10 signs your healthy eating may have gone too far


29 year old Marcia could honestly say that her one passion in life was health and fitness. Each and every day, she would rise at 4:45am to put herself through a gruelling gym session, an exercise regime that she found help her keep her weight at a lean 57kg. When her demanding job finished each day, Marcia would also try to run the 5km to her home. Marcia closely followed a ‘clean eating’, paleo diet which featured seeds, nuts, salads, white fish and almond milk and preferred to prepare all of her meals. Although Marcia had not had her period in 2 years, her main health problem was recurrent stress fractures in her lower spine and ankle, which were impacting her ability to train and keep her weight at 57kg.

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While this description may sound extreme, and very much like an eating disorder, such restrictive eating practices are yet to be formally recognised in psychological literature. In this example, Marcia’s Body Mass Index (BMI) remains in the normal range, and while she is experiencing some side effects after following such a rigid diet and exercise regime; she does not have a full blown eating disorder. So when does healthy eating go too far?

Orthorexia was first described by an American doctor in the late 1990’s, who was seeing an increasing number of female patients in practice who were presenting with a number of eating disorder related symptoms including eating only an extremely limited variety of foods and maintaining an extremely low body weight without satisfying the criteria for a clinical eating disorder. These girls were obsessed with only consuming foods that were ‘pure’ and ‘healthy’, and as a result tended to consume only extremely low kilojoule, unprocessed foods, which in turn kept their body weight extremely low. Unlike sufferers of a clinical eating disorder, these girls were not malnourished, as their diets were packed full of nutritious food choices, but their weight was low, they looked exceptionally thin and low mood was common.

From a clinician’s perspective, such a scenario presents a challenging situation. In this example, Marcia has a low body weight for her height but is not clinically underweight, and while her eating patterns are rigid and obsessive, they are not clinically disordered. Blood biochemistry can be checked for signs of physiological distress but in most cases, return within normal ranges as food or supplement intake, although minimal keeps the girls within normal biochemical ranges.

There is nothing wrong with healthy eating – whether your definition of ‘healthy’ includes eating low sugar, low fructose, vegan or ‘clean’ eating but when diet and exercise habits negatively impact other areas of life, whether it be relationships, mood or being able to maintain a life outside of the lifestyle choice, when obsessively healthy eating becomes an issue. In these instances, such dietary restriction is only a hop, skip and jump away from a clinical eating disorder and proactive steps do need to be taken to create balance from a nutrient, exercise and general life perspective.

The first step individuals can take to help normalise extreme eating habits is to ensure that their nutrient intake is adequate. Essential nutrients including iron, zinc, calcium and Vitamin B12 all tend to suffer when food intake is limited and can easily be checked via blood test with your GP. Limiting excessive exercise is also crucial – an hour a day is more than enough exercise for the average person. Ideally exercise should also be done with another person so that exercise becomes a social outlet rather than a sole obsession.

Next, if the restrictive eating and exercise behaviours have been present for some time, exploring the underlying emotional triggers such as stressors at home or at work that may be directly or indirectly related to the depressed mood and rigid eating patterns is an important part of the process. There are a number of simple techniques including diarising emotional feelings and thoughts to help identify stressors and anxiety triggers that may be being currently managed via obsessive food and exercise habits. For some individuals, this level of reflection may require professional help from a skilled counselor who specialises in food and eating issues to help work through the underlying issues.

Unfortunately as the concepts of pure, idealistic and unsustainable models of healthy eating continue to be preached by those who are not qualified to do so, the incidence of conditions such as orthorexia is likely to increase. The key for us as a society to be more aware of these risks, be mindful of the warning signs in those closest to us, and provide the necessary support early on to help prevent those at risk from damaging their bodies, simply because of an unhealthy obsession with all things healthy.

10 signs your healthy eating may have gone too far

  1. 1. You skip social occasions for fear of having to eat food you have not prepared.
  2. 2. Your skin is dull and your hair is falling out.
  3. 3. You have lost your period.
  4. 4. You feel constantly tired.
  5. 5. You have been experiencing recurrent injuries.
  6. 6. You will only eat a very limited range of foods.
  7. 7. You never eat cake or enjoy a drink.
  8. 8. You are exercising for more than 2hr a day.
  9. 9. People are constantly commenting that you look too thin.
  10. 10. You are still not happy with your body no matter what you eat or how much you exercise.

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  • Emmaly says:

    Wow very interesting read and an eye opener to say the least. This actually describes me exactly. I am unsure whether i want to change it though.

  • Deborah says:

    I had orthorexia in my late 20s and early 30s, and unfortunately as well as being underweight and obsessed about food, I was also a vegan who didn’t know how essential B12 is, so I developed a B12 deficiency that affected my central nervous system, causing insomnia and short-term-memory loss. I didn’t menstruate for two years. I was very aerobically fit, but not strong, because I wasn’t eating enough protein or fat or carbohydrate, so I was tired all the time. It was the memory loss that helped me realise I had a problem – my boss said my memory was deteriorating, then the B12 deficiency was picked up, then I really struggled to eat food rich in B12, eventually went to a dietician who specialised in eating disorders (think I was an overeater) and was shown a chart of what a healthy adult eats in a day – it was what I ate in two or three days.
    I was incredibly relieved to have the diagnosis (she called it an “atypical anorexia nervosa” rather than orthorexia, but it was orthorexia – I had so many rules about what were the right and wrong things to eat, and when, and how), and was able to put on some weight and expand my range of foods. it took several years to recover my physical and mental health, and I still slip back into “defensive eating” when I’m overstressed.
    I stayed fit, but increased my weight, strength and stamina, because I was eating enough, and doing enjoyable exercise (lots of walking in parklands).
    it suprises me that orthorexia is not considered a clinically diagnosed eating disorder – it is disordered eating! and people can become quite malnourished while doing it. not in danger of dying from it, as with anorexia nervosa, but really not well, mentally or physically.

  • Jamin says:

    This seems a lot like trying to create a disorder where none exists. If you replaced every instance of exercise with children (getting up early to make healthy food for them, coming home after a hard day’s work and spending two hours playing with them regardless of how you feel, even getting injured in the process) then it wouldn’t be considered “obsessive” and would be praised as somebody fighting to get a quality balance in life.

    Getting sick because you are on a fad diet isn’t a disorder, it is just a passion for healthy living without a passion for peer reviewed research.

  • Chantell says:

    I would have to check again but does the DSM-V not make provisions for orthorexia under the OSFED or UFED diagnostic criteria?

  • anabel says:

    What stands out for me is what appears to be a total lack of fat in her diet apart from some nuts. Nothing wrong with eating clean but I think some people have taken that definition to the extreme while pushing their bodies beyond what is reasonable. I had spent years on PT and eating really lean and have figured out I can maintain my weight by regular walks and some weights for strength and just eat a natural diet. ie grass fed full fat dairy & meat, eggs, fish, loads of veggies and salad, nuts, seeds. No longer struggling with cravings, easy to eat out, loads of recipes that actually taste good. Blood work has improved and I feel great. Not going to freak out over the odd piece of bread or dessert when I’m out for dinner but I have to say eliminating carbs/sugar from the staples part of my diet has been life changing. Each to their own though!

  • Crazy. Although I think the comment above about replacing with children is a bit naive / judgemental. Anything that results in a deterioration of health to that degree is certainly an issue.
    Messages about positive body image are still not getting across.

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