Health Matters 4/1: When Healthy Eating Becomes Unhealthy


By Najeeb Riaz, MD

Most people aspire to eat a healthy diet.

In fact, eating fresh foods and limiting fatty, sugary, processed foods are cornerstones of good health.

But focusing too much on eating healthy — to the point of obsession — might signal an eating disorder called orthorexia and result in physical and mental health issues.

The Princeton Center for Eating Disorders at Penn Medicine Princeton Medical Center provides treatment for adults, adolescents, and children as young as 8 who suffer from eating disorders, including orthorexia.

About Orthorexia

Orthorexia is characterized as an obsession with proper or healthy eating. According to the National Eating Disorders Association (NEDA), people with orthorexia become so fixated on so-called healthy eating that they actually damage their own well-being.

What begins as a desire to eat healthier escalates into more and more rigid, self-imposed food restrictions with negative health consequences, including low calcium levels that can lead to osteoporosis, congestive heart failure, and weight loss and malnutrition.

Orthorexia can begin with eliminating something like gluten or sugar from your diet, and then progress to where your diet is very, very limited to a small selection of foods that do not meet your dietary needs.

Another example of orthorexia is only eating foods that are 100% organically grown, which can be difficult to confirm when it comes to every ingredient in a meal.

In addition to the physical effects of orthorexia, there is a social isolation aspect as well. Over time, it becomes almost impossible for someone with orthorexia to go out to eat or attend social gatherings because of concerns surrounding food.

It is uncertain how many people suffer from orthorexia, but the NEDA estimates that 20 million women and 10 million men in the United States will have an eating disorder of some kind at some point in their lives.

Risk Factors

Orthorexia is most common in young adults in their mid-to-late 20s, who are establishing themselves professionally.

Individuals with perfectionist tendencies or obsessive-compulsive disorder (OCD) may be at increased risk for developing orthorexia. OCD is characterized by repetitive, unwanted, intrusive thoughts (obsessions) and irrational, excessive urges to do certain actions (compulsions).

Symptoms of OCD typically begin during childhood, the teenage years, or young adulthood and may include:

• Doubts about doing something right, like turning off the stove or locking a door. (Obsession)
• Thoughts about harming or having harmed someone. (Obsession)
• Counting and recounting money because a person can’t be sure they added correctly. (Compulsion)
• Repeatedly checking to see if a door is locked or the stove is off. (Compulsion)

An estimated 1.2% of U.S. adults experience OCD each year, according to the National Alliance on Mental Illness.

Watch for These Signs

While OCD may increase the risk for orthorexia, not all individuals with orthorexia have OCD. Signs that someone may have orthorexia include:

• Worrying or having anxiety about food quality.
• Avoiding eating out or eating food prepared by others because it may not meet dietary rules.
• Spending excessive time researching foods and planning meals.
• Refusing to eat a broad range of healthy foods because they question their nutritional value or purity.
• Fear of losing control; that eating even one meal that does not meet their standards would be disastrous.
• Being overly critical of others’ food choices.
• Shifting between self-satisfaction and guilt as they continue adjusting dietary restrictions.
• Showing physical signs of malnutrition due to limited food choices.

Treatment is Available

If you are concerned that you or a loved one may have orthorexia, talk with your doctor and seek treatment.

Treatment for orthorexia typically involves the same processes as treating other eating disorders. At the Princeton Center for Eating Disorders, treatment includes individual and group therapy, as well as nutrition counseling and medical treatment for any related health problems the individual may be experiencing.

Care is provided by a multidisciplinary treatment team that includes:

• Board certified psychiatrists
• Registered nurses and mental health associates
• Licensed psychotherapists, including psychologists, social workers, and professional counselors
• Registered dietitians/nutrition therapists
• Consulting physicians who are board certified in their specialty areas
• Admissions and utilization review professionals
• Certified teachers that provide tutoring support
• Specialist providers, as needed

Early detection of any eating disorder, including orthorexia, is critical. Recognizing the symptoms of and seeking treatment for orthorexia are the first steps toward a full recovery.

For more information about the Princeton Center for Eating Disorders, call 609-853-7575 or visit

Najeeb Riaz, MD, is the medical director of the Princeton Center for Eating Disorders at Penn Medicine Princeton Medical Center.