A fixation on ‘clean eating’ can be harmful – and perfectionists may be at greater risk of taking it too far

Clean eating diets have become increasingly popular over the past few years. This style of eating emphasises consuming whole foods and avoiding processed foods (even minimally processed foods) as much as possible.

Given how important diet is for our health, we might assume that the better your diet is, the better your health will be. But as one clean eating influencer has revealed, being too restrictive with your diet can have the opposite effect on your health.

Instagram influencer Alice Liveing recently opened up about the harm becoming a clean-eating influencer had on her health. In an interview in The Times, Liveing revealed her restrictive diet, accompanied by extreme workouts, had a serious effect on her health – leading to poor sleep, low mood and energy levels, poor brain function and even the loss of her period.

Read more: A dietitian puts extreme 'clean eating' claims to the test – and the results aren't pretty

Liveing’s story highlights how focusing on achieving an unrealistic health ideal – in this case, the perfect, healthy diet – can run the risk of becoming all-consuming and “addictive”. For some, this fixation with healthy eating and the pursuit of the “perfect diet” may even result in orthorexia – an unhealthy obsession with eating healthily.

Disordered dieting

Orthorexia is not yet officially recognised as an eating disorder. But in 2022, experts in the field released a statement agreeing that orthorexia is distinct from other eating disorders – such as anorexia.

They also proposed some diagnostic criteria for orthorexia. This includes compulsive diet practices (done with the belief it will promote optimal health), an exaggerated fear of ill health if they stop said diet (accompanied by emotional reactions such as fear and shame) and following an increasingly restrictive diet.

Orthorexia can affect many aspects of a person’s life – including their social, academic and even work life. It also has many physical consequences – and may lead to anaemia, severe weight loss and malnutrition. It can also cause feelings of anxiety and guilt, especially if a person deviates from their strict diet.

Many factors are thought to be linked to the onset of orthorexia. Some examples include a history of eating disorders or mental health disorders, lifestyle factors (such as exercising frequently) and social factors (including being excessively influenced by the media).

People with certain personality traits – such as perfectionism – may also be at greater risk of developing orthorexia, as our previous research has shown.

Perfectionism

Perfectionism is a personality trait characterised by an irrational need for perfection. It has two overarching dimensions – perfectionistic strivings and perfectionistic concerns.

Perfectionistic strivings include a personal commitment to being perfect. Perfectionistic concerns include fears about being imperfect. Both of these dimensions of perfectionism have previously been linked to developing anorexia and bulimia.

Perfectionism is also linked to orthorexia, as our meta-analysis (study of studies) showed. Looking at the available body of research, we found that both perfectionistic strivings and perfectionistic concerns were linked to orthorexia.

But perfectionistic strivings emerged as the most important aspect of the two when it came to a person’s likelihood of having orthorexia. This differs from other eating disorders – with research showing perfectionistic concerns being more strongly linked to developing anorexia and bulimia.

This finding shows us that the factors that contribute to orthorexia are distinct from other eating disorders – and that orthorexia tends to be triggered more by a desire for the “perfect” diet or “perfect” health, rather than a fear of being imperfect.

Because orthorexia lacks official diagnostic criteria, it’s hard to know how many people are affected. But one recent study suggested as many as 55% of regular exercisers have orthorexia. And with so many young people now relying on social media for lifestyle and nutrition advice, there’s a risk that orthorexia could become more common in the future.

Researchers and doctors face a substantial challenge to keep pace. There’s a clear need to conduct more research so we better understand orthorexia, how it can be prevented and how we can help those who are struggling.

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.