When “healthy” becomes an obsession:
exploring the line between healthy eating and orthorexia

Taking care of what we eat is important: choosing healthy options, reducing ultra-processed foods, and maintaining a balanced diet. But what happens when the desire to do the right thing with food becomes a mental trap filled with restrictions, fear, and guilt? This is where orthorexia comes into play: when healthy eating becomes an obsessive need, and crossing that line can lead to significant distress.

What is orthorexia?

The term “orthorexia nervosa” was introduced by Steven Bratman in 1997 to describe an obsession with eating “right,” where what’s “correct” is what’s considered healthy—until eating is no longer pleasurable and turns into an exercise of extreme control.
To this day, it is not recognized as an official diagnosis in the DSM‑5, but when the distress is clinically significant, it may fall under the category of Other Specified Feeding or Eating Disorder (OSFED).

According to a recent review by Dakanalis et al. (2023), orthorexia nervosa involves rigid beliefs about what one can or cannot eat, intense anxiety when breaking these self-imposed rules, and a real impact on daily life—socially, emotionally, and occupationally.
Orthorexia often begins with good intentions: taking care of oneself, being responsible, improving health. But it can evolve into an internal struggle: increasingly strict rules, distress when deviating from routine, and absolute rigidity.

How do I know if it’s orthorexia or just healthy eating?

It’s not about what you eat, but how you relate to food.
Healthy eating turns into orthorexia when food choices generate stress, when every item carries a moral label (“this is good, this is bad”), and when choosing what to eat becomes a rigid obligation—where breaking the “rules” causes guilt or anxiety.
This rigidity relates to the concept of mentalization: categorizing food in absolute terms (good vs bad) reflects a non-mentalizing mindset, where nuance and complexity are lost.

The key difference lies in the relationship with food: while healthy eating allows for flexibility, socializing, and enjoyment without fear, orthorexia imposes control, avoids spontaneity, and turns every meal into a moral test.

When the obsession is no longer about health

A qualitative study based on blog entries by women who experienced orthorexia clearly illustrates this process. The study by Greville-Harris, Smithson, and Karl (2019) analyzed 40 blog posts written by fifteen women who self-identified with orthorexia nervosa.
Their writings showed how an initial motivation to improve health and well-being (driven by good intentions and positive habits) evolved into an increasingly rigid need for dietary perfection. When they failed to meet their own food rules, emotions such as anxiety, guilt, and frustration would arise.
This study shows that orthorexia may not begin as a disorder—it can start as a genuine attempt at self-care. However, without a flexible relationship with food, it can turn into a persistent source of emotional suffering.
In some cases, it may also stem from self-punishment or excessive self-criticism, rather than care.

Key takeaways:

Listening to your body is more important than following strict rules.
Ask yourself: how do I feel when I eat? Is there pleasure or guilt?
Eating healthy doesn’t mean eating perfectly—flexibility is part of health.
If eating “right” becomes a source of anxiety, it may be time to seek professional help.
It is possible to rebuild a free and compassionate relationship with food—and it’s worth it.

In summary

Healthy eating itself is not the problem; the real concern arises when food choices turn into a rigid moral duty that limits freedom, well-being, and enjoyment.
While orthorexia often starts as a form of self-care, this is not always the case. In some individuals, it may emerge from extreme self-demand or a negative relationship with the body, and its development varies according to each person’s emotional and life history.
What at first may seem like a healthy habit can gradually become a control dynamic, where health is no longer a genuine goal but becomes a source of distress and suffering.

References:

Dakanalis, A., et al. (2023). Orthorexia and Orthorexia Nervosa: A Comprehensive Examination of the Literature. Nutrients, 15(8), 1762.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10490497/

Meule, A., et al. (2024). Orthorexic tendencies and its association with weight control methods. Frontiers in Nutrition, 11, 1355871.
https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2024.1355871/full

Harrison, C. (2025, May 2). “I was scared to even eat the vegetables in my fridge”: the eating disorder that focuses on food purity. The Guardian.
https://www.theguardian.com/global/2025/may/02/orthorexia-eating-disorders-rfk-jr

Greville-Harris, M., Smithson, J., & Karl, A. (2019). What are people experiencing when they describe themselves as having orthorexia nervosa? Qualitative Health Research, 29(11), 1615–1627.
https://pubmed.ncbi.nlm.nih.gov/31721111/

When “healthy” becomes an obsession: exploring the line between healthy eating and orthorexia