How the perfect meal can make you ill

What is orthorexia?

Orthorexia is an eating disorder in which the quality of food is the main focus. Those affected develop a compulsive fixation on „healthy“ foods and avoid anything considered unhealthy. This obsession goes far beyond a normal interest in good nutrition. People often spend a lot of time studying nutritional information, checking vitamin contents and searching for „better“ foods, sometimes even buying products from distant regions.

The motivation to eat healthier increasingly becomes an obsession, leading to more and more foods being classified as unsuitable. In extreme cases, people may subsist only on fruit and vegetables, often sourced from organic shops or specialised online stores.

What are typical signs of orthorexia?

Orthorexia manifests as an extremely strict and compulsive eating pattern. People with orthorexia develop personal dietary rules that they follow rigidly. Even small deviations, such as eating an item deemed „unhealthy“, can cause strong feelings of guilt and failure. Over time these rules become ever more restrictive, so that fewer and fewer foods are considered „acceptable“. Some sufferers not only avoid sugar but cut out entire food groups like carbohydrates or eat exclusively raw foods.

Another common feature is an intense preoccupation with the quality of food. Many spend hours analysing nutritional values, vitamin contents and selecting „healthy“ foods. Foods are strictly categorised and often judged by subjective criteria. The method of preparation and specific eating habits, such as avoiding meals after 6 pm, are also frequently part of the behaviour.

Orthorexics often regard their diet as the only correct one and try to convince others. The enjoyment of food increasingly takes a back seat while control over eating becomes more important. Social contacts can suffer as invitations to eat are declined for fear that the offered food will not meet strict personal standards.

What are the consequences of orthorexia?

People suffering from orthorexia obsessively focus on an extremely „healthy“ diet and severely restrict their food choices. This large restriction can lead to significant malnutrition, as essential nutrients such as protein, calcium, iron, vitamin B12 and vitamins A, D, E and K may be missing. Besides the physical consequences, many also show signs of psychological distress such as anxiety disorders, emotional instability and exhaustion.

Eating behaviour progressively loses its enjoyable character and becomes an obligation. Meals must be carefully planned and prepared, and the list of forbidden foods grows. The compulsion to control leads to ritualised eating patterns that provide no pleasure anymore. Instead, food becomes a source of guilt and failure, particularly when „unhealthy“ items are consumed. In some cases orthorexia can also serve as a coping mechanism to stabilise self‑esteem, with sufferers feeling „better“ than others.

A strong drive for perfection and a compulsive attitude towards food characterise those affected. They often struggle to recognise their own weaknesses or tiredness and ignore physical warning signs. These tendencies to deny problems and the constant control over food can lead to social isolation, as many avoid eating outside the home and withdraw increasingly from social activities.

In particularly extreme cases orthorexia can cause malnutrition that weakens the immune system and increases the risk of infections. With a very restricted diet, dramatic weight loss can even occur. If the fixation persists, there is also a risk that orthorexia may develop into a more serious eating disorder such as anorexia nervosa, where fasting becomes more frequent or trust in one's own eating behaviour is lost entirely.

Is orthorexia a recognised illness?

Orthorexia is still not officially recognised as an eating disorder by the professional community. The term does not appear in standard reference works and many experts do not view it as an independent illness. The exact number of people who develop pathological eating habits is not yet clearly established.

In the international classification of diseases ICD‑10, orthorexia is not listed as a separate disorder. It could, however, be classified under “eating disorders not otherwise specified”. Likewise, in the alternative classification system DSM‑5 it is not listed as an independent illness but falls under the category “feeding or eating disorders characterized by avoidance or restriction of food intake”.

An important criterion for distinguishing orthorexia as pathological behaviour is the level of suffering experienced by the person. As long as the behaviour does not cause significant limitations in daily life and does not give rise to severely distressing fears, it can be seen as part of a healthy lifestyle. However, if there is a marked impairment in quality of life, severe restrictions or intense anxiety, the behaviour is assessed as problematic and pathological. A precise diagnosis and differentiation can only be made through psychological assessment, which forms the basis for developing an appropriate treatment plan.

How does a doctor diagnose orthorexia?

Diagnosing orthorexia is particularly difficult because it is not recognised as an official eating disorder. Physicians and therapists use a variety of methods to identify the disorder. It begins with a thorough medical history to determine whether the person's eating habits stem from a genuine health interest or are motivated by compulsion, anxiety and the need for purity or avoidance of contamination.

This is followed by a behavioural analysis that examines the extent of preoccupation with food. Critical indicators include excessive meal planning, searching for specific foods or preparing dishes according to very particular rules. Avoiding entire food groups and the impact on daily life are also analysed. Another important step is the emotional assessment, which looks at how much the individual's self‑esteem depends on following the diet and whether guilt or anxiety occur when rules are broken. It is also examined whether the diet serves as a coping mechanism for other emotional problems.

The social and functional impacts of the diet are also assessed, especially whether there is social isolation, conflicts with others or reduced performance at work or school. Physical health problems such as signs of nutrient deficiencies or other physical limitations are also investigated, for example through blood tests or bone density measurements. In some cases collaboration with nutritionists or dietitians is sought to distinguish between a healthy diet and a potentially harmful eating pattern.

How to overcome orthorexia: practical tips

• Stop dividing foods into „good“ and „bad“. Accept that all foods can be part of a healthy diet when consumed in moderation.
• Occasionally include foods you normally avoid, e.g. fast food or sweets. This helps loosen the compulsion for „healthy“ eating.
• Take time to prepare and enjoy meals without aiming for perfection. Enjoyment should come first, not the choice of „perfect“ ingredients.
• Keep a food diary to reflect on your eating habits and recognise the influence of orthorexia on your thought patterns.
• Practice mindful eating by taking meals slowly and without distractions. Pay attention to taste and satiety.
• Schedule regular breaks from focusing on food, during which you engage in other activities.
• Accept that not every meal has to be perfect. Deviations are normal and part of a healthy, balanced diet.
• Use special occasions or travel to intentionally enjoy „unhealthy“ foods without worrying about your diet.
• Seek professional help if you have difficulty changing your eating habits. A therapist or nutritionist can help you make balanced decisions. It is advisable to work with a professional on a meal plan to prevent deficiencies, understand the condition and reduce feelings associated with anorexia.

Orthorexia is an excessive obsession with healthy eating that can lead to health and social problems. A balanced diet is therefore of great importance.