Tag: orthorexia nervosa

Orthorexia in Males: Fitness Goals Turned Health Obsession

Meal prepping, meal timing, and “counting macros” are all the rage in the health and fitness industry. But when it starts to take over your life, this healthy lifestyle can eventually become an unhealthy obsession.  

Throughout society’s current “age of information”, emerging nutrition research and scientific data have become more accessible to the public. The wide variety of nutrition information has been used to support society’s influence of “clean eating” and other popular diet trends deemed healthy. Nutrition and fitness influencers encourage people to eat “clean”, which usually means eating more whole foods and omitting processed foods and preservatives. However, some will take these practices more seriously with the inclusion of weighing, measuring, and counting every food consumed on a daily basis. This lifestyle can eventually become more harmful than healthful to a person’s overall well being.

While it is known that the diet industry markets extensively to females, men have had increased societal pressure to be active and show it physically. These reasons tend to be masked as common motivators men have to adopt healthy eating. A goal that starts with fitness eventually becomes more serious in some men, where the focus shifts to reasons beyond just being healthy. Though focusing on health is important, it is also important to recognize when an eating style is more disordered than orderly. General eating disorders, such as anorexia nervosa (AN) and binge eating disorder (BED), are known to develop more in women, but studies are finding a rise in eating disorders among men [5]. To be more specific, active, healthy men are becoming more at risk of developing an emerging eating disorder named Orthorexia Nervosa (ON). 

The term Orthorexia Nervosa was first coined by Bratman and Knight in 1997 from the Greek words orthos (correct) and orexis (appetite) [1]. ON is described as a pathological fixation with consuming proper nutrition characterized by an obsessional adherence to strict dietary regimens. This condition is fueled by fears of sickness, disease, and a desire for overall physical well-being. More specifically, people with ON are more focused on the quality of their food rather than the quantity they are consuming. These individuals have such fixated nutritional beliefs that they will consume foods based on their nutritional properties rather than for enjoyment and taste [5]. Some studies suggest that ON features erroneous food beliefs, or a magical belief about the benefits and functions of certain foods [5]. For example, raw foodism includes the belief that chewing food too fast affects protein digestion and amino acid absorption. These food obsessions combined with inconsistent balance, loss of food moderation, and social withdrawal can have negative impacts on relationships and emotional health.

The American Psychiatric Association (APA) currently does not recognize Orthorexia Nervosa as an eating disorder, but its condition is gaining serious attention from health professionals. So far studies have found the prevalence of ON to be between 1% and 7% of the population, in fact, research is showing that 6.9% of men are likely to develop ON [8]. 

A rise in ON’s prevalence has been seen in a possible connection with the rise in social media. A recent study on participants, who followed healthy eating accounts on Instagram, found that 49% of its participants met orthorexia criteria [7]. The incidence in which ON occurs has not been significantly studied, however studies that have been conducted mainly focused on the emotional and physical consequences of ON. These consequences are believed to be stemmed from co-occurring conditions rather than the possible neurological profile of ON in the brain [5]. 

Orthorexia Nervosa is not an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, however, it’s characteristics are similar to that of anorexia nervosa and obsessive-compulsive disorder (OCD) [3,5]. Common diagnostic criteria include perfectionism, trait anxiety, and impaired working memory [5]. The difference between anorexia and orthorexia is merely the motivation for disordered eating followed by the extent to which the conditions are portrayed [2,3]. In addition, anorexic disordered individuals do not flaunt their behaviors the way orthorexic individuals do [3]. A potential reason why Orthorexia Nervosa has not been concerned enough to be an official psychological disorder could include the motivation of healthful behaviors for longevity reasons rather than for the desired body type. The co-occurring conditions of OCD and anorexia may also be more often considered a primary concern to diagnose. 

