Are the Motives for Food Choices Different in Orthorexia Nervosa and Healthy Orthorexia?

Misinformation, thin-ideal internalization, and resistance to treatment: an interpretive phenomenological analysis of the experience of orthorexia nervosa

PURPOSE

Orthorexia nervosa (ON) is an emerging pattern of disordered eating which may be driven by a pathological desire to consume only highly nutritious foods, absent concern over body weight, as is noted in anorexia nervosa (AN). This study seeks to clarify the development and progression of ON and add to researchers' understanding of this potential disorder.

METHOD

Utilizing Interpretive Phenomenological Analysis to guide data collection and analysis, interviews were conducted with 18 individuals who self-identified as having ON.

RESULTS

Participants described a clear distinction between orthorexia nervosa and clinically recognized eating disorders, with which they had prior experience. In addition, they demonstrated patterns of inflexible thinking that guided their perceptions of themselves and others. As a result, participants rapidly integrated newly acquired nutritional information, which led to escalations in restriction, social isolation, and physical symptoms of malnutrition. While prior findings on the relationship between ON and weight are conflicting, previously proposed criteria for ON emphasize an absence of weight-related concerns. The results of the present study suggest that weight control is a primary motivating factor in the escalating pattern of restriction.

CONCLUSION

The nuanced results from this work evidence the value of interpretive qualitative approaches to improve understanding of ON. In particular, participants' described inflexible thinking with respect to eating behaviors may help inform or revise screening instruments and provide important insights for treatment of ON.

LEVEL OF EVIDENCE

Level V, qualitative descriptive research.

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

The study objectives were to investigate correlates of healthy orthorexia (HeOr), its relation with impulsivity, and the moderating role of adaptive personality traits among a Lebanese adult sample. The sample was recruited from seven community pharmacies, from the five districts in Lebanon, chosen from a list provided by the Lebanese Order of Pharmacists in a convenient way. The questionnaire included the Teruel Orthorexia Scale (TOS) to measure HeOr, Big Five Inventory (BFI) to assess adaptive personality traits, and the I-8 scale for impulsivity. Higher extraversion (B = -4.31) was significantly associated with lower healthy orthorexia. The interaction perseverance by extraversion was associated with higher healthy orthorexia; in those with higher perseverance, higher extraversion was associated with more healthy orthorexia. Our study presents findings that could be of significant clinical relevance in the future, especially with the interest increase in Orthorexia Nervosa prevalence, which subsequently prompts more research and intrigue about HeOr. Furthermore, it places healthy eating and consistent commitment to a healthy diet within a clearly defined scientific frame, on which further investigation can be based.

A Portuguese Adaptation of the Teruel Orthorexia Scale and a Test of Its Utility with Brazilian Young Adults

The aims for this study were to perform a Portuguese language cross-cultural adaptation of the Teruel Orthorexia Scale (TOS) and to evaluate the scale's psychometric properties, including verifying the frequency of behaviors characteristic of orthorexia nervosa and healthy orthorexia, among a group of Brazilian gym users. First, we adapted the Spanish version of the TOS to the Brazilian Portuguese language following international protocols to guarantee idiomatic, semantic, conceptual, and cultural equivalence. Then participants completed both the new Portuguese version of the TOS and a socioeconomic questionnaire. Among our sample of 226 young Brazilian adults (63.7% men; M _age = 28.8, SD = 5.1 years), we assessed the bi-factorial model of the TOS through factorial, convergent, and discriminant validity, reliability, and factorial invariance. We calculated the mean scores of the TOS factors and the frequency of behaviors of both orthorexia nervosa and healthy orthorexia. The new Portuguese version was well understood by participants, and the TOS bi-factorial model presented adequate psychometric properties and showed invariance in independent subsamples and in men and women. The mean scores were different between sexes only for orthorexia nervosa, with women obtaining higher values. The frequency of orthorexia nervosa behaviors was 5.3% and of healthy orthorexia was 41.2%. Based on these findings, the Brazilian Portuguese version of the TOS can be a useful tool for investigating orthorexia-like behaviors in future research.

