When Healthy Becomes Unhealthy: Orthorexia

Fresh vegetables are important components of a...
Fresh vegetables are important components of a healthy diet. But if this is the only thing you will eat, you might be taking it too far. (Photo credit: Wikipedia)

Chances are you’ve heard of Anorexia nervosa. Bulimia nervosa. Binge Eating Disorder. Maybe even EDNOS (Eating Disorder Not Otherwise Specified). Long-distance runners have some tendencies to flirt with eating disordered behaviors; after all, we’re somewhat obsessed with health, nutrition and exercising.  That’s all fine and dandy, unless it’s taken too far.

For some, our personalities and obsessive running habits enter into the dark side, leading toward full-fledged, diagnosable mental illnesses. I should know, having battled one throughout my twenties and still struggling to stay in recovery. Before I started the recovery process, I had never heard of orthorexia, which is a version of ED that takes healthy eating habits to an extreme. With so many runners following strict diets from gluten-free to vegan and paleo, we at Salty Running thought it would be wise to shed some light on the topic!

Is orthorexia an eating disorder?

It’s not an officially recognized disorder; which is why the definition is so vague. Orthorexia is an obsession with healthy eating, although not necessarily about calories and weight like anorexics and bulimics. In its literal meaning, “fixation on righteous eating,” orthorexia might start innocently with the intent of healthful eating (i.e., avoidance of sugar or chemicals), but it can ultimately turn into a problem when this fixation becomes all-consuming, and self-esteem becoming wrapped up in purity of diet, according to the National Eating Disorder Association (NEDA) website. An orthorexic might begin viewing each day as a chance to “be good,” “avoid food slip ups” and rise above peers in dietary prowess, strict eating, fasting and exercising.  This is extremely similar to an anorexic type of thinking.

English: A display of high fat foods such as c...
A display of high fat foods such as cheeses, chocolates, lunch meat, french fries, pastries, doughnuts, etc.  AKA…an orthorexic’s nightmare. (Photo credit: Wikipedia)

The irony lies in that orthorexics intend to be extremely healthful in intent and dedicate themselves to healthy eating, but food choices become so restrictive in variety and/or calorie intake that the result is anything but healthy. Food can start to become a source of identity (oh, she’s so thin and healthy; oh, she’s the one who “only eats healthy food”) and a source of control (I might not be able to control this work meeting, but I can control what goes into my body), which are common underlying causes for other eating disorders.

The Ugly Outcomes

Nutritional deficits may result because diet becomes too strict, lacking in moderation and balance, but the social problems might be even more obvious. According to NEDA, orthorexics may be socially awkward or isolated in that their life begins to revolve around food (this happened and still does sometimes to me as I tried to avoid all situations with food at the center, which tend to be quite a few!). Orthorexics no longer eat intuitively or listen to their body’s hunger cues…typically, they feel failure if they stray from their ‘safe’ diet of only certain foods.

Steven Bratman, the doctor who first named orthorexia, explains his own personal journey by saying, “I pursued wellness through healthy eating for years, but gradually I began to sense that something was going wrong. The poetry of my life was disappearing. My ability to carry on normal conversations was hindered by intrusive thoughts of food. The need to obtain meals free of meat, fat, and artificial chemicals had put nearly all social forms of eating beyond my reach. I was lonely and obsessed…I found it terribly difficult to free myself. I had been seduced by righteous eating. The problem of my life’s meaning had been transferred inexorably by food, and I could not reclaim it.” (As seen on www.orthorexia.com).

How Does Healthy Become So Unhealthy?!?

Society pushes an ideal of thinness and health, so it’s easy to become wrapped up in these behaviors that result in that ideal. When someone is ‘eating healthy,’ they may deny any problem at all since this is a good thing.  And it is!  Nothing is wrong with eating healthy or running or taking care of oneself, not at all!!  What’s unhealthy is when eating “right” becomes the only topic on the forefront of your mind, or when deviating from a strict diet causes extreme guilt and anxiety, or when only eating certain foods is done to avoid major life issues and results in isolation.

According to the NEDA site, if you answer yes to most of the following questions, you might be battling a form of orthorexia:

  • Do you wish you could just eat and not worry about food quality?
  • Do you wish you could spend less time thinking about food and more time thinking about life?
  • Does it seem beyond your control to eat a meal prepared by someone else – just one meal – and try not to control what is being served? (i.e., would you pack your own meal when visiting friends for a dinner party.)
  • Do love, joy, play and creativity take a back seat to following the perfect diet?
  • Do you feel guilt or self-loathing when you stray from your diet?
  • Do you feel in control when you stick to the right diet?
  • Have you put yourself on a nutritional pedestal and wonder how others can possibly eat the foods they eat?

ALMOST Anorexic/Bulimic/Orthorexic


I recently began reading Almost Anorexic, which talks about the millions of people who aren’t clinically diagnosable for an eating disorder, according to the DSM-V, but who suffer all the same with very real disordered behaviors and thoughts revolving around food, body image, and exercise.  One in 200 adults have endured full-blown anorexia, but 1 in 20 have had at least some of the symptoms characterizing the disorder. Just because you don’t meet the full diagnostic criteria does not mean that you aren’t battling all the same.

At this point in my recovery, I still fall into this ‘almost’ category most days. I’m not extremely underweight and I definitely do eat; I don’t fear fat like I used to and I’m not as crazy about exercising; I don’t write down everything I eat, I don’t own a scale and I don’t count calories. But I still bash my body and food is at the forefront of my mind most days in terms of what is ‘good’, what is ‘bad,’ and how I can avoid it even when it interferes with social happenings. I still struggle. If I went to a doctor or dietician, they couldn’t diagnose me with a legitimate eating disorder at this point, but the struggle is still very real.

