Healthy eating has always been encouraged in the United States. Something that comes to mind is First Lady Michelle Obama’s Let’s Move campaign; this program planned to combat childhood obesity through pushing for healthier school lunches emphasizing whole grains, fruits, and vegetables (Tanne, 2010). The combination of the lunch reform and the US Department of Agriculture’s transition from the outdated “food pyramid” to the portion-conscious “MyPlate”, an informational graphic that enforces the consumption of whole foods and portion control, along with other societal motivators has brought nutrition and health to the world stage (Aspray et al., 2014). While the emphasis of clean eating in America is warranted – the age-adjusted prevalence of obesity in American results was 42.4% in 2018 – the attention surrounding a healthy lifestyle may contribute to disordered eating (Hales et al., 2020).
Orthorexia nervosa, literally meaning “correct appetite” in Greek, was labeled as an eating disorder in 1997 by Steven Bratman (Bratman, 1997). Orthorexia is an obsession with proper nutrition that elicits complex and restrictive eating patterns to attain optimal health (Dunn & Bratman, 2016). To put it in perspective, someone struggling with Orthorexia may follow a restrictive diet, have strict eating rituals, or extensively plan their meals. Orthorexia deviates from other well known eating disorders, like Anorexia or Bulimia, because Orthorexia describes an obsession with the purity and nutritional value of foods while other eating disorders are characterized by an unhealthy desire to lose weight. Due to pop culture’s endorsement of clean eating, Orthorexia is often deemed a virtue instead of a disorder. In fact, unlike other eating disorders, Orthorexia is not officially recognized in the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5), leading to a lack of scientific literature and vagueness of diagnostic material. Although Orthorexia still isn’t considered as an official diagnosis, current research has worked towards assembling a list of potential criteria necessary for an Orthorexia diagnosis. Dr. Ryan Moroze and other eating disorder researchers proposed a collection of potential criteria; below is a pasted portion (Moroze et al, 2015):
Criterion A. Obsessional preoccupation with eating “healthy foods,” focusing on
concerns regarding the quality and composition of meals. (Two or more of the
following.)
1. Consuming a nutritionally unbalanced diet due to preoccupying beliefs about
food “purity.”
2. Preoccupation and worries about eating impure or unhealthy foods, and on
the impact of food quality and composition on physical and/or emotional health.
3. Rigid avoidance of foods believed by the patient to be “unhealthy,” which may
include foods containing any fat, preservatives, food-additives, animal products,
or other ingredients considered by the subject to be unhealthy.
4. For individuals who are not food professionals, excessive amounts of time
(e.g. three or more hours per day) spent reading about, acquiring and/or
preparing specific types of foods based on their perceived quality and
composition.
5. Guilty feelings and worries after transgressions in which “unhealthy” or
“impure” foods are consumed.
6. Intolerance of others’ food beliefs.
7. Spending excessive amounts of money relative to one’s income on foods
because of their perceived quality and composition.
Criterion B. The obsessional preoccupation becomes impairing by either of the
following:
1. Impairment of physical health due to nutritional imbalances, e.g. developing
malnutrition due to an unbalanced diet.
2. Severe distress or impairment of, social, academic or vocational functioning
due to obsessional thoughts and behaviors focusing on patient’s beliefs about
“healthy” eating.
Criterion C. The disturbance is not merely an exacerbation of the symptoms of
another disorder, such as obsessive compulsive disorder, or of schizophrenia or
another psychotic disorder.
Criterion D. The behavior is not better accounted for by the exclusive observation
of organized orthodox religious food observance, or when concerns with
specialized food requirements are in relation to professionally diagnosed food
allergies or medical conditions requiring a specific diet
Although this paper is directed towards an academic and medical audience, familiarizing the general public with the manifestations of Orthorexia will hopefully spread awareness on the dark side associated with encouraging a diet lifestyle. Even though many people acknowledge that aspects of pop culture promote disordered eating, like the prevalence of photoshop and dangerously thin models, anorexia or bulimia are probably the disorders they are thinking of. For many people, orthorexia may seem counterintuitive in a way: how can one be too healthy? The statement “everything is good in moderation” is usually used in the context of occasionally indulging in junk food. Yet, it is apparent that it also applies to the opposite side of the spectrum; Orthorexia highlights how intentional healthy eating can spiral into an obsession that damages an individual’s well being.
