Vegetarian diet and orthorexia nervosa: a review of the literature

The Mediating Role of Social Camouflaging on the Relationship Between Autistic Traits and Orthorexic Symptoms

Background/Objectives: Recent lifestyle and dietary changes, driven by health awareness and ecological concerns, have led to the rise in numerous type of diets, which can promote well-being but may also contribute to Orthorexia Nervosa (ON), which have been suggested to be linked to autism spectrum disorder. This study aimed to explore the relationship between autistic traits, social camouflaging, and orthorexic tendencies in female university students, focusing on how these factors intersect with specific dietary habits. Methods: 554 female students were recruited via an online survey and assessed with the Adult Autism Subthreshold (AdAS) Spectrum, the Camouflaging Autistic Traits Questionnaire (CAT-Q), and the ORTO-R. Participants were categorized into four groups based on AdAS Spectrum and CAT-Q quartiles. Results: Vegans and vegetarians exhibited higher orthorexic tendencies and specific autistic traits. High scorers on the AdAS Spectrum and CAT-Q also showed higher ORTO-R scores, with both AdAS Spectrum and CAT-Q total scores, as well as certain domains, serving as significant positive predictors of higher ORTO-R scores. Notably, the AdAS Spectrum total score had a significant direct and indirect effect (through the CAT-Q) on the ORTO-R total score. Conclusions: The study found significant associations between autistic traits, social camouflaging behaviors, and orthorexic tendencies in female university students. These findings suggest that the strict dietary behaviors and rigid thinking characteristic of orthorexia may be influenced by underlying autistic features, highlighting the need for further research into the intersection of autism and eating disorders.

Orthorexia in obsessive-compulsive personality disorder: the impact of perfectionism and metacognition

BACKGROUND

Obsessive‒compulsive personality disorder (OCPD) is characterized by a rigid need for control, orderliness, and perfectionism, often impairing functionality. Traits such as striving for an "ideal" figure can lead to orthorexic tendencies, characterized by an obsessive focus on healthy eating, which can result in significant social, psychological, and physical complications. This study investigates the presence of orthorexic tendencies in individuals with OCPD and examines whether these tendencies are predicted by metacognition and perfectionism, with a focus on the mediating role of metacognition.

METHODS

The study included 73 patients diagnosed with OCPD through the DSM-5 Structured Clinical Interview (SCID-5-PD) and 73 healthy controls matched by age, sex, and education level. Perfectionism, orthorexia, and metacognition were assessed via the Frost Multidimensional Perfectionism Scale (FMPS), Meta-Cognition Questionnaire-30 (MCQ-30), and ORTO-11 scale. Pearson correlation, linear regression, and mediation analyses were conducted to explore these relationships.

RESULTS

OCPD patients had lower BMIs and higher scores for perfectionism, orthorexia, and metacognitive activity than did the control group. A negative correlation was found between the FMPS and ORTO-11 scores. MCQ scores were positively correlated with FMPS scores and negatively correlated with ORTO-11 scores. In the mediation analysis, metacognition was found to have a partial mediating effect on the relationship between perfectionism and orthorexia.

CONCLUSION

Perfectionism and dysfunctional metacognition significantly contribute to orthorexic tendencies in individuals with OCPD. These findings suggest that metacognitive therapy may effectively address and reduce orthorexic behaviors in this population.

Patterns of implicit and explicit identity as a vegan or vegetarian in predicting healthy orthorexia and orthorexia nervosa

Orthorexia nervosa (OrNe) is an eating disorder characterised by a pathological interest and preoccupation with healthy foods and a healthy diet. Evidence suggests that tendencies towards OrNe may be prevalent across diet groups, and this is particularly the case in vegans and vegetarians. Our previous work has identified that alongside individual differences in obsessive compulsiveness and perfectionism, cognitive biases (attentional preference for healthy-related cues) are associated with OrNe, whereas explicit identity (as a vegan/vegetarian) is only associated with a healthy orthorexia form. No work has assessed whether one's known identity (explicit identity) or that form of identity which is based on fast acting cognitive associations (implicit identity) further differentiate healthy orthorexia from OrNe tendencies in addition to compulsiveness and perfectionism. One hundred and forty-four self-identified vegans (n = 45), vegetarians (n = 50) and meat-eaters (omnivores) (n = 49) (66 females, 74 males, 4 non-binary; M age = 35.09) completed measures of current hunger status, obsessive compulsivity, perfectionism, the Teruel Orthorexia Scale, perceived identity centrality as a vegan/vegetarian (explicit identity) and a "self as vegan/vegetarian" implicit association test (implicit identity). Results showed increased orthorexia tendencies in both vegans and vegetarians compared to meat eaters (omnivores) but only in terms of healthy orthorexia. In addition, no differences were shown for OrNe suggesting the diet type is not influential in pathological orthorexia. Explicit identity and current hunger status were both shown to be associated with healthy orthorexia and not OrNe. Implicit identity as a vegan/vegetarian was unrelated to both dimensions, while compulsiveness and perfectionism predicted OrNe. Despite individuals implicitly associating the self with being a vegan/vegetarian, this identity does not serve as a maker of orthorexia nervosa.

What is more likely in orthorexia nervosa: perfectionism or OC symptoms? A bayesian method in clinical and non-clinical samples

PURPOSE

Orthorexia Nervosa (ON) exhibits specific features that may overlap with Obsessive-Compulsive Disorder (OCD), Perfectionism Striving (PS), and Perfectionism Concern (PC). While previous literature has shown predictiveness in different characteristics of ON, this study aimed to determine if PS, PC and OCD symptoms could predict ON dimensions in at-risk populations using Bayesian models.

METHOD

The study enrolled 622 individuals from three different at-risk populations: people who were following treatment for an Eating Disorder (Patients), people who were following a diet (Dieters) and University students with a degree in medicine or nursing (Students).

RESULTS

Using Bayesian probabilistic methods and considering group factors, the model was enhanced highlighting that ON characterised Patients, Dieters, and Students. The predictiveness of OC features, PS, and PC in different ON characteristics was confirmed in each group, and different patterns were observed in the three groups. Regarding problems related to ON, predictors were higher in Patients, followed by Dieters and Students. Posterior Predictive Distribution (PPD) showed that almost 50% of Patients incur ON-related problems. In ON knowledge, Patients and Dieters are very similar. When feelings related to ON were considered, Patients and Dieters showed different interactions.

CONCLUSION

Clinicians should consider that one in two patients suffering from EDs might develop ON-related problems. People on a diet could show similar patterns of symptoms to patients in ON knowledge and feelings. Finally, our results confirm that perfectionism represents a risk factor for ON in each group considered.

Orthorexia nervosa in dietitians and dietetics students-prevalence, risk factors, and interventions: a scoping review using a systematic approach

CONTEXT

Orthorexia nervosa (ON) is characterized by compulsive behaviors and increased concerns about healthful eating. Dietitians appear to be especially vulnerable to ON, and it is still debatable whether the disordered eating behaviors motivate individuals to enroll in nutrition programs, or whether these behaviors result from an exaggerated preoccupation with healthy eating triggered during their nutrition studies.

OBJECTIVE

The aim was to provide an overview of the present state of knowledge about the prevalence, risk factors, and interventions addressing ON among dietitians and dietetics students. More specifically, it was examined whether dietitians and dietetics students differ from students attending different education programs or other health professionals with regard to the severity and risk factors of ON, and whether the extent of ON changes during the progression in the nutrition education years of study.

