Prevalence of orthorexia among medical students in Erzurum, Turkey

Evaluation of factors related to organic food consumption and orthorexia nervosa tendencies

The relationship between organic food consumption, awareness of reducing ecological footprint, and orthorexia nervosa (ON) tendencies has yet to be explored in detail. This study aimed to determine factors related to organic food consumption and ON tendencies in young adults. Also, the relationship between organic food consumption, awareness of reducing ecological footprint, and ON tendencies was investigated. This study was conducted with 887 young adults (58.4% female, 41.6% male, aged 18-25 years, mean age 20.8 ± 2.55 years). Study data were obtained with a web-based questionnaire. The questionnaire included socio-demographic characteristics, anthropometric measurements, the Organic Food Consumption Scale (OFC), ORTO-11, and the Awareness Scale for Reducing Ecological Footprint (ASREF). While 17.2% were overweight or obese, 74.9% had a normal body weight. There were no differences by sex in terms of ORTO-11, OFC, and ASREF total scores (p > .05). Significant positive correlations were found between ASREF and OFC (p < .001), while negative correlations were found for ORTO-11 and OFC (p < .001). A higher ASREF and increased ON tendencies predicted increased organic food consumption (p < .05). Furthermore, higher organic food consumption behaviors and awareness of reducing ecological footprint predicted increased ON tendencies (p < .05). Findings from this study will contribute to a deeper understanding of the factors associated with organic food consumption and ON tendencies among individuals. By shedding light on the interplay between ecological awareness, organic food consumption, and orthorexic tendencies, policymakers and health professionals can develop targeted interventions to promote sustainable and healthy food consumption.

Unveiling Anxiety Factors in Orthorexia Nervosa: A Qualitative Exploration of Fears and Coping Strategies

Orthorexia nervosa represents a controversial phenomenon in the realm of eating practices, characterized by an obsessive fixation on consuming only foods deemed 'healthy', and a preoccupation with food purity. While the existing literature has identified the presence of stressful behaviors among individuals with orthorexia, the precise factors and circumstances eliciting these stress-inducing emotions remain the subject of ongoing inquiry. This study aims to explore the triggers and situations that precipitate stressful beliefs and emotions among individuals who self-identify as preoccupied with healthy eating, as well as the coping mechanisms developed to manage these feelings. Through conducting one-to-one interviews with thirteen individuals, thematic analysis was employed to elucidate the nuances of their experiences. Participants articulated concerns regarding the contamination of foods available in supermarkets and restaurants, thereby prompting the meticulous selection of food sources and aversion to dining out. The prospect of trying new foods and engaging in social gatherings involving food emerged as anxiety-inducing scenarios, prompting individuals to adhere to monotonous dietary patterns and impose self-isolation. Additionally, medical appointments were perceived as stressful, driven by health concerns underpinning the adoption of stringent dietary practices. These findings underscore the spectrum of fears and coping mechanisms exhibited by individuals with orthorexia nervosa, which hold profound implications for their overall well-being.

Orthorexic tendency and its association with weight control methods and dietary variety in Polish adults: a cross-sectional study

The methods for controlling weight play a central role in formally diagnosed eating disorders (EDs) and appear to be important in the context of other nonformally recognized disorders, such as orthorexia nervosa (ON). These methods also have an impact on eating behaviors, including dietary variety. Our study aimed to: (i) assess the intensity of ON tendency by sex and BMI groups, (ii) evaluate the associations between ON tendency, weight control methods, and dietary variety, and (iii) determine the extent to which weight control methods and dietary variety contribute to the ON tendency among both females and males. Data were gathered from a sample of 936 Polish adults (463 females and 473 males) through a cross-sectional quantitative study conducted in 2019. Participants were requested to complete the ORTO-6, the Weight Control Methods Scale, and the Food Intake Variety Questionnaire (FIVeQ). Multiple linear regression analysis was employed to evaluate associations between ON tendency, weight control methods, and dietary variety. Females exhibited a higher ON tendency than males (14.4 ± 3.4 vs. 13.5 ± 3.7, p < 0.001, d = 0.25). In the regression model, the higher ON tendency was predicted by more frequent use of weight control methods, such as restricting the amount of food consumed, using laxatives, and physical exercise among both females and males as well as following a starvation diet in females, and drinking teas to aid bowel movements among males. Moreover, the higher ON tendency was predicted by higher dietary variety, lower age in both sexes, and higher level of education among males. However, there were no differences in ON tendency across BMI groups. In conclusion, the findings showed that ON tendency was predicted by a higher frequency of weight control methods commonly used by individuals with anorexia nervosa (AN) and bulimia nervosa (BN). The resemblance to these two EDs is also suggested by the higher intensity of ON tendency among females and younger people. However, the prediction of ON tendency by dietary variety indicates that the obsessive preoccupation with healthy eating may not be advanced enough to observe a decrease in the dietary variety among these individuals.

Orthorexia Nervosa and Healthy Orthorexia in a Physically Active North American Population

The Teruel Orthorexia Scale (TOS) defines two related but distinct constructs: Orthorexia Nervosa (OrNe), a pathological fixation on a healthy diet, and Healthy Orthorexia (HeOr), an interest in a healthy diet independent of psychopathology. Here, we (a) assessed both types of Orthorexia in a large North American sample using the TOS and (b) explored if engaging in regular physical activity was associated with a greater risk of Orthorexia. A cohort of physically active adults (n = 927; 41% men) completed the TOS, as well as the Rapid Assessment of Physical Activity (RAPA), to broadly assess aerobic physical activity level and participation in strength and/or flexibility training. As expected, scores for HeOr and OrNe differed between participants, with lower scores for Orthorexia Nervosa in our physically active non-clinical sample. Higher HeOr scores were associated with lower BMI, and this was true for both men and women. We also found that measures of Orthorexia were associated with self-reported physical activity: active adults reporting more aerobic physical activity had higher HeOr scores, with the most active men having the highest scores. Notably, adults who reported regular strength training had higher scores for both HeOr and OrNe, with men who strength trained showing higher OrNe scores than women. Here, those who participate in regular strength training are more likely to exhibit orthorexic behaviors, and this effect was more pronounced for men than women. Prior work has validated the TOS in young, primarily female samples of non-English speakers outside the United States: present data from an age-diverse, physically active, gender balanced sample support the use of TOS for measurement of Orthorexia Nervosa and Healthy Orthorexia in English speakers and suggest that more work is needed to assess potential gender differences in these constructs.

Reliability generalization meta-analysis of orthorexia nervosa using the ORTO-11/12/15/R scale in all populations and language versions

BACKGROUND

The ORTO scale was developed in 2004 as a self-report questionnaire to assess symptoms of orthorexia nervosa (ON). ON is an unhealthy preoccupation with eating healthy food. The scale aims to measure obsessive attitudes and behaviors related to the selection, purchase, preparation, and consumption of pure, healthy food. Since its development, the ORTO-15 has been adapted into several shorter versions. The objective was to conduct a reliability generalization meta-analysis of the ORTO scale and its variant versions in all populations and languages.

METHODS

A systematic literature search was conducted to identify studies reporting the internal consistency of ORTO. Random-effect models were used to evaluate summary statistics of reliability coefficients, weighting the coefficients by the inverse variance using the restricted maximum likelihood method. The heterogeneity among the reliability coefficients was evaluated and assessed using numerous statistical metrics. The tau (τ), tau2 (τ2), I2, H2, R2, df, and the Q-statistic are among those obtained. Meta-regression analyses were used to examine moderators such as age and sex.

RESULTS

Twenty-one studies (k = 21) involving 11,167 participants (n = 11,167) were analyzed. The overall effect estimate on internal consistency was 0.59 (95% CI 0.49-0.68), with a minimum reliability coefficient of 0.23 and a maximum reliability coefficient of 0.83. The heterogeneity statistics were found to have an I2 of 99.31%, which suggested high heterogeneity owing to a decrease in the confidence interval (95% CI) and an increase in variability. Sensitivity analysis revealed that a few studies strongly influenced the overall estimate. Egger's test suggested possible publication bias. Neither age nor sex significantly moderated reliability via meta-regression.

CONCLUSIONS

The ORTO scale has a relatively low pooled reliability coefficient. Alternative ON assessment tools with enhanced psychometric properties are needed. Clinicians should not base diagnoses or treatment decisions on ORTO alone. Comprehensive psychiatric assessment is essential for accurate ON evaluation.

