What's the Difference Between Orthorexia Nervosa and a Healthy Diet?

Craving healthy foods does not necessarily mean you have an eating disorder. (Photo: Photo Creative/Shutterstock)

How strict you should be about eating healthy? Is there a point when being fixated on eating well is harmful, a sign of an obsessive preoccupation or even a type of an eating disorder?

Along those lines, the term orthorexia nervosa describes people who obsessively try to control their diet for purity's sake.

What is orthorexia nervosa?

The National Eating Disorder Association (NEDA) explains it this way:

"Those who have an "unhealthy obsession" with otherwise healthy eating may be suffering from "orthorexia nervosa," a term which literally means “fixation on righteous eating.” Orthorexia starts out as an innocent attempt to eat more healthfully, but orthorexics become fixated on food quality and purity. They become consumed with what and how much to eat, and how to deal with “slip-ups.” An iron-clad will is needed to maintain this rigid eating style. Every day is a chance to eat right, be “good,” rise above others in dietary prowess, and self-punish if temptation wins (usually through stricter eating, fasts and exercise). Self-esteem becomes wrapped up in the purity of orthorexics’ diet and they sometimes feel superior to others, especially in regard to food intake. "

This isn’t an officially recognized eating disorder at this point, but I can see how it could be a big problem for some people. According to NEDA, the root cause can be a desire to control one’s life, as a way of finding safety, an escape from fears, using food to create an identity, or trying to find spirituality through food.

Is there a difference between an eating disorder and having strict eating habits?

Sometimes those who purposefully choose a certain lifestyle, or who have food allergies and intolerances, are lumped in with those who have an obsessive, fearful relationship with food that causes them to make some of the same choices (such as eating an organic diet).

So what’s the difference? Some have claimed that anyone who eats a “pure diet,” or would be unwilling to eat a meal here or there without worrying about it (unless they had a life-threatening food allergy) should be labeled as orthorexia nervosa.

I disagree. And here’s why:

There's a difference between making choices out of fear and a desire to control, and making choices out of a risk-benefit analysis. There are many people who decide to eat a certain way — whether it be a paleo diet, vegan or a whole foods diet — and stick with it.

Why I often choose to avoid certain foods

slice of cake with candle in shape of heart
Celebrating a birthday with cake is a great tradition — but what if it makes you feel lousy the next day?. (Photo: Nataliya Arzamasova/Shutterstock)

Take me for example. I know that if I eat certain foods, I will suffer digestive issues that I would rather avoid. I've found that I don’t feel well after eating most sweets, even those from natural sources. To the outsider, my behavior of turning down dairy, avoiding gluten (my gluten intolerance is likely linked to past iron issues), and not eating many sweetened foods, could seem like I am “obsessive and being controlled by my food decisions.” While my diet could look normal compared to how people ate a couple hundred years ago, compared to the average American today, it could appear limited and even obsessive.

But nothing could be further from the truth. For example, it was my dad’s birthday recently and so I took him to a restaurant for dinner. I made the choice to try out a few foods that included some dairy and corn, and I enjoyed my homemade cake along with him. That day of compromise lead to digestive discomfort and loss of energy, demonstrating to me once again that it really may not be worth it for me to eat those foods. By choosing not to eat those foods, I'm simply weighing the benefits and risks and making my choices.

Someone with orthorexia nervosa would view that kind of decision as a slipup and would have to punish themselves for. For me, I feel no self-condemnation, but rather thoughtfulness about whether eating cake is really worth the sugar crash later in the day. Someone with orthorexia nervosa would be disdainfully aware of the “rightness” of their food choices and look down on others for their food decisions, whereas I'm happy to serve cake to others even if I have to abstain myself.

Are 'slipups' viewed with shame?

NEDA says that, “Following a healthy diet does not mean you are orthorexic, and nothing is wrong with eating healthfully. Unless, however, 1) it is taking up an inordinate amount of time and attention in your life

2) deviating from that diet is met with guilt and self-loathing; and/or

3) it is used to avoid life issues and leaves you separate and alone.”

I think that the second point is huge. If you're feeling guilt and self-loathing for “slipups,” I think it’s time to reconsider why you're making the choices you make. Food choices should always be about choosing the best for yourself, not out of fear and unhealthy restraint.

Is your diet too strict to be healthy?

I found it interesting that Dr. Steven Bratman, the alternative medicine practitioner who coined the term orthorexia nervosa in the 1990s, based it on his own experience. He found that he, and many of the people he consulted, obsessed over diets. Like them, he found that intrusive thoughts about food were taking over his life. He learned to recognize that his food purity rules were actually causing nutritional issues for him.

And I think for me that begs the question of what happens in our minds when we cut out food groups we never were meant to cut? Our bodies absolutely need healthy fats, and I understand completely why food cravings and food thoughts would take over if you were fat-starving yourself. For me, eating a well-balanced and healthy diet has done so much for me in terms of thinking about food less. If you find that the diet you chose for yourself — whether it’s a really low carb-diet, really low-fat diet, raw vegan — leaves you obsessive and fearful about food, perhaps you should reconsider taking such a strict line towards a food group.