Understanding Orthorexia: When "Healthy Eating" Becomes Harmful

Orthorexia is a term used to describe an intense fixation to only eating foods considered “healthy” or “clean.” While many parents may not be familiar with the word, the behavior of “clean eating” is becoming more common, especially among adolescents and young adults. Unlike other eating disorders that focus on how much food is eaten, orthorexia centers on food quality and perfecting nutritional intake.

While encouraging nutritious choices is important, orthorexia becomes concerning when the desire to eat healthy becomes extreme or overwhelming. Children and teens with orthorexia may become highly anxious about food choices, focus on achieving optimal nutritional intake, avoid situations involving food altogether or cut out entire food groups when there is no medical reason to do so. These restrictive eating patterns are often influenced by diet culture, social media trends or misinformation that is not always based on well researched science.

Orthorexia’s food restriction in both the amount and variety of foods consumed can cause children and teenagers to miss out on essential nutrients needed for growth and development, increasing the risk of malnutrition.

Signs and Symptoms to Watch For

Orthorexia can be difficult to identify because “eating healthy” is often praised in society and is a goal most people try to achieve. As a result, eating patterns that start as positive changes become concerning behaviors that may go unnoticed, be reinforced or even be celebrated.

Common signs may include:

• Compulsive checking of ingredient lists and nutrition labels.
• Inability to eat a food or foods if nutritional information is not available.
• Increasing concern and opinions about the perceived health of ingredients.
• Eliminating food groups or formerly enjoyed foods without medical necessity.
• Eating only a very limited range of “safe”, “clean, or “pure” foods.
• Excessive time spent researching food, food production, or planning meals.
• Avoidance of restaurants, social situations involving food or dramatically altering the types of foods ordered and eaten while dining out.
• Bringing personal food to events or refusing to eat outside the home.
• Judging others’ food choices or expressing moral superiority around nutrition.
• Tracking and counting of various nutritional components such as carbohydrate intake or caloric intake.

While often orthorexia starts as focus on health, over time the food changes can lead to malnutrition and other potential health consequences including:

• Gastrointestinal System
• Nausea and stomachache symptoms as the body gets out of the habit of processing the correct balance and appropriate volume of nutrients.
• Gastroparesis, a condition that slows or stops the movement of food from the stomach to the small intestine, can result in nausea, bloating, vomiting or feeling full quickly.
• Constipation is common due to slow gut movement, which starts because the body automatically conserves energy needs when a human isn’t getting enough to eat.
• Cardiovascular System
• When the body does not receive enough calories or the correct balance of nutrition, it begins breaking down its own tissue for fuel, including muscle, and it slows down any physical process that can be slowed down to save energy.
• As the heart rate is slowed and the blood pressure drops, we see increased risk of abnormal heart rhythms and even heart failure.
• Neurological System
• The brain requires significant energy to function. Restrictive eating can lead to difficulty concentrating, slowed thought processing, and obsessive thoughts.
• Dizziness or fainting
• Disrupted sleep patterns
• Worsened mood and increased anxiety
• Other Physical Effects
• Reduced white blood cell (infection fighting cell) production can weaken the immune system.
• Low intake of nutrition or imbalanced nutritional intake may cause dry skin, brittle hair and increased hair loss.
• Decreased energy and stamina are often noted as the body tries to minimize energy expending activities and conserve energy.

Diagnosis and Treatment

While there is currently no treatment specifically for orthorexia, any disorder involving disordered eating patterns typically involves a multidisciplinary care team, which may include:

• A therapist to address underlying anxiety, rigidity and thought patterns
• A registered dietitian to restore balanced nutrition and to provide nutritional education
• A physician to assess and monitor medical stability

If your child or adolescent becomes increasingly rigid, anxious or isolated around food, it may signal more than an interest in healthy eating. Families who notice concerning patterns should seek evaluation from a health care professional experienced in eating disorders.

The Eating Disorders Program at Nationwide Children’s Hospital provides comprehensive care for children and teens diagnosed with eating disorders or showing signs of disordered eating patterns.