Healthy orthorexia, orthorexia nervosa, and personality traits in a community sample in Turkey

OBJECTIVE

Orthorexia nervosa is an eating disorder characterized by a rigid preoccupation with a perceived healthy diet. However, little is known about healthy orthorexia compared to orthorexia nervosa. The current study examined the relationship between healthy orthorexia and orthorexia nervosa and personality traits in a Turkish sample.

METHODS

Three hundred fifty participants from a community sample aged 18-65 were included in the study. Participants completed a sociodemographic data collection form, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Teruel Orthorexia Scale (TOS), and the 10-Item Personality Inventory (TIPI).

RESULTS

The frequency of healthy orthorexia was 32.3% and orthorexia nervosa was 10.2%. There were no differences between genders regarding healthy orthorexia and orthorexia nervosa scores. Healthy orthorexia symptoms were negatively correlated with depression and anxiety (r = -0.11 and r = -0.20, respectively, P < .05), while they were positively correlated with agreeableness (r = 0.17), conscientiousness (r = 0.14), and extraversion (r = 0.15). Orthorexia nervosa symptoms were positively associated with anxiety (r = 0.12), depression (r = 0.10), and healthy orthorexia (r = 0.55). Hierarchical regression analyses demonstrated that depression was negatively associated with healthy orthorexia symptoms, explaining 4% of the variance. The agreeableness trait was positively associated with healthy orthorexia symptoms, explaining 4% of the variance. However, no specific personality trait was associated with orthorexia nervosa symptoms.

CONCLUSION

To our knowledge, the present study is the first to examine the relationships between personality traits, healthy orthorexia, and orthorexia nervosa symptoms in a Turkish sample. Sociocultural factors may be important for understanding orthorexia nervosa and healthy eating behaviors in this population.

A Study of the Relationship between University Students' Food Neophobia and Their Tendencies towards Orthorexia Nervosa

Food neophobia, known as an avoidance of the consumption of unknown foods, can negatively impact nutritional quality. In orthorexia nervosa, there is an excessive mental effort to consume healthy food. Individuals exhibiting symptoms of food neophobia and orthorexia nervosa may experience food restrictions. This study aimed to assess food neophobia levels and orthorexia nervosa tendencies among university students, investigate the potential association between the two constructs, and explore the effect of the demographic characteristics of the participants on the variables. This is a descriptive cross-sectional study. The study sample consisted of 609 students enrolled at Recep Tayyip Erdoğan University. The data were collected through Google Forms using a sociodemographic information form, the Food Neophobia Scale, and the ORTO-11 scale. Ethics committee approval and institutional permission were obtained for the study. Of the students participating in the survey, 71.9% were female, 14.6% were classified as neophobic, and 47.1% had orthorexia nervosa symptoms. The mean scores from the Food Neophobia Scale (39.41 ± 9.23) and the ORTO-11 scale (27.43 ± 5.35) were in the normal range. Food neophobia was significantly higher among those who did not consume alcohol. Orthorexia nervosa symptoms were significantly more common among married people. In the correlation analysis, no significant relationship was found between age, food neophobia, and orthorexia nervosa. It can be said that food neophobia in this study is similar to in other studies conducted on university students. In addition, about half of the participants had symptoms of orthorexia nervosa. This result is higher compared to other studies conducted with university students. The findings of this study indicate that the participants care about the healthfulness of food.

The validation of the Barcelona Orthorexia Scale-Spanish version: evidence from the general population

PURPOSE

To validate the Spanish version of Barcelona Orthorexia Scale (BOS) in general population, analyzing its items and both its internal structure and psychometric properties (internal consistency and temporal stability). In addition, the relationship between ON and external measures of attitudes towards food was assessed.

METHOD

The general population sample consisted of 446 women and 104 men, aged between 18.31 and 69.44 years (M = 36.03; SD = 12.46). Of these, 39 participants answered again the questionnaires after one month from the first application. The assessment instruments were a sociodemographic questionnaire, the BOS, the Eating Attitudes Test-26 (EAT-26) and the Dutch Eating Behavior Questionnaire (DEBQ).

RESULTS

The final version of the BOS is composed of 35 items. Exploratory factor analysis extracted an internal structure of 5 factors (Behavioral, Concern for healthy food, Attitudes and beliefs about food, Vital achievement and Emotional discomfort). The BOS-35 and the factors presented good internal consistency (α = .80-.90), and an adequate temporal stability (r = .62-.88). The highest association was observed between the Emotional Distress (BOS) and the Diet subscale (EAT-26; r = .51).

CONCLUSIONS

This first validation of the BOS has shown adequate psychometric properties, being a valid and reliable instrument to assess ON in the general population. Level of evidence Level II: Evidence obtained from well-designed controlled trials without randomization.

Exploring the relationship between dysfunctional metacognitive processes and orthorexia nervosa: the moderating role of emotion regulation strategies

BACKGROUND

Dysfunctional metacognitive processes and emotional dysregulation have been widely documented in the eating disorder literature. Despite numerous research and recent consensus suggesting the categorization of orthorexia nervosa as a form of eating disorder, no previous study has examined whether aberrant metacognitive processes also correlate with orthorexia nervosa tendencies. This paper investigates potential associations between symptoms of orthorexia nervosa and dysfunctional metacognitive processes while also exploring whether such relationships may be influenced by adaptive/maladaptive emotion regulation strategies.

METHODS

We conducted a cross-sectional study in all Lebanese governorates. In total, 423 Lebanese adults completed an online questionnaire including the Teruel Orthorexia Scale, the Emotion Regulation Questionnaire, the Difficulties in Emotion Regulation Scale - 16 Item Version, and the Metacognitions Questionnaire - Short Form.

RESULTS

Higher physical activity, expressive suppression, emotion regulation difficulties, positive metacognitive beliefs about worry, and need to control thoughts were significantly associated with higher orthorexia nervosa. Additionally, the emotion regulation strategies moderated the relationships between two dysfunctional metacognitive processes and orthorexia nervosa. Specifically, cognitive self-consciousness was negatively related to orthorexia nervosa only in individuals with low (versus higher) emotion suppression (maladaptive emotion regulation strategy). In contrast, negative beliefs about worry uncontrollability and danger positively predicted orthorexia nervosa only in individuals with lower (versus high) cognitive reappraisal (adaptive emotion regulation strategy). Lower socio-economic status and having a university level of education compared to secondary level were significantly associated with lower orthorexia nervosa.

CONCLUSION

Our study provides the first empirical evidence for the existence of significant associations between dysfunctional metacognitive processes and orthorexia nervosa. It also highlights that these pathways are considerably modulated by individuals' ability to regulate their emotions adaptively versus maladaptively. Our findings thus suggest that therapies aimed at improving thought monitoring and emotional regulation may be beneficial for individuals with symptoms of orthorexia nervosa.

Orthorexia and Orthorexia Nervosa: A Comprehensive Examination of Prevalence, Risk Factors, Diagnosis, and Treatment

Orthorexia nervosa is an emerging and controversial eating disorder characterized by an obsessive preoccupation with healthy eating and an extreme fixation on food purity. Despite growing public interest in orthorexia, its classification as a distinct eating disorder remains a subject of ongoing debate in the mental health community. This paper comprehensively reviews the current literature on orthorexia nervosa, exploring the prevalence rates, risk factors, diagnosis, and treatment options. The paper offers an overview of orthorexia and its historical context and explores the challenges and considerations in diagnosing orthorexia and orthorexia nervosa. Specifically, the distinction between "orthorexia" and "orthorexia nervosa" is a debated issue in eating disorder research due to a lack of clear diagnostic criteria, making it challenging to accurately differentiate between an obsession with healthy eating and a more severe form with potential distress and impairment. Given the absence of formal diagnostic criteria, developing valid and reliable assessment tools is crucial to accurately identify and treat individuals experiencing these disorders. The paper's final section covers the existing treatment approaches for orthorexia nervosa. Overall, the paper highlights the complex and multifaceted nature of orthorexia nervosa. This review contributes to the ongoing discourse surrounding orthorexia and provides valuable insights for clinicians, researchers, and stakeholders in the mental health and eating disorders fields.