Orthorexia is another disordered way of eating that isn’t necessarily ‘clinically diagnosable.’ Sometimes eating disorders seem so black and white but there is SO. MUCH. GRAY.

Allergies, Gluten and Vegetarianism, Oh my!

We all know people who are paleo, gluten-free, vegan, and vegetarianism and most are for all the right reasons, including many of our Salty bloggers.  Research has shown that often these diets are mere excuses for weight-loss dieting.  According to Almost Anorexic, a national study found that 96 percent of American adults who reported following a gluten-free diet actually tested negative for Celiac disease via blood analysis. Bloat and stomach issues may arise from eating too much gluten, but it doesn’t necessarily mean avoidance is the only option. Some seem to ‘self-diagnose’ in order to avoid carbohydrates.

Again, healthy eating is a good thing (just like Cinnamon showed us that running is really a GOOD thing!), but sometimes it can lead you on a path to self-destructive behavior. “I can’t eat that because I’m vegetarian” and “I’d love to have a piece of your birthday cake but I can’t because I’m vegan” are phrases I hear in every day situations.  While there’s nothing wrong with that if it’s the whole truth, it’s important to be honest with yourself when you begin to limit your food intake.

As a female athlete, do you struggle with eating intuitively and letting go of negative thoughts surrounding body image? Are you vegan/paleo/gluten-free and do you follow this regimen for the right reasons or do these orthorexic/restrictive tendencies seem all too familiar?

I'm a new momma, full-time non-profiter, and coffee lover. I write about healthy body image, half marathon training, and recovery from eating disorders. I'm currently training to maintain fitness throughout the winter and break 1:27:00 in my next half marathon.

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  1. Thank you for sharing this info! I am a dietitian, and honestly had never heard of this term (granted, EDs are not my area of expertise). I think one key missing component to your post is the treatment factor (“So I might have orthorexia. Now what?”). I think the first step is make sure it is not, in fact, a diagnosable eating disorder. People with eating disorders tend to think their condition is less severe than it often is, so getting a professional’s advice is important. Contact a treatment center near you or call the NEDA helpline 800- 931-2237 to get recommendations. Even if it’s not a diagnosable ED, I would think counseling would be vital to a healthy and rapid recovery. If it’s not diagnosable, insurance probably won’t cover treatment; however, it would be well worth it to help identify the underlying issues and give you the skills to empower change. If one-on-one counseling is just not financially feasible, a local support group can still offer some of the same benefits.
    Again, thanks for shedding light on the topic! It’s so good to hear you are doing well in your recovery!

    1. Hi Kristen,
      Thanks so much for taking the time to read the post and for chiming in with your dietitian voice. Indeed, an important aspect is treatment in persons with disordered eating and more often than not habits are more serious and wrecking havoc on the body much more than the person may think! Like you said, NEDA is a great resource and actually how I found my inpatient treatment program when I was struggling with purging type anorexia, Remuda Ranch. Even if the behaviors don’t categorize within a diagnosable disorder, like you said, talking with a therapist is a great start to peel away the layers and get to the root of the problem. Here in Columbus, there is a place called The Center for Balanced Living, which offers free group therapy sessions once per week, not only for the person battling ED behaviors, but also for family members (separate groups).

  2. I find that in our culture, it’s not enough to be skinny, you have to be FIT. 6 pack abs are not good enough: I have to be a cross fit maniac and GO GOGOGOGOGOGOGOogogogogogo. If I don’t have full definition everywhere, I’m ugly, lazy. “STRONG IS SEXY” is the new “You can’t be too rich or too skinny.”

    My Sister in Law remarked that a friend’s wife was really fit and only ate egg whites for lunch and plain steel cut oats for breakfast. No dairy, fruits, veggies. Sister in Law said “I would rather be a bit pudgy and eat what I want.” but I hate this dichotomy! Either eat “not healthy” and get fat or be a freak but “healthy”. Which of course, isn’t necessarily healthy.

    Sister in Law is vegetarian too… She doesn’t eat unhealthy!

    She said this in front of my young daughter too… I was kinda pissed. I don’t want my kid thinking that egg whites and plain oats is at all healthy. (Does this other woman eat more that as stated? I hope so but wasn’t presented as such) Or that eating variety of foods is fat-inducing.

    Maybe I shouldn’t have, but I said “Oh no, that sounds like disordered eating.” Sister in Law then had to explain to my daughter that yes, you *should* get a variety of delicious, nutritious foods and not eat only one thing.

    I wonder if super focused eating/super fitness is our new status symbol. I have time, money and willpower enough to eat only organic non-this, non-that steamed, never microwaved food. I dunno. I’m tired of it. Can’t I just run??

    1. Hi Marcie!
      It kills me when comments are made in front of young children in terms of restrictive diets and ‘good’ food versus ‘bad’ food. They are like sponges and it’s only going to perpetuate the problem of eating disorders afflicting youngsters!!

      1. Hey Ginko! thanks for the comment… do you have *any* clue what I should have said? Or do you think that this was an okay reaction? It’s a struggle!

  3. I’m a vegan distance runner, and many people assume it’s a cover up for an eating disorder. But, when I decided to become vegan 2 years ago, I stopped feeling any guilt over food. I frequently indulge in vegan sweets like ice cream, or unhealthy meals, like veggie burgers and fries. I am truly following my ethics, and enjoying food at the same time, and I’ve never felt healthier! i used to fall into the trap of “I need to eat as healthy as possible when training” and now I think “I’ll eat whatever I want, which is usually very healthy, but with dessert if I feel like it”