What Is Orthorexia Nervosa ?

What Is Orthorexia?

It may be possible to take a healthy diet too far. A growing number of health and nutrition experts believe some people take the notion of eating well to risky extremes. There’s a name for it: “orthorexia nervosa,” or “orthorexia” for short.

It’s not an official diagnosis. But the basic idea is that it includes eating habits that reject a variety of foods for not being “pure” enough. Eventually, people with orthorexia begin to avoid whole meals that don’t meet their standards or that they don’t make themselves.

Some experts think there are similarities between the constant worry about food seen in orthorexia as in eating disorders like bulimia and anorexia nervosa. All are about food and control.

What ‘Orthorexia Nervosa’ Means

Steven Bratman, MD, MPH, a California physician, coined the term in 1996. It means “fixation on righteous eating.” Since then, many medical professionals have accepted the concept.

If you have orthorexia, you might:

  • Bury yourself in food research. It’s one thing to spend a few minutes scanning a product label or surfing the web for more information on ingredients. But with orthorexia you may spend hours thinking about food and planning meals.
  • Refuse to eat a broad range of foods. It’s normal to pass on some foods because you don’t like the way they taste or the way they make you feel. But with orthorexia you might decide to drop whole categories of foods from your diet — grains, for example, or any foods with preservatives, or all foods that just don’t seem “healthy,” or all of the above.
  • Fear losing control. You feel that you’re doing the right thing by eating healthy. But you may also be afraid that eating even one meal you didn’t prepare — including dinner at a restaurant — can be disastrous.
  • Be overly critical of your friends’ food choices. At the same time, you may have no rational explanation for your own.
  • Find yourself in a vicious circle. Your preoccupation with food causes you to bounce between self-love and guilt as you change and restrict your diet.

In extreme cases, you might cut out so many food choices that you become malnourished.

How to Get Help

As with bulimia and anorexia, your doctor or nutritionist may be able to help with orthorexia. Because of the emotional aspects of the condition, they may ask you to see a mental health professional.

The key is to recognize that your fixation on food may be bad for you. You’ll need to train yourself to think differently about it. If you do, you’ll be on your way to eating right for real.

Epidemiology of Orthorexia Nervosa


Orthorexia nervosa (ON) is a condition characterized by extreme dietary restrictions in the name of healthy eating. It involves rigid ritual surrounding the preparation and eating of food, with strict avoidance of all foods thought to be not ‘clean.’

It is paradoxical that while ON is brought on by a strong impulse to achieve good health through a clean diet, it may result in malnutrition, social and psychological isolation and disorders, and a lowered quality of life.

Diagnostic Tools

The diagnostic criteria and assessment tools for ON are still in the making. Those presently available include the following:

  • The Bratman and Knight 10-point scale
  • The ORTO-15 scale with 15 items
  • The ORTO-11 scale with 4 items cut down from the ORTO-15
  • The ORTO-11 Hu scale with 4 less items (different from the four removed in the ORTO-11)
  • The Eating Habits Questionnaire (EHQ) with 21 items

None of these have yet been fully validated, and so the reliability of these measures is yet to be established. The ON studies are therefore limited to estimates of prevalence, which may range from 7 percent to almost 58 percent, when applied to the general population. In specific populations, prevalence rates may be estimated to be as high as 82 percent, as among dieticians and healthcare specialists.

It is not yet clear whether ON is more prevalent in men or in women, but studies tend to show that women have a higher rate. Other studies do, however, show contradictory data, as well as disparities in risk factors such as:

  • Age
  • Level of education
  • Body mass index
  • Smoking and alcohol
  • Focus on nutrition and health for the sake of career or enjoyment – may breed a sense of pressure to be healthy in eating habits to maintain a proper image. For instance, healthcare professionals, artistes, or professional athletes, may have higher levels of knowledge about social conceptions of healthy eating, and also feel that they have to eat clean food, and thus fall into ON tendencies, strengthened by perfectionist thinking.
  • People who already have eating disorders have been found to have a higher risk of ON both at baseline, and, strangely, three years after treatment. It is postulated that patients recovering from eating disorders have a higher prevalence of ON correlated with improvement in their symptoms, or with changes towards a milder form of the original conditions.

It is also important to realize that individuals developing ON are a part of a society which lays undue importance on the personal effort to achieve a healthy body shape and size, as part of the individual’s moral obligation to society, and thus values those who obey these expectations by healthy behavior and eating habits.

These habits may later become detrimental to the person’s physical and mental health, but still remain fixed and strong out of a desire and conviction to adhere to social norms.

The unconscious reward envisaged is an acceptable social position and increased self-esteem, reaped by exerting immense self-discipline in the pursuit of individual healthy eating.


Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.

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