Is there such a thing as eating too healthfully?

Orthorexia can be bit of a tricky topic: while it isn’t formally included as its own eating disorder in the Diagnostic and Statistical Manual (DSM-5), there’s growing concern about the physical and psychological impact of striving to eat “properly” in overly “healthy” patterns. At the same time, it seems counterintuitive to be concerned about eating too healthfully.

When is this a problem, and what should you do if you have concerns that this might be an issue for you or someone in your life?

Orthorexia is a pathological obsession or compulsion to eat healthfully or purely. Anorexia nervosa, as included in the DSM-5, includes the hallmark drive for weight loss and thinness. With orthorexia, the goal isn’t necessarily weight loss but a drive to consume foods considered pure, natural, or virtuous—distress is typically experienced around foods perceived as unhealthy. It’s also separate from appropriate or constructive efforts at supporting bodily function, because orthorexia results in a negative impact on functioning or health

Although there isn’t an official screening tool or standardized diagnostic criteria to assess (yet this is a work in progress

[2]), asking the questions below might highlight if or how orthorexic tendencies might be problematic. It can be helpful to take a look at this from both the mental health and physical health points of view.

1) If my eating choices are driven by a desire to support my body’s health, am I actually meeting my body’s needs?

To support our physical health, meals and snacks need to meet the basic principles of adequacy, balance, and variety. We need to get enough fuel (energy and hydration) to support metabolic functions, include all the major food groups (including carbohydrates, fats, and proteins) and be exposed to a wide variety of foods to engage our senses and provide an array of micronutrients.

It’s certainly possible that pursuing an aggressive eating pattern means we’re not getting all the nutrition our body needs in one form or another. If our choices are rigid, omit entire food groups, or get progressively more and more limited, malnutrition could be a problem.

2) Are you no longer eating foods you once enjoyed?

Often, choosing nutritious foods to help support physical function and overall health means adding foods to ensure adequate intake of healthful foods. “Pathological nutrition” (as eating disorders dietitian and orthorexia expert Jessica Setnick calls it) often results in reductions or limitations around intake. Preference for eating only healthy foods can be a socially acceptable way of restricting our intake.

Is there a sense of fear and anxiety around foods that once brought enjoyment and pleasure? Do you notice your food choices becoming narrower and narrower?

3) Do my eating patterns and choices impact my functioning and engagement in life?

Here are some of the ways that orthorexia can have a negative impact on your daily life, outlook, and mental health:

• Obsessive thoughts: frequent and intrusive thought patterns about what you’re allowed or not allowed to eat, what you’ve eaten in the past, or what you will eat in the future. These thoughts can occupy a large chunk of the day, distract from other activities, or be a frequent and repetitive focus of attention.

• Feeling isolated or socially limited: Do rigid eating patterns or limited permission to eat a variety of foods prevent you from hanging out with friends, socializing with coworkers, or joining family at meals or events? Are your eating patterns helping you plug in to your social life, or are they barriers? Are you only able to socialize with those whose eating patterns look like yours?

• Attaching moral value or self-worth to what are perceived as virtuous choices: Do you see yourself as a better person for the choices you make around food? Are you harsh on yourself when your meals and snacks don’t live up to your own standards? Is this an ever-moving target you never reach? Feeling a sense of accomplishment with nourishing and taking care of our bodies can be appropriate, but if this feels like a significant or inflexible part of your identity or how you judge your self worth, it can be a sign that it’s orthorexia.

• Harsh judgment of yourself or others’ food choices: Are you unable to eat at restaurants based on what else is on the menu? Is your social circle limited because of what others are eating? It might feel uncomfortable to recognize there’s an element of judgment in our assessment of others’ choices. What impact is this having on our lives?

4) What’s the deeper reason behind my food choices?

See if you can identify what is driving your quest to eat healthfully. Have you experienced a health event in your family that brought health and eating patterns to the forefront of your attention? Experiencing a loss or having a health scare often prompts us to evaluate our own health risks or those of other people in our lives; If this feels panicky or obsessive, though, that can be a red flag.

Does making specific food choices give you a sense of control or safety? Are you choosing foods based solely on the fact that they feel safe and won’t cause you anxiety?

If it feels like you’re experiencing any of the above symptoms, or answered yes to any of the questions, know that it is absolutely worth it to get help. As always, we’re here for support.


1. Setnick, Jessica. The Eating Disorders Clinical Pocket Guide, 2nd Edition. 2016 Academy of Nutrition and Dietetics.
2. Dunn TM, Bratman S. On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eating Behaviors. 2016: 21(11-17).



Meg Salvia, MS, RDN, CDE is the dietitian at Walden Behavioral Care’s Peabody clinic. She sees adolescents and adults in the partial hospitalization program as well as in the binge-eating intensive outpatient program. She is also a board-certified diabetes educator (CDE). She began her career working in research at Joslin Diabetes Center and joined Walden Behavioral Care’s team in 2013. Meg earned a Master’s degree in nutrition from Boston University and a BA in English from Boston College.