Orthorexia nervosa in yoga practitioners: relationship with personality, attitudes about appearance, and yoga engagement

PURPOSE

Disordered eating symptoms and a high prevalence of orthorexia nervosa can be found in yoga practitioners. Given that yoga is increasingly used as a complementary treatment for eating disorders (ED), understanding the relationship between yoga practice and the development of disordered eating is crucial to guide treatment recommendations. The goal of this work is, therefore, to study the relationships between orthorexia nervosa (ON) and potential risk factors for ON, in an international sample of experienced yoga practitioners.

METHOD

An online questionnaire that included several psychometric instruments was responded by 469 yoga practitioners. Instruments used were the Teruel orthorexia scale, Yoga immersion scale, Passion scale, Frost multidimensional perfectionism scale, Self-discipline scale of NEO-PI-R, Drive for thinness scale of EDI, and Beliefs about appearance scale. Descriptive statistics, correlational analysis and multiple regression were used to evaluate relationships between ON and the other variables.

RESULTS

The main predictors of orthorexia nervosa were the drive for thinness and a healthy orthorexia, suggesting that, like in anorexia and bulimia, orthorexic individuals are also concerned with food quantity and physical appearance, rather than just food quality.

CONCLUSIONS

The potential effects of yoga on eating behaviours and attitudes of long-term practitioners, particularly the high prevalence of orthorexia nervosa and the concern for physical appearance, should be taken into consideration when using yoga as prevention or treatment for eating disorders.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

Differences in preferred fat level, sweetener type, and amount of added sugar in chocolate milk in a choice task relate to physical activity and orthorexia

Fluid dairy milk consumption has decreased over the last 4 decades, and this drop has accelerated with the introduction of many competing beverage alternatives, such as plant-based milks and bottled water. Conversely, flavored milk sales remain strong, but many adults avoid flavored milk because of concerns about added sugar and calories and/or excessive sweetness. Here we used two discrete choice experiments to assess interest for a dark chocolate milk drink in adults, and explored whether there might be a consumer segment who prefers a more bitter, lower sugar chocolate milk. Adults were recruited from the Mid-Atlantic region of the United States for two conjoint analysis studies. In a general population cohort (n = 735), type of sweetener was the most important attribute (24%), followed by milk fat (19%), grams of added sugar (16%), front of pack messaging (15%), package type (12%), carton size (8%), and protein content (6%). Attribute importance was relatively consistent in a second study with a younger, more physically active cohort (n = 1017). Product choices in the active cohort were related to orthorexia and physically activity scores, indicating revealed preferences in a choice task are reflective of personal lifestyle and eating behavior. In both cohorts, three consistent consumer segments were identified and characterized: the calorie conscious, the average consumer, and the natural eaters. These data can help uncover lifestyle differences between adult consumers that impact their food product choices.

Not all personal definitions of healthy eating are linked to orthorexic behaviors among French college women. A cluster analysis study

PURPOSE

This study represents a first attempt to explore the typology of French female young adults based on personal definitions of healthy eating and to examine inter-group differences regarding their tendencies towards Orthorexia Nervosa (ON), eating disordered (ED) and obsessive-compulsive (OC) behaviors.

METHOD

362 female adults (Mage = 23.43, SD = 3.82) completed a 40-item questionnaire assessing personal definitions of healthy eating, the Eating Habits Questionnaire, the Eating-Disorders Inventory-3 and the Obsessive-Compulsive Inventory-Revised.

RESULTS

Exploratory factor analysis yielded 6 factors for healthy eating definitions: "Health benefits", "Politico-ecological", "Restriction", "Pleasure", "Socio-cultural" and "Dietary avoidance". Cluster analysis based on these factors identified 3 distinct groups: "Self & Environment aware " (SEA), "Restrictive-Avoidant" (RA) and "Sociable-Pleasure seeking" (SP). The SEA cluster emphasized the "Health benefits", "Politico-ecological" and "Dietary avoidance" factors while defining healthy eating. The RA cluster highlighted the "Restriction" and "Dietary avoidance" factors while the SP cluster mainly emphasized the "Pleasure" and "Socio-cultural" factors. Compared to all other clusters, the SEA cluster displayed greater scores in ON behaviors. The RA cluster displayed greater scores in ED behaviors compared to SP cluster. No significant difference was found between clusters regarding OC behaviors.

CONCLUSION

Findings from this study suggest that ON behaviors can vary depending on personal definitions of healthy eating. They further indicate that the definitions of healthy eating related to ON behaviors are largely different from those related to ED and OC behaviors. This study offers considerable support for the possibility of ON being a distinct condition from ED and OC behaviors.