Maternal Bonding as a Protective Factor for Orthorexia Nervosa Risk in Dietetics Students

This study aimed to determine the prevalence of the risk of orthorexia nervosa (ON) in dietetics students in Greece, and its relationship with diet, risk of eating disorder (ED), body mass index (BMI), body image flexibility, and parental attachment. The participants were 132 dietetics students, with a mean age of 22.94 ± 3.5 years, who completed a series of questionnaires that recorded sociodemographic, clinical, and anthropometric characteristics; adherence to the Mediterranean diet (MedDiet); ON indicators as determined by the ORTO-15 questionnaire; body image flexibility, with the Body Image-Acceptance and Action Questionnaire (BI-AAQ-5); the risk for ED as assessed using the EAT-26; anxiety level according to the STAIT 6 instrument; and recollection of their parents' attitudes towards them during the first 16 years of life, with the Parental Bonding Instrument (PBI). ON risk appeared to be significantly associated with BMI (p = 0.002), exercise frequency (p = 0.023), anxiety level (p = 0.002), risk of ED (p < 0.001), body image inflexibility (p < 0.001), and inversely with the affectionate constraint of maternal bonding (p = 0.036). In conclusion, disordered eating behaviors and body shape concerns are prevalent among dietetics students, with parental attachment to the mother influencing their occurrence. Identification of potential ON and development of prevention mechanisms during childhood could help eliminate these concerns and improve the lives of dietetics students.

Perfectionism or Perfectionisms in Orthorexia Nervosa

Purpose: Perfectionism is considered a transdiagnostic construct that characterises eating disorders (EDs) and obsessive-compulsive disorder (OCD) and that could also depict orthorexia nervosa (ON). The principal aim of this study was to investigate what dimensions of perfectionism mostly represent ON. Moreover, it was evaluated if dieting impacted the presence of orthorexic features and perfectionistic behaviour. Methods: The sample consisted of two groups-the "Diet" (n = 93), and the "No Diet" (n = 94) groups-composed of people with high and low orthorexic tendencies, respectively. Participants filled out self-report questionnaires to investigate orthorexic tendencies and different facets of perfectionism. Results: Analyses highlighted that people with high orthorexic tendencies showed higher perfectionistic features and that ON had a significant relationship with different facets of perfectionism. No interactions with diet were found. Therefore, no other differences were highlighted when the group type (Diet/No Diet) was considered. Conclusions: Regardless of diet, different facets of perfectionism characterise ON: perfectionism as a personality trait and perfectionism related to EDs and to obsessive-compulsive features. Our results evidenced that perfectionism could also be considered a useful construct in the conceptualization of orthorexia nervosa.

Nutrition knowledge, diet quality and orthorexic behaviors in Polish students-a pre-post repeated cross-sectional study

Nutrition knowledge acquired in college students may not only help in promoting an adequate diet, but also lead to excessive preoccupation with healthy eating, which is referred to as orthorexic behaviors. This study aimed to assess the relationship between nutrition knowledge, diet quality and orthorexic behaviors among college students of food and nutrition majors. Data were collected from a sample of 131 college students through a pre-post repeated cross-sectional study conducted from 2018 to 2021. The participants were asked to complete the ORTO-6 questionnaire, the nutrition knowledge test "GAROTA", and the Beliefs and Eating Habits Questionnaire (KomPAN). The results indicated that students' preoccupation with healthy eating (orthorexic behaviors score) during the study period did not change, in contrast nutrition knowledge and diet quality increased. There was no correlation between the orthorexic behaviors score and the nutrition knowledge score, both at the beginning and end of the study. At the beginning of the study, the orthorexic behaviors score correlated positively with "Pro-Healthy Diet Index" and "Diet-Quality Index", and inversely with "Non-Healthy Diet Index". However, at the end of the study, no significant correlations were observed between these variables. It can be concluded that nutrition knowledge determined positively the quality of the diet of students in food and nutrition majors, while did not affect the occurrence of orthorexic behaviors.

Is Orthorexia Nervosa a Non-specific Eating Disorder or a Disease in the Spectrum of Obsessive-Compulsive Disorder?

BACKGROUND

In recent years, there has been a dramatic increase in awareness in society that healthy nutrition has positive effects on health. However, obsession with these behaviors towards healthy foods causes negative effects on health and quality of life.

AIM

The aim of this study was to elucidate the relationship between the incidence of orthorexia nervosa (ON) in medical school students and the level of conscious awareness, obsessive-compulsive disorder, eating attitudes and behaviors, health anxiety, and body image to clarify the unclear issues in the literature, such as whether orthorexia nervosa is among the psychological disorders, "where" it will take place, and which diagnoses it can be associated with.

METHODS

Students between the 1^st and 6^th grades of medical school were invited to participate in this research. The Sociodemographic Data Form, Maudsley Obsessive-Compulsive Question Index (MOCI), Eating Attitude Test Short Form (EAT SF-26), Health Anxiety Inventory-Weekly Short Form (HAI-SF), ORTO-11 scale, Body Perception Scale, and Conscious Awareness Scale have been applied to the students.

RESULTS

In univariate analysis, the eating disorder scale, body image scale, and awareness scale total scores all had an impact on orthorexia. Each increase in the eating disorder scale score increased the diagnosis of orthorexia 1.07 times, while each increase in the body image scale score increased the diagnosis of orthorexia 1.09 times. Additionally, each increase in the conscious awareness scale score decreased the diagnosis of orthorexia by 0.92 times. When all variables were re-evaluated in the multivariate analysis, it was seen that the total scores of the body image scale and conscious awareness scale affected the diagnosis of orthorexia. There was a weak inverse relationship between the orthorexia scale score and only the health anxiety inventory total score (p<0.05).

CONCLUSION

Regarding the outcomes of this research, one can say that orthorexia affected the eating disorder scale, body image scale, and awareness scale total scores. While the increase in the eating disorder and body image scale scores increased orthorexia, the increase in the conscious awareness scale score had a decreasing effect.

Orthorexia and eating attitudes in health sciences students

Background

The prevalence of eating disorders and orthorexia nervosa has steadily increased and this situation may lead to severe physical, psychological, and social disorders.

Aim

The aim of this study was to investigate the prevalence of disordered eating attitudes and orthorexia tendencies among university students studying in various Health Sciences departments in Turkey.

Subjects and Methods

The study subjects were selected from Health Sciences Faculty students. Among the students who accepted the study, 639 people were reached by simple random sampling method. The EAT-40 and ORTO-15 which are validated instruments for the screening of abnormal eating behaviors and orthorexia nervosa respectively, were used as measurement tools.

Results

The majority of the students who participated in the study were found to exhibit orthorexic tendencies, and male students had a higher orthorexic tendency in comparison to female students (p = 0.022). More specifically, the students studying in the Department of Nutrition and Dietetics had lower orthorexic tendencies compared with the students from other departments. There was no significant relationship between BMI values and the mean ORTO-15 scores, whereas the mean EAT-40 score was found to increase statistically significantly with increased BMI (p = 0.038). There was a statistically significant difference between the departments and classes in terms of mean EAT-40 scores, whereas no difference was found regarding gender.

Conclusion

Orthorexia nervosa is a common problem for university students studying in health-related departments. Interestingly, the orthorexic tendencies of girls and students studying in the Nutrition and Dietetics department were found to be lower in this study. It was determined that all students except the Nutrition and Dietetics department had orthorexia tendencies. More comprehensive studies are needed to better understand orthorexia nervosa and healthy lifestyle interaction.

The effect of social media use on orthorexia nervosa: a sample from Turkey

OBJECTIVES

the current study evaluated the orthorexic tendencies of social media users and the factors affecting these tendencies.

METHODS

a total of 2526 adult participants (696 male and 1830 female, 28.4 ± 10.3 years) completed a questionnaire that includes personal information, the Orthorexia Nervosa Scale (ORTO-11), the Social Media and Eating Behavior Scale (SMEB), and the International Physical Activity Questionnaire Short Form (IPAQ). Body mass index (BMI) was calculated from the reported weight and height of the participants. Independent-sample t-tests or chi-square tests were computed to evaluate various information of the participants according to the ON tendency. A binary logistic regression analysis was used to identify risk factors.

