- Orthorexia was first defined in 1997 and, loosely translated, refers to a pathological obsession with eating what the individual considers healthy.
- The prevalence of orthorexia is difficult to determine, with dramatic differences depending on the population studied. Prevalence rates in studies range from 0.1% to 90.6%.
- The desire for perfectly 'clean' eating in patients usually leads to disruptions in social life and negatively impacts both physical and mental health.
What is orthorexia?
Orthorexia can be defined in various ways but is primarily an obsession with 'healthy' eating. Individuals, following specific patterns, progressively exclude more and more types of food from their diet because they consider them unsuitable or dangerous. Unlike anorexia nervosa or bulimia the goal of those suffering from orthorexia is not usually weight loss but rather the selection of 100% quality and "clean" foods, strict adherence to dietary habits, and achieving a perfectly healthy
Groups at risk include:
- People working in nutrition or medicine
- Individuals following alternative diets
- Those dissatisfied with their own bodies
- People prone to addictions (e.g., alcohol, drugs, excessive physical activity)
How is orthorexia diagnosed, and what are the typical signs?
There is currently no standardised procedure for diagnosing orthorexia, so health professionals can use a variety of tools, from specific questionnaires (Bratman questionnaire, ORTO‑15, EHQ, etc.) to body composition measurements or blood samples. In 2014, Moroze and colleagues proposed four groups of criteria for identifying orthorexia, covering the following areas (full text here):
A) Obsession with "healthy" food, primarily focusing on the composition and quality of the food
B) The negative impact of this obsession on social, physical or psychological well‑being
C) This behaviour cannot be explained by the worsening of symptoms of other pre‑existing diseases
D) The behaviour is not due to the elimination of foods because of a food allergy or other illness requiring a change in eating habits
In practice, manifestations of orthorexia may include:
- Fear of "unhealthy" foods
- Strict elimination of foods because of their perceived unsuitability/dangerousness (e.g., pesticide residues, food additives, refined sugar, wheat flour, etc.)
- Extreme stress at loss of control over food and remorse after 'breaking' dietary protocol
- Obsessive monitoring of food packaging, composition and origin
- Prioritisation of planning and preparing meals according to own and usually very strict rules
- Trying to avoid eating in the company of others
What are the consequences of orthorexia?
1. Interference with physical health
In orthorexia, the ever‑shrinking range of "allowed" foods often leads to deficiencies of particular macro and micronutrients, are very common. Common deficiencies include good quality protein, omega‑3 fatty acids, vitamin D, magnesium, iron, zinc, selenium, fibre and many others. This may (or may not) result in low energy availability, malnutrition or sudden weight loss.
These deficiencies may manifest themselves as excessive fatigue, cramps, increased susceptibility to disease, reduced hair and nail quality, or abnormalities in blood tests, for example.
2. Impairment of mental health
Obsessive adherence to "clean" foods and strict eating habits is difficult to maintain alongside everyday life. As a result, people with orthorexia can often feel anxious, frustrated and guilty. The desire to eat perfectly healthy food consumes their time, leading to constant planning and preparation of home‑cooked meals, as food from other sources does not meet their strict criteria. This can reduce their ability to manage daily activities, lower productivity, and lead to avoidance of social interactions.
3. Disruption to social life
Dining with friends or colleagues is a nightmare for someone with orthorexia. Eating "out" would mean losing control over their diet, and sharing their rigid food rules with others is often uncomfortable. In short, the need for a 'clean' diet takes precedence over social relationships, which often results in the isolation that is common among people with orthorexia.
Early diagnosis and professional care are essential in the treatment of orthorexia
First and foremost, it is important to remember that orthorexia can be as serious as any other eating disorder and, if left untreated, can cause irreversible damage.
In particular, early detection of the problem is an important factor - but paradoxically, this is the main stumbling block. This is because the sick person is often unaware of the negative consequences of his or her behaviour and the initial impulse that something is wrong comes from those close to them.
In the treatment process, it is then advisable to work with a doctor as well as a nutritional therapist and a psychologist. The basic element of orthorexia therapy is cognitive‑behavioural therapy, in which the patient must first become truly aware of the problem itself and then actively learn how to deal with it.
Bottom line
Orthorexia is characterised by an obsessive adherence to a "healthy" diet, where the goal is typically not weight loss, but a perfectly clean and balanced diet aimed at achieving perfect health. Along with anorexia and bulimia, it falls under the category of eating disorders and, if left untreated, can irreversibly damage the health of the sufferer.
Orthorexia negatively affects a person physically, mentally, and emotionally, and the sufferer is usually unaware of its presence and danger. However, those around them may notice warning signs, such as the gradual elimination of more and more foods, reluctance to consume food not prepared at home, excessive scrutiny of food composition, origin, or nutritional value, and, not least, increasing social isolation.
In treating orthorexia, a comprehensive approach involving a physician, nutritional therapist, and psychologist is recommended. Generally, the earlier the disorder is identified, the lower the risk of irreversible harm to the patient's health.