DATA SOURCES

MEDLINE (Ovid), PubMed, EMBASE (Ovid), PsycInfo (EBSCO), CINAHL (EBSCO), Cochrane, ProQuest Central, CABI, ProQuest Dissertations, Google Scholar, ScienceDirect, and SpringerLink were searched on May 8, 2021, and updated on November 12, 2022.

DATA EXTRACTION

Records were screened for eligibility; study characteristics, methodology, and findings of included articles were extracted; and the methodological quality assessed using the AXIS tool. Each step was preceded by a calibration exercise and conducted independently and in duplicate by pairs of 2 reviewers. Any disagreements were resolved through discussions.

DATA ANALYSIS

A narrative synthesis was performed, whereby the characteristics, methodologies, and results of included studies were compared.

CONCLUSIONS

Results were inconclusive; yet, a general status of the relatively "high" prevalence of ON among dietitians and dietetics students was established, stressing the need for systematic research to understand and mitigate orthorexic tendencies in this group. It is still too early to answer questions pertaining to prevalence, risk factors, interventions, and differences between dietetics students and other majors when it comes to severity and progress of ON throughout the continuing years of study, or between dietitians and other professional groups.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework Identifier: DOI 10.17605/OSF.IO/BY5KF.

Validation of the Italian version of the Eating-Related Eco-Concern Questionnaire: insights into its relationship with orthorexia nervosa

Introduction

Urgent calls for research on the relationship between climate change concerns and eating disorder risk have been made. This study aimed to validate an Italian version of the Eating-Related Eco-Concern Questionnaire (EREC), a brief unidimensional measure of eating behaviors related to eco-concern.

Methods

Six hundred and sixty-three adults (85% females, mean age 37 ± 12 years) completed the EREC, Climate Change Worry Scale (CCWS), Eating Disorder Examination-Questionnaire (EDE-Q), Eating Habits Questionnaire for orthorexia nervosa symptoms (EHQ-21), and questions on dietary habits and motivations, and past experiences of extreme climate events.

Results

Confirmatory factor analysis results indicated that the original one-factor model showed acceptable fit to the data after including the error covariation between two pairs of items. Internal consistency was adequate, and EREC scores correlated positively and strongly with CCWS scores. Participants scored significantly lower in EREC than in CCWS, indicating greater climate-related concerns in general terms than relating specifically to eating. While EREC was unrelated to EDE-Q scores, weak-to-moderate correlations were observed with EHQ-21 subscale and total scores. Pro-environmental and/or ethical reasons for current diet and personal experience of extreme climate events were associated with significantly higher EREC scores.

Discussion

The Italian EREC appears to be a valid and reliable tool for the screening of eating-related concerns and behaviors related to climate change. Ecological concerns may represent a healthy adaptive response, but the EREC can serve as a valuable tool to identify individuals whose eating behaviors related to eco-concern might warrant further clinical attention due to potential risks of developing rigid or unhealthy patterns.

The Psychosocial Aspects of Vegetarian Diets: A Cross-Sectional Study of the Motivations, Risks, and Limitations in Daily Life

INTRODUCTION

The popularity of vegetarian and vegan diets is linked to various motivations, such as health, ethics, ecology, and social and religious influence. India has the highest proportion of vegetarians and vegans. The practise of these diets is linked to moral and health reasons and environmental concerns. Vegetarianism may also be associated with eating disorders such as orthorexia (ON).

AIM

The main aim of this study was to determine the psychosocial aspects of vegetarian diets. Understanding these aspects is crucial for identifying potential risks and developing effective interventions. This study investigated the reasons for following vegetarian diets, the duration of dietary adherence, the occurrence of feelings of restriction in selected situations, and the risk of orthorexia and other eating disorders.

METHODS

A questionnaire survey was conducted among 186 individuals (82 vegetarians and 104 traditional dieters) between October 2023 and April 2024. The survey was administered via a Computer-Assisted Web Interview (CAWI) using Google Forms, distributed through social media, forums, and private messages. The inclusion criteria for the study group included consent, an age over 18, and a vegetarian diet, excluding those with eating disorders or diseases requiring strict diet therapy. The control group criteria were similar, excluding vegetarians and those requiring special diets. Four unreliable questionnaires were excluded from the analysis. The survey consisted of four sections: metric data, the ORTO-15 questionnaire, the EAT-26 questionnaire, and the TFEQ-13 questionnaire.

RESULTS

The main motivations for following vegetarian diets were ethical and environmental (86.9%) and health (32.1%) reasons. Over half of the vegetarians had been following a plant-based diet for over five years. Vegetarians were more likely to feel restricted in restaurants and when grocery shopping. The ORTO-15 results indicate a higher risk of orthorexia among vegetarians (48.8% vs. 29.4% in the control group; p = 0.00673). The EAT-26 questionnaire showed a higher, but not statistically significant, risk of eating disorders among vegetarians (23.8% vs. 14.7%; p = 0.11391). The TFEQ-13 showed no significant differences between groups (Subscale 1: food restriction, p = 0.77279; Subscale 2: lack of control in overeating, p = 0.91935; Subscale 3: eating under the influence of emotions, p = 0.16612).

CONCLUSIONS

This study concluded that ethical and environmental considerations and a belief in health benefits mainly drive vegetarians. An analysis of BMI revealed no significant differences between groups. The ORTO-15 results suggest a higher risk of orthorexia among vegetarians. The EAT-26 indicated a higher, but not statistically significant, risk of eating disorders among vegetarians and vegans. The TFEQ-13 showed no significant differences in restrictive eating, lack of control in overeating, and emotional eating. Vegetarians were likelier to encounter dietary difficulties in restaurants and shopping but less likely to feel socially excluded.

The association between food neophobia, bi-dimensional aspects of orthorexia, and anxiety among vegetarians and omnivores

Vegetarianism is a growing trend, and food neophobia and orthorexia nervosa could act as barriers to achieving a healthy vegetarian diet. The aim of this study is to compare the levels of food neophobia, anxiety, and both healthy and pathological aspects of orthorexia among vegetarians and omnivores. Additionally, the study aims to identify the relationships between food neophobia, anxiety, and orthorexia. In this cross-sectional online survey, a total of 324 vegetarian and 455 omnivores adults participated. The questionnaire consisted of four sections: sociodemographic, lifestyle, and health-related characteristics, the Food Neophobia Scale (FNS), the Teruel Orthorexia Scale (TOS), and the Generalized Anxiety Disorders-7 Scale. Vegetarians exhibited lower FNS scores (p < 0.001) and had higher healthy orthorexic scores (p < 0.001) than omnivores. There were no differences between groups for anxiety scores (p > 0.05). Regression analysis indicated that higher food neophobia (OR: 0.953, 95% CI:0.937-0.968) and TOS-OrNe scores (OR: 0.946, 95% CI: 0.901-0.993) were associated with lower odds of following a vegetarian diet. Conversely, higher TOS-HeOr scores (OR: 1.135, 95% CI:1.096-1.176) were linked to an increased likelihood of adopting a vegetarian diet. Furthermore, both FNS and GAD-7 scores showed negative correlations with TOS-HeOR (r = -0.124, p < 0.001 and r = -0.129 p < 0.001, respectively), and positive correlations with TOS-OrNe (r = 0.106, p < 0.001 and r = 0.146, p < 0.001). In conclusion, vegetarians exhibit lower levels of food neophobia and a greater interest in healthy eating than omnivores. Additionally, the distinct correlation between two dimensions of orthorexia and food neophobia and anxiety provides support for the two-dimensional nature of orthorexia.