RESULTS

according to ORTO-11, 56.1 % of the participants had a tendency to ON, and the trend to ON increased with age and BMI (p < 0.05). People without ON tendency spent more time (172.2 ± 119.9 min/day) on social media. Participants who followed webpages with healthy nutrition and sport-exercise recommendations had an increased ON risk when compared to those who did not follow those pages (p < 0.05). In addition, although there was a significant difference between participants in physical activity level according to the ON tendency, this relationship was not significant in the regression model (p > 0.05).

CONCLUSION

this study indicates that increasing social media usage, especially web pages that include health and nutrition recommendations, may boost the tendency to ON. Thus, raising awareness of social media may be beneficial to people who have a tendency to ON.

Exploring the moderating role of mindfulness, mindful eating, and self-compassion on the relationship between eating-disordered quality of life and orthorexia nervosa

Orthorexia nervosa (ON) is characterised by an obsessive focus on healthy eating, following restrictive dietary practices and dietary restrictions escalating over time. The aim of this study was to explore mindfulness, mindful eating, self-compassion and quality of life in a female population. Two hundred eighty-eight participants completed Orthorexia, Self-Compassion, Mindful eating, Mindfulness and Eating Disorder Quality of Life scales. The results indicated that there was a negative relationship between ON and mindfulness, self-compassion and mindful eating. Furthermore, the present study found a positive relationship between lower quality of life and ON, while findings indicated that self-compassion and the awareness facet of mindfulness moderated the relationship between ON and QOL. The present results contribute to a better understanding of orthorexic eating behaviours in a female population, and identify the moderating capacity of self-compassion and mindfulness. Further implications and future directions are discussed.Level of evidence Level V, cross-sectional descriptive study.

The indirect role of orthorexia nervosa and eating attitudes in the association between perfectionism and muscle dysmorphic disorder in Lebanese male University students - results of a pilot study

BACKGROUND

The literature highly concentrates on disorders related to body image among women but only minimally when it comes to the male population; hence, in order to provide general practitioners, and primary care physicians in general, and psychiatrists in particular, with additional information concerning muscle dysmorphia among male university students in Lebanon, this study seemed essential, and was therefore conducted to (1) identify the prevalence of MDD, and (2) evaluate the indirect effect of eating attitudes in general and orthorexia nervosa in particular, in the association between perfectionism and muscle dysmorphic disorder (MDD) among a sample of male university students.

METHODS

In this cross-sectional study conducted between September 2021 and May 2022, 396 male university students from multiple universities in Lebanon filled the online Arabic questionnaire.

RESULTS

The results showed that 26 (6.6%) of the participants had MDD. Orthorexia nervosa and eating attitudes mediated the association between perfectionism and MDD; higher perfectionism was significantly associated with higher ON and more inappropriate eating; higher ON and more inappropriate eating were significantly associated with higher MDD, whereas perfectionism had a significant total direct effect on MDD. The high prevalence of MDD among male university students in Lebanon implies further investigation on the national level in the country.

CONCLUSION

Awareness campaigns among the university students could be adopted at the national level to increase the level of knowledge on the concepts of obsessive self-destructive perfectionism, orthorexia nervosa and muscle dysmorphia.

The Prevalence of Orthorexia Nervosa among Greek Professional Dancers

The aim of this study was to determine the prevalence of orthorexia nervosa (ON) among professional dancers in Greece, as well as its relationship with nutrition, body mass index (BMI), body image flexibility, and parental bonding. The participants were 96 professional dancers, with a mean age of 23.41 ± 5.13 years, who completed a battery of questionnaires recording sociodemographic, clinical, and anthropometric characteristics; adherence to the Mediterranean diet (MedDiet); indications of ON, as determined by the ORTHO-15 questionnaire; body image flexibility, using the body image-acceptance and action questionnaire (BI-AAQ-5); and their recollection of their parents’ attitudes towards them during the first 16 years of life, with the parental bonding instrument (PBI). The study population was classified into two groups, based on BMI: normal weight, and underweight. ON was shown to be significantly correlated with BMI (p = 0.006)-present in normal weight subjects- and body image inflexibility (p < 0.001). Parental body image inflexibility was significantly correlated with a low bonding relationship as perceived in childhood. In conclusion, disordered eating attitudes and body shape concerns are prevalent among professional dancers and appear to be associated with their parental relationship during childhood. Identification of potential ON and development of preventive mechanisms could help to eliminate such concerns and improve the nutrition of professional dancers.

Orthorexia nervosa in gay men-the result of a spanish-polish eating disorders study

BACKGROUND

The purpose of this exploratory study was to identifying demographic factors and unique predictors of ON e.g., the use of pre-exposure prophylaxis (PrEP), the use of social media and the Grindr ® dating application among a sample group of Spanish and Polish identifying gay men.

METHODS

The study was conducted in Poland and Spain between March and June 2021 using questionary: ORTO-15. Data was collected using a three-section self-administered questionnaire. The first section contained demographic data, the second part was the Polish and Spanish version of the Orto-15, and the third part was the Polish and Spanish version of the EAT-26.

RESULTS

Total enrollment was 394 gay men. In regression proportional hazards single model, significant predictors of ON were: age (OR = 0.964, 95% CI, 0.944-0.984), BMI (OR = 0.895, 95% CI, 0.848-0.944), staying in an informal relationship compared to being single (OR = 2.138, 95%CI, 1.225-3.732), occasional use of Pre-exposure Prophylaxis (OR = 4.667, 95%CI, 1.186-18.362) and use of the Grindr application (OR = 5.312, 95%CI, 3.373-8.365). Instagram users had lower risk of ON (OR = 0.479, 95%CI, 0.279-0.822). The multivariate analysis showed that Grindr usages (OR = 4.72; 95%CI, 2.89-7.72) correlated with higher risk of ON. Higher BMI (OR = 0.913, 95%CI, 0.861-0.98) and daily use of Pre-exposure Prophylaxis (OR = 0.142, 95%CI, 0.03-0.674) is associated with lower risk of ON.

CONCLUSIONS

The most important predictors of orthorexia nervosa in gay men are: low BMI and the use of Grindr. The effect of daily usage of PrEP is associated with lower risk, and occasional use is associated with increased risk, of orthorexia nervosa.

The association between social media addiction and orthorexia nervosa, eating attitudes, and body image among adolescents

AIM

This study was planned to determine the relationship between social media addiction and orthorexia nervosa (ON), eating attitude and body image among adolescents.

METHOD

This cross-sectional study was conducted with 1232 high school-going adolescents. Data were collected using the Social Media Addiction Scale for Adolescents, Eating Attitude Test-26 (EAT-26), Body Image Scale (BIS) and ORTO-11 questionnaire.

RESULTS

Social media addiction levels were higher in girls than in boys (p < 0.05). Multiple linear regression analysis showed that a better body image was associated with lower social media addiction scores (β =  - 0.268, p < 0.001). Social media addiction was significantly associated with a greater risk of eating behavior disorders (OR: 1.07, 95% Cl: 1.04-1.10) and ON tendency (OR: 1.02, 95% Cl = 1.00-1.04). Adolescents who stated that they always or often read nutrition-related posts on social media had an increased likelihood of eating behavior disorder risk (OR: 6.77, 95% CI: 3.84-11.94) and ON tendency (OR: 5.49, 95% CI: 3.39-8.88).

CONCLUSION

This study demonstrated that social media addiction was associated with a higher eating behavior disorder risk, ON tendency and lower body image. Moreover, frequent reading of posts about nutrition on social media was positively associated with ON tendency and eating behavior risk. These results highlight that adolescents should be educated about social media use and its content to minimize the negative effects of constant exposure to unrealistic body images and nutrition-related misinformation and reduce the risk of eating disorders and ON among adolescents. Level of evidence Level V, cross-sectional descriptive study.

Orthorexia and autism spectrum in University workers: relationship with gender, body mass index and dietary habits

OBJECTIVE

To date, few studies have investigated the relationship between autistic traits and emerging phenotypes of restrictive disorders, such as Orthorexia nervosa (ON). The aim of the present work was to investigate the relationship between ON symptoms and autistic traits in a population of University employees, focusing on the impact of gender, weight and type of diet.

METHODS

All academic and technical/administrative workers of University of Pisa were invited by mail to fulfil through an anonymous online form the Adult Autism Sub-threshold Spectrum (AdAS Spectrum) and the ORTO-R.

