Healthy Choices

Orthorexia: When healthy eating goes extreme

Two years ago, Sacramento native Jordan Younger was running the popular lifestyle blog “The Blonde Vegan” and becoming the Web’s go-to guru on plant-based eating. Based in New York, Younger had built a personal brand by writing about the dangers of processed foods and pesticides and the benefits of organic juice cleanses.

Despite her success, Younger was also building a paralyzing fear of what she considered unhealthful food, a disorder known as orthorexia nervosa that’s being diagnosed in a growing number of health-conscious Americans.

Sometimes called the “Whole Foods syndrome,” referring to the upscale, health-focused supermarket chain, orthorexia can cause malnourishment and other problems for those who take clean eating too far.

“I was just piling these fears up, and believing everything was totally true and in order to be my perfect, fit self and never get sick, that this was what I had to do,” Younger said. “Unless it was a vegetable, or a fruit, or an unsalted almond, I wouldn’t eat it.”

Orthorexia usually begins with a simple resolution to eat well and avoid the kinds of fatty, processed foods that have caused obesity, high blood pressure and other common health ailments among Americans. For some, however, those good intentions spiral into an obsession with food so intense that it weighs on a person’s work and social life and leads to severe weight loss.

Though orthorexia is not classified as an eating disorder by the American Psychiatric Association, many nutritionists believe it will continue to show up as ultra-restrictive diets such as paleo and raw food grow more popular.

Now 25, Younger said committing to a vegan and more-healthful diet meant eliminating more foods from her plate – meat, dairy, gluten, oil, refined sugar, flour and the rest. Feeling hungry and imbalanced, and terrified that unwholesome foods would toxify her system, she continued cutting ingredients from her approved list. Along the way, she stopped going out with friends and family because she couldn’t eat from most menus.

“I thought, ‘I’m not doing this right – I’m not eating healthy enough or clean enough,’ ” she said. “I had such a strict limit on food even within the vegan umbrella. I was just so, so, so obsessed with what I was going to eat every day and what I wasn’t going to eat. And I was always starving.”

The condition is most likely to affect people with underlying emotional issues that would cause them to restrict food intake too intensely, said Thom Dunn, an associate professor of psychological sciences at the University of Northern Colorado and one of few researchers in the nation looking at the phenomenon.

Dunn estimates orthorexia affects less than half of 1 percent of the U.S. population, although there haven’t been enough clinical studies to reliably calculate its prevalence. Anorexia nervosa and bulimia nervosa, formally diagnosable conditions with much longer histories, affect about 2 percent of Americans.

Still, orthorexia has received a whirlwind of social media attention. Anecdotally, it’s been seen most commonly in affluent white females, said Dunn, but it could hit anyone.

“There are a lot of people out there who maybe don’t have the full-blown condition, but are really having problems because they have this idea that they have to be as healthy as possible, as opposed to as skinny as possible,” said Dunn, noting the distinction between orthorexia and anorexia. “People are talking about it, because everybody kind of knows somebody who might get carried away.”

Unlike anorexia nervosa sufferers, who obsess over how much food is consumed, orthorexic patients are preoccupied with what goes into their bodies, said Deborah Cohen, a licensed marriage and family therapist who treats eating disorders at Soul Wisdom Therapy in Sacramento and Davis. Orthorexia’s symptoms include spending more than three hours a day thinking about healthful food, continually limiting the number of foods acceptable to eat, suffering social isolation because of a limited diet and feeling guilt or self-loathing when a strict regimen isn’t followed.

When orthorexia becomes severe, people limit their diets to so few foods that they become malnourished and lose weight. Some develop anemia, brittle bone syndrome and immune system suppression.

Some fall into the disorder under pressure from celebrities and other public figures who advertise extreme diets online, and magazines that regularly advise the public to drop carbohydrates, cut fat or make other dramatic changes, said Lisa Petersen, clinical director of the Eating Recovery Center of California in Sacramento.

“It’s a phenomenon in our culture,” she said. “It’s troubling, but not surprising, that we see this subset growing rapidly. We see these permutations of healthy lifestyle, and what you hear will affect what you glom onto.”

The tendency to “tweet-what-you-eat,” particularly among young people, may also be propelling obsessive thoughts, Dunn said.

“Now all of a sudden you can get online and you can see how strict you are compared to other people,” he said. “There’s a sense of superiority. You’ve removed dairy from your diet and eggs? Well, I can do better than that.”

Cohen, who’s recognized orthorexic traits in people for several years, said it’s common for the condition to occur alongside anorexia or bulimia.

“One can become another, and they can be happening at the same time,” she said. “They share many characteristics – anxiety, the need for control, isolation, low self-worth. The more eating disorders that are involved, the more serious the client’s mental health status can be.”

Hannah Haakenson of Sacramento said her orthorexic tendencies began in college, where she was mostly eating vegetables and other healthier foods while exercising excessively, and coming into conflict with friends who didn’t agree with her beliefs around food.

“It really rocked the boat in my world,” she said. “I isolated myself, had a lot of anxiety. It was almost like a light switch – it would turn on fast. Whenever someone invited me over or girlfriends were going out to eat, or the students were going out to the dining hall, my anxiety would peak.”

After seeking treatment at the Eating Recovery Center, Haakenson said she learned to relax about food.

“My relationship with food now, I would use the words freedom and balance,” Haakenson said. “Sometimes, something is so yummy that I want to have three servings, and sometimes it’s not my favorite and I don’t finish it. It’s not because I’m restricting myself, it’s because I’m not feeling it. It’s a lot more free and enjoyable.”

Younger also received professional help, prompted by loved ones concerned about her anxiety, thinning hair and weight loss. After months of treatment, she released a book in November about her recovery from the condition, and changed the name of her blog to “The Balanced Blonde.” She now eats eggs, fish and meat in addition to fruits and vegetables.

“It’s time to advocate a lifestyle that doesn’t involve restriction, labeling or putting ourselves into a box,” she wrote on her blog. “To accept moderation, to accept balance, to allow for happiness and growth and change and fluctuation. Life is an ebb and flow, and our bodies and our mindsets evolve! It is okay to embrace that, and it’s detrimental to our health and our well-being not to.”

Editor’s note: This story was changed Jan. 12 to correct the spelling of Hannah Haakenson’s name.

Sammy Caiola: 916-321-1636, @SammyCaiola

Orthorexia resources

Soul Wisdom Therapy

2620 J St., Sacramento;


621 Fourth St., Suite 6, Davis


Eating Recovery Center of California

3610 American River Drive No. 140, Sacramento;

(916) 800-3398

Center for Hope of the Sierras

601 Sierra Rose Drive No. 202, Reno;