Motivations matter: moral and health-related motives indirectly relate to differential psychological health indicators among vegetarians

Due to rising popularity of vegetarianism in recent years, research interest has surged in examining the relationship between vegetarianism and psychological health. However, given inconsistent findings in prior research, the answer to whether practicing vegetarianism is associated with better or worse psychological health is still elusive. The present investigation aimed to demonstrate that vegetarians are not homogeneous in terms of psychological experiences, such that it is crucial to consider the motives behind vegetarians' dietary choice when examining their psychological health. In a survey study with 266 vegetarians and 104 omnivores, it was shown that health vegetarians displayed higher levels of disordered eating as compared to moral vegetarians and omnivores. Mediation analyses further revealed that, among vegetarians, health motivation was positively correlated with disordered eating tendencies, indirectly linking it with poorer psychological health; moral motivation was positively correlated with prosocial behavior, which in turn predicted better psychological health. These findings have implications for understanding the psychological health of vegetarians with different dietary motives and for developing interventions to promote their psychological health.

Relation between orthorexia nervosa and healthy orthorexia: A latent profile analysis

Orthorexic eating behaviors can be conceptualized as a bidimensional construct encompassing an orthorexia nervosa dimension (ON) and a healthy orthorexia dimension (HO). Although variable-centered studies showed that ON and HO are distinguishable orthorexic eating behaviors, the evidence of whether they can co-occur or be distinct in subgroups of individuals is still limited. The present study aimed to address previous person-centered studies' limitations by examining profiles of ON and HO among a convenience sample of 251 French-speaking Canadian adults (85.7% women; Mage = 33.56). Profile membership was examined as function of participants characteristics such as age, gender, body mass index, frequency of physical activity and sports and vegetarianism. The relation between profile membership, intuitive eating and disordered eating attitudes and behaviors was also assessed. Latent profile analysis (LPA) were used to estimate profiles of ON and HO. Results from LPA did not provide support for the distinguishability of ON and HO. Indeed, they revealed the presence of two profiles showing co-occurring levels of ON and HO that only differed quantitatively: low (68.9% of the sample; low levels of ON and HO) or moderate orthorexic eating behaviors (31.1%; moderate levels of ON and HO). Participants who declared being vegetarian and being more frequently involved in physical activities and sports were more likely to belong to the moderate orthorexic eating behaviors' profile. Finally, participants from the moderate orthorexic eating behaviors' profile showed higher levels of disordered eating attitudes and behaviors, whereas those from the low orthorexic eating behaviors' profile showed higher levels of intuitive eating. Findings from the present study question the distinguishability of ON and HO dimensions. They also suggest that, similarly to ON, HO is also related to higher eating and lifestyle preoccupations.

The various facets of orthorexic eating behavior: five case reports of individuals with supposed orthorexia nervosa

BACKGROUND

Orthorexia nervosa, defined as a fixation on eating healthy according to subjective criteria, is recently being discussed as another variant of disordered eating behavior. Further characteristics are rigid adherence to nutritional rules, anxieties and avoidance behavior in the context of eating as well as a focus on health, not on body shape or weight loss, which is supposed to differentiate orthorexic from other disordered eating behavior. Although diagnostic criteria have been suggested, they have rarely been used in case reports published to date. Hence, the aim of this study was to present five individuals with supposed orthorexia nervosa, using preliminary diagnostic criteria to assess their eating behavior.

CASE PRESENTATION

The five cases (three females, two males) reveal the great variety of disordered eating behavior. Fear of unhealthy overweight (case A), supposed orthorexic eating behavior as a coping strategy for anorexia nervosa (case B), the exclusive consumption of animal products with a total exclusion of fruits and vegetables (case C), the fixation on exercise and athletic goals (case D) as well as a focus on a vegan diet and unprocessed foods (case E) are facets of orthorexia nervosa with varying degrees of impairment.

CONCLUSIONS

It is concluded that orthorexia nervosa manifests itself in very different ways and that more research is needed in order to determine whether it could be a useful additional category of disordered eating behavior.

Assessing the presence and motivations of orthorexia nervosa among athletes and adults with eating disorders: a cross-sectional study

PURPOSE

Orthorexia nervosa involves restricting diet based on quality rather than quantity. Although orthorexia is well reported in many at-risk populations, limited data addresses its presence in individuals with eating disorder history (EDs) or athletes. We aimed to identify the presence and potential drivers of orthorexia in adults with EDs and endurance athletes, compared to control subjects.

METHODS

Participants ≥ 18y included: people with a diagnosed eating disorder (ED as per DSM-5); endurance athletes (training/competing ≥ 5 h/week); or control subjects. Participants (n = 197) completed an online survey assessing orthorexia (eating habits questionnaire, EHQ), eating motivations (TEMS-B) and compulsive exercise (CET).

RESULTS

ED had the highest orthorexia symptom severity (92.0 ± 3.02, n = 32), followed by athletes (76.2 ± 2.74, n = 54) and controls (71.0 ± 1.80, n = 111) (F (2) = 18.2, p < 0.001). A strong positive correlation existed between weight control motives and higher orthorexia symptom severity (r = 0.54, 95% CI [1.35, 2.36], p < 0.001), while a weak negative association existed between Hunger and Pleasure motives and higher orthorexia symptom severity (r = 0.23, 95% CI [- 2.24, - 0.34], p = 0.008; r = 0.26, 95% CI [- 2.11, - 0.47], p = 0.002, respectively). A moderate positive relationship was found between CET and orthorexia symptom severity (95% CI [1.52, 3.12], p < 0.001).

CONCLUSION

Adults with ED history and endurance athletes have greater orthorexia symptom severity compared to control. Clinicians working with at-risk populations should screen patients and be aware of red-flags of orthorexic traits, desire to control weight, and compulsive exercise behavior.

LEVEL OF EVIDENCE

III: Evidence obtained from cohort studies.

Disordered Eating Attitudes and Food Choice Motives Among Individuals Who Follow a Vegan Diet in Brazil

Importance

It remains controversial whether adhering to a vegan diet may be associated with a higher prevalence of disordered eating. Also, main food choice motives and their association with disordered eating in this population are still unknown.

Objective

To determine the association between disordered eating attitudes and food choice motives of individuals who follow a vegan diet.

Design, Setting, and Participants

This is a cross-sectional online survey conducted between September 2021 and January 2023. Individuals of both sexes, aged 18 years or older, following a vegan diet for at least 6 months, currently living in Brazil were recruited through advertisements on social media.

Exposure

Adherence to a vegan diet and food choice motives.

Main Outcomes and Measures

Disordered eating attitudes and food choice motives.

Results

Nine hundred seventy-one participants completed the online survey. Median (IQR) age and BMI of participants was 29 (24-36) years and 22.6 (20.3-24.9), respectively, and 800 participants (82.4%) were female. Most participants (908 respondents [94%]) were categorized with the lowest level of disturbed eating attitudes. "Need and hunger," "liking," "health," "habits," and "natural concerns" were the most important food choice motives in this population, while "affect regulation," "social norms," and "social image" were the less important ones. Adjusted models showed that "liking," "need and hunger," and "health" were associated with lower levels of disordered eating attitudes, while "price," "pleasure," "sociability," "traditional eating," "visual appeal," "social norms," "social image," "weight control," and "affect regulation" were associated with higher levels of disordered eating attitudes.