RESULTS

A total of 285 subjects filled out the questionnaires. Participants with significant autistic traits were included into the Broad autism phenotype (BAP) group, while others into the No BAP group. Subjects in the BAP group reported significantly higher ORTO-R scores than others, while no difference was reported for gender, work position, type of diet, age and BMI. Females showed significantly higher ORTO-R scores and lower BMI than males. Older subjects showed a higher BMI. No significant differences in ORTO-R scores were reported depending on type of diet and work position. A decision tree model, with ORTO-R score as dependent variable, revealed in the first step significantly higher ORTO-R scores in the BAP group than in the No BAP group, and in the second step significantly higher ORTO-R scores among females only in the No BAP group.

CONCLUSION

Our results further confirm the association between ON and autism spectrum, which seems to overcome the impact of gender in this population.

LEVEL OF EVIDENCE

Level V, descriptive study.

Association between the bi-dimensional aspect of orthorexia and healthy behaviors among lebanese adolescents

BACKGROUND

Recently, there has been a blooming focus on "eating healthy and clean", with the ideal of being healthy becoming a popular lifestyle trend. Previous research suggested the presence of two forms of orthorexia: Orthorexia Nervosa (OrNe) and Healthy Orthorexia (HeOr). Taking into consideration that orthorexia thoughts are led by the desire to reach an optimal physical health, the dedication to a healthy living may require healthy lifestyle habits: smoking cessation, moderate alcohol intake, and increased physical activity. The main study aim was to determine, among Lebanese adolescents, the association between healthy behaviors and the two likely forms of orthorexia (OrNe and HeOr), given that the adolescent phase is a risky period in the development of eating disorders.

METHODS

A cross-sectional study, conducted between January and April 2022, enrolled 444 adolescents aged between 14 and 18 years, with an equitable random sample from all the Lebanese governorates (mean age 16.23 ± 1.15 years; 60.1% females). The Teruel Orthorexia Scale (TOS) was used to assess orthorexic eating tendencies. The Lebanese Waterpipe Dependence Scale, the Fagerström Test for Nicotine Dependence and the Alcohol Use Disorder Identification Test scales, all validated in adolescents, were used to evaluate the association between orthorexia and healthy behaviors.

RESULTS

Higher TOS OrNe scores were significantly and highly correlated with the TOS HeOr scores (r = 0.68; p < 0.001). In the bivariate analysis, waterpipe smoking was weakly but significantly associated with more OrNe, whereas more physical activity was significantly and moderately associated with more HeOr. After adjusting over all sociodemographic characteristics, other behaviors and the other dimension of orthorexia, more alcohol use disorder was significantly but strongly associated with higher OrNe, whereas more physical activity remained significantly associated with higher HeOr.

CONCLUSION

In light of our results, OrNe and HeOr might be considered as different entities, mainly in their associations with alcohol consumption and physical activity. This supports the hypothesis of OrNe being a new form of eating disorder, whereas HeOr possibly showing protective characteristics. Orthorexia is still a topic of controversy, especially in the probable presence of two facets that are still difficult to differentiate.

Food addiction, orthorexia nervosa and dietary diversity among Bangladeshi university students: a large online survey during the COVID-19 pandemic

PURPOSE

Maladaptive eating behaviors like food addiction (FA) are common among students, and orthorexia nervosa (ON) is being evaluated as a new condition among eating disorders (EDs). Moreover, dietary diversity (DD) is recognized as an important component of a healthy diet. Thus, the current study sought to examine the prevalence of ON and FA as well as the factors associated with ON, FA, and DD among university students in Bangladesh during the COVID-19 pandemic.

METHODS

Four-thousand-and-seventy-six students were recruited and completed an online survey consisting of the Bratman Orthorexia test, the modified Yale Food Addiction Scale, and a questionnaire based on the Food and Agriculture Organizations' guidelines. Inferential statistics, bivariate and multivariable linear regression were used for analyzing data.

RESULTS

ON and FA were observed in 1.7% and 7.5% of participants, respectively, with 43.8% exhibiting Health Fanatic eating attitude. The mean DD score was 5.96 (SD = 1.56). Students with ON consumed more legumes, nuts, seeds, and vegetables including dark green leafy vegetables whereas students with FA consumed more organ meats and eggs. Students who were older-aged, married, formerly smoked, had fitness goals, and had guilty feelings about violating food rules were more likely to have ON, whereas those who were female, were married, actively smoked, and were overweight and obese were more likely to have FA.

CONCLUSIONS

The findings suggest that students from Bangladesh are at risk of FA, and less so for ON. These entities and low DD deserve more research attention in Bangladesh to increase awareness and ensure appropriate interventions.

Association between religiosity and orthorexia nervosa with the mediating role of self-esteem among a sample of the Lebanese population - short communication

BACKGROUND

Orthorexia Nervosa is not yet classified as an eating disorder albeit it can be found in different populations. This condition can be characterized by a preoccupation with the quality of food, accompanied by obsessive thoughts regarding eating behaviors, leading to malnutrition. Previous associations have been reported between high levels of eating disorders and lower levels of self-esteem; where individuals have low self-esteem due to the pressured felt to fit the norms of society in beauty standards. The aim of the present study was to evaluate the relationship between religiosity and orthorexia nervosa via either trait or state self-esteem.

METHODS

This study was conducted between September 2021 and February 2022 and included 428 participants from all Lebanese governorates. The Teruel Orthorexia Nervosa scale was used to measure orthorexia nervosa. The following scales state self-esteem and religiosity were used to measure self-esteem.

RESULTS

Sociodemographic characteristics (age, gender, marital status, household crowding index, body mass index and education) were entered in the mediation model as confounding variables. Higher religiosity was significantly associated with higher state self-esteem (Beta = 0.07), while higher state self-esteem was significantly associated with lower identification of those that exhibited ON tendencies or symptoms (Beta= -0.11).

CONCLUSION

A high state self-esteem was correlated with a lower level of orthorexia nervosa. Higher religiosity was shown to be associated with higher self-esteem, which in turn was associated with a decrease in the scores of orthorexia nervosa.

Diet Quality and Level of Nutrition Knowledge among Young People with Orthorexic Tendencies

The aim of the study was to determine the level of nutrition knowledge and diet quality, understood in terms of healthy and unhealthy eating habits, among young people with orthorexic tendencies. The participants were school students, university students, and those employed in the Lublin region (N = 473). The data were collected by means of a questionnaire. The participants were asked to provide socio-demographic data through filling in the ORTO-15 questionnaire and the Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN). The participants obtained results ranging from 9.3 to 100 (M = 31.15; SD = 11.81) in the non-healthy diet index, from 0.4 to 78.6 in the pro-healthy diet index (M = 21.79; SD = 11.08), and from 0 to 23 in the domain of nutrition knowledge (M = 13; SD = 4.23). A variance analysis showed no significant differences between the pro-healthy diet index and the level of nutrition knowledge. The group with orthorexia obtained statistically higher results in the pro-healthy diet index. Those with a tendency toward orthorexia obtained statistically higher results in the non-healthy diet index. The variance analysis showed that the level of nutrition knowledge of those not focused on healthy foods was significantly lower than in the other groups. The results of the ORTO-15 questionnaire correlated negatively with the pro-healthy diet index and the level of nutrition knowledge, and positively with the non-healthy diet index. We concluded that: 1. the orthorexic group and the group with a tendency toward orthorexia could be characterized with a moderate intensity of a healthy diet and a low intensity of a non-healthy diet; and 2. the level of nutrition knowledge in the orthorexic group did not significantly differ from that of the other groups.

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.

Orthorexia nervosa, mindful eating, and perfectionism: an exploratory investigation

PURPOSE

Research has drawn associations between Mindful Eating (ME) and perfectionism in the aetiology and treatment of eating disorders (ED), but understanding into the relationship between these factors and Orthorexia nervosa (ON) is limited. The purpose of this research is to explore the relationship between perfectionism, ME, and ON.

METHOD

Participants (n = 670) completed the Düsseldorf Orthorexia scale, the Mindful Eating Behavior scale, and the Big-Three Perfectionism scale Short-form, to reveal the relationship between ON, ME, and perfectionism. The relationship was assessed using correlational and regression analyses.

