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What is orthorexia?

Hadyn Luke posted this on Tuesday 4th of March 2014 Hadyn Luke 04/03/2014

Tags: Special populations


Personal trainers and fitness instructors may occasionally work with people with specific disorders relating to diet and exercise. This blog is about one such disorder that has only been recognised and named in recent years: orthorexia nervosa.

Eating disorders

Most people will have heard of eating disorders such as anorexia nervosa and bulimia. Personal trainers will also encounter people in the gym who take exercising to extremes, for example, carrying out weight training every day without giving their body time to recover (see our blog on Resistance Exercise: How to avoid overtraining).

Unlike anorexics and bulimics, orthorexics are not concerned so much with the amount they eat, but with the quality of the food they consume.

What does orthorexia mean?

Orthorexia is an obsession with eating healthily.

The name comes from the Greek word “orthós”, which means correct, and “orexsis”, which means hunger. Orthorexia is often described as “righteous eating”.

Where did the idea of orthorexia come from?

The term was coined by Dr Stephen Bratman in 1997, who himself became obsessed with healthy eating and finally realised the detrimental effect this was having on his life. He wrote a book: Orthorexia Nervosa: Health Food Junkies Overcoming the Obsession With Healthy Eating, and also developed a test to help people self-diagnose.

Although Bratman contends the condition is widespread in his native Amercia, there is as yet no scientific evidence for this.

What are the symptoms of orthorexia?

Although a personal trainer may well have clients who like to discuss diet and talk about their desire to eat healthily, the orthorexic takes this to an extreme. They will be obsessed with reading about diet and health issues, and will cut out foods that get a bad press.

In the most severe cases, a person with orthorexia will go without eating altogether rather than eat foods that they consider “bad” for them. This is not the same as someone who has a general interest in eating healthily or following a particular diet such as veganism for health reasons or because they don’t want to see animals harmed (see our blog on Pescetarianism and Veganism).

The sort of foods they tend to cut out are sugar and salt, wheat, gluten and dairy, as well as caffeine and alcohol. Like those who are detoxing (see our blog on The Detox Diet – does it work?), they will cut out whole food groups, but on a long-term basis. They believe their choice of diet is best, even if it’s extreme and often simply based on reading media reports about food without investigating in more depth.

The irony of orthorexia is that in the search for an ultra-healthy diet, the subject will restrict their food intake to such an extent that their health suffers.

How is orthorexia diagnosed?

At present there is no universal agreement on classifying what comprises orthorexia and very little scientific study. This means that diagnosing orthorexia in a subject is not done by following set criteria.

Fitness professionals with concerns about a client should look out for warning signs such as whether they obsess over news stories about food scares, talk about completely cutting out certain essential food groups or seem to be using food as a way of feeling in control.

Subjects can also find that their obsession has a knock-on effect on other areas of their life, from damaging their relationships to preventing them from carrying out hobbies and pastimes that they previously enjoyed.

Who is likely to suffer from orthorexia?

A 2009 news story in The Guardian newspaper quoted Ursula Philpot, Chair of the British Dietetic Association's mental health group, as saying: “Those most susceptible are middle-class, well-educated people who read about food scares in the papers, research them on the internet, and have the time and money to source what they believe to be purer alternatives.”

However, a 2004 Italian study*: ‘Orthorexia nervosa: A preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon’, by Donini, Marsili, Graziani, Imbriale ad Cannella, found that the orthorexic subjects in its study group (28 people out of 404 subjects) actually had a lower level of education than the rest of the group.

It also found that subjects had a “strong or uncontrollable desire to eat when feeling nervous, excited, happy or guilty”. The prevalence of orthorexia was found to be higher in men than women, which is important for a fitness professional to note as eating disorders are generally considered more common among women.

When might a personal trainer work with someone with orthorexia?

Any fitness instructor might already count people with orthorexia among their clients – whether they realise it or not. This is why it’s helpful for personal trainers to have at least a basic understanding of what the condition is. Equally, a personal trainer may be referred a client who has been diagnosed with orthorexia, in which case, they will need to take this into consideration when they are devising work outs and routines for this particular client.

*Study reported in Eating Weight Disorders (Vol 9/No 2 , 2004)

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