Conclusions and Relevance

In this cross-sectional study, as opposed to previous suggestions, levels of disordered eating were very low among vegans, although certain food choice motives were associated with disordered eating attitudes. Understanding the motivations of adhering to diets that may impose restrictions, which include vegan diets, may help tailor interventions focused on promoting healthy eating and preventing or treating disordered eating.

An integrative model as a step toward increasing the awareness of eating disorders in the general population

Eating disorders (EDs) represent a contradictory chapter of clinical psychiatry, i.e., although they are associated with significant prevalence and risks in the long term (including vital risk, especially for anorexia nervosa), the therapeutic resources are minimal and based on low-quality data. Another contradiction arose in the last few decades, i.e., a variety of new EDs have been described, either by clinicians or signaled by mass media, but their systematic exploration is progressing very slowly. Entities like "food addiction," "orthorexia nervosa," or "emotional eating disorder" still require intensive exploration in order to find the most accurate diagnostic instruments, diagnosis criteria, prevalence data, vulnerability factors, and therapeutic approaches. This article is focused on integrating into a comprehensive model a variety of EDs not specified or loosely defined by the current international classifications of psychiatric disorders. This framework is intended as an instrument for stimulating clinical and epidemiological research, with potential favorable consequences for therapeutic research. The dimensional model suggested here includes four main categories that accommodate the already recognized EDs (i.e., anorexia nervosa, bulimia nervosa, and binge eating disorder) as well as ten EDs that still need intensive research to find their clinical and pathophysiological characteristics. More good-quality studies are urgently required regarding this topic, based on the mental and physical negative impact these EDs may have in the short and long term, especially in vulnerable populations (e.g., pregnant women, athletes, adolescents, etc.).

From the need to the knowledge. Feeding emotions and thoughts: Assessing emotion regulation strategies in food tribes

Some people choose to follow a certain dietary habit because they are guided by strong beliefs, but also to pursue a healthy lifestyle. Food tribes are defined as social groups sharing common values and beliefs that underlie food and lifestyle choices. The current study aimed to investigate potential differences in emotion regulation between specific food tribes, and when comparing food tribes to people who conversely do not follow a dietary habit. Specifically, we examined the presence of rumination, psychological inflexibility, and emotional contagion as components of emotion dysregulation. A Google form was developed to obtain all the information needed to respond to our research questions and goals, and investigate the following food groups: Veganism, Fruitarianism, Raw Food Diet, Paleodiet, Blood Type group, Breatharianism, Macrobiotic Diet, and Other. The final sample consisted of 378 healthy subjects (117 males, 258 females, 3 other) ranging in age from 18 to 70 years. The first part of Google form consisted of general questions about the participant's dietary habits while the second part included specific questionnaires assessing the psychological constructs we investigated. Vegan people were less conditioned by others in their food choices when compared to the other food tribes. The Paleodiet group associated its food choice with health reasons as well as the Blood Type group. Differences were found in the presence of cognitive inflexibility and rumination, reflective thinking, emotional dysregulation, emotional contagion and also in the representation of their real and ideal (food) communities. Clinical implications are discussed.

Exploring the role of positive body image in healthy orthorexia and orthorexia nervosa: A gender comparison

Current scholarship on orthorexia nervosa remains undecided about the role of body image in this novel eating disorder. This study aimed to explore the role of positive body image in differentiating between healthy orthorexia and orthorexia nervosa and assess how this might differ for men and women. A total of 814 participants (67.1% women; age M = 40.30, SD = 14.50) completed the Teruel Orthorexia scale, as well as measures of embodiment, intuitive eating, body appreciation and functionality appreciation. A cluster analysis revealed four distinct profiles characterized by high healthy orthorexia and low orthorexia nervosa; low healthy orthorexia and low orthorexia nervosa; low healthy orthorexia and high orthorexia nervosa; and high healthy orthorexia and high orthorexia nervosa. A MANOVA identified significant differences for positive body image between these four clusters, as well as that there were no significant differences between men and women for healthy orthorexia and orthorexia nervosa, despite men scoring significantly higher than women on all measures of positive body image. Cluster × gender interaction effects were found for intuitive eating, functionality appreciation, body appreciation and experience of embodiment. These findings indicate that the role of positive body image in healthy orthorexia and orthorexia nervosa may differ for men and women, making these relationships worthy of further exploration.

Effects of single plant-based vs. animal-based meals on satiety and mood in real-world smartphone-embedded studies

Adopting plant-based diets high in fiber may reduce global warming and obesity prevalence. Physiological and psychological determinants of plant-based food intake remain unclear. As fiber has been linked with improved gut-brain signaling, we hypothesized that a single plant-based (vegetarian and vegan) compared to an animal-based (animal flesh) meal, would induce higher satiety, higher mood and less stress. In three large-scale smartphone-based studies, adults (nall = 16,379) ranked satiety and mood before and after meal intake. Meal intake induced satiety and higher mood. Plant-based meal choices did not explain differences in post-meal hunger. Individuals choosing a plant-based meal reported slightly higher mood before and smaller mood increases after the meal compared to those choosing animal-based meals. Protein content marginally mediated post-meal satiety, while gender and taste ratings had a strong effect on satiety and mood in general. We could not detect the profound effects of plant-based vs. animal-based meals on satiety and mood.

Psychometric properties of the Teruel Orthorexia Scale (TOS) among a French-Canadian adult sample

BACKGROUND

Psychometric properties of the Teruel Orthorexia Scale (TOS) have been examined in several languages (Arabic, English, Portuguese, Spanish, and Turkish), but not in French.

PURPOSE

The objective was to examine the psychometric properties of the TOS among a French-Canadian adult sample.

METHODS

Participants were 296 French-speaking Canadian adults (M = 34.2 years, SD = 11.9, 85.1% women). They completed the TOS alongside with several other measures (e.g., alcoholic consumption, cigarette smoking, disturbed eating attitudes and behaviors, frequency of physical activities, intuitive eating, vegetarian diet, and negative affect).

RESULTS

The results supported the a priori two-factor representation (orthorexia nervosa and healthy orthorexia) of the French version of the TOS and provided further support for the superiority of an exploratory structural equation modeling approach, relative to a confirmatory factor analytic approach. Furthermore, the results supported no differential item functioning as a function of respondents' characteristics (age, body mass index, diagnosis of eating disorders, frequency of physical activities, gender, and vegetarian diet). Latent mean differences were found in healthy orthorexia and orthorexia nervosa factors as a function of respondents' characteristics. Finally, significant correlations were found between TOS factors and convergent measures (alcohol consumption, cigarette smoking, disturbed eating attitudes and behaviors, intuitive eating, and negative affect).

CONCLUSION

The present study confirmed that the French version of the TOS has satisfactory psychometric properties (i.e., factor validity and reliability, no differential item functioning, and convergent validity).

LEVEL OF EVIDENCE

V, cross-sectional study.

Healthy orthorexia vs orthorexia nervosa: associations with body appreciation, functionality appreciation, intuitive eating and embodiment

PURPOSE

Current conceptualizations and measures of orthorexia nervosa may not be accurately distinguishing between the healthy vs pathological pursuit of a healthy diet, leading to very high prevalence rates and risking the pathologizing and stigmatizing of healthy eating more generally. Recent research has identified healthy orthorexia as a novel construct conceptually distinct from orthorexia nervosa, which represents the non-pathological pursuit of a healthy diet. In light of the strong body of evidence supporting the role of positive body image in eating behavior, the current study aimed to examine the associations between healthy orthorexia, orthorexia nervosa, intuitive eating and indices of positive body image.

