Orthorexia–Dieting Gone Awry

By Sandra Meyerowitz, M.P.H., R.D., L.D.

You’ve heard of anorexia and bulimia, but now there is another term that has surfaced in the world of disordered eating. It is called orthorexia nervosa (“orthorexia”).  In 1997, Steven Bratman, MD coined the term as he identified many of his patients with an obsession to eat healthily. His patients were not trying a new diet or experimenting with health foods, rather they were creating a long-term eating pattern that was life controlling. Orthorexia is not an official eating disorder listed in the Diagnostic and Statistical Manual of Mental Disorders, but it is a condition that needs to be addressed.

Unlike anorexia and bulimia where people try to control the quantity of food consumed, orthorexia revolves around the quality of food ingested. An orthorexic is very strict with food choices and decides if an item is good before eating it. For some, it is a fear or hatred of cooked food and only raw organic foods grown locally will suffice. For others, it is the total obsession with a type of diet that promotes a pathological fixation on food and often a feeling of being virtuous. Social isolation is not uncommon among orthorexics due to the need to eat highly specific foods and because the camaraderie that usually surrounds meals loses its value.

Orthorexia starts with good intentions. For example, an orthorexic may begin changing their eating behaviors to control a medical condition like asthma or a food allergy. Instead of creating a healthy balanced diet, the person begins to eliminate foods and food groups. This  leaves only a handful of options on which to live. Unfortunately, orthorexics do this for an extended period of time. In the end, this behavior promotes stress rather than nourishment.

Orthorexia may seem like an uncommon problem, but it is appearing more often nationally and locally. Laura Spalding, owner of Yoga East, says that she sees more people with obsessive eating behaviors now than in the past. Despite efforts to promote a balanced diet, she finds people take dieting to extreme limits.

Generally, changing eating habits for most people is a step in the right direction. It is when people get carried away with the idea that a good diet can only be better with stricter limitations that trouble ensues.

To see if you may a have a mild case of orthorexia take Dr. Bratman’s 10

Question survey*:

1) Are you spending more than three hours a day thinking about healthy food?

2) Are you planning tomorrow’s menu today?

3) Is the virtue you feel about what you eat more important than the pleasures you

receive from eating it?

4) Has the quality of your life decreased as the quality of your diet increased?

5) Have you become stricter with yourself?

6) Does your self-esteem get a boost from eating healthy? Do you look down on people who don’t eat this way?

7) Do you skip foods you once enjoyed in order to eat the “right” foods?

8) Does your diet make it difficult for you to eat anywhere but at home, distancing you from friends and family?

9) Do you feel guilt or self-loathing when you stray from your diet?

10) When you eat the way you’re supposed to, do you feel in total control?

If you answered yes to two or three questions, you may have a mild case of orthorexia. Four or more means that you may indeed be orthorexic and could benefit from a more balanced approach to eating.

Dr. Bratman identifies this new disorder with the intent of bringing people back to middle ground. He emphasizes finding a balance, including spontaneity in your eating habits and remembering that there is more to life than food. His book Health Food Junkies: Orthorexia: Overcoming the Obsession with Healthful Eating  was published in 2001.

More often than not, people eat poorly and don’t care enough to change their ways. It is much more unusual to meet an individual who tries to eat healthy to the point of becoming unhealthy. The nutritional guidelines of eating a variety of foods in moderation still hold true. If you feel that you have fallen into an unhealthy pattern of eating, than seek help from a registered dietitian who will be able to help steer you to a sensible diet.

* Reprinted with permission from Steven Bratman, MD.


  1. Bratman S. Health Food Junkies: Orthorexia: Overcoming the Obsession with Healthful Eating. New York, N.Y.: Broadway Books; 2001
  2. Stuppy P. Orthorexia: Too Much of a Good Thing. Today’s Dietitian. April, 2002.

Image from: www.kosamablog.com/2010/09/what-does-a-balanced-diet-plate-look-like/




Sandra Meyerowitz, M.P.H., R.D., L.D. is the owner of Nutrition Works, a health promotion company specializing in weight loss and eating for wellness. She can be reached via e-mail: sandram@thelouisvilleoffice.com or (502) 339-9202.

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