Taking "Clean Eating" Too Far Can Be a Sign of an Eating Disorder

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Diet culture is so ingrained in our society, we may not see a child or teen opting for a veggie burger or green juice as a reason for concern. But some adolescents begin labeling foods as "unhealthy" and "healthy" or "clean," and allow those labels to dictate what they allow themselves eat. This focus on "healthy" eating to the point that it becomes an unsafe obsession with only eating "healthfully" is called orthorexia nervosa—an eating disorder that can be dangerous, particularly as it is celebrated by so many aspects of our society.

Recently, celebrities Will and Jada Pinkett Smith shed light on how their son Jaden was following a very restrictive relationship with food. While not diagnosed with orthorexia nervosa, the Smith's worried. “Will and I had a bit of an intervention with Jaden because he’s a vegan but we realized he wasn’t getting enough protein,” Pinkett Smith said on her show Red Table Talk when Jaden was age 21. “He just looked drained. He was depleted, he wasn’t getting the nutrients.” (Jaden now eats a healthful vegetarian diet and is recovering, say his parents.)

The number of young people with orthorexia nervosa seems to be rising; the stress of the recent COVID-19 crisis seems to have intensified all EDs, particularly as COVID-19 news coverage often stigmatized those in larger bodies. “Data is beginning to emerge suggesting an uptick in eating disorders following the pandemic and related lockdowns,” says Lisa Ranzenhofer, PhD, a clinical psychologist at the Eating Disorder Research Unit/Columbia Doctors, and an assistant professor at the New York State Psychiatric Institute in New York City. “Youth with [pre-existing] eating disorders also had more severe presentations during this period.”

If you or a loved one are coping with an eating disorder, contact the National Eating Disorders Association (NEDA) Helpline for support at 1-800-931-2237

For more mental health resources, see our National Helpline Database.

What Is Orthorexia Nervosa?

Orthorexia nervosa, often referred to as orthorexia, is a fixation on maintaining a "perfect" diet. This can include avoiding foods or groups of foods because of a concern—whether about undiagnosed allergies, worry over how how a food is prepared, concern over the origin of a food, and more. An example might be only eating organic foods. While it sounds similar to anorexia, the two EDs are different. Anorexia is defined by a fixation on how food affects body appearance. Orthorexia is defined by a fixation on how food affects perceived health.

This may mean looking for foods that are "free-from" (as in free from gluten, dairy, meat, additives, etc.), only eating organic, spending hours scanning labels and researching foods they deem "safe," and avoiding meals that don't meet this criteria. This kind of restriction can wind up depriving your adolescent of the nutrition their growing body needs, as well as their interpersonal relationships.

Signs and Symptoms of Orthorexia

Orthorexia can be a bit trickier to recognize because our culture has normalized many of the habits that might show up in orthorexia. Eating "clean" might not be on a parent's radar as something problematic if they do it too, or associate "clean" with "health." Foods like organically grown raw vegetables, meatless meals, nut milk, and yogurt with no preservatives may sound fine at first. However, when a young person spends this much time focusing on an algorithm of "health" requirements before choosing to eat, this can quickly become orthorexia.

“Orthorexia is about eliminating more and more foods—no sugar, no carbs, going vegan,” says Lynn Corey, LCSW, CEDS-S, CETP, Clinical Manager for the Behavioral Health Outpatient Services at Robert Wood Johnson University Hospital Somerset, in Somerville, NJ. Label-reading may become a time-consuming pursuit, with the child scanning for additives, “bad” ingredients, and information on how the food was grown and processed. In some cases, the young person with orthorexia may worry about other family members’ foods somehow “contaminating” theirs in the refrigerator or kitchen cabinet.

This pursuit of clean eating becomes increasingly disruptive. “The diet is so restrictive that the adolescent’s behavior shifts,” explains Jennifer Leah Goetz, MD, Medical Director, Child & Adolescent Inpatient Unit, and Assistant Professor of Psychiatry and Behavioral Sciences, at Johns Hopkins Hospital Children's Center in Baltimore. “They can’t go out to dinner with family because their diet is limited. They can’t go on sleepovers because the right food isn’t available.”

Lisa Ranzenhofer, PhD

Often, the line between healthy eating and orthorexia is rigidity: the majority of teens do not need to 'eat clean' all the time to be healthy.

