When Does 'Clean Eating' Become a Disorder?

It is possible to overdo healthy eating. A new study pinpoints risk factors for the eating disorder orthorexia.

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Eating healthfully is obviously important, but when “clean” eating becomes an obsession that’s harming your mental health, it may be a major sign of a lesser-known eating disorder known as orthorexia nervosa.

Unlike other eating disorders, such as anorexia and bulimia, research on orthorexia is fairly limited. So, in the first review of its kind, researchers at York University in Toronto decided to look at all existing studies on the condition published through 2018 to figure out what exactly puts someone at risk.

According to their findings, published in the journal Appetites, risk factors for orthorexia include:

  • Obsessive-compulsive traits
  • Dieting
  • Poor body image
  • A drive for thinness
  • A history of another eating disorder
  • Being a vegetarian or vegan (lacto-vegetarians, or people who eat dairy products but not meat or eggs, were at highest risk for the condition, and those on a strict eating schedule, spending lots of time preparing meals, were also at higher risk)

"In our research, we found equal rates of men and women who struggle with symptoms of orthorexia nervosa," said senior study author Jennifer Mills, Ph.D., associate professor of psychology at York University. "We still think of eating disorders as being a problem that affects mostly young women. Because of that assumption, the symptoms and negative consequences of orthorexia nervosa can fly under the radar and not be noticed or taken seriously."

Of course, not all people who work hard to eat healthy food have orthorexia. It’s when the drive to eat this way starts to harm you physically and socially that it enters dangerous territory.

"The long-term impact of these findings is that they will lead to better recognition among health care providers as well as members of the public that so-called healthy eating can, in fact, be unhealthy,” Dr. Mills said. “It can lead to malnourishment or make it very difficult to socialize with people in settings that involve eating. It can also be expensive and time-consuming.”

A Lesser Known Eating Disorder

This study on risk factors for orthorexia is especially valuable because the disorder isn’t currently recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is published by the American Psychological Association and used by most mental health physicians. However, awareness of the disorder is on the rise, and a lack of diagnostic criteria in the DSM-5 makes it even more difficult to diagnose, according to the National Eating Disorders Association (NEDA).

Unlike people with anorexia—who restrict the amount of food they eat in the hopes of reaching or keeping a low weight—people with orthorexia focus obsessively on the food’s quality and preparation, rather than its quantity, according to the study. They may put a great deal of time into planning and preparing “clean” or otherwise “healthy” meals until it reaches a point where it is inhibiting their ability to live a normal life. Sometimes, it also results in unhealthy weight loss.

Symptoms of Orthorexia and Treatment Options

According to NEDA, symptoms of this eating disorder include:

  • Checking of ingredients nutritional labels compulsively
  • An increase in concern about the health of ingredients in your food
  • Eliminating more and more food groups (like all sugar, all carbs, all meat, all dairy, etc.) from your diet
  • An inability to eat anything but a small group of foods that you’ve deemed “healthy” or “clean”
  • Abnormal interest in what others are eating and how healthy it is
  • Feeling highly distressed when you can’t access “safe” or “healthy” foods
  • Spending hours a day thinking about what food might be served at upcoming events
  • Body image concerns (may or may not be present)
  • Following food and “healthy” lifestyle blogs on social media obsessively
  • Body image concerns may or may not be present

If you think you may have orthorexia, your best course of action is to seek psychotherapy, ideally from a therapist who has experience with clients who have eating disorders, according to NEDA. There aren’t yet clinical guidelines for the treatment of orthorexia, but experts recommend it be treated similarly to anorexia and/or obsessive-compulsive disorder.

You can learn more about orthorexia on NEDA’s website.

See more helpful articles:

8 Things You Might Not Know About Eating Disorders

How Eating Disorders Can Affect Your Reproductive Health

10 Top Myths About OCD