METHODS

The current study employed a cross-sectional design. An online community sample (N = 835; 62% women; M_age = 40.24, SD = 14.45) completed self-report questionnaires including the Teruel Orthorexia Scale, Body Appreciation Scale-2, Functionality Appreciation Scale, Intuitive Eating Scale-2, and Experience of Embodiment Scale.

RESULTS

Intuitive eating and indices of positive body image were significantly positively associated with healthy orthorexia and inversely associated with orthorexia nervosa. A hierarchical multiple regression analysis found that intuitive eating and indices of body image were uniquely associated with 13.3% of the variance of healthy orthorexia above and beyond that accounted for by orthorexia nervosa. Intuitive eating moderated the relationship between healthy orthorexia and orthorexia nervosa.

CONCLUSION

The findings of this study provide support for intuitive eating and indices of positive body image as worthy of further exploration as important factors which distinguish between healthy orthorexia and orthorexia nervosa.

LEVEL OF EVIDENCE

V, descriptive study.

Development and Validation of an Eating-Related Eco-Concern Questionnaire

Eco-concern, the distress experienced relating to climate change, is associated with mental health, yet no study has examined disordered eating related to eco-concern. This study developed and validated a 10-item scale assessing Eating-Related Eco-Concern (EREC). Participants (n = 224) completed the EREC, Climate Change Worry Scale (CCWS), and Eating Disorder Examination-Questionnaire (EDE-Q). Construct validity, convergent validity, and internal consistency were evaluated. Sex differences in EREC were evaluated using t-tests. Associations among the EREC, CCWS, and EDE-Q were evaluated using linear regression models. Sensitivity analyses were conducted in individuals below EDE-Q global score clinical cut-offs. Factor analysis suggested that all items loaded adequately onto one factor. Pearson's correlation and Bland-Altman analyses suggested strong correlation and acceptable agreement between the EREC and CCWS (r = 0.57), but weak correlation and low agreement with the EDE-Q global score (r = 0.14). The EREC had acceptable internal consistency (α = 0.88). No sex difference was observed in the EREC in the full sample; females had a significantly higher mean score than males in sensitivity analysis. The EREC was significantly positively associated with the CCWS and EDE-Q global and shape concern scores, but not in sensitivity analysis. The EREC is a brief, validated scale that can be useful to screen for eating-related eco-concern.

Traditional, Vegetarian, or Low FODMAP Diets and Their Relation to Symptoms of Eating Disorders: A Cross-Sectional Study among Young Women in Poland

Background: Eating disorders (EDs) are an ever-growing problem, seen most commonly among young women. People with EDs are particularly predisposed to restrictive eating patterns. Diet therapy for many diseases involves the elimination of certain food groups, and the use of restrictive diets in people with EDs may indirectly influence the recurrence of the disorder. The aim of this study was to assess the prevalence of the possible presence of EDs and orthorexia symptoms among young women following a traditional, alternative (vegetarian), or therapeutic (low FODMAP) diet. Methods: The analysis was based on 420 responses from female respondents aged 19 to 30 years. The research tool consisted of questionnaires to assess the possible presence of EDs (SCOFF), cognitive-behavioral aspects of eating (TFEQ-13), and the presence of orthorexia symptoms (ORTO-15). Results: Uncontrolled and emotional eating was least common in women on a vegetarian diet (5.6 ± 3.7; 3.5 ± 2.7; p < 0.05). Women on a low FODMAP diet were most prevalent with symptoms of orthorexia (n = 37, 47.4%; p < 0.05). Conclusions: It seems important to perform screening tests for eating disorders before recommending diet therapy in order to individually adjust the dietary regimen and refer patients to appropriate specialists.

Exploring the role of mindful eating and self-compassion on eating behaviours and orthorexia in people following a vegan diet

Orthorexia nervosa (ON) is a new concept that is more prevalent in vegan populations. ON is characterised by obsessive focus on healthy eating, following restrictive dietary practices and dietary restrictions escalating over time. The aim of this study was to explore problematic eating behaviours in a vegan population, and to explore whether mindful eating and self-compassion have an impact on ON. Two hundred and eighty-seven females and twenty-eight males who followed a vegan diet completed scales in Orthorexia, Self-Compassion, Mindful, Emotional, External and Restraint Eating. The results indicated that individuals with high levels of ON display low levels of self-compassion, and high levels of restrained eating. Moreover, the findings indicated that self-compassion, but not mindful eating, partially mediated the relationship between restrained eating and orthorexia nervosa. The present results contribute to a better understanding of orthorexic eating behaviours in a vegan population, and identifies the mediating capacity of self-compassion. Further implications and future directions are discussed.Level of evidence: Level V, cross-sectional descriptive study.

Individual differences in selective attentional bias for healthy and unhealthy food-related stimuli and social identity as a vegan/vegetarian dissociate "healthy" and "unhealthy" orthorexia nervosa

Previous work identified the operation of an attentional bias (AB) towards healthy food related stimuli among those with increasing tendencies towards orthorexia nervosa (ON) using a modified Stroop task. The current work aimed to replicate and extend our understanding of this effect by incorporating alternative measures of AB (i.e., the dot probe task) and ON (i.e., the Teruel Orthorexia Scale [ToS]) in a sample of self-defined vegans/vegetarians. The theoretical assertion of the ToS is the conceptual broadening of orthorexia with differentiable dimensions - one characterised as a "healthy" preoccupation with healthy food/eating patterns (HeOr) and the other by a more underlying pathology (OrNe). This study also aimed to examine the pattern of responding across these two dimensions according to factors known to predict ON. Eighty-six participants (mean age = 33.0 years; 20 males, 66 females) completed measures of obsessive compulsivity, perfectionism, state/trait anxiety and ToS as well as a dot probe designed to measure AB for healthy and unhealthy-related food stimuli, threat ratings of each of words utilised and perceived identity centrality as a vegan/vegetarianism. Results showed a dissociation of predicted determinants for "healthy" ON (HeOr) and pathological ON (OrNe). HeOr was predicted by increasing identity centrality whereas OrNe was predicted by increased OCD and perfectionism, and increased interference for healthy-related food words (in particular slowed disengagement) and not unhealthy related food words. Threat-related ratings of unhealthy food words was shown to be common across both dimensions. This pattern highlights cognitive and individual differences-based correlates of pathological and non-pathological ON.

Orthorexia nervosa and dieting in a non-clinical sample: a prospective study

PURPOSE

Orthorexia Nervosa (ON) is characterised by excessive attention to a dietary regimen perceived as healthy. A critical factor in the distinction between ON and other eating disorders (EDs) is the dichotomy of quality-versus-quantity of food intake. We investigated whether specific types of diet or dieting frequency are associated with orthorexic features, explored the overlap between ON and EDs symptoms, and examined which constructs are predictive of ON after 6 months.

METHODS

A total of 1075 students (75.1% female, mean age 20.9) completed a set of questionnaires assessing Orthorexia, Eating Disorders, Obsessions and Compulsions, Anxiety and Depression; 358 individuals (79.9 female, mean age 20.9) agreed to participate in the study and completed the same questionnaires after 6 months. Different regression models were defined to investigate our hypothesis.