Eating disorder hotline: 1-800-931-2237
Aspray, W., Royer, G., Ocepek, M.G. (2014). Food Policy Since 2009: The Obama Administration’s Policies and Michelle Obama’s Bully Pulpit. In: Formal and Informal Approaches to Food Policy. SpringerBriefs in Food, Health, and Nutrition. Springer, Cham. https://doi.org/10.1007/978-3-319-04966-3_6
Bratman, S (1997). Health Food Junkie. Yoga Journal, 42-50.
Dunn, T. M., & Bratman, S. (2016). On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eating Behaviors, 21, 11–17. https://doi.org/10.1016/j.eatbeh.2015.12.006
Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief, no 360. Hyattsville, MD: National Center for Health Statistics. 2020
Moroze, R. M., Dunn, T. M., Craig Holland, J., Yager, J., & Weintraub, P. (2015). Microthinking about micronutrients: A case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria. Psychosomatics: Journal of Consultation and Liaison Psychiatry, 56(4), 397–403. https://doi.org/10.1016/j.psym.2014.03.003
Tanne, J. H. (2010). Michelle Obama starts project to combat childhood obesity. BMJ: British Medical Journal, 340(7743), 387–387. http://www.jstor.org/stable/25674060
On Psychology and Neuroscience 
Hi Julia, I enjoyed reading your post because it helped me reflect on the different types of eating behaviors. Our readings and discussions in class about eating disorders mainly focused on anorexia nervosa and bulimia nervosa, so it was interesting to learn about orthorexia nervosa, which I had never heard of before. We learned how the former two eating disorders affect and are impacted by the dopaminergic system in our brain. I wonder, could orthorexia nervosa also be related to the same neurotransmitter system? Could it be possible that reinforcement is involved in individuals who are persistent about their pure food beliefs and maintain their strict diet to the point at which their physical health is impaired? I would be curious to learn if brain structural and functional imaging data in these individuals differ.
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Hello Julia, I enjoyed reading your blog post and learning more about Orthorexia and dieting culture. Although I was already familiar with Orthorexia, I did not know that the DSM-5 does not officially recognize it. I found this lack of recognition to be disheartening, given that Orthorexia can be equally distressing and impairing as other eating disorders. Additionally, many insurance companies refuse to cover the cost of treatment or therapy without an official diagnosis. As a result, individuals with Orthorexia may have a more challenging time accessing affordable professional help. Given this and society’s glamorization of healthy eating and restrictive diets, I am curious whether it would discourage or prevent individuals with Orthorexia from recognizing that their preoccupation with healthy habits is unhealthy.
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Hi Julia,
I really enjoyed learning about Orthorexia Nervosa. Even though I have taken several classes on psychological disorders, I did not know that Orthorexia Nervosa existed until reading your post. Typically, the emphasis in my classes has been on Anorexia and Bulimia Nervosa. Your post made me think about other instances where disordered eating is overlooked because it is classified as healthy. When overweight individuals have Anorexia or Bulimia is one instance that stood out to me. It is often considered unhealthy when an underweight or average-weight person engages in disordered eating. However, if an overweight person engages in these same behaviors, it is often suddenly no longer considered concerning. If anything, they view these individuals as trying to get healthier. What do you think would be an action plan for increasing the awareness and recognition of unstereotypical disordered eating?
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Hi Julia, I found your post about orthorexia nervosa informative and interesting! It was especially insightful how you noted that national campaigns to eat healthier (which have inevitably affected our culture) have a purpose in combatting obesity, but may influence the prevalence of eating disorders. Moreover, I think the potential criteria that you shared from Dr. Ryan Moroze are important to keep in mind as we learn about this mental health disorder since, upon first hearing about orthorexia nervosa, I wondered: what distinguishes this pattern of eating from eating lots of healthy foods? I think that this can be determined by not only the rigidity with which an individual follows their healthy eating intentions, but also by the stressful thoughts and aversive feelings an individual experiences in response to “transgressions in which ‘unhealthy’ or ‘impure’ foods are consumed.” As with other mental health disorders, a key feature in diagnosis is the degree to which the disorder or related thoughts impact an individual’s daily life. -Katia
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I felt that this was a very informative and relative read. I had always known something like orthorexia existed, but I did not know there was a name for the disorder. I cannot help but wonder if orthorexia is primarily due to inaccurate perceptions of a healthy and balanced diet. In other words, if someone excessively adhered to a strict diet, but that diet included fats, carbs, etc., and only avoided actually unhealthy things such as processed foods, would that person still have a disorder? In that case, I feel like the disorder would mostly stem from the impracticality of avoiding processed foods in certain situations, which would likely cause anxiety. I am curious to learn more about this topic!
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