— Lisa Ranzenhofer, PhD

This lack of flexibility regarding “clean food” is a hallmark of the disorder. “Often, the line between healthy eating and orthorexia is rigidity: the majority of teens do not need to 'eat clean' to be healthy,” says Dr. Ranzenhofer. “Healthy eating for most adolescents includes regular meals and snacks from a wide range of food groups and types of foods. It is flexible and adaptive depending on the situation.” It is important to note, too, that "clean eating" doesn't have one definition—in fact, it means very little in terms of a food's nutritional value or health. This kind of rigidity in thinking is what can often lead to an ED like orthorexia.

In addition to this singular focus on “free-from” foods, a child with orthorexia may become malnourished. You may not necessarily see this, so it's best to watch your child's actions and listen to what they say in relation to food, eating, and how they define "health." Your teen may also seems isolated and withdrawn as their intense focus on clean eating preoccupies them.

What Causes Orthorexia Nervosa?

Parents often wonder why an eating disorder takes root and may blame themselves. “Did I encourage her issues by stressing the importance of organic food versus the conventional kind?” wondered one parent about her daughter’s struggle with orthorexia.  

“The best way to understand eating disorders is a multi-perspective model,” says Dr. Goetz. She explains that both nature and nurture contribute to eating disorders. “There seems to be a heritability factor among EDs that is present, but typically some sort of life stress unleashes an ED. There’s stress or trauma that can unmask and lead to an ED in genetically vulnerable individuals.”

It is also nearly impossible to divorce diet culture from eating disorders, particularly one like orthorexia. While not all people who diet will develop an ED, many who develop EDs have dieted. In fact, research has found that dieting is the most important predictor of developing an eating disorder.

In general, personality types that are more obsessive/compulsive and dependent can be more prone to eating disorders. Dr. Goetz cautions, though, that doesn’t mean these individuals are bound to get an ED. “A whole constellation of factors are at work,” she says. Your child’s social circle can also be an influencing factor, with peer pressure to eat a certain way or bullying and body-shaming possibly contributing to the situation. In addition, while dieting and talk around diet culture is normalized, parents may consider looking at their own relationships with food, eating, and their bodies, as well as how they speak about them around their kids.

Treatment Options for Orthorexia

If you notice your child is focusing on nutrition or "healthy eating" more, it is worth talking to them to get a sense of why. Once a parent notices that their child’s focus on “eating healthy” has become extreme and compulsive, or if you suspect they may be focusing more on "health" over enjoyment when eating, it’s time to take action. Here are some steps you can take to get your child the support they need.

Consult Your Family Healthcare Provider

They may have known your child for a number of years and can see if your teen is still meeting their nutritional requirements and on a good growth curve. They can also provide education on and advice for appropriate nutrition. They can also recommend specialists who can help your child with their specific needs.

Find a Specialist

If your child is deeply struggling, your usual healthcare provider may be able to offer referrals, says Dr. Goetz. This might involve a therapist, a nutritionist, and/or a psychiatrist to address the issue. If you aren’t able to get a referral in this way, you can find well-trained experts via the National Eating Disorders Association (NEDA ) or Academy for Eating Disorders websites. Each case of orthorexia is unique; there is no one-size-fits-all prescription for what kind of expert to see or for how long.

Work Together as a Family

Know that families are crucial for recovery, and family counseling is commonly part of treatment. “One thing that parents don’t always appreciate is the degree to which teens mimic the behavior they see, like a parent always being on a diet,” says Dr. Goetz. “A mother or father may ask, ‘Can I stay on my diet while my kid has an ED,’ to which I would say, ‘No, your relationship to food and your body should be modeled in a way that is conducive to your child having healthy habits.’”

While a parent’s eating habits do not cause EDs in their children, they can influence how a child’s attitudes and behaviors develop. A good message for parents to reinforce, says Dr. Goetz, is that all foods have value; they are not intrinsically “good” or “bad," and there is no moral value in food. It’s about enjoying a varied diet. Additionally, it's important to remind the entire family that all bodies are good bodies.

A Word From Verywell

It can be concerning to discover that your teen is struggling with an eating disorder. However, working with your teen and a healthcare provider can help them develop a healthy relationship with food, eating, and their body.

If you notice something seems off with your teen, trust your gut. "Just because one’s child or teen says that nothing is wrong does not mean nothing can or should be done—in fact, lack of recognition of the seriousness of the illness is a common feature of the disorder," says Dr. Ranzenhofer. "Parents should trust their instincts and insist on a visit to the doctor if an eating disorder is suspected." 

Should you become concerned, contact a healthcare provider for an evaluation, and don't be afraid to seek out a second opinion should you need it.

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