I talk a lot about eating disorders here and today we’re going to be talking about orthorexia nervosa, and touch a little bit on orthorexia in men specifically.

The best-known eating disorders are probably anorexia and bulimia. And the most common one is probably binge eating disorder.

Orthorexia is probably not as well known as any of those, but I think it is more common than its current prominence suggests.

It’s just that the symptoms will often be assumed to just be part of eating healthy or following a diet.

What Is Orthorexia?

In simple terms, orthorexia is the obsession with eating healthy or “pure” foods. In other words, healthy eating taken to an extreme.

The term was first published in a 1997 edition of Yoga Journal by a doctor named Steve Bratman.

I couldn’t find the original print for this post, but I did find it republished and you can read it in full at beyondveg.com.

Here are the key points that I want to draw attention to from the article:

• Orthorexia was referred to as a pathological fixation in eating “proper” food.
• It often starts with wanting to improve health or overcome illness.
• Due to the willpower involved to stick to a diet or way of eating, it can take on an almost holy or spiritual feeling so when you slip up, you feel like you have sinned.
• This can mean you try to go stricter or “cleaner” or “healthier” to make up for the sin.
• Thoughts get dominated by needing to resist temptation and feelings of worry and guilt around food.

There were a lot of publications since that 1997 article that Dr Bratman was not involved in. And as a result, he shared some updated guidance that you can read here.

The core concept of orthorexia involving the obsession with eating in a certain way because you deem it better has not changed though.

It is important to note that not all healthy eating habits are orthorexia or disordered.

When it reaches a point that causes a substantial disruption to your day-to-day life is when it is likely to be called orthorexia.

It is also worth noting there is no one set type of diet that gets deemed orthorexic as the foods deemed “pure” will differ from person to person.

Someone that is a follower of a low-carb or ketogenic diet may find fruit to be “sinful” or “impure”. Someone who follows a low-fat or low-calorie diet may feel the same way about peanut butter.

Symptoms Of Orthorexia And Warning Signs

As I mentioned, there is a fine line between healthy eating and the point where it becomes orthorexia.

A lot of the symptoms of orthorexia may actually just sound like they are normal things we do when trying to eat healthily.

And in a lot of cases, they probably are.

So it is important to consider the scale and extent of these behaviours and the level of disruption they cause.

For example, not wanting to have a piece of cake because it doesn’t fit into your diet might be healthy eating. Not wanting to have a small piece of cake on your birthday and feeling guilty and stressing about it for days in advance would be much more likely to fall into the category of orthorexia.

So what are the common symptoms to look out for?

I’ve made you a list because I’m nice like that.

• Cutting out entire food groups from your diet in order to make it more healthy. Over time, the number of foods or food groups may increase.
• Judging other people’s eating habits, whether you say anything to them or not.
• Obsession with following a diet that you deem healthy.
• Increased focus on what you’re eating to the extent that it can interfere with your day-to-day life. The cake example I mentioned earlier fits in well here.
• Feeling unable to put aside your own food rules or guidelines.
• Needing to know the exact calories or macronutrients of the food and drink you’re having.
• Guilt, anxiety and stress overeating foods that you consider unclean.
• Linking your emotional well-being to eating in a certain way or relying on those foods to provide your sense of well-being.
• Feeling uncomfortable or insecure when you don’t have full control over the food you’ll be eating or how it’s prepared – going to restaurants or a friend’s house for dinner are good examples here.
• Rigid eating patterns.
• Constantly checking food labels.
• Avoiding social situations because of how you feel about the food you’ll be having or what others might be having.

As I mentioned, many of these can definitely just be in the context of a specific diet or eating plan and it’s important to note the extent of the disruption caused, how frequently it happens, and how much of an impact it ends up having on you.

And I will talk about testing for orthorexia shortly too.

I got you covered.

Causes Of Orthorexia

As with most eating disorders and mental health conditions, there isn’t any one specific cause. And this eating disorder probably hasn’t been as well researched as others either.

But there are some common risk factors that can lead to eating disorders that in general terms, still apply here.

Namely:

• Past trauma
• Emotional distress
• Perfectionist or obsessive personality or behaviour patterns
• Stress, depression or anxiety
• Feeling the need to have control over something

I can definitely relate to that last one. I went through a couple of phases when things weren’t going all that well in my life and I became more focused on my control over food to help me feel in charge of something. And if I didn’t have that control, I felt like I had nothing.

Let’s look at my keto diet example again.

Say someone was heavier than they wanted to be and felt very self-conscious about their body. Maybe they had body dysmorphia and their self-esteem was at rock bottom.

They followed the keto diet, cut out carbs, got to a target weight and felt great. They had a lot of positive reinforcement because people praised their weight loss.

Suddenly there is a strong link in their mind between feeling good, happiness and not having carbs.