Vegetarian diet and orthorexia nervosa: a review of the literature

BACKGROUND

The number of individuals following a vegetarian diet has increased in the last 50 years. Although the causal connection between orthorexic behaviors and vegetarianism remains widely assumed, evidence in support of this assumption has been largely inconsistent.

OBJECTIVE

The purpose of the study was to conduct a review of the relationship between vegetarian diet and orthorexic eating behavior and to give future directions in this area.

METHODS

A search of the literature within PubMed/Medline was conducted. The search terms were "orthorexia", "orthorexic", "orthorexia and vegetarian", "orthorexia and vegan" and "orthorexia and vegetarianism". Out of 117 journal articles, 14 met the predefined inclusion criteria and were analyzed.

RESULTS

The results demonstrated that following a vegetarian diet was found to be related to orthorexic eating behaviors (in 11 out of 14 studies).

CONCLUSION

Further longitudinal research is needed to investigate whether following a vegetarian diet serves as a risk factor in the development of orthorexia nervosa.

LEVEL OF EVIDENCE

Level V, narrative review.

Orthorexia nervosa is associated with positive body image and life satisfaction in Chinese elderly: Evidence for a positive psychology perspective

OBJECTIVE

Obsessive attention to healthy eating might paradoxically lead to physical and psychosocial impairments, a potential eating disorder termed orthorexia nervosa (ON). An ongoing debate concerns whether ON should be categorized as an eating disorder, an obsessive-compulsive disorder, or a mental disorder at all. A missing voice in this debate is ON in the elderly, which remains unknown, despite health being a more central issue in everyday life during old age. Similarly missing is ON in East Asia, which remains largely unexplored.

METHOD

The current study investigated ON in 313 Chinese elderly (M = 67.90, SD = 7.94) using the Chinese version of the Düsseldorf Orthorexia Scale (C-DOS). Questionnaires were used to measure traditional eating disorder symptomatology, body image (body dissatisfaction, body appreciation, and functionality appreciation), lifestyle behaviors (fruit and vegetable consumption and time spent on physical activity), and indexes of well-being (psychological distress, food-related quality of life, and life satisfaction).

RESULTS

ON symptoms were positively related to physical activity, fruit and vegetable (F&V) consumption, body appreciation, functionality appreciation, and life satisfaction, but negatively related to body dissatisfaction. Compared with those without ON, the elderly with ON scored higher on positive psychological/lifestyle measures but lower on negative psychological measures.

DISCUSSION

Contrary to the dominant characterization of ON as a variant of disordered eating, in Chinese elderly ON was associated with several positive lifestyle and psychological measures. Thus, ON in the elderly might not be viewed as a form of disordered eating but can be protective and beneficial.

Pathological Preoccupation with Healthy Eating (Orthorexia Nervosa) in a Spanish Sample with Vegetarian, Vegan, and Non-Vegetarian Dietary Patterns

Orthorexia nervosa (ON) has been defined as an obsessive and pathological attitude towards healthy nutrition. The aim of this study was to compare individuals who followed a vegan, vegetarian, and omnivore diet in terms of ON behaviors and to examine their prime motivations, attitudes, and behaviors towards food. The Spanish version of the ORTO-15 test — ORTO-11-ES — and the Food Choice Questionnaire (FCQ-SP) were used with a demographic questionnaire in an online survey disseminated among the social networks of different vegetarian associations and the general population. Of 466 individuals, 55% followed an omnivore diet, 23.5% were vegetarian and 21.7% were vegan. Results revealed relationships between type of diet and FCQ-SP dimensions for: health and natural content (H = 8.7, p < 0.05), sensory appeal (H = 11.4, p < 0.01), weight control (H = 40.4, p < 0.01), and familiarity (H = 37.3, p < 0.01). Our results confirm the findings of recent studies showing that individuals who follow a vegan or vegetarian diet are more likely to develop a pathological preoccupation with healthy eating versus omnivores. Further studies are required to determine the potential lines of action for the prevention of ON.

