Paradoxical bio-citizenship: Examining healthy eating from lay and professional perspectives

In a society saturated with health messages, the concept of an eating disorder based on an obsession with healthy eating involving pathological behaviours and thoughts— “orthorexia nervosa”— presents a paradox, raising questions about extreme healthism and psychiatry's expanding reach into contemporary life. To explore this matter, we re-analysed data from six existing studies, including 56 interviews (individuals preoccupied with healthy eating; bodybuilders practising extreme healthy eating; health practitioners specialising in eating disorders; fitness instructors) — and anonymous eating disorder support forums — through a bio-citizenship lens (biological rights, civic responsibility, self-care). Themes included food marketing; advantages/challenges of healthy eating; and healthy eating as pathological. For lay participants, healthy eating was tied to moral and practical considerations (medical, personal, professional, ecological) affirming their identity as responsible citizens. Younger participants followed tailored, often calorie-restricted, diets to enhance physical appearance and professionalism, while older participants emphasised healthy diet for illness prevention. Professionals highlighted pervasive health food marketing, and social media's role in the promotion of extreme health behaviours, which clients defended. On support forums, plant-based diets were scrutinised for calorie content, and orthorexia nervosa was portrayed as superior to other eating disorders. Findings suggest a paradoxical bio-citizenship where socially approved yet risky pro-health behaviours are pathologised. Efforts to formalise orthorexia nervosa medically must address these paradoxes, along with new ways of expressing biological identity through self-improvement and self-labelling. As early diagnosis is emphasised, psychiatric and non-psychiatric professionals face challenges in identifying and reorienting individuals who may have crossed the blurred boundaries of "healthy" bio-citizenship.