According to the National Eating Disorder Association (NEDA), the warning signs and symptoms of ON include, but are not limited to:

  • Inflexible eating patterns
  • Obsession over the quality of food 
  • Intense frustration if rules are broken
  • Entire dismissal of food groups
  • Constant worry about sickness and disease
  • Increased anxiety around certain foods
  • Weight loss

Severe cases of ON involve an increased risk of malnutrition due to nutritional deficiencies from restricting some or all of an entire food group. Even when a person is strictly eating “clean” foods, there can be major gaps and lack of variety in their diet. This can ultimately disrupt gut health and hormonal balance. Other health consequences include testosterone deficiency, hyponatremia, and metabolic acidosis. In the short-term, fatigue, difficulty concentrating, and digestive problems are also possible health-problems.  

The continuous rise in healthy-eating propaganda across various formats can become overwhelming, especially in people who share a predisposition for anxiety, OCD tendencies, and perfectionism. Men are becoming more health-conscious, but it is being paralleled with a problematic growth in an obsessive mentality noticeable in those seeking the “perfect diet”. Studies show that men are more likely to adopt a healthy diet for positive health reasons than merely just weight loss [8]. The pressure society puts on men compared to women questions the actual prevalence of men becoming orthorexic. It may be higher than society thinks. A man being told by the media that “putting on muscle” should be done by eating clean, for example, could increase their risk of developing ON. One study done on college males found the traits of men with muscle dysmorphia were similar to ON [4]. As mentioned earlier, though, more research is needed on the incidence of which ON occurs.

Nonetheless, the key component in recognizing Orthorexia Nervosa is when healthy eating habits become obsessively restrictive and obsessive behaviors become socially problematic. Since Orthorexia Nervosa is still new to the medical community, a standard treatment plan does not currently exist. However, it has been approached by health professionals in similar ways to the treatment of anorexia. Focusing on decreasing rigid eating patterns and increasing flexibility in food choices can be successful ways to combat orthorexia and its social isolation tendencies.

Sara Piecukonis, MS, RDN is a registered dietitian with Bright Road Recovery.


1. Bratman S, Knight D. Health Food Junkies: Orthorexia Nervosa– Overcoming the Obsession With Healthful Eating. New York, NY: Broadway; 2000.

2. Brytek-Matera, Anna et al. “Orthorexia Nervosa and self-attitudinal aspects of body image in female and male university students.” Journal of eating disorders vol. 3 2. 24 Feb. 2015, DOI:10.1186/s40337-015-0038-2 

3. Dell’Osso, L., Abelli, M., Carpita, B., Pini, S., Castellini, G., Carmassi, C., & Ricca, V. (2016). Historical evolution of the concept of anorexia nervosa and relationships with orthorexia Nervosa, autism, and obsessive-compulsive spectrum. Neuropsychiatric disease and treatment, 12, 1651–1660. https://doi.org/10.2147/NDT.S108912

4. Gorrasi, I., Bonetta, S., Roppolo, M., Abbate Daga, G., Bo, S., Tagliabue, A., Ferraris, C., Guglielmetti, M., Arpesella, M., Gaeta, M., Gallé, F., Di Onofrio, V., Liguori, F., Liguori, G., Gilli, G., & Carraro, E. (2019). Traits of orthorexia nervosa and muscle dysmorphia in Italian university students: a multicentre study. Eating and weight disorders : EWD, 10.1007/s40519-019-00779-5. Advance online publication. https://doi.org/10.1007/s40519-019-00779-5

5. Koven, N. S., & Abry, A. W. (2015). The clinical basis of orthorexia Nervosa: emerging perspectives. Neuropsychiatric disease and treatment, 11, 385–394. https://doi.org/10.2147/NDT.S61665

6. National Eating Disorder Association. “Orthorexia.” Accessed June 1st, 2020.

7. Turner, Pixie G, and Carmen E Lefevre. “Instagram use is linked to increased symptoms of orthorexia Nervosa.” Eating and weight disorders: EWD vol. 22,2 (2017): 277-284. DOI:10.1007/s40519-017-0364-2. 
8. Barthels, Friederike, and Pietowsky, Reinhard. “Orthorectic Eating Behaviour – Nosology and Prevalence Rates.” Psychotherapie, Psychosomatik, Medizinische Psychologie, 2012. Accessed June 1, 2020.


When Healthy Eating Becomes Dangerous

By Claire St John, MPH RD

Diet buzzwords are everywhere these days, from eating ‘clean’ to ‘pure’ to paleo to raw veganism. Although these terms have nebulous definitions, many people take up the banner of their personal food plan, encouraging others to do the same.

