Is a Concern About Healthy Eating Too Much of a Good Thing?

For some, it can be unhealthy to focus on food labels.

Posted Nov 04, 2019

After decades of telling my weight-loss clients and the readers of our books to read food labels, I now fear I may be promoting a different eating disorder: orthorexia, or an obsession with healthy eating. (Orthrexia nervosa means "correct diet.")

The term was coined by Steven Bratman, an American physician who used it in a 1977 Yoga Journal article. It is worth learning about orthorexia now because we may encounter someone with this problem at our Thanksgiving dinner. This would be the guest who wanders into the kitchen to read the label on the discarded can of pumpkin to make sure it is organic or frowns when noticing that the drippings for the turkey are being used to make gravy. It could be the guest who avoids putting anything with carbohydrates on his plate or anything made with butter and cream. Or it is a relative who insists on lecturing everyone on the benefits or dangers of consuming certain foods and acts as if consumption of “bad" foods will lead to everyone at the table developing a host of diseases.

These behaviors may be only annoying. However, if they veer toward the compulsive, they may indicate the presence of orthorexia. Often, if challenged, such an individual points to information on the Internet, from media, or in a book that reinforces his or her food beliefs. Presenting research-based evidence that contradicts these beliefs is futile in changing the orthorexic’s mind. Even quoting large-scale studies showing that vitamin X or mineral Y does not have the curative or longevity powers ascribed to them will not be believed.

I have a neighbor in his mid-80s who is convinced that semi-starvation is the route to longevity; maybe even immortality. His gaunt frame, now almost fat-free and losing muscle, is a testimony to the restrictive nature of his diet. Will he live longer than others who eat more freely and are a normal weight for their age, as do rats put on such a restrictive diet? He may be hungry all the time, but he feels his way of eating is the healthiest.

As an article by Koven and Abry points out, people with orthorexia may have a form of compulsive behavior. The problem, they say, is that such behavior is masked as healthy, and not pathological, even though the effect can be the complete avoidance of foods whose nutrient content is essential to good health.

A response to the orthorexia should not be what I call “neglectful eating.” Paying no attention to portion size, empty calories, sugar, salt, and fat content may increase susceptibility to a variety of diseases. Nor, if the healthy eater should become sick, should the neglectful eater say, ”See what happens when you avoid junk food!”

Years ago, Jim Fixx, the author of The Complete Book of Running, died at the age of 52 during his daily run. Couch potatoes rationalized their reluctance to exercise by saying, "See what happens when you run? You die young!” What they did not realize was that he might have died even younger without his exercise regimen.

It is also important to distinguish between the many who avoid (or choose to eat) specific foods for medical, religious, or cultural reasons. The diabetic who must measure units of carbohydrates, the kidney disease patient who may have to decrease potassium intake, the person without a gall bladder who avoids fried foods, those with food allergies, gastrointestinal problems, excessively high cholesterol or low iron stores, as well as those with osteoporosis, lactose intolerance, or religious prohibition, seem to engage in eating behaviors as compulsive as that of the orthorexic. But rarely, if ever, do such individuals label foods they eat or reject as "healthy" or "unhealthy." They are simply allowable or not, in relation to their medical, religious, or cultural needs.

Some mental health practitioners support efforts to label orthorexia as a diagnosable eating disorder. If this were to occur, how would such a disorder be treated? According to the National Eating Disorder Association (NEDA), there is no definitive treatment; practitioners often try treatments that may work with other types of compulsive behavior.  

One symptom—searching for the perfect-utopian diet that will ensure perfect health and a long, healthy life—must cause the individual with orthorexia great distress, because our definition of a healthy diet keeps changing. Maybe the problem is that finding the perfect diet is almost impossible. There is little reason to believe that in the near future, nutrition experts will be able to develop a single diet that settles forever how much of each nutrient we should consume based on our gender, age, medical status, and, of course, research. But if and when each of us will know exactly what we should be eating every day, maybe then the orthorexic's compulsive search can end.


“The clinical basis of orthorexia nervosa: emerging perspectives,” Koven N and Abry A, Neuropsychiatr Dis Treat.2015; 11:385-394.