For years, public health campaigns have urged people to eat more vegetables, avoid ultra-processed food and cut back on sugar. But therapists across the United States say a growing number of patients are taking that advice to an extreme, developing an obsessive preoccupation with “clean” or “pure” eating that is disrupting their lives. The pattern has a name: orthorexia.

Image Illustration. Photo by Bakd&Raw by Karolin Baitinger on Unsplash

The term was coined in 1997 by physician Steven Bratman to describe a fixation on healthy eating that becomes so rigid and anxiety‑provoking it undermines a person’s physical and mental health. Bratman’s early description of orthorexia as an "obsession with proper nutrition" has since been echoed by major eating-disorder organizations and a growing body of research.

What Is Orthorexia?

Unlike anorexia nervosa or bulimia, which are defined in part by a drive for thinness, orthorexia centers on a drive for health and purity. People who struggle with it may cut out entire food groups they view as “toxic” or “unclean” — such as carbohydrates, sugar or gluten — even in the absence of medical allergies or intolerances.

The National Eating Disorders Association describes orthorexia as an “obsession with proper or ‘healthful’ eating” that can lead to malnutrition and impairment in daily functioning when rigid rules crowd out flexibility and balance. NEDA notes that the condition is not yet a formal diagnosis in the DSM-5 but is increasingly recognized by clinicians.

A Disorder Without an Official Diagnosis

Orthorexia is not currently listed as a distinct eating disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM‑5), the handbook used by psychiatrists and psychologists to classify mental health conditions. The National Eating Disorders Association stresses that the absence of a DSM category makes it difficult to know exactly how many people are affected or whether orthorexia represents a stand‑alone disorder, a variant of anorexia, or a form of obsessive‑compulsive disorder.

That diagnostic gray zone has not stopped therapists from seeing the pattern in their offices. In a recent report on AOL, clinicians describe a sharp increase in clients whose eating habits began as attempts to improve health but escalated into punishing dietary regimes that dominate their thoughts and social lives. The article, citing New York–based psychotherapists who specialize in eating disorders, notes that people with orthorexia may initially be praised for their “disciplined” diets even as they slide into nutritional deficiencies and isolation.

How Common Is Orthorexia?

Because there is no standardized diagnostic test, estimates of orthorexia’s prevalence vary widely. A 2016 U.S. college study found that while a commonly used screening questionnaire suggested that more than 70 percent of students had orthorexic tendencies, only about 20 percent reported cutting out an entire category of food — a sign that the tool may dramatically overestimate the problem. The authors concluded that the true prevalence in their sample was likely below 1 percent.

Other research points to especially high rates in certain groups. A 2023 systematic review in the Journal of Eating Disorders reported that more than half — an estimated 55.3 percent of people in exercising populations screened positive for orthorexia tendencies, though the authors noted significant variation among studies and potential overestimation due to inconsistent tools.

Similar patterns have appeared in professional and academic circles focused on nutrition. A pilot study of nutrition students and practicing nutritionists in Jordan found that up to 72 percent met a commonly used threshold for orthorexic behavior on one screening scale, although the rate dropped to about 32 percent when stricter cut‑offs were used.

Social Media, Diet Culture and a Perfect-Storm for Obsession

Therapists say the cultural backdrop matters. In a landscape saturated with wellness influencers, detoxes and “what I eat in a day” videos, it can be hard to distinguish between health‑conscious habits and disordered patterns. A 2023 study in the journal Nutrients linked higher orthorexia scores to exposure to social media content that moralizes food as either perfectly clean or dangerously toxic.

A recent analysis in the Washington Post underscored how extreme “clean eating” trends on platforms such as TikTok can push vulnerable people toward orthorexia. The article cited emerging research suggesting that roughly 6.9 percent of the general population may experience orthorexia‑like symptoms, compared with estimates as high as 35 to nearly 58 percent in high‑risk groups like healthcare professionals, athletes and artists. Experts caution, however, that the lack of agreed‑upon diagnostic criteria makes these numbers imprecise.

Warning Signs Therapists Are Watching For

Clinicians emphasize that healthy eating by itself is not a problem. The red flags emerge when food rules become rigid, all‑consuming and punitive. The National Eating Disorders Association lists early indicators such as compulsively checking ingredient labels, spending hours a day planning meals, and cutting out more and more food groups — carbohydrates, dairy, or all animal products — in the name of health. These behaviors may be accompanied by intense distress if “safe” foods are not available, or by moral judgments about one’s own and others’ eating.

The advocacy group ANAD (the National Association of Anorexia Nervosa and Associated Disorders) similarly highlights warning signs including significant weight loss or malnutrition resulting from eating only foods perceived as “clean,” a fixation on the “right” way to eat, and a shrinking range of acceptable foods that interferes with work, school or relationships. ANAD notes that these patterns can severely damage quality of life even when they are praised as dedication or discipline from the outside.

Health Consequences Beyond the Plate

Even when calorie intake is adequate, highly restrictive “clean” diets can fall short on key vitamins, minerals and macronutrients. NEDA warns that orthorexia can lead to malnutrition, hormonal disruptions and other medical complications when major food groups are eliminated over time without professional guidance. The organization notes that psychosocial functioning often suffers as well, as people withdraw from social events that involve food or experience intense shame and guilt when they break their self‑imposed rules.

In interviews with AOL, therapists describe patients whose fixation on avoiding “harmful” ingredients has left them socially isolated, anxious and exhausted. Some report spending much of the day researching food, traveling with their own meals to avoid “unsafe” options, or skipping meals altogether when they cannot control the menu. Such accounts mirror clinical descriptions of orthorexia’s impact on mental health, including heightened anxiety, obsessive–compulsive traits and perfectionism documented in recent reviews of the condition.

Treatment: From Obsession Back to Balance

Because orthorexia is not formally codified in diagnostic manuals, treatment typically draws on approaches used for other eating and anxiety disorders. Therapists commonly employ cognitive behavioral therapy (CBT) to help patients challenge black‑and‑white beliefs about food, gradually reintroduce feared items and rebuild flexibility around meals. Eating-disorder specialists say multidisciplinary care — combining mental‑health treatment with nutrition counseling — is often the most effective route, especially when medical complications are present.

Major advocacy organizations maintain helplines, screening tools and referral networks for people who suspect they or a loved one may be struggling. NEDA offers a confidential online screening questionnaire and a searchable database of in‑person and virtual treatment providers in the United States. The group’s helpline resources are designed to connect callers with support groups, clinicians and information on evidence‑based care options, including lower‑cost services for those without insurance or with high deductibles.

A Subtle Disorder in a Culture That Applauds Control

Orthorexia can be especially difficult to spot because it often masquerades as virtue. In a culture that celebrates self‑discipline and “clean living,” skipping birthday cake or packing separate food for every outing can look like admirable willpower rather than a warning sign that food and health have become sources of fear.

For therapists on the front lines, the message is less about demonizing wellness trends and more about reclaiming flexibility. Healthy eating, they argue, should support a full life — not shrink it. As research efforts ramp up and public awareness grows, clinicians hope that naming orthorexia will help more people recognize when their pursuit of health has quietly crossed the line into harm, and encourage them to seek help long before an “ideal” diet becomes a dangerous one.