.

If you suspect that a loved one is struggling with orthorexia, Levinstein suggests the following:

“First approach the conversation indirectly, asking about how different aspects of their lives are going, if anything is challenging, to build up to discussing your concern.”

Reaching out to a trusted medical provider and asking additional questions can help ensure that you or your loved one receives appropriate and timely care.

Here are a few questions you can ask:

• Can you tell me about when these behaviors/thoughts started?
• Can you tell me what prompted you to change the way you think and feel about food?
• How often do you find yourself worrying about the food you eat?
• Have you avoided certain foods because you are fearful they may negatively impact your health?
• Have you noticed any increase in how frequently you think about food and exercise?
• Have you noticed that your activities of daily living (e.g., showering, getting ready for the day) are interrupted by your recent dietary changes?

We are here to help support you and your loved one on the journey to cultivating a peaceful relationship with food -- a relationship that allows you to find enjoyment with food as well as nourish and honor what your body needs and craves. If you find yourself wanting to learn more about eating disorders or if you’re unsure about the level of care that best supports you, we are here to help.

Note: Orthorexia is not currently recognized as an eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5  ). However, orthorexia is a serious form of disordered eating that is currently on the rise. Many of the signs and symptoms experienced by those struggling with orthorexia overlap with eating disorders recognized in the DSM-5. Find out more about the difference between eating disorders and disordered eating here.

Related Reading

• What is Orthorexia? Orthorexia Defined
• Orthorexia: Can Clean Eating Lead to Binge Eating?
• 6 Ways to Combat Diet Culture
• Eating Disorder Facts & Myths