The Prevalence of Orthorexia Nervosa in Polish and Lebanese Adults and Its Relationship with Sociodemographic Variables and BMI Ranges: A Cross-Cultural Perspective

The prevalence of orthorexia nervosa (ON) appears to be increasing, and more research into its cross-cultural aspects is required to provide culturally appropriate psychological treatment. Until now, there has been relatively little research published about ON across cultures. Therefore, the objectives of the present study were to determine: (1) the prevalence of ON in Polish and Lebanese adults and (2) the association between ON and sociodemographic variables and Body Mass Index (BMI) in two culturally different samples. One thousand two hundred and sixty-two adults participated in the present study (NPoland = 743 adults; NLebanon = 519 adults). The Düsseldorf Orthorexia Scale and the Eating Habits Questionnaire were used in the present study. Information about age, sex, anthropometry, and marital status was obtained from all participants as well. The Polish sample had an ON prevalence rate of 2.6%, while the Lebanese sample had an ON prevalence rate of 8.4%. No significant correlation was found between ON and age in both samples. A statistically significant difference was found between marital status and country on ON, with the highest mean score seen among Lebanese singles. In Lebanon, having a low of BMI ≤ 25 kg/m2 compared to a high BMI was significantly associated with lower ON tendencies, while this association was not significant among Polish participants. This study was the second to focus on the prevalence of ON in Western and non-Western countries and its association with sociodemographic characteristics and BMI ranges. Knowledge about ON and its correlates in diverse populations may inform the design of culturally tailored behavior change interventions and the development of culturally appropriate tools in various groups to improve their dietary patterns.

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.

The Dark Side of Healthy Eating: Links between Orthorexic Eating and Mental Health

Orthorexia nervosa (OrNe) describes a behavior where eating overly healthy develops into an obsession leading to significant impairment and stress. Initial studies support a bi-dimensional structure of orthorexic eating with one dimension healthy orthorexia (HeOr, interest in healthy eating), which can be distinguished from the dimension OrNe. The present study pursued the goals to examine the negative consequences of OrNe on mental health, whether HeOr buffers these effects, and the role of gender. Data from two cross-sectional online surveys were combined (study 1 n = 385, 310 women; study 2 n = 398, 265 women; mean age: 28.9 ± 12.0 year) both generating data on psychological wellbeing, life satisfaction, stress, anxiety, and depressive symptoms in relation to OrNe and HeOr (Teruel Orthorexia Scale). By means of correlation and moderation analyses, OrNe was shown to be associated with poorer mental health, especially in the female sample. In terms of HeOr, clear gender differences appeared. There were no meaningful correlations in women. In men, however, HeOr correlated with better mental health. Further, the link between OrNe and poorer mental health was mitigated when there were high HeOr levels. Present findings support the hypotheses that OrNe is associated with pathological consequences and that HeOr may act as a buffer for these consequences. Gender differences in the clinical manifestation of orthorexic eating confirm previous knowledge and have important implications for targeted prevention and treatment strategies.

Developmental pathway of orthorexia nervosa: Factors contributing to progression from healthy eating to excessive preoccupation with healthy eating. Experiences of Dutch health professionals

Orthorexia nervosa (ON) has in recent years attracted attention, but the scarcity of empirical research on the matter generates uncertainty about its progression. This study aims to gain insight into the developmental pathway of ON and factors contributing to it, to establish its etiology. In order to gain insights into health professionals' experience with patients that they identified as suffering from ON, this study adopted mixed methods, with a sequential exploratory design: first, semi-structured interviews (n = 10) were conducted; following, a questionnaire (n = 101) was administered online. Nutritionists, psychologists, psychotherapists, and support workers with experience in treating eating disorders in the Netherlands were the study's target group. Results shed light on environmental factors influencing the development of ON (e.g. pseudoscientific nutritional experts on social media), baseline risks (e.g. high level of education), initiating events (e.g. experiencing a break up), symptoms (e.g. feelings of depression and anxiety), diagnosis and type of treatment administered (e.g. cognitive-behavioral therapy). The current study is unique in its use of health professionals' experiential knowledge to assess how ON develops and who typically develops it. Furthermore, it contributes to the sparse literature on potential ways to treat ON. More top-down investigations into health professionals' experiences are encouraged as the literature on ON thickens.

Selective attentional bias to food-related stimuli in healthy individuals with characteristics towards orthorexia nervosa

PURPOSE

It has been argued that orthorexia nervosa (ON) is a unique type of disordered eating of food considered by the individual to be healthy. Given that in other eating disorder populations attentional preference for food-related cues influences eating behaviours, is it also likely that these biases may be a characteristic of ON tendency.