For some people, eating better means buying whole foods and organic produce when possible. But for others, eating a ‘perfect’ diet becomes an unhealthy obsession that takes over their lives. At its worst, it can result in malnourishment, mental, behavioral and health issues.

It’s ironic that an effort to eat better could compromise health, but that’s what Dr. Steven Bratman noticed in the 1990s when he coined the term ‘orthorexia,’ derived from the Greek for ‘correct eating.’ Before he was a doctor, Bratman lived on a commune with people who argued against cutting vegetables for fear of losing nutrients. Others avoided plants from the nightshade family, such as tomatoes, potatoes and eggplants. Although many of his friends and eventually patients touted their healthful diets, Dr. Bratman observed their health declining.

As a Registered Dietitian who works with eating disordered patients, I’ve seen the effects of orthorexia first-hand. People with orthorexia tend to focus on what they eat rather than how much they eat,as in cases of anorexia nervosa. The results, however, are similar. Both the anorexic and the orthorexic tend to be dangerously underweight, and their labs show low iron and low total protein.

“It’s important to know that someone can start out with orthorexia and slip into the psychological symptoms of anorexia,” said Tamson Overholtzer, Director of Bright Road Recovery in Claremont Village and a licensed Marriage and Family Therapist. “When this happens, the focus is not just on the perfect diet, but also on fear of weight gain.”

Unlike anorexia, orthorexia can hide in plain sight, and is often unwittingly encouraged by friends and family who admire the orthorexic’s willpower and dedication to diet.The disorder can begin innocently, with something as simple as a resolution to eat better.

Magazine articles, news segments and a billion Internet sites constantly promote the “hot, new diet.” People cut out gluten without knowing what, exactly, it is. Dairy is demonized daily and sugar and carbohydrates are called poison by people with Ph.Ds. It’s no surprise that people don’t know what to eat, and as the headlines pile up, they might cut foods out of their diet almost randomly.

Eliminating entire food groups can lead to nutrient deficiencies, but as health fails, the obsession with healthy eating can intensify. Feelings of fatigue are assumed to be due to toxic foods lingering in the diet. Insatiable cravings for ‘forbidden foods’ are chalked up to the addictive attributes of the American food supply instead of simple hunger and undernourishment.

Because the diet is so restrictive, it becomes difficult to eat at restaurants. The orthorexic might carry his food around with him, because restaurants and stores can’t meet his high standards.

Eating at friends’ houses is out, because it’s burdensome listing all the foods he can’t eat. People don’t seem to understand anymore. They say he’s lost too much weight, but losing weight is a good thing, right? When the right foods aren’t available, the orthorexic will skip meals rather than contaminate his body.

Oftentimes, neither the orthorexic nor his family and friends realize there is a problem until it becomes very serious. Because healthy eating has taken on nearly religious status in our culture, those who eliminate ‘bad’ foods are celebrated.

When someone comes to me  for help with their restrictive eating patterns, I start them on a meal plan that includes starches, proteins, fats, fruits and vegetables in amounts that will support their bodies. In Meal Support sessions we eat together, allowing me to help each client through the anxiety of eating ‘forbidden foods.’

In these sessions, I usually remind my clients of the basic nutrition information that they’ve replaced with an ornate structure of food rules, misinformation and fear.

Yes, she knows essential fatty acids are necessary for survival, that protein is required for life, that carbohydrates are the best source of energy and the brain runs on glucose. But their diets were so healthy!

Treatment isn’t always necessary if early intervention is possible. If you or someone you love might be slipping into orthorexia or anorexia, a meeting with a therapist or Registered Dietitian who understands eating disorders can be life-changing..

“It’s hard to overstate the importance of early intervention,” Overholtzer said. “The sooner the symptoms are addressed with a dietitian or therapist, the more likely you are to have a positive outcome and avoid needing additional treatment intervention.”

Many people just need a reminder of what healthy eating looks like, what the body needs for peak performance and some real information about food and nutrition.


–We originally posted this article June 2016.