RESULTS

Findings suggest that ON is associated with the number and type of diets followed over a lifetime. Moreover, participants with EDs, body dissatisfaction, or a dysfunctional idea of thinness are more likely to report a greater degree of ON features. After 6 months, the best predictors of ON characteristics are the same ON characteristics assessed at the first administration, with a significant role in the ideal of thinness.

CONCLUSIONS

ON is more frequent in individuals with a previous diagnosis of EDs and in individuals who followed a restrictive diet or a vegan/vegetarian one; the number of lifetime diets, beliefs, and behaviors related to the ideals of thinness or body dissatisfaction is common features of ON. Moreover, considering that having ON features in the past is the best ON predictor in the present, we can presume that ON is a construct stable over time.

LEVEL OF EVIDENCE

Level IV: Evidence obtained from multiple time series analysis such as case studies. (NB: Dramatic results in uncontrolled trials might also be regarded as this type of evidence).

Orthorexia nervosa and its association with narcissism in fitness center users

PURPOSE

Orthorexia nervosa (ON) is an eating behavior where patients obsessively try to reach health through "purity" of food. Narcissism is a personality trait characterized with the self-belief of grandiosity, importance and need of appreciation. Both of these conditions are connected through self-image in way of reaching perfection through health and body image, whereas one of the ways for reaching it is exercising. This cross-sectional study aimed to investigate ON and its possible association with narcissism in fitness center users.

METHODS

The study included 1017 fitness center users and three questionnaires were used for the assessment: general information, ORTO-R and Narcissistic personality inventory-13 (NPI-13).

RESULTS

There was a significant negative correlation (r = - 0.467, p < 0.001) between the ORTO-R score and the NPI-13 score. Comparison of the ORTO-R score between different durations of using a fitness center showed statistically significant differences (H = 134.72, p < 0.001). The subjects who are using the fitness center for less than 1 year have the highest ORTO-R score, while those who are using it 1-3 years have the lowest ORTO-R score. Moreover, multiple linear regression showed that ORTO-R score retained significant association with NPI-13 (β ± SE, - 0.416 ± 0.026, p < 0.001) and the duration of using a fitness center (0.576 ± 0.068, p < 0.001) after model adjustment for age and BMI.

CONCLUSION

These results are implying that fitness center users could possibly be vulnerable of developing ON and that there is a strong association between ON and narcissism in this population. However, future larger-scale longitudinal studies are needed to address these findings.

LEVEL OF EVIDENCE

Level V, cross-sectional survey-based study.

What do Italian healthcare professionals think about orthorexia nervosa? Results from a multicenter survey

PURPOSE

Orthorexia nervosa (ON) is an obsession for healthy and proper nutrition. Diagnostic criteria for ON are lacking and the psychopathology of ON is still a matter of debate in the clinical and scientific community. Our aim was to better understand the Italian clinical and scientific community's opinion about ON.

METHODS

Anonymous online survey for Italian healthcare professionals, implemented with the REDCap platform and spread through a multicenter collaboration. Information was gathered about socio-demographic, educational and occupational features, as well as about experience in the diagnosis and treatment of EDs. The main part of the survey focused on ON and its features, classification and sociocultural correlates.

RESULTS

The survey was completed by 343 participants. Most responders (68.2%) considered ON as a variant of Eating Disorders (EDs), and 58.6% a possible prodromal phase or evolution of Anorexia Nervosa (AN). Most participants (68.5%) thought the next DSM should include a specific diagnostic category for ON, preferably in the EDs macro-category (82.1%). Moreover, 77.3% of responders thought that ON deserves more attention on behalf of researchers and clinicians, and that its treatment should be similar to that for EDs (60.9%). Participants thinking that ON should have its own diagnostic category in the next DSM edition had greater odds of being younger (p = 0.004) and of considering ON a prodromic phase of another ED, such as AN (p = 0.039).

DISCUSSION

Our survey suggests that the scientific community still seems split between those who consider ON as a separate disorder and those who do not. More research is still needed to better understand the construct of ON and its relationship with EDs; disadvantages and advantages of giving ON its own diagnosis should be balanced.

LEVEL OF EVIDENCE

V (descriptive cohort study).

Functional gastrointestinal symptoms and increased risk for orthorexia nervosa

PURPOSE

Recent guidelines point out the possible risk for orthorexia nervosa in functional gastrointestinal disorders, however, to date, no study has investigated this association. The present study aimed to explore the potential relationship between irritable bowel syndrome-related functional gastrointestinal symptoms and certain maladaptive eating behaviours, such as symptoms of orthorexia nervosa and emotional eating.

METHODS

A sample of 644 Hungarian volunteers (M_age = 22.37; SD_age = 3.95) completed a survey with the following questionnaires: the Rome IV Diagnostic Questionnaire (R4DQ) for adults-Irritable bowel syndrome module for the measurement of functional gastrointestinal symptoms, the Hungarian version of the ORTO-15 questionnaire (ORTO-11-Hu) to assess symptoms of orthorexia nervosa, the Three-Factor Eating Questionnaire (TFEQ) Emotional Eating subscale to measure symptoms of emotional eating and the Short Health Anxiety Inventory (SHAI) for the assessment of health anxiety. Spearman's rank correlation was used to explore the associations between the measured variables, and structural equation modeling was used to test the proposed mediation models.

RESULTS

Functional gastrointestinal symptoms were positively related to symptoms of orthorexia nervosa and emotional eating. The relationship between functional gastrointestinal symptoms and symptoms of orthorexia nervosa was partially mediated by health anxiety, while the association between functional gastrointestinal symptoms and symptoms of emotional eating was partially mediated by symptoms of orthorexia nervosa.

CONCLUSION

Our findings highlight the possible risk for developing orthorexic symptoms in functional gastrointestinal symptoms, which could lead to other types of disordered eating patterns, such as emotional eating. The results also underscore the potential role of health anxiety in these relationships.

LEVEL OF EVIDENCE

Level V (descriptive cross-sectional study).

Investigating Orthorexia Nervosa With the ORTO-R in a Sample of University Students With or Without Subthreshold Autism Spectrum: Focus on Dietary Habits and Gender Differences

BACKGROUND

The aim of the present study was to investigate the presence of Orthorexia (ON) symptoms in a sample of University students with or without autistic traits (AT), specifically focusing on evaluating the role of gender and of dietary habits in the association between ON and autism spectrum.

METHODS

Subjects were requested to anonymously fill out the questionnaires through an online form.

RESULTS

Two thousand one hundred forty students participated in the study. Subjects with significant AT, measured by means of the Adult Autism Sub-threshold spectrum (AdAS Spectrum) reported significantly higher ON symptoms, as measured by ORTO-R scores, than subjects with low AT. Females and subjects following a vegetarian/vegan diet reported significantly higher ORTO-R scores than males and than subjects following an omnivorous diet, respectively. Significant positive correlations were found between ORTO-R and AdAS Spectrum scores. A decision tree model, with gender, type of diet and presence of high AT as independent variables and ORTO-R score as dependent variable, showed in the first step the presence of significantly higher ORTO-R scores among females than among males, and in the second step showed in both genders the presence of higher ORTO-R scores among subjects with high AT than in those with low AT. A significant interaction of gender and presence/absence of high AT was reported on ORTO-R score, with a higher increasing trend of ORTO-R score with the increase of AdAS Spectrum score among females than among males.

CONCLUSIONS

Our results further highlighted the association between AT and ON, in particular among females.

