Orthorexia: Taking healthy eating to the extreme

The National Eating Disorders Collaboration estimates that around one million Australians live with eating disorders, with more than 30% of adolescents engaging in some kind of disordered eating behaviour.¹

You may be familiar with disorders like anorexia and bulimia, but are you aware of the condition ‘orthorexia’?

Here, we look at this less-understood mental health condition, plus what you can do if you or a loved one experiences it.

Orthorexia nervosa describes an obsession with certain supposedly healthy eating regimes, leading, in some cases, to nutritional deficiencies or even malnutrition.

In recent years, fad diets that restrict or eliminate certain foods and nutrients, like the paleo diet, ketogenic diet and Whole30 diet, have grown in popularity.

Orthorexia takes diets like these to the extreme, characterised by an excessive fixation with eating healthy food.

Although orthorexia is not yet officially recognised as a clinical diagnosis², it is considered a serious mental health condition in a category that experts call ‘disordered eating’ (which refers to a wide range of abnormal eating behaviours).

“The main differentiation between disordered eating and a clinically diagnosed eating disorder is the severity and frequency of behaviours,” says Bupa Dietitian, Rosalyn D'Angelo.

“People with orthorexia often have misunderstandings about food and nutrition, which may sometimes be based on inaccurate information from less-reputable sources.”

For example, D'Angelo has noticed people avoiding dairy foods, “because yoghurt, milk and cheese are seen as ‘unclean’ by some wellness gurus.”

“Trained nutrition scientists know that these foods are rich sources of calcium, protein, iodine, zinc and vitamin B12,” she says.

People with orthorexia, then, may be depriving themselves of nutrients that are important for the body.

Calcium, for instance, is essential for heart function, and if there isn’t enough available in the blood your body takes it from your bones (which can lead to osteoporosis).

The signs and symptoms of orthorexia can be behavioural, psychological² and physical³. These include:

Behavioural:

• an obsession with eating ‘healthy’ food
• a fixation with the quality (but not necessarily quantity) of food
• avoiding certain food groups, like dairy or grains
• severely restricting certain nutrients like fat and sugar or foods like nightshade vegetables
• avoiding social events involving food that doesn’t comply with the diet.

Psychological:

• anxiety or guilt about food choices
• mood swings
• depression.

Physical:

• weight loss
• fatigue
• low energy.

According to D’Angelo, orthorexia can have serious effects on a person’s social, physical and mental wellbeing.

It can also lead to:

• lack of energy
• poor concentration
• a weakened immune system caused by nutritional deficiencies
• long-term health problems, such as osteoporosis.

“If people are severely restricting their intake, or cutting out entire food groups, they are at higher risk of malnutrition or nutrient deficiencies, with common micronutrient deficiencies including iron, vitamin D and calcium,” says D’Angelo.

D’Angelo cautions people against relying on social media for nutrition advice, and suggests always checking the credentials of the person promoting it.

“It’s important for people to understand that the decisions they make [about nutrition] can affect their long-term health,” she says. “Make sure the advice you are taking is well-informed and backed by solid evidence, not just a celebrity endorser, social influencer or model.”

You can also familiarise yourself with the Australian Dietary Guidelines. While limiting your intake of added sugars, saturated fat, salt and alcohol, the guidelines recommend a diet that incorporates the 5 core food groups, including:

• fruit
• vegetables and legumes
• wholegrain breads and cereals
• lean meats, fish, poultry, nuts, seeds and eggs
• low-fat dairy.⁴

“Take the focus away from what you should be cutting out and focus instead on nourishing your body with foods that it needs,” D’Angelo advises.

“Also understand that ‘extra’ foods can be enjoyed sometimes, and can definitely be part of a healthy diet. What would life be if you couldn’t enjoy a slice of cake at your nephew’s birthday party?”

Eating-related conditions can affect people of all ages, across all cultural and socio-economic backgrounds. If you’re worried that you or someone you know is experiencing orthorexia, support and professional advice is available.

People experiencing any of the symptoms mentioned in this article may need to seek treatment to avoid serious long-term health problems. Visit your GP if you’re concerned.

The Butterfly Foundation has a National Support Line (1800 33 4673) and web counselling service that provides free, confidential support for anyone concerned about eating disorders or negative body image.

The National Eating Disorders Collaboration provides support and information online.