Orthorexia Nervosa/Clean Eating: When Eating Healthily Goes Too Far
Sat, April 10, 2021

Orthorexia Nervosa/Clean Eating: When Eating Healthily Goes Too Far

Recipes and cooking app Kitchen Stories found in its 2019 survey that 36.24% of US consumers eat a healthy and balanced diet very often, as cited by Daniela Coppola of German statistics platform Statista. Kitchen Stories also said 39.67% eat a healthy and balanced diet sometimes and 11.35% do so rarely. Interestingly, 10.03% consume healthy food very often while 2.73% of respondents never followed a healthy and balanced diet. While the aforementioned statistics are commendable, there is also the darker side of healthy eating.

For instance, people might cancel social plans because they impose strict control over the food they consume, wrote Sherry Landow of UNSW Sydney Newsroom, the university’s daily source of research news, corporate updates, and commentary by experts. They might also experience severe emotional distress after eating so-called “unhealthy” food. These are signs of “healthy eating” disorder or orthorexia nervosa, which refers to one’s obsession with eating healthily. 

What Is Orthorexia Nervosa?

Nutritionist, lecturer, and researcher at UNSW Sydney Dr. Rebecca Reynolds explained that it is a proposed mental health condition that makes a person take healthy eating to the extreme to the detriment of their mental and physical wellbeing. It is a proposed eating disorder as it hasn’t been recognized as a unique disorder.

However, researchers are trying to understand more about the symptoms and causes of orthorexia, as well as how it is different from anorexia nervosa and obsessive-compulsive disorder.  “Orthorexia isn’t just looking after what you eat – it’s taking this to a level where it has significant negative impacts on your life,” noted Dr. Reynolds, who is also researching about orthorexia for three years.  

An individual’s idea of “healthy” could be grounded on their own understanding of nutrition or an existing diet trend regardless if they are not supported by scientific facts or studies. People who suffer from orthorexia nervosa could experience constant anxiety during mealtimes, extreme shame when breaking their self-imposed eating rules, or panic when watching other individuals consume foods that are deemed unhealthy.  

Dr. Reynolds said a person with orthorexia would be so fixated with healthy eating that it would compromise their normal functioning. 

Previous Research on Clean Eating

Michelle Allen, Kacie M. Dickinson, and Ivanka Prichard published a 2018 study on scientific research portal NCBI (National Center for Biotechnology Information) involving 763 women from ages 17 to 55 in a self-report questionnaire on their eating behavior and beliefs about clean eating.

The authors found that 673 (88.3%) of women responded to the open-ended question about their overall opinion towards clean eating. 267 (39.7%) had positive views of clean eating, 40.3% (271) had a negative opinion, and 20.1% (135) were neutral. When the participants’ opinions of clean eating were related to whether they followed dietary advice from clean eating sites, 63.9% (108) held a positive opinion towards clean eating, 14.8% (25) held a negative opinion, and 21.3% were neutral.

Respondents who seldom adhered (74 women or 41.8%) or never adhered (85 women or 26%) to clean eating were significantly less likely positive about affirmative clean eating. They also were likely to hold a negative opinion about clean eating at 44.1% (78 women) and 51.4% (168 women) respectively.

When the study touched upon the sub-themes of positive and negative opinion towards clean eating, 139 women (21%) felt that it improves health, 35% (232 women) thought it was an important concept, and 310 women (46%) believed it can encourage healthy eating.

On the other hand, 36% (238 women) thought clean eating was a food fad, 31% (207 women) felt it was unrealistic to adhere to clean eating, and 30% (203) perceived it to be potentially damaging. 45% (145 women) of non-adheres said clean eating was a food fad, while 36% of seldom adheres perceived it as potentially damaging.

These results show how exposure to clean eating sites may influence women’s eating practices, though more studies need to be done with regard to whether the information there are from credible sources and to what degree their recommendations may be detrimental for people with eating concerns.

Eating “Right” and “Pure”

Diet trends can be correlated with philosophies about how humans should live. For instance, the paleo diet mimics the diet of human-gatherer ancestors. The said diet restricts the consumption of dairy, legumes, and grains. Likewise, a raw food diet requires consumers to eat a high proportion of raw food, claiming that cooked ones contain harmful toxins.

Such clean eating trends occurred along with the growth of Instagram. Dr. Reynolds argued, “Social media is also partly to blame, with influencers and celebrities sometimes glorifying extreme diets.” Stress and a general lack of control can also be contributing factors.

Researchers have developed questionnaires to determine if individuals are becoming too fixated with eating healthily. Questions like “Do your thoughts constantly revolve around healthy nutrition and do you organize your day around it?” and more appear on such questionnaires, stated Dr. Reynolds.  

Why Is Orthorexia Not Clinically Recognized?

Dr. Reynolds and Sarah McMahon conducted a survey of 365 health professionals in their 2019 study “Views of Health Professionals On the Clinical Recognition of Orthorexia Nervosa: A Pilot Study,” via research and journal portal Springer Link.

52 completed it, 37 people left the survey unfinished, and seven responses were removed due to having incomplete answers. Of the 52 respondents, 96% were female and 2% were male. The participants were also psychologists (48%) and dieticians (48%), with 90% of them practicing in Australia.

71% or nearly ¾ of the professionals believed that there should be a separate diagnosis for Orthorexia nervosa, 21% disagreed, and 8% were unsure. The figures buttressed a similar statistic of 68.5% in Walter Vanderecyken’s “Media Hype, Diagnostic Fad or Genuine Disorder? Professionals' Opinions About Night Eating Syndrome, Orthorexia, Muscle Dysmorphia, and Emetophobia,” a 2011 study published on Taylor & Francis Online, an international academic publisher. 

However, convergence with other eating disorders like avoidant restrictive food intake disorder and anorexia nervosa, including other psychological disorders such as obsessive-compulsive disorder, were roadblocks in making orthorexia a separate condition.

Dr. Reynolds reasoned, “It takes time for something new to potentially become a distinct disorder that's recognized in diagnostic manuals.”

Getting Help

It’s important to follow a healthy and balanced diet, but obsession in any aspect of life is unhealthy for the body or mind, including “healthy” eating. It’s not okay if a person turns down a friend’s invitation to dinner because they are serving a certain type of food, Dr. Reynolds asserted. She recommended speaking with a general practitioner (GP) or finding more information in institutes that cater to eating disorders.


We need to adhere to a balanced and healthy diet, but it should not hinder us from eating the foods we enjoy. Healthy eating should not in any way compromise our physical and mental health. In fact, it’s supposed to improve our overall wellbeing. Being healthy doesn’t mean eliminating entire food groups without the recommendation of a physician. Balance is still key to living a robust, happy life.