And in their mind, carbs become demonised and stigmatised and having carbs becomes such a negative, it’s basically a sin.

That is a basic example and it can and will often be much more complex and much deeper than that.

Orthorexia Test And Criteria

There is a 10-question test you can do for orthorexia called the Bratman test.

If you answer yes to 4 or 5 questions, there is a strong possibility you have orthorexia and should seek professional help.

That means no random snippets from a blog or social media. That means genuine, real, professional help.

You can do the test for free here.

And in case you want to come back to it later on in your own time, I have also pasted the questions for you below:

• Do you spend more than 3 hours a day thinking about your diet?
• Do you plan your meals several days ahead?
• Is the nutritional value of your meal more important than the pleasure of eating it?
• Has the quality of your life decreased as the quality of your diet has increased?
• Have you become stricter with yourself lately?
• Does your self-esteem get a boost from eating healthily?
• Have you given up foods you used to enjoy in order to eat the ‘right’ foods?
• Does your diet make it difficult for you to eat out, distancing you from family and friends?
• Do you feel guilty when you stray from your diet?
• Do you feel at peace with yourself and in total control when you eat healthily?

When I did it, I answered yes to 6 or 7 of those so based on that, it’s likely I am still dealing with some orthorexic behaviour patterns.

There are also 2 parts to diagnosis.

• Part A is:
  • An obsessive focus on healthy eating
  • Distress over unhealthy food choices
  • Compulsively following food rules
  • Sense of anxiety and shame from breaking those rules
  • Increasing strictness over time
• Part B is:
  • Noticing mental and physical health issues
  • Issues on a day-to-day basis around relationships, and also in work or in aschool
  • Body image and self-esteem start to become linked to diet

Just to be absolutely 100% clear, I am not a professional and have zero qualifications to diagnose, advise on or treat specific instances of suspected or confirmed eating disorders.

If you suspect you have an eating disorder or any mental health condition for that matter, I can be an empathetic listening ear, and I can provide information that is already publicly available.

That’s it. So please do seek professional help if this is something you are dealing with.

How Common Is Orthorexia?

There haven’t been a lot of large-scale studies and I struggled to find much by way of authoritative stats but I have summed up what I did find below.

• A 2004 study of 404 people estimated a prevalence of 6.9%.
• A 2014 study estimated it can be as high as 86% among Ashtanga Yoga practitioners. I think this one is a very specific case as yoga focuses heavily on ideas of cleanliness and purity so it’s more natural for that to translate into diet and eating habits.
• By contrast, a 2017 study of 275 college students estimated the prevalence to be below 1%.
• A self-administered questionnaire in 2011 returned results as high as 57.5%.
• There are also some stats on specific populations or demographics:
  • Orthorexia affects 31% of female and 41% of male athletes.
  • 12.8% of dietitians in a study in Austria
  • 32.1% of ballet dancers
  • As high as 81.8% of opera singers

But as I said, it is difficult to find genuine authoritative stats from large-scale studies.

Plus I think a lot of people who might be orthorexic may just think they’re being healthy, which means many people could possibly have it without realising.

That can go both ways though.

We might think we’re being healthy and have orthorexia. Or because we are focused on a diet for a period of time, we might think we have orthorexia when we are just being particularly focused for a period of time.

So this takes us back to that fine line between healthy eating and an eating disorder.

Orthorexia Diet Example And Experience

As I mentioned, the foods that people consider healthy or “pure” will vary for each individual so there isn’t any one typical orthorexia diet example.

But I can talk about my own experience so you can get some idea of what it’s like.

I am going to sidestep saying I definitely had or have orthorexia as I have never been formally diagnosed. But it seems very likely at least.

In terms of my experience, my food obsession really got into gear after I lost a lot of my weight.

I made steady progress for a while and then after a while when I plateaued, that’s when I got frustrated and more desperate and kept trying the newest or latest trend or fad.

And that is how I ended up on the paleo diet for a period of time.

I was eating pretty much just fruit, nuts, oils, seeds, lean proteins, and vegetables. Overall it was a very nutritious way to live but very restrictive.

And I wanted to follow it as strictly as possible.

That meant going out or special occasions became stressful and I started to worry about them weeks in advance.

That habit actually hasn’t left me entirely yet and is something I am still prone to occasionally.

What I used to do was starve myself for most of the day. It sounds like I was trying to “make space” for the food I would be having but it wasn’t about calories or the volume of food.

I felt like I was about to be poisoning myself so I wanted to let my body be able to just focus on processing that food as quickly as possible.

Plus I would do a long sweaty cardio session the next day to help get that food out of my system.

If my diet before my weight loss was harming my physical health, this one was now taking its toll on my mental health.

All of my meals were planned out. No refined or processed ingredients.