To further understand orthorexia nervosa: DOS validity for the Portuguese population and its relationship with psychological indicators, sex, BMI and dietary pattern

PURPOSE

Orthorexia nervosa (ON) is considered a pathological fixation with healthy eating. Despite recent research focus, there is still a lot of inconsistent information concerning ON, including its definition and validity of its measuring tools. This study aimed to extend the current knowledge on ON, by developing and validating the Portuguese adaptation of the Dusseldorf Orthorexie Scale (DOS) and studying its prevalence and relationship with different psychological indicators, sex, BMI and dietary pattern.

METHODS

Data were collected online, through self-report questionnaires, and two different samples were collected, with 513 (Sample 1) and 541 participants (Sample 2) from the general population.

RESULTS

DOS' one-dimensional factorial structure and reliability was confirmed. ON's prevalence was 10.52%. Results revealed that women present higher scores on DOS than men, but no differences were found regarding the BMI groups. DOS was positively related to all psychological indicators, with moderate and strong relationships with disordered eating and inflexible eating. Sample 2 was used to explore ON's differences between dietary patterns, with results demonstrating that omnivores present significantly lower levels of orthorexic tendencies, when compared with the vegetarian, vegan, and paleo groups.

CONCLUSIONS

The present study is the first to successfully validate a measure that assesses ON for the Portuguese population and adds to the existing literature in several other important ON aspects.

LEVEL OF EVIDENCE

Level V-validation study.

Orthorexia Nervosa: differences between clinical and non-clinical samples

BACKGROUND

Orthorexia Nervosa (ON) is a construct characterized by behaviors, emotions, and beliefs on eating healthy food and excessive attention to diet; moreover, dieting has been considered a risk factor in ON symptoms development. The principal aim of this study was to investigate the differences in clinical and non-clinical groups most at risk of ON. Aspects that could be associated with ON (Eating Disorders [EDs], obsessive-compulsive symptomatology, perfectionistic traits, anxiety, depression, Body Mass Index [BMI]) were investigated in all groups.

METHODS

The sample consisted of 329 adults belonging to four different groups. Three were on a diet: Anorexia/Bulimia Nervosa group (N = 90), Obesity/Binge Eating Disorder group (N = 54), Diet group (N = 91). The Control group consisted of people who were not following a diet (N = 94). Participants completed several self-administered questionnaires (EHQ-21, EDI-3, OCI-R, MPS, BAI, BDI-II) to assess ON-related features in different groups.

RESULTS

Analyses highlighted higher orthorexic tendencies in Anorexia/Bulimia Nervosa, Obesity/BED, and Diet groups than in the Control group. Moreover, results have shown that in the AN/BN group, eating disorders symptomatology and a lower BMI were related to ON and that in Obesity/Binge Eating Disorder and Diet groups, perfectionism traits are associated with ON.

CONCLUSION

Individuals who pursue a diet share some similarities with those who have an eating disorder regarding emotions, behaviors, and problems associated with orthorexic tendencies. Moreover, perfectionistic traits seem to predispose to higher ON tendencies. In general, these results confirm the ON as an aspect of the main eating disorders category.

The Polish version of the Düsseldorf Orthorexia Scale (PL-DOS) and its comparison with the English version of the DOS (E-DOS)

PURPOSE

Although orthorexia nervosa, the fixation on health-conscious eating behaviour, was first described in the 90 s, there is no clear understanding whether existing ON measures are appropriate for its assessment. The objectives of the present study were to: (1) examine the psychometric properties of the Polish version of the DOS (PL-DOS) and to compare the PL-DOS with the English version of the DOS (E-DOS) as well as (2) evaluate the prevalence of ON among Polish university students and compare the prevalence rates of ON among Polish and U.S. students.

METHODS

Four-hundred and twelve students (77.2% female) with a mean age of 24.62 years (SD = 6.86) participated in the present study. All participants completed the Polish version of the Düsseldorf Orthorexia Scale (PL-DOS), the Eating Habits Questionnaire (EHQ) and the Eating Disorder Inventory (EDI).

RESULTS

Reliability analysis for the PL-DOS showed strong internal consistency with a Cronbach's alpha coefficient of 0.840 and a coefficient omega of 0.840, 95% CI [0.808, 0.866]. Significant correlation coefficients were found between the PL-DOS and all subscales of the EHQ. Confirmatory factor analysis showed that the one-factor model had poor fit. Polish students had an ON prevalence rate of 6.6%, lower than that of U.S. students (8%).

CONCLUSIONS

Our findings validate the use of the PL-DOS as an appropriate ON measure for a Polish population.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Development and Validation of the Test of Orthorexia Nervosa (TON-17)

This study aims to develop and validate a new self-report questionnaire to measure orthorexia nervosa (ON). Based on a current review of the scientific literature and interviews with people at risk of orthorexia, 40 items were selected to test orthorexia nervosa (TON-40). A total sample of 767 individuals (M = 26.49, SD = 9.66, 56.98% women) participated in the study. The exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and composite construct analysis (CCA) were performed to find an appropriate model of sufficient reliability and validity and stable construction. Convergent validation was performed regarding the correlation of the TON-17 with another measure of ON (ORTO-15), eating disorders (the EAT-26 and DEAS), healthy behavior (the HBI), quality of life (the Brief WHOQOL), physical health (the GRSH), anxiety (the GAD-7), depression (the PHQ-9), and obsessive-compulsive disorder (the OCI-R). Gender, Body Mass Index (BMI), and the medical reasons for a restrictive diet were also examined. As a result of the structural analyses, the number of items was reduced from 40 to 17. The best fit indices of the TON-17 were found for the hierarchical bi-factor model, with three lower-order factors (Control of food quality, Fixation of health and healthy diet, and Disorder symptoms) and one general higher-order factor (Orthorexia). According to the 95th percentile method of estimation, the prevalence of ON was 5.5% for the TON-17 total score. The TON-17 scale and subscales showed good psychometric properties, stability, reliability, and construct validity. The TON-17 indicated a positive relationship with the ORTO-15, EAT-26, DEAS, HBI, OCI-R, GAD-7, and PHQ-9. TON-17 can be considered as a useful tool for assessing the risk of ON.

Orthorexia Nervosa Inventory (ONI): development and validation of a new measure of orthorexic symptomatology

PURPOSE

To overcome the problems associated with existing measures of orthorexia, we assessed the reliability and validity of a new measure: the Orthorexia Nervosa Inventory (ONI).

METHOD

An online survey was completed by 847 people recruited from undergraduate nutrition and psychology courses and from advertisements in Facebook and Instagram targeting both healthy eaters (with keywords such as "clean eating" and "healthy eating") and normal eaters (with keywords such as "delicious food" and "desserts").

RESULTS

Exploratory factor analysis revealed three factors with 9 items assessing behaviors and preoccupation with healthy eating, 10 items assessing physical and psychosocial impairments, and 5 items assessing emotional distress. With this sample, all scales demonstrated good internal consistency (Cronbach's α = 0.88-0.90) and 2-week test-retest reliability (r = 0.86- 0.87). Consistent with past research, ONI scores were significantly greater among vegetarians and vegans, and among those with higher levels of disordered eating, general obsessive-compulsive tendencies, and compulsive exercise. Additionally, whereas ONI scores did not significantly differ between men and women, the scores were negatively correlated with body mass index.

