Orthorexia: When “Healthy Eating” Goes Too Far?


Might your personal training clients be exhibiting behaviors aligned with orthorexia?

We love to see our personal training clients thriving and prioritizing their health and well-being in whatever ways serve them the best. But for some of our clients, healthy eating can become an obsession; just like anything else, it can be taken too far. They may obsess over nutritional practices through constant calorie counting, weighing food, and compulsively reading food labels. Can so-called “healthy” eating be taken too far? Personal trainers should be aware of the signs of orthorexia and its unintended consequences.

Orthorexia, coined in the 1990s, is an eating disorder characterized by compulsive habits, eating “pure” or “clean” foods, extreme restriction, hyper-fixation with nutrition, rigidity in daily eating habits, and/or cutting out entire food groups in the name of “eating healthy”. As professionals, we need to remain attuned with our clients’ habits, and be able to tell the difference between a commitment to healthy eating and potentially dangerous health-behavior patterns.

Comparison Time

Healthy Habit Compulsive Practices
Thoughtful meal planning, but allowing room for flexibility and change


Rigid meal planning with no room for flexibility or nuance


Selecting mostly unprocessed food options when possible and taking a food-first approach


Obsessively selecting only products that fit the client’s definition of “clean” or “safe”


Demonstrating an appreciation and respect for all macronutrients


Strict elimination of a particular food group due to a perceived, (non-research supported) benefit


Client can thoughtfully troubleshoot when confronted with challenges or a scheduling conflict that requires a shift in eating practices


Client experiences emotional turbulence if any obstacle or schedule challenge does not allow for them to stick to their strict schedule of eating


Client does not appear to be experiencing disturbances in their overall health due to eating practices


Client appears to be experiencing a decline in performance, digestive disorders, anemia, significant weight loss/muscle mass reduction


Mindfully observing caloric intake and exercise Religiously tracking every food and beverage item and/or obsessively calculating macronutrient ranges.
Eating foods in balance and enjoying all foods  

Strictly sticking to a specific macronutrient or caloric window and avoiding any foods the client deems “bad” or “unclean”.

Continuing to enjoy social gatherings  

May avoid social gatherings as the food choices will likely not align with the client’s perceived needs and preferences.

Client does not generally experience food guilt or shame related to a food choice or set of choices


Client may feel extreme guilt or share or stress after eating any food classified as “unhealthy” in their mind


Client can modify food choices when preferred options are not readily available


Client experiences extreme anxiety when preferred options are not available


Does not think about food 24-7 Food is a dominating thought in the client’s mind

Health Consequences of Orthorexia

When someone is dealing with orthorexia, they typically experience malnutrition (from cutting out a food group or severely limiting intake), calorie deficits and weight loss, anxiety, and social isolation. Each of those can lead to further negative outcomes.

Orthorexia often starts out as a well-intended desire to just eat better, improve nutrient intake, and balance meals. We know part of the “formula” for living a healthy life is being mindful of nutritional practices but doing so in balance and not at the risk of sacrificing joy or one’s sanity.

This obsessive focus on food requires intervention that is outside our scope of practice to address. As a health and exercise professional, if you suspect a client may be struggling with this, lean on professionals in your referral network to provide additional support for that client. Most often this will be a primary care provider and mental health professional.

It’s important to talk with your clients about nutrition and not just as an overarching concept, but the practices they engage in. We will likely be their first line of defense should their well-intended efforts land somewhere else and they spiral into an obsessive pattern. Be aware. Stay aware.

Fitness Nutrition Coach


Dr. Erin Nitschke, NFPT-CPT, NSCA-CPT, ACE Health Coach, Fitness Nutrition Specialist, Therapeutic Exercise Specialist, and Pn1 is a health and human performance college professor, fitness blogger, mother, and passionate fitness professional. She has over 15 years of experience in the fitness industry and college instruction. Erin believes in the power of a holistic approach to healthy living. She loves encouraging her clients and students to develop body harmony by teaching focused skill development and lifestyle balance. Erin is also the Director of Educational Partnerships & Programs for the NFPT. Erin is an editorial author for ACE, IDEA, The Sheridan Press, and the Casper Star Tribune. Visit her personal blog at belivestaywell.com