In pursuit of better health, one of the first things we’re likely to do is to identify strategies for healthier eating. While we may or may not be working toward weight loss, we look for ways to incorporate more whole, less processed foods like fruits, vegetables, whole grains, and healthy fats. Along the way we may begin considering where these foods are coming from and whether or not they’re sustainable. We might be interested in pursuing foods that are local and seasonal. We may educate ourselves on the benefits of eating organic in an effort to eliminate pesticides and GMOs. We might experiment with different cooking methods to maintain or enhance the nutrient profiles of our food. And we might choose to eat certain foods more often, and others less often. All of these actions have merit and can contribute to really positive health outcomes. But is there such a thing as taking a good thing too far?


As with most things, too much of a good thing has the potential to become toxic—even when you might be looking to remove the ‘toxic’ from your life. For a moment, imagine being so concerned with whether or not there are traces of pesticides in your food that you become inordinately suspicious of even the foods you’ve come to trust—because you can’t be sure of their purity. Consider what it would be like if you became so concerned with keeping your meals pure or healthy, that you spend hours a day obsessing over meal planning. Visualize staying home from social gatherings, eating out, and weddings because you don’t trust any of the food that’s provided… moreover, you can’t stomach the thought of watching other people eat them.

Silly? Sounds like some crazy extreme that’s caused by spending too much time on social media? Perhaps something that happens to ‘other’ people? Or maybe it doesn’t sound all that silly at all. Maybe you haven’t taken it to a place where you’ve crossed any lines—but you’ve been in the ballpark. And if that’s the case? You wouldn’t be alone.

At Starkel Nutrition, we believe in holistic health. This means we have to take into consideration the multifaceted nature of health. Enjoyment and flexibility in eating, stress, as well as relationships—these are all a part of the puzzle. When we take healthy eating too far, these aspects of health are compromised.

In 1994, Steven Bratman, MD, MPH coined the term, ‘orthorexia’ to describe the extreme behaviors he was seeing among some of the patients in his practice. It combines use of the Greek ‘orthos’ (‘right’ or ‘correct’) with ‘rexia,’ in an attempt to draw a parallel between the disordered eating of anorexia nervosa and what he was seeing with people taking healthy eating to the extreme.[1] His patient’s commitment to eating ‘healthy’ seemed to be taking over their lives. He introduced the term in conversation in an effort to illustrate, in a gentle and semi-humorous way, the behaviors he was noticing that were no longer serving them. They were demonstrating some of the characteristics of a full-blown eating disorder, like anorexia nervosa. However instead of a collection of behaviors adopted with the intent of becoming thinner, orthorexia nervosa describes behaviors, taken to the extreme, picked up in order to be healthier.

Currently, orthorexia nervosa is not listed in the DSM5, a diagnostic manual used by the American Psychiatric Association, as a recognized eating disorder—although this may be up for future consideration. In 2011, however, 2/3 of a cohort of health professionals and social workers reported signs and symptoms of orthorexia that they deemed to have ‘clinical significance.’ At this point those that had observed the behavior agreed that it deserved further research and consideration.[2] Over time, anecdotal evidence of orthorexia has continued to build.

In October of 2016, 22 years after originally giving a name to what he’d noticed in some of his patients, Dr. Bratman made available an updated self-test that might help you to determine if you could be on the road to orthorexia. Please note that orthorexia does not look exactly the same for each person. Take a look at these 6 questions:[3]

  1. I spend so much of my life thinking about, choosing and preparing healthy food that it interferes with other dimensions of my life, such as love, creativity, family, friendship, work, and school.
  2. When I eat any food I regard to be unhealthy, I feel anxious, guilty, impure, unclean and/or defiled; even to be near such foods disturbs me, and I feel judgmental of others who eat such foods.
  3. My personal sense of peace, happiness, joy, safety, and self-esteem is excessively dependent on the purity and rightness of what I eat.
  4. Sometimes I would like to relax my self-imposed ‘good food’ rules for a special occasion, such as a wedding or a meal with family or friends, but I find that I cannot. (Note: this does not apply if you have a medical condition that makes ANY exceptions to your diet unsafe)
  5. Over time, I have steadily eliminated more foods and expanded my list of food rules in an attempt to maintain or enhance health benefits; sometimes I may take an existing food theory and add to it with beliefs of my own.
  6. Following my theory of healthy eating has caused me to lose more weight than most people would say is good for me, or has caused other signs of malnutrition such as hair loss, loss of menstruation, or skin problems.

If you are at all concerned because some or all of these resonate—for you or someone you are close to—it might be time to consider getting more information and/or some help. While there is not an official diagnosis for orthorexia, behaviors that have transitioned to the extreme might require assistance from a professional trained to treat disordered eating. To read more, please visit the National Eating Disorders Website,, or call to schedule an appointment with Grace Lautman, our Certified Nutritionist who specializes in disordered eating. Getting back on track involves finding ways to put eating behaviors and practices back into balance in terms of how they fit into the overall picture of health—which includes many other factors such as relationships, physical activity, hobbies, work, self-care, etc. Having someone on the outside to help provide knowledge and perspective can make all the difference.


Written by Samantha, Student Intern

Edited by Grace Lautman, CN, LMHCA


  1. Bratman, Dr. Steven. “What Is Orthorexia? | Orthorexia”. N.p., 2017. Web. 6 Feb. 2017.
  2. Koven, Nancy and Alexandra Abry. “The Clinical Basis Of Orthorexia Nervosa: Emerging Perspectives”. Neuropsychiatric Disease and Treatment (2015): 385. Web.
  3. Bratman, Dr. Steven. “Orthorexia”. N.p., 2016. Web. 6 Feb. 2017.