CONCLUSION

The ONI is the first orthorexia measure to include items assessing physical impairments that researchers and clinicians agree comprise a key component of the disorder. Additionally, at least for the current sample, the ONI is a reliable measure with expected correlations based on the past research.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

Orthorexic tendencies moderate the relationship between semi-vegetarianism and depressive symptoms

PURPOSE

Vegetarianism and semi-vegetarianism (i.e., overly vegetarian diet with rare consumption of meat) have been repeatedly linked with depression. As the nature of this association is unclear, we explored whether orthorexic (i.e., pathologically healthful eating) tendencies and ecological/ethical motives to follow a vegetarian diet may moderate the relationship between (semi-)vegetarian diets and depressive symptoms.

METHODS

Five-hundred eleven adults (63.4% females; 71.2% omnivores, 19.2% semi-vegetarians, 9.6% vegetarians) completed the Patient Health Questionnaire (PHQ-9) questionnaire-measuring depressive symptoms-and the Düsseldorf Orthorexia Scale (DOS)-measuring orthorexic tendencies. Based on respective questions, participants were categorized as omnivores, semi-vegetarians, and vegetarians (including vegans) and were asked to indicate whether they chose their diet based on ecological/ethical motives. Moderation analyses were carried out with PROCESS.

RESULTS

Adjusted for age, sex, and body mass index, there was a statistically significant interaction effect between diet (omnivore vs. semi-vegetarianism vs. vegetarianism) and DOS scores when predicting PHQ depression scores. At low or medium DOS scores, diets did not differ in PHQ depression scores (all ps > 0.05). At high DOS scores, however, semi-vegetarians had higher PHQ depression scores than both omnivores (p = 0.002) and vegetarians (p < 0.001). The interaction between diet and ecological/ethical eating motives when predicting PHQ depression scores was not statistically significant (p = 0.41).

CONCLUSION

Semi-vegetarians with strong orthorexic tendencies show more depressive symptoms than omnivores and vegetarians. The complex nature of the relationship between vegetarianism and depression requires further investigation.

LEVEL OF EVIDENCE

III, case-control analytic studies.

Assessing Orthorexia Nervosa: Validation of the Polish Version of the Eating Habits Questionnaire in a General Population Sample

Extreme focus on healthy eating, called orthorexia nervosa (ON), was assessed using a 21-item Eating Habits Questionnaire (EHQ). The present study aimed to validate the Polish version of the EHQ in a general population sample. Nine hundred sixty-seven women (59%) and men participated in the present study. Data was obtained from an internet-administered survey. Exploratory factor analysis with the first split sample (n = 502) produced a three-factor solution accounting for 47% of the variance. In confirmatory factor analysis with the second split sample (n = 465), the three-factor structure showed satisfactory goodness-of-fit (comparative fit index (CFI) = 0.99, root mean square error of approximation (RMSEA) = 0.008). Reliability analysis for the Polish version of the EHQ across the whole questionnaire showed strong internal consistency (α = 0.88, intraclass correlation coefficient (ICC) = 0.86). The internal consistency, measured by Cronbach's alpha coefficients, for the EHQ subscales were 0.85 (knowledge), 0.81 (problems), and 0.81 (feelings and behaviors). Total EHQ score was positively correlated with its three subscales, cognitive restraint, uncontrolled eating, and emotional eating, and was negatively correlated with body mass index (BMI). The Polish version of the EHQ is a reliable questionnaire that can be used with confidence to better assess ON in a general population sample.

Restrained Eating and Vegan, Vegetarian and Omnivore Dietary Intakes

There are a significant number of studies on cognitive restraint among individuals with varying dietary patterns. Although most research has found that vegetarians report higher levels of cognitive restraint compared to non-vegetarians, many studies have contributed inconsistent results. The aim of the current study, therefore, was to assess any differences between groups with varying dietary patterns on cognitive restraint and other disordered eating pattern. The second objective was to examine determinants of cognitive restraint in individuals adhering to a vegan diet, a vegetarian diet and an omnivore diet. Two-hundred and fifty-four participants with varying dietary patterns completed the Three-Factor Eating Questionnaire, the Perseverative Thinking Questionnaire and the Eating Habits Questionnaire. Our results indicated that both vegetarian and vegan groups showed a significantly lower cognitive restraint, lower emotional eating and lower uncontrolled eating than those who followed an omnivorous diet. In addition, these both groups following a plant-based diet have shown more cognitions, behaviours and feelings related to an extreme focus on healthy eating (orthorexia nervosa) than group following an omnivorous diet. There were no significant differences between the groups in perseverative thinking. Core characteristics of repetitive negative thinking was a significant predictor of cognitive restraint in vegans. Feeling positively about healthy eating predicted cognitive restraint among vegetarians. Problems associated with healthy eating and feeling positively about healthy eating predicted cognitive restraint among individuals following an omnivorous diet. Knowledge of predictors of cognitive restraint may serve as a psychological intervention goal or psychoeducation goal among individuals with varying dietary patterns.

Orthorexia Nervosa, a challenging evaluation: analysis of a sample of customers from organic food stores

An excessive control of quality of food can turn into Orthorexia Nervosa (ON). The organic store customers (OSCs) can be apopulation at risk for ON. The aims of this study were to assess ON symptoms prevalence among them, comparing them with non-OSCs and investigate potential predictors of ON. Across-sectional survey was carried among 121 OSCs and 119 non-OSCs. The questionnaire assessed socio-demographic characteristics and investigated current dietary habits. The main outcome measures used were ORTO-15 and Eating Habits Questionnaire (EHQ). Chi-squared analyses were performed to assess differences between groups (OSCs and non-OSCs). Logistic and linear regressions were performed to evaluate potential predictors of ON symptoms and to compare questionnaires. As main results, OSCs had ahigher probability to result positive at ORTO-15 compared to non-OSCs. The prevalence among OSCs was 69.4% and 23.1% (using ORTO-15 with 40 and 35 cut-offs). Higher EHQ scores were reported among OSCs (p < 0.001). Potential predictors were mainly being an OSC or following food restrictions. Predictors varied using different cut-offsof ORTO-15 and EHQ. These results suggest the association between OSCs and ON symptoms. Some differences were found between ORTO-15 and EHQ. Further studies need to be performed to improve diagnostic tools.

Interaction between Vegetarian Versus Omnivorous Diet and Unhealthy Eating Patterns (Orthorexia Nervosa, Cognitive Restraint) and Body Mass Index in Adults

The objective of the present study was two-fold: Firstly, to investigate unhealthy eating patterns and body mass index among individuals following a vegetarian diet and those following an omnivorous diet. Secondly, to examine interaction between vegetarian versus omnivorous diet and unhealthy eating patterns (orthorexia nervosa, cognitive restraint) and body mass index using a structural equation modeling approach (SEM). The study included 370 participants: 188 participants following a vegetarian diet and 182 following an omnivorous diet. Unhealthy eating patterns and body mass index were measured. Our results showed that individuals following a vegetarian diet were more likely to engage in orthorexic eating behavior compared to individuals following an omnivorous diet. In addition, they had a significantly lower levels of cognitive restraint and lower body mass index than individuals following an omnivorous diet. Use of SEM method showed that: (1) following a vegetarian diet and orthorexia nervosa were directly associated, (2) following an omnivorous diet and cognitive restraint were directly related and (3) following an omnivorous diet had a greater tendency to cognitive restraint and an elevated body mass index. More research is necessary to further understand the complexity of the relationship between type of diet and unhealthy eating patterns in adults.