METHODS

Eighty healthy individuals completed the ORTO-15 questionnaire (ON tendency), a modified Stroop task containing words related to healthy and unhealthy foods and perceived hunger levels pre- and post-testing. The ORTO-15 was used to identify participants within this sample who demonstrated more or less of the characteristics of ON.

RESULTS

Results suggest that the presence of attentional bias to healthy, but not for unhealthy food-related stimuli independently predict increased ON tendency. Increased attentional bias towards healthy food-related stimuli is associated with increased scores on the ORTO-15.

CONCLUSION

Attentional bias, as a deficit in information processing, towards healthy food-related stimuli accounts for variability in ON characteristics.

LEVEL OF EVIDENCE

Level I, experimental study.

Classification of Orthorexia Nervosa: Further evidence for placement within the eating disorders spectrum

PURPOSE

Orthorexia Nervosa (ON) may belong on the eating disorder (ED) or obsessive-compulsive (OC) spectrum. We sought to provide additional evidence regarding the working classification of ON as an ED.

METHODS

512 individuals completed a measure of ON symptoms (rBOT), ED symptoms (Eating Disorder Examination Questionnaire), OC symptoms (Obsessive-Compulsive Inventory Revised), food choice motives (Food Choice Questionnaire), and perfectionism (Multidimensional Perfectionism Scale).

RESULTS

ON symptoms were more strongly linked to ED symptoms than to OC symptoms. ON symptoms were related to body weight and shape concerns, and with prioritizing weight above health with respect to food selection. Both ED and ON symptoms were moderately related to perfectionism, while OC symptoms were strongly related to perfectionism.

CONCLUSION

Our results support ON being classified on the ED spectrum; however, whether ON represents a precursor to an ED, an ED with added health concerns, or a disorder that evolves from an ED is not certain. Future longitudinal research is necessary to test these alternate possibilities.

Assessing psychological and nutritional impact of suspected orthorexia nervosa: a cross-sectional pilot study

BACKGROUND

To date, research on the dietary patterns of individuals with potential orthorexic symptoms is lacking. This cross-sectional pilot study aimed to explore the feasibility of assessing dietary patterns with psychological traits and states of individuals with possible orthorexic tendencies.

METHODS

Dietary intakes of 10 individuals (two males and eight females) were assessed using 24-h recall. Mean age of participants was 28.3 years; mean body mass index was 21.2 kg m^-2 . Nutrient intakes were compared with current dietary guidelines and the Eatwell Guide (Public Health England, 2016). Participants completed the ORTO-15, the Eating Attitude Test (EAT-26), the Obsessive-Compulsive Inventory-Revised edition (OCI-R), Paulhus's Spheres of Control (SoC), the Rosenberg's Self-Esteem Scale (RSES) and the Multidimensional Body-Self Relations Questionnaire (MBSRQ).

RESULTS

High levels of disparity across participants' psychometric scores and 24-h recall results were observed. There was no single pattern of self-imposed dietary restrictions among participants. Described dietary practices failed to meet the guidelines for several nutrients.

CONCLUSIONS

The results of this pilot study suggest that an extensive investigation of the diets of individuals with possible orthorexic tendencies in a large-scale study would contribute to the understanding of this condition. In addition, the use of multiple psychometric instruments is recommended for diagnosing orthorexic nervosa.

What are the key features of orthorexia nervosa and influences on its development? A qualitative investigation

Orthorexia nervosa (ON) - a pathological obsession with healthy eating - is an emerging eating disorder. The precise nature of ON and its causes remain unclear, yet few published research studies speak directly to those with ON tendencies or professionals working with them. Our study redresses this gap in the literature by uncovering the defining ON features and the factors influencing its development. The exploratory qualitative research design included semi-structured interviews with those self-identifying as orthorexic or obsessively preoccupied with healthy eating (n = 9), and professionals working with ON and eating disorders - psychologists, dieticians and a family therapist (n = 7). Data were analysed thematically. ON emerged as multifactorial, with a variety of interrelated influences needing to coalesce for 'healthy eating' to become pathological. Key features included rigidity and control (around food choices, routines and preparation) and moral judgements around food, along with a range of negative psychosocial and physical impacts. Influences on the development of ON were organised according to their occurrence at the individual (micro) level, external/relational (meso) level and societal (macro) level. Influences on the individual included