RESULTS

A positive association was observed between perfectionism and ON. Moreover, perfectionism demonstrated a significant negative correlation with three out of four ME facets, with "eating without distraction" displaying the highest correlation. The "eating with awareness" facet of ME demonstrated a significant relationship with ON, in a negative direction. An unexpected relationship was observed between the focused eating facet of ME and ON, with a positive association being found. A further regression analysis revealed both perfectionism and ME to predict orthorexic tendencies.

CONCLUSION

These findings identify a relationship between ON, ME, and perfectionism. It offers suggestion for the complexity of ME, and how it should be recognised by its different components, estimating a differential predictability and estimation of ON. Further research is required to clarify the direction of causality in the relationships observed, to inform the clinical diagnoses and intervention of ON.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Exercise dependence and orthorexia nervosa in Crossfit: exploring the role of perfectionism

Physical exercise and healthy diet have a positive effect on health. However, the pathological dimension of both behaviors, namely exercise dependence and orthorexia nervosa, can lead to negative results. So far, literature on these behaviors in the context of high-intensity sports is limited. The present study aims for investigating exercise dependence and orthorexia nervosa in a sample of Crossfit athletes, as well as examining the mediating role of perfectionism in their manifestation.The sample consisted of 110 people who attended Crossfit programs and 131 active gym members. The Exercise Dependence Scale was used to assess exercise dependence, the ORTO-15 to assess orthorexic behavior and the Almost Perfect Scale to evaluate perfectionism.19.8% of crossfitters and 3.8% of gym members were at risk for exercise dependence. 11.7% of participants in the Crossfit group and 10% of participants in the control group had orthorexic symptoms. An association was found between the scores on the two behaviors. In addition, the dimension of perfectionism high standards predicted obligatory exercise and orthorexia nervosa, while the dimension of discrepancy predicted only exercise dependence.The study suggests that exercise dependence is more evident in Crossfit compared to gym athletes and may be accompanied by orthorexic symptoms. Orthorexia nervosa is a noticeable phenomenon in the population of active exercisers. Perfectionism is a risk factor for obligatory exercise and orthorexia. A more demanding selection of target populations is encouraged in order to better understand exercise dependence, orthorexia nervosa and their personality background.

Temperaments and orthorexia nervosa: a cross-cultural study between Germany and Lebanon

The aim of this study was to explore the association between affective temperaments and orthorexic eating and whether temperament may explain cross-cultural differences in this behavior while considering the two dimensions of orthorexic eating, healthy (HeOr) and nervosa (OrNe). To accomplish this, 337 and 389 individuals were recruited in Lebanon and Germany, respectively. The brief version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego explored depressive, hyperthymic, cyclothymic, anxious and irritable temperaments, and the Teruel Orthorexia scale explored orthorexic eating. HeOr appeared comparable between countries but OrNe was higher in Lebanon. In terms of affective temperaments, the higher the depressive, cyclothymic, irritable, and anxious temperaments, the higher were the levels of OrNe. Only the hyperthymic temperament scale was positively associated with HeOr. Three-step regression analysis indicated only gender as a unique predictor for HeOr. By contrast, gender, depressive, hyperthymic, and anxious temperament as well as the two-way interactions country*depressive temperament and country*hyperthymic temperament were significant predictors of OrNe. The positive association between OrNe and depressive temperament was only found for the German sample while the negative association between hyperthymic temperament and OrNe was somewhat stronger in the Lebanese sample. Overall, a higher healthy interest in diet was linked to the hyperthymic temperament. Findings emphasized the role of temperaments in pathological orthorexic eating in general as well as in explaining cross-cultural differences in these behaviors. The assessment of temperaments could help to fit treatments for eating pathologies to individuals from different cultures, focusing interventions more on these aspects.

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).

PREVALENCE OF ORTHOREXIA NERVOSA IN ACADEMICIANS AND THE INFLUENCING FACTORS

Objective: Orthorexia Nervosa/Healthy Eating Obsession is defined as a pathological obsession for consuming appropriate and healthy food. The aim of this study is to determine the prevalence of orthorexia nervosa in academicians working in a public university and the influencing factors. Methods: This study was concluded between 01 January– 01 March 2020 to determine the prevalence of Orthorexia Nervosa and its correlation with influencing factors. The data of the study were collected using the Eating Attitude Test-40 (EAT-40) and the ORTO-11 along with the information form. Results: In this study, it was observed that an advanced age caused a higher risk of eating disorder. In addition, the variables of being in the age range of 34-41 years, being female, and receiving undergraduate education were significant in terms of reducing the risk of Orthorexia Nervosa (p>0.05). Conclusion: Factors such as industrialization, developments in the socio-economic structure, and mass media cause changes and new tendencies in dietary habits and food consumption. As it is believed that these conditions will become even more widespread in the future and affect all sections of society, including academicians who are accepted to be a risk group due to their perfectionist structure; it is of prime importance to raise awareness of society and inform individuals from a multidisciplinary approach including dieticians.

Orthorexia and Eating Disorders in Adolescents and Young Adults: A Systematic Review

Background: In recent years a new term in the field of eating behaviors has emerged, namely “orthorexia”. This behavior is associated with significant dietary restrictions and omission of food groups. The aim of the present study is to estimate the possible correlations between orthorexia and eating disorders in young adults and adolescents. Methods: A systematic review of related articles in PubMed, Google Scholar, and PsycInfo was conducted up to 30 June 2021. Results: A total of 37 studies (16,402 subjects) were considered eligible for this systematic review. Significant correlations were observed in most of the studies between orthorexia and eating disorders. However, the majority of studies adopted a cross-sectional design. Conclusions: An association between and eating disorders emerged. Prospective studies seem necessary to investigate associations and succession of orthorexia and eating disorders over time.

Lifestyle-Related Risk Factors of Orthorexia Can Differ among the Students of Distinct University Courses

Orthorexia nervosa (ON) is defined as the excessive attention on healthy eating, and studies especially focused on food quality ON prevalence in university students can be extremely variable. The objective of this study is to investigate whether there was a difference in ON risk between health-scientific, economic-humanistic, sport sciences and dietetics and nutrition students, and to evaluate if lifestyle-related ON risk factors (dieting, physical activity, drugs and supplements use) could have an impact in different ways in determining ON risk among students attending these four programs. Participants were recruited at the University of Pavia and received a two-section questionnaire including demographic and lifestyle information and the ORTO-15 questionnaire. A total of 671 students (54% F e 46% M) completed the questionnaire (median age 21.00 (IQR 20.00−23.00), median BMI 21.77 kg/m2 (IQR 20.06−23.66 kg/m2)). The 31.2% had ORTO-15 test scores < 35, and were considered at risk of having ON. No differences were found in ON risk among the students attending the four university courses. Dieting was confirmed as the major ON risk factor for health-scientific, economic-humanistic and sport sciences students. The type of sport practiced was an important determinant of ON risk only for the economic-humanistic course, while supplements use was statistically different between sport sciences students with or without ON. Our findings may suggest that lifestyle-related risk factors of orthorexia can differ among the students of distinct university courses, but these results need to be supported by further longitudinal and prospective studies.

Orthorexia Nervosa in Adolescents and Young Adults: A Literature Review

Adolescents are a nutritionally vulnerable population; eating disorders are more common among adolescents and young adults. Orthorexia nervosa (ON) is a non-formally recognized condition characterized by an obsessive preoccupation with eating healthy and "pure" foods; the quality and not the quantity of food is pivotal in ON. ON is a complex entity which can be associated with severe diet restrictions, a negative impact on social relationships, and with physical and mental health conditions, including obsessive-compulsive disorder. In light of this, a literature review regarding the background, diagnosis, features, risk factors, interplay with the social media, and management of ON is presented in this article, with a focus on adolescents and young adults.

Orthorexia nervosa and substance use for the purposes of weight control, conformity, and emotional coping

PURPOSE

Orthorexia nervosa (ON), characterized by extreme behaviors driven by the goal of eating only healthy and pure foods, could plausibly be associated with avoidance of nicotine, alcohol, and illicit drugs. However, findings from the limited research on these relationships are mixed, and other eating disorders are associated with greater substance abuse.

METHOD

An online survey was completed by 471 participants (86% women, mean age = 20) recruited from undergraduate courses and through an Instagram advertisement. The questionnaires assessed ON symptomatology; frequency of smoking, alcohol consumption, and illicit drug use; abuse of these substances; and motivations for using these substances.

RESULTS

ON scores were not significantly related to the level of use or abuse of nicotine, alcohol, or most illicit drugs. Yet, ON scores were positively correlated with frequency of using illicit depressant drugs. Further, among substance users, ON scores were positively associated with smoking or vaping for the purpose of weight control, and with consuming alcohol and using illicit drugs for the purposes of conformity and coping with such negative emotions as anxiety and depression.

CONCLUSION

Although people who are high in ON symptomatology may be at least partly driven by a strong desire to be as healthy as possible, they are not less likely to use potentially harmful drugs. Instead, many of them may even turn to certain drugs for the same weight control and emotional-coping motives that guide the behaviors of individuals with other eating disorders.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

Associations between orthorexia, disordered eating, and obsessive-compulsive symptoms: A systematic review and meta-analysis

OBJECTIVE

Orthorexia nervosa (ON) is defined as an unhealthy obsession with healthy eating, focusing on concerns regarding food quality and composition. Currently, there is still a lack of consensus about a clear definition of the construct. Specifically, it has yet to be clarified whether ON pertains to eating disorders (EDs) or obsessive-compulsive disorder (OCD) spectrum. Hence, we conducted a systematic review and meta-analysis addressing the magnitude of the association between these groups of symptoms.

METHOD

PubMed, Medline, SCOPUS, PsychINFO, CINAHL, and Web of Science were searched from inception up to February 2021. Data from individual studies were pooled using a random-effects model. Pearson's r was used as the effect size metric. Subgroup analyses were conducted exploring the role of ON-related instruments, body mass index, study quality, and cultural context.

RESULTS

Thirty-six studies met the eligibility criteria and were included in the meta-analysis. Random-effects model yielded a moderate association between ON and EDs symptoms with an overall effect size of r = .36 (p < .001; 95% confidence interval [CI] = 0.30-0.43). On the other hand, the results showed a small association between ON and OCD symptoms with a mean effect size of r = .21 (p < .001; 95% CI = 0.15-0.27).

DISCUSSION

Meta-analytic findings showed that ON symptoms are more associated to EDs compared to OCD. Despite the similarities, the nonhigh magnitude of the pooled correlations suggests that ON might be different from pre-existing EDs and OCD. Hence, ON might be treated as a stand-alone ED and included as an emerging syndrome in the DSM classification.

Association between impulsivity and orthorexia nervosa: any moderating role of maladaptive personality traits?

OBJECTIVES

To explore the possible moderating relation between impulsive behavior and maladaptive personality traits in regards to orthorexia nervosa (ON).

METHODS

This cross-sectional study was conducted between July and December 2019 and recruited 519 Lebanese adults from seven community pharmacies randomly selected from a list provided by the Lebanese Order of Pharmacists. The Teruel Orthorexia Scale (TOS) was employed to assess orthorexic eating tendencies, the I-8 measured impulsivity and the Personality Inventory for DSM-5 (PID) evaluated maladaptive personality traits.

RESULTS

Our results showed that, for I-8 subscales, only higher perseverance (B = 0.31) was significantly associated with higher ON. In regard to PID-5 subscales, only higher negative affect (B = - 0.34) was significantly associated with lower ON. Furthermore, significant interactions were found between personality traits and impulsivity to predict TOS-ON.

CONCLUSION

The current results show that female gender, maladaptive personality traits and impulsivity present contributing factors regarding orthorexic eating. Certain impulsivity dimensions were confirmed to interact with personality traits in the prediction of orthorexic eating thereby highlighting possible risk factors and psychopathological mechanisms.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Dietary Behavior and Risk of Orthorexia in Women with Celiac Disease

Evidence points to a link between celiac disease and eating disorders. Although with the current limited knowledge, orthorexia cannot be formally recognized as an eating disorder, some features are similar. This study is the first to examine individuals with celiac disease in terms of the prevalence of risk of orthorexia. Participants were 123 females diagnosed with celiac disease. The standardized ORTO-15 questionnaire was used to assess the risk of orthorexia. In this study, eating habits and physical activity were assessed. The effect of celiac disease on diet was self-assessed on a 5-point scale. Taking a score of 40 on the ORTO-15 test as the cut-off point, a risk of orthorexia was found in 71% of individuals with celiac disease, but only in 32% when the cut-off point was set at 35. There was a positive correlation between age and ORTO-15 test scores (rho = 0.30). In the group with orthorexia risk, meals were more often self-prepared (94%) compared to those without risk of orthorexia (78%) (p = 0.006). Individuals at risk for orthorexia were less likely to pay attention to the caloric content of food (46%) relative to those without risk of orthorexia (69%) (p = 0.001). For 64% of those at risk for orthorexia vs. 8% without risk had the thought of food that worried them (p = 0.001). Given the survey instrument for assessing the prevalence of orthorexia and the overlap between eating behaviors in celiac disease and orthorexia, the prevalence of orthorexia in celiac disease cannot be clearly established. Therefore, future research should focus on using other research tools to confirm the presence of orthorexia in celiac disease.

Orthorexia nervosa: The relationship with obsessive-compulsive symptoms and eating attitudes among individuals with and without healthcare professionals

BACKGROUND: Today, individuals with eating disorders or orthorexia nervosa (ON) are increasing. OBJECTIVE: This study aimed to determine the association between ON, eating attitudes, and obsessive-compulsive symptoms among healthcare and non-healthcare professionals. METHODS: The present study was cross-sectional, and conducted by 310 healthcare, and non-healthcare professionals. Data on demographic characteristics, the Orthorexia Nervosa Evaluation Scale (ORTO-15), the Eating Attitudes Test-40 (EAT-40), and the Maudsley Obsessive-Compulsive Inventory (MOCI) were obtained by a questionnaire form. Additionally, the body weight and height of participants were taken to calculate the body mass index (BMI). Data were analyzed with SPSS statistical package 24.0. RESULTS: The ORTO-15 score of 30.3% of healthcare professionals and 27.1% of non-healthcare professionals were ≤40 (p: 0.616). The EAT-40 scores were found to be ≥30 in 7.7% of healthcare professionals and 4.5% of non-healthcare professionals (p: 0.081). According to the MOCI scores, the possibility of obsessive-compulsive symptoms was high in 29.7% of healthcare professionals (p <  0.001). There was a weak negative correlation between ORTO-15 and EAT-40 (r: –0.176, p: 0.002) and MOCI (r: –0.170, p: 0.003); and EAT-40 and MOCI (r:0.166, p: 0.03). CONCLUSION: Further studies are required to understand the relationship between ON and eating disorders that are included in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) criteria.

The Effects of the COVID-19 Pandemic Lockdown on Eating, Body Image, and Social Media Habits Among Women With and Without Symptoms of Orthorexia Nervosa

The COVID-19 pandemic is negatively impacting people's mental health worldwide. The current study examined the effects of COVID-19 lockdown on adult women's eating, body image, and social media habits. Furthermore, we compared individuals with and without signs of orthorexia nervosa, a proposed eating disorder. Participants were 143 women, aged 17-73 years (M = 25.85, SD = 8.12), recruited during a COVID-19 lockdown in Canada from May-June 2020. Participants completed self-report questionnaires on their eating, body image, and social media habits during the pandemic. The Eating Habits Questionnaire (EHQ) assessed symptoms of orthorexia nervosa. Compared to the period prior to lockdown, women with higher total orthorexia nervosa scores reported eating a lot more than usual, feeling greater pressure to diet and lose weight, thinking about food more often than usual, experiencing greater weight gain, and perceiving more pressure from social media specifically to lose weight and to exercise, compared to their healthy counterparts. We examined associations between individual EHQ subscales and perceived changes to eating and weight. Women who scored high on EHQ-Problems reported seeing more weight loss content on their social media than those who reported fewer orthorexia nervosa symptoms. Conversely, those who scored low on EHQ-Feelings reported feeling a lot less pressure to lose weight, somewhat less or a lot less pressure to lose weight or to exercise from social media specifically, and trended toward less laxative use during lockdown, compared to those who scored higher on orthorexia nervosa. And those who scored low on EHQ-Knowledge reported feeling somewhat less or a lot less pressure to lose weight than those who reported more orthorexia nervosa symptoms. Together, the findings suggest that women with symptoms of orthorexia nervosa are experiencing an exacerbation of disordered eating thoughts and behaviors during COVID-19, and that social media may be a contributing factor.