If I slipped up, my all-or-nothing mentality would kick in and I would have a food binge and then get back on track the next day.

That really did lay a foundation for binge eating disorder that I have had to deal with subsequently.

I also hit a 2500 consecutive day streak on MyFitnessPal, meaning I logged my calories and food for 2500 days in a row. That includes Christmas, holidays, birthdays – everything.

I became a lot more reclusive and just couldn’t enjoy going out with friends or family if food was involved. It used to stress me out and I would need to look up the menu beforehand if we were going out to a restaurant.

And I would always ask for the least processed-sounding thing on the menu which usually meant salad with some grilled chicken.

I do still check food labels as I like to have some awareness of the ingredients and nutritional value of what I am eating. Plus I have also recently found I have an issue with dairy so need to avoid it.

But I am not as obsessed with it and I have learned to relax a lot more around it.

Orthorexia In Men

Most of my content is more geared towards men so of course I did want to touch on orthorexia in men specifically.

As we already covered, there isn’t a huge amount of research on orthorexia in general. At least not in terms of what I could find.

But I did find a 2018 article suggesting that young, healthy males are more likely to be at risk of developing orthorexia.

The article mentions that men are more likely to diet not just for weight loss but with other performance goals in mind, which means that they are more likely to be focused on nutritional value and macronutrients.

That doesn’t mean women can’t or won’t develop the same symptoms or eating disorders. It just means that based on common trends, men seem more likely to end up going down the road of this specific disorder.

I couldn’t find any stats to back that up but anecdotally it seems to make sense.

On my Instagram Explore page, meal prep accounts will typically be run by men. Men are more likely to have goals around body composition, gaining muscle, and achieving optimal performance.

Again, that does not mean women don’t have performance goals or want to gain muscle. Just from my own experience and from what I see (so maybe “within my own bubble” is a better way to put it), those kinds of goals tend to be more common among men.

Plus I guess there is some sort of hyper-masculine or macho notion behind sacrifice, seeming hardcore and enduring hardship too.

I definitely had symptoms and behaviours that overlap with orthorexia, and even if I was never diagnosed, it’s extremely likely that I had or still have orthorexia. And I know a few other guys who do too.

And it takes its toll.

Healthy eating is great. When it causes huge amounts of disruption to you just trying to live your life, it’s probably less good.

Orthorexia Recovery And Treatment

Just to emphasise again, I am not a qualified professional and this is an area you should really be seeking specific advice from someone who is qualified to give that to you.

But from my understanding, there is no specific treatment for orthorexia. Treatment can however be approached in a similar way to other eating disorders and some other mental health conditions.

In this case that would mean some psychotherapy and gradual exposure to the foods that cause distress. Cognitive behavioural therapy may also be beneficial here.

If there is an underlying cause or trigger that led you to develop orthorexia then being able to address that might also help.

Again, that’s a very, very basic example. I’m not a professional.

In my case, I don’t remember what took me away from the paleo diet. I might have just moved on to another trend.

But some of the orthorexic habits and behaviours have still stayed with me and it is a tough one to shake.

But there are some things that have helped me:

• Putting my energy into something positive like this blog and my YouTube channel
• Making sure I am hitting my daily minimum targets for calories, protein, carbs, fats, fibre, vitamins, and minerals. As long as I am hitting those I stop worrying about whatever else I have on top of that.
• Loosening up on tracking my calories. I still keep a ballpark estimate of my calories But I am not rigidly tracking anymore.

And it has helped.

I don’t feel much guilt around food anymore. I do still think about it a lot and do still like to plan ahead. But after taking it very gradually, I’ve been able to introduce foods that I used to feel guilty about and vary my diet a lot more.

It’s still something I am working on but I am doing a lot better.

Wrapping Up On Orthorexia

The key points you want to remember on orthorexia are as follows.

It often starts with good intentions before slipping into disordered behaviour. There is a fine line between healthy eating and this eating disorder that can be easily crossed.

There is no specific clinical treatment but psychotherapy and gradual exposure to the foods that cause you distress or guilt can help.

If you have or suspect you have orthorexia, please do get professional help. It is a genuine eating disorder and mental health condition.

If you are on a diet, aim for 90% consistency. That 10% wiggle room allows you to be imperfect and provides a buffer to stop you from becoming fixated on sticking to that diet in its purest form.

And try to take food out of your control every now and then. Eat out at restaurants, get takeaways, and go to other people’s houses. Again, it acts as a safety net to stop you from getting fixated on a certain way of eating.

And just like any other eating disorder or mental health condition don’t hesitate to get help.

It can be hugely disruptive to your life and cause a hell of a lot of stress or distress. And there’s never any shame in asking for help.

If you’re in the UK, check out BEAT. If you’re in the US, check out NEDA.

And I’m not qualified to help. I can be listening here and I can point you in the right direction.