How to Tell If You Have Orthorexia

Need healthy eating inspiration? Only if you've been living under a rock. From popular wellness bloggers who espouse an "eat like me, look like me" approach, to Instagram feeds flooded with clean eating recipes and food diary photos, to nutrition articles warning about foods to never eat and ingredients to avoid, the constant barrage is hard to miss.

When did healthy living become more about what you should delete versus what to eat?

"Unfortunately, it's become socially acceptable to be obsessive about food," says Marci Evans, a registered dietitian, eating disorders specialist and body image expert who owns a private practice in Cambridge, Massachusetts. In other words, food has become a form of self-expression, and how we eat is now a part of personal identity. People are seeking out like-minded communities to support their ideologies around food.

So what's the big deal? Let me take you back to a presentation about the harms of taking healthy eating to an extreme at the Academy of Nutrition and Dietetics' recent Food and Nutrition Conference and Expo in Boston.

[See: The Eating Disorder Spectrum -- From Pregorexia to Drunkorexia.]

In a cavernous convention hall, an estimated 4,000 registered dietitians listened intently to three experts discuss orthorexia nervosa, a term coined by one of the panelists Dr. Steven Bratman to describe an unhealthy obsession with healthy eating. The condition, not yet classified as a full-fledged eating disorder (though Bratman recently proposed diagnostic criteria to encourage it to be considered one), is increasingly on the radar of health care professionals. It clearly struck a chord with the audience. During the 90-minute panel, the topic was trending on Twitter, and it became one of the most talked about sessions at the conference.

The condition differs from anorexia nervosa, in which people's distorted self-image leads them to severely restrict calories for fear of becoming fat. With orthorexia nervosa, or more commonly referred to as simply "orthorexia" ("ortho" means right; "orexia" means hunger), the goal isn't necessarily thinness, but a desire to be pure, clean and healthy. In his presentation, Bratman described orthorexia as a "disease disguised as a virtue."

It's about good intentions that have gone too far. It's when a desire to eat right totally takes over someone's life -- leading to anxiety, guilt, self-judgment and often social isolation.

"Your identity should not depend on you being the healthiest eater in the room," Evans, who was a co-panelist, told me later. (The third panelist was Jessica Setnick, a registered dietitian and eating disorders expert in Dallas, Texas.)

So why are we seeing a rise in orthorexia? Evans says people's tendency to bucket foods into good and bad categories -- and their eating into good and bad days -- may be adding to the problem. Our society's laser focus on health without emphasizing the pleasures and enjoyment of food, as well as the worshiping of certain "miracle" foods, are contributing factors, too.

Of course, just because you've decided to become vegan, go paleo, try a detox cleanse or follow a strict eating regimen, doesn't mean you have orthorexia, Evans says. The problem is when your eating becomes increasingly restrictive and it starts to negatively impact your self-worth, happiness and well-being.

[See: How to Break 7 Unhealthy Habits.]

If you're wondering if your healthy eating has, in fact, become unhealthy, Evans suggests asking yourself these questions:

-- Are you spending more time thinking about your food choices than you wish you were?

-- Do you find that the main barometer of how you feel about yourself on any given day is based on how you've eaten?

-- Do you tend to demonize certain foods and think you cannot eat the foods you enjoy?

-- Are you flooded with anxiety, shame, guilt or negative physical sensations when you eat something that is not on your list of permitted foods?

-- Do you feel like your eating has become compulsive instead of an active choice?

-- Are you increasingly eliminating more foods and adding to your list of food rules to try and achieve the same health benefit?

-- As you cut out more foods and try to eat healthier, has your fear of disease gotten worse?

-- Does your eating regimen make it hard for you to interact with friends, family or colleagues?

-- Are you likely to stay home from a social event over a fear of what type of food will be served?

-- Is your eating adding to your overall stress?

-- Has a medical professional told you that you're experiencing negative health symptoms because of your strict diet?

[See: 12 'Unhealthy' Foods With Health Benefits.]

Answering yes to any of the questions is a warning sign that you may be at risk for orthorexia. Evans recommends reaching out to a registered dietitian -- and potentially a mental health counselor -- so you can be evaluated. Your food choices should not be a reflection of your morality or value, she says. A registered dietitian can help reduce these food fears and create an approach to eating that is flexible, less rigid and pleasurable.

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