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

Is it unhealthy to focus on the details of the food label?

Posted Nov 04, 2019

After decades of telling my weight-loss clients and readers of our diet books to, “… read food labels…” I now am afraid that I may be promoting a somewhat new eating disorder. It is called orthorexia and describes an obsession with healthy eating (orthrexia nervosa means correct diet).

The name was proposed by Steven Bratman, a physician in the U.S. who coined this term in a 1977 article in Yoga Journal.  It is worth learning about this type of eating 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 the “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, the 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-eighties 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 the article by Koven and Abry point 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 eating, even though the effect can be complete avoidance of foods whose nutrient contents are 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 contents of food, as well as avoidance of vegetables, fruit, calcium-rich foods to prevent osteoporosis, high-fiber foods, and even sufficient water intake, 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 younger without exercise.

It is also important to distinguish between the many who avoid (or choose to eat) specific foods because of underlying medical, religious, and cultural reasons. The diabetic who must measure units of carbohydrate, the person with kidney disease 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 these with osteoporosis, lactose intolerance, or religious prohibition, seem to engage in eating behaviors that seem to be 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.

Even though some mental health practitioners are supporting efforts to make orthorexia into a valid eating disorder, if this were to occur how would such an eating disorder be treated? According to the National Eating Disorder Association ("NEDA"), there is no definitive treatment, and practitioners often use treatments that may work with other types of compulsive behavior.  

One of the symptoms, searching for the perfect-utopian diet that will ensure perfect health and a long, healthy life, must cause the individual with orthorexia great distress. This is because our definition of a healthy diet keeps changing. What if a hypothetical individual with orthorexia decides to avoid all carbohydrates, including those with high fiber (beans, brown rice, buckwheat groats, farro, bran etc.) only to learn that (this is hypothetical) doing so is increasing his risk of high blood pressure? Or eats large quantities of cabbage, cauliflower, brussel sprouts, and broccoli only to learn that (hypothetical again) studies have shown such a diet is bad for developing good gut flora. As anyone who follows “breaking news” about how nutrient X is now good or bad for us, knows the reverse may be shown two year later.

Maybe the problem is that finding the perfect utopian healthy diet is almost impossible.  There is little reason to believe that in the near future nutrition experts will be able to develop the definitive healthy diet, that is, a diet that settles forever how much of each nutrient we should be eating based on our gender, age, medical status and, of course, research. At the same time, there is little reason to believe that new food plans will no longer be aggressively marketed; they sell products, books, and media time. There is also little reason to believe that the so-called personalized diets will be based on enough scientific evidence to be truly personalized.

 But if and when each of us will know exactly what we should be eating every day; maybe then the compulsive search by the orthorexic will end.


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