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You may not have heard of orthorexia, but you’ve probably seen it. It’s an eating disorder that’s characterized as an obsession with only consuming “healthy” foods—and it’s on the rise, says Sadi Fox, PhD, a licensed psychotherapist who specializes in eating disorders.

We all have that friend who talks a little too much about things like “clean eating,” or that random food group they’re entirely avoiding in pursuit of better health. Think: carbs, sugar, gluten (provided they don’t have an allergy). The problem? Orthorexia can result in nutritional deficiencies, mental health challenges, and social isolation. It can also be a “slippery slope” for other disordered behaviors, Fox says.

Still, the signs of orthorexia can be very difficult to identify. Since eating healthy is generally perceived as a good thing, people with orthorexia might be praised for their disorder, not know they have a problem, and not end up getting the help they need—which is the case for some patients who work with Fox. “A lot of people are just like, ‘Whoa, I didn’t even realize how deep [into my eating disorder] I was,’” she says.

When it comes to this sneaky mental health condition, signs and symptoms may be hard to spot. Here’s what experts want you to know about orthorexia.

Meet the experts: Sadi Fox, PhD, is a psychotherapist specializing in eating disorders at Flourish Psychology, a Brooklyn-based private psychotherapy practice. Kelli Rugless, PsyD, is a clinical psychologist and eating disorder specialist at the virtual talk therapy practice Flourish Psychology. Emily Van Eck, RD, is a dietitian and intuitive eating counselor at Emily Van Eck Nutrition.

What is orthorexia?

Put simply, orthorexia is when eating healthy goes from a goal to an obsession, skewing what “healthy” even means in the process.

With orthorexia, a person becomes so focused on avoiding foods they think are harmful that they end up depriving their body of the nutrition it needs, says Kelli Rugless, PsyD, a clinical psychologist and eating disorder specialist at the private therapy practice Flourish Psychology. It’s important to note that the foods people avoid aren’t always based on good, accurate information. People with orthorexia might make choices based on different approaches they see on social media, but that doesn’t necessarily mean it’s backed by science, says Fox.

In reality, if you ask a nutritionist, cutting out entire groups of foods, no matter what they are, can result in a pretty unhealthy diet. Because their diets can become so restrictive, people who are orthorexic might lack key nutrients, not get sufficient calories for normal bodily functions, and have digestive issues like constipation, says Emily Van Eck, RD, a nutritionist who works with patients with eating disorders.

It’s not officially recognized in the DSM-5 (the handbook for diagnosing mental disorders), but orthorexia is an eating disorder that has risen significantly over the past few years, according to the experts who treat it. Without formal diagnostic criteria, it’s challenging to determine exactly how many people in the U.S. struggle with orthorexia, per the National Eating Disorders Association—but prevalence varies across countries and populations, ranging from 6.9% in the Italian population to 88.7% in Brazil, per a 2021 review in the International Journal of Environmental Research and Public Health. Other studies suggest orthorexia might be more common in Instagram users (49% prevalence) nutrition students (72% prevalence), and populations that exercise (55% prevalence). Plus, athletes and endurance athletes (runners especially) have higher symptom severity when it comes to orthorexia, according to a 2023 study in Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity.

Beyond the physical complications that come with orthorexia, the eating disorder is also associated with mental and emotional challenges, including dealing with shame, guilt, fear, and social isolation when it comes to food, says Rugless. “Their relationship with food becomes obsessive,” says Rugless. They might avoid social situations where they can’t control what they eat. Plus, the stress that comes with an eating disorder can ruin your quality of life, says Van Eck.

Compared to eating disorders like anorexia and bulimia, in which a person’s primary motivation might be to change the look of their body, orthorexia typically starts with the goal to eat the healthiest foods possible, says Rugless. This goal doesn’t happen in a vacuum, though. “It’s diet culture’s newest attack,” says Fox. Media and social media’s support of things like “clean eating,” different harmful dietary practices, and general health misinformation may contribute to fears about “toxic” foods and could be supporting this uptick in orthorexia, per a 2023 study in Nutrients. Basically, social media is playing a role in the increase of this eating disorder, which can have serious consequences on someone’s health.

Signs And Symptoms Of Orthorexia

How can you tell if someone is simply eating healthy or dealing with an eating disorder? Look for rigidity, says Rugless. If a friend is dividing foods into black and white categories (like “good” and “bad”) and cutting out entire food groups aside from allergies or religious and cultural traditions, that’s a sign they could be dealing with something deeper. They also might avoid certain restaurants, bring their own food, or refuse to eat altogether if they can’t access a food they’re okay with. They may also spend a lot of time researching food or spending money on health foods they can’t afford, adds Fox.

People who struggle with orthorexia tend to focus on not eating anything “harmful,” “damaging,” or “bad,” Rugless says. Instead, they consume foods they believe are “pure,” or “clean.”

People are a bit moralistic about it,” says Fox. If you have a friend who feels particularly judgy about food—or even about what you eat—that also might be a sign of an unhealthy relationship with food.

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