The larger issue is that the same argument could be used for many, I'd even guess most, of the people here. Even tracking calories at all would be considered a pretty big red flag for a significant chunk of the population.  I have no doubt that it is a legitimate condition. Just like bacterial infections were quite real before the ability to properly diagnose them came about. But proper criteria for diagnosis and treatment are vitally important in any type of medicine. In that sense it is a bit worthy of dismissal at this point. The "I know it when I see it" approach can work to an extent. But mental illness in general requires a lot of work to remove as much subjectivity as possible from diagnostics. And that hasn't happened with orthorexia yet. The APA tends to be a bit overly lax there as it is. And when they haven't given things a goahead yet then I think there's some justification for skepticism.