Marin County is renowned for its local farmers’ markets, boutique fitness studios, and organic food stores. In 2022, the County Health Rankings & Roadmaps recognized Marin as the healthiest county in California (MarinCounty.gov). According to the Marin Department of Health and Human Services, Marin has an extended life expectancy of seven years above the national average. With access to high-quality health care and proximity to green spaces, Marin is known for its longevity, affluence, and enthusiasm for wellness. However, under this exterior of health and wellness, an obsession with having the perfect lifestyle may quietly be taking root.
The National Library of Medicine (NLM) describes orthorexia nervosa (ON) as a “pathological obsession with proper nutrition that is characterized by a restrictive diet, ritualized patterns of eating, and rigid avoidance of foods believed to be unhealthy or impure.” Although it shares characteristics with anorexia nervosa (AN), such as the need for control, identity around physical attributes, and the moralization of food, orthorexia stems from a desire to reach optimal health, whereas anorexia typically stems from a preoccupation with thinness.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) does not recognize orthorexia as an official mental disorder, but clinicians within the field of disordered eating widely acknowledge it. According to The National Eating Disorder Association (NEDA), an estimated 21-57 percent of the general population engage in orthorexic behaviors.
Based on an article by ACUTE, Center for Eating Disorders & Severe Malnutrition, without an official diagnosis, orthorexia in individuals often goes unchecked since many of its symptoms can be mistaken for “health-conscious” behavior. Scrutinizing a vegetable’s exposure to pesticides, overthinking a dairy product’s origin from hormone-supplemented cows, or worrying whether a food’s packaging contains plastic-derived carcinogenic compounds are all examples of obsessive traits associated with orthorexia. The line between pursuing healthy habits and becoming preoccupied with them is growing increasingly thin, a gray area local experts are keen to examine.
Kathleen Smyth is the head professor of the Health and Kinesiology Department at the College of Marin. Through her years of teaching health sciences and living in Marin County, she has noticed ongoing orthorexic and disordered eating patterns in the area.
“As a fourth-generation San Franciscan, I have noticed new and generational wealth coming to the Bay Area. That kind of money leads to this idea of perfectionism, especially around food, since the whole idea of healthy and natural foods kind of started here in the 60s and 70s,” Smyth said.
This long-standing emphasis on ‘clean’ eating helps explain why new diet trends have gained so much traction among younger generations. An article published by the Newport Institute, a mental health rehab center for young adults, found that young adults were more susceptible to developing orthorexia as a form of control or experimentation, and from the influence of social media. A statistical analysis published by NEDA on media consumption and its effects on disordered eating found that, despite 40 percent of weight loss advertisements making false claims and 90 percent containing deceptive statements, almost 70 percent of people who encountered such content said it influenced their perception of health and their concept of an ideal body.
“Many of my students come into my classroom saying they’re just going to ‘eat clean’, but what does that even mean?” Smyth said. “Influencers on social media are sharing information that they have no right to be giving out, and I think that’s where a lot of these [behaviors] start from.”
Beyond social media, the pressure to eat ideally also surfaces in athletics. Brooke Lee, a senior on the girls varsity cross country and track and field teams, describes how food stigmatization and diet culture can affect athletes.
“I’ve grown up focusing on health, but in sports [your diet] is very situational, and the focus isn’t always on being ‘healthy’, it’s more on fueling your body,” Brooke said. “During training [your food] switches over to quick carbs, which usually means processed foods and sometimes pushing away other food [groups] like fiber.”
According to an article from the University of San Francisco on sports nutrition, physically active individuals have specific nutritional needs; 55-65 percent of their daily caloric intake should be carbohydrates, and 25-30 percent should come from fat. Although these macronutrients are essential for both daily function and intense exercise, they are often characterized as ‘bad’ or ‘unhealthy’ and subject to stigmatization as valuable fuel for athletic performance.
“Sometimes I can be hard on myself about eating too many ‘processed’ foods, since there is sometimes a narrative in sports, especially running, that you need to be skinnier to be better. People think they need to cut out food or eat very healthy, but the narrative really needs to change to just eating enough,” Brooke said.
A 2021 research paper published by the NLM explores the obsession among athletes with eating perfectly and achieving ultimate health. It found that among collegiate athletes aged around 20, across all genders, almost 70 percent demonstrated orthorexic tendencies. The article suggests that obsessive traits around food increase the risk of developing eating disorders, which can lead to a decrease in performance, serious injuries, and needing to take time off from a sport.
In addition to physical issues like nutrient deficiencies or malnutrition, registered dietitian and certified intuitive eating counselor Leah Kern speaks to the psychological harm a preoccupation with food can have.
“When you’re obsessing over every single eating decision, then you’re causing yourself a ton of stress, and since you need to eat multiple times a day, when food is your trigger for stress, you become chronically stressed, which negatively impacts your health, effectively going against the aim of trying to be ‘healthy,’” Kern said.
A research paper from the National Institute of Health dissects the relationship between stress and digestion, where it was proven that when stress levels are high during eating, the body goes into “fight or flight” mode. This diverts energy from proper digestion, resulting in less nutrient absorption, increased stomach acid, and higher cortisol.
“Orthorexia is simply an unhealthy obsession with health,” Kern said, “People tend to think that diet and exercise are the only aspects of a person’s health, but really it’s determined by factors like sleep, genetics, socioeconomic status, and so many others.”
According to healthypeople.gov, the Social Determinants of Health (such as economic stability, quality education, access to health care, your neighborhood and built environment, and community) can be large indicators of physical and mental well-being. In a blog post on Kern’s website titled “Social Determinants of Health: Why Diet Culture Misses the Bigger Picture,” she states that it contributes to over 50 percent of a person’s health, and that “these are conditions that are often out of your control, and they tie into many overall inequities, racism, and elitism in diet culture.”
“[People struggling with orthorexia] get sucked into the tiny details that they forget the basic necessities of whether they’re eating enough, whether they’re satisfied with their meals, and making sure that food doesn’t take up too much mental real estate,” Kern said. “The complicated thing about orthorexia is that it isn’t an eating disorder, but it’s disordered eating, and if your quality of life is suffering, then it’s a problem, and you deserve help.”
Understanding orthorexia is challenging given how its behaviors blur the line between health-conscious and obsessive. However, there are tangible ways to identify and support those struggling with these tendencies.
“The key difference between orthorexia and simply being healthy is the obsessiveness: when someone becomes consumed with trying to be perfect [with their diet], they tend to restrict and isolate themselves,” Smyth said. “So I think the best way to start mitigating orthorexic tendencies would be teaching people to enjoy meals with their family and friends again, and that all foods are good in moderation.”
Education on topics such as orthorexia, anorexia, or other types of disorders is critical to help mitigate them. According to the National Institute of Mental Health, nearly nine million young adults in the U.S. struggle with some kind of disordered eating, so starting conversations in schools allows for a controlled teaching environment on such topics.
“Bringing awareness to [orthorexia] at younger ages and stopping it in its tracks so that people don’t have to suffer for as long would help,” Kern said. “Unfortunately, we live in a culture where disordered relationships with food are not only normalized but praised, so when you’re struggling with something like orthorexia, it is hard to detach yourself from the personality traits that come with it.”
Kern’s beliefs support a need for full recognition, better education, and a cultural shift in how our society talks about health. If you believe yourself or a loved one is struggling with orthorexia, please consider reaching out to specialists such as psychologists or registered dieticians for support. With continued awareness about the effects of orthorexia and other eating disorders, the public may become better equipped to recognize the signs and support those affected.