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.

Is orthorexia nervosa a feature of obsessive-compulsive disorder? A multicentric, controlled study

PURPOSE

The term orthorexia nervosa (ON) was coined to describe altered thoughts and behaviours related to healthy eating. The prevalence of ON was found to scale up to almost 90% among high-risk populations (ballet dancers, athletes, and health workers). ON seem to share psychopathological aspects with both Eating Disorders (ED) and Obsessive-Compulsive Disorder (OCD). The aim of the study was to analyse the frequency and intensity of ON symptoms among subjects diagnosed with OCD, hypothesising that they would be higher than in two control groups (subjects with anxiety-depressive disorders and general population).

METHODS

We conducted a multi-centre, observational, controlled study. Subjects filled in a socio-demographic questionnaire including questions related to life-style and two psychometric instruments: ORTO-15, for ON symptoms, and OCI-R, for OCD symptoms. Post hoc analysis of the dataset was performed using the revised version of ORTO-15, the ORTO-R.

RESULTS

In the final sample of 328 subjects, the overall prevalence of ORTO-15-ON was 59.5%, mean score 37.9 ± 4.2. The mean score at the ORTO-R was 16.6 ± 4.6. No statistically significant differences were found in the prevalence of ON or in the mean ORTO-15 score among OCD patients and the two control groups, and this was confirmed by the multiple regression analysis. At the ORTO-R re-scoring, OCD patients scored significantly lower than the two clinical subgroups (p = .0005) and a lower ORTO-R score was associated to positivity at the OCI-R, confirming the initial hypothesis of the study.

CONCLUSIONS

ON symptoms do seem to be more prevalent among subjects suffering from OCD. The psychometric properties of tools available to calculate ON symptoms, namely ORTO-15 vs. ORTO-R, play a relevant role in explaining such finding. ORTO-R seems to be a valid alternative able to overcome such difficulties, though further studies are needed to confirm this.

Orthorexia nervosa and its association with alexithymia, emotion dysregulation and disordered eating attitudes among Lebanese adults

OBJECTIVE

This study aims to explore whether orthorexia nervosa, like other eating disorders, is associated with difficulties identifying, describing, and regulating one's own emotions among a sample of Lebanese adults.

METHODS

A cross-sectional study was conducted during October 2020, during the lockdown period imposed by the government for the COVID-19 pandemic. All participants above 18 years of age were allowed to participate in this study. A total of 787 Lebanese adults out of 920 (85.54%) completed an online survey including Arabic versions of the ORTO-R measure of orthorexia, the Toronto Alexithymia Scale, the Difficulty in Emotion Regulation Scale, and the Eating Attitudes Test.

RESULTS

After making sure that all norms are verified, hierarchical linear regressions were conducted to evaluate the association between disordered eating attitudes (EAT scores) and ON (model 1), and after controlling for difficulties in emotion regulation (DERS score) (model 2). Model 1 accounted for 15.1% of the variance of ON (adj. R² = 0.151, F(1, 786) = 140.06, p < 0.001) and showed that higher levels of disordered eating (higher EAT scores) (β = 0.15) were significantly associated with more ON tendencies and behaviors. When adding the DERS total score to the model, Model 2 was a much better fit with 17.7% of the variance of ON (adj. R² = 0.177, F(2, 786) = 84.44, p < 0.001), with higher levels of emotion dysregulation (higher DERS scores) (β = 0.06) and more disordered eating attitudes (higher EAT scores) (β = 0.13) were associated with higher levels of ON (Table 5).

CONCLUSION

The present research suggests that people with high ON tendencies experience troubles recognizing, regulating, and describing their emotions, similarly to other disordered eating.

LEVEL OF EVIDENCE

5.

Validation of the Greek ORTO-15 questionnaire for the assessment of orthorexia nervosa and its relation to eating disorders symptomatology

PURPOSE

The aim of the study was the validation of the Greek version of the ORTO-15 questionnaire. An additional aim was to explore the relation between orthorexic and eating disorder behaviors in a sample of Greek students.

METHODS

ORTO-15 was translated and adapted in the Greek language. After its final version was drafted, its test-retest reliability was checked. Then, the questionnaire was administered to 120 students of psychology along with EAT-26. Additionally, demographics, BMI and information related to eating disorders were collected.

RESULTS

The Greek version of the ORTO-15 questionnaire showed acceptable internal consistency (Cronbach's a 0.7). Factor analysis produced a three-factor model similar to the original English version of the questionnaire. The correlation of ORTO-15 and EAT-26 revealed that higher measurements in the diet and bulimia EAT-26 scale were related to increased orthorexic symptomatology. Finally, there was no significant correlation between the 3 factors of the ORTO-15 (emotional, rational and behavioral) and age, education or Body Mass Index.

CONCLUSIONS

This study is the first attempt to assess orthorexia nervosa in a Greek student population. ORTO-15 was found to be a reliable tool for the measurement of orthorexia in Greece. Finally, in accordance with other studies, orthorexic symptoms were partially related to eating disorder symptomatology, thus raising the question of possible similarities and overlap between the two clinical constructs.

LEVEL OF EVIDENCE

Level V, Cross-sectional descriptive study.

Low self-esteem predicts orthorexia nervosa, mediated by spiritual attitudes among frequent exercisers

OBJECTIVE

The aim of this study was to measure how orthorexic tendencies relate to age, self-esteem, and spirituality. We conducted the study on a sample of Hungarian adults performing regular fitness activity.

METHOD

175 participants completed a four-part online survey: demographics and training habits, the Rosenberg Self-Esteem Scale, the Eating Habits Questionnaire-Revised (EHQ-R), and one of the Spiritual Awareness questionnaire's subscale. We performed univariate linear regression to assess the predictor role of age on orthorexic tendencies. Mediation analysis was conducted to determine the effect of self-esteem on orthorexic tendencies and the mediator role of spiritual attitudes.

RESULTS

Age negatively correlated with EHQ-R, and there were no gender differences. Lower self-esteem was a predictor for orthorexic tendencies with the total effect of ß = -0.3046 (p < 0.0001). In part, this is a direct relationship, but it is mediated by spiritual awareness as well.

DISCUSSION

Among frequent exercisers, strict dieting is likely to originate from a lack of self-esteem due to perfectionist standards, social comparison, and the aspiration of being in control. In case self-esteem is achieved through spiritual approaches, individuals may experience positive changes in their attitudes toward eating and their bodies as well. In the future, it is important to confirm whether the EHQ-R indicates diagnostic boundaries.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

Personality profiles in young adults with orthorexic eating behaviors

PURPOSE

Orthorexia nervosa (ON), defined as an excessive preoccupation with healthy eating, has gained more interest in the literature over these past few years. However, little is known about its risk and protective factors, in particular with regards to personality.

METHODS

A total of 3235 college students (10.32% men, 89.67% women) with a mean age of 21.13 (SD = 2.23) answered self-administered questionnaires assessing ON, psychopathological symptoms, and personality disorders including schizotypal, borderline, paranoid, obsessive-compulsive, and narcissistic personality. A subsample of 106 participants (91.51% women, mean age = 20.91, SD = 2.31) was selected based on the DOS cutoff score, and was then considered as the "orthorexic subsample".

RESULTS

Hierarchical cluster analysis was performed in the orthorexic subsample and led to the identification of four groups: 1-a cluster with a low level of traits (L); 2-a cluster with moderate traits and low narcissistic traits (MD); 3-a cluster with a low level of traits and moderate narcissistic traits (MN); 4-a cluster with high paranoid and narcissistic traits (PN) and a moderate level of schizotypal and borderline traits. Levels of anxiety, obsessional-compulsive, and depressive symptoms were higher in the PN and MD clusters than in the L and MN clusters. Social phobia was higher and self-esteem lower in the MD cluster and hypochondriasis was higher in the PN and MN clusters.

CONCLUSIONS

This study suggests that ON can be associated with different personality profiles, some of them displaying significant psychopathological levels. It also emphasizes the importance of taking into account personality disorder traits of young adults with orthorexic eating behaviors.

LEVEL OF EVIDENCE

Descriptive (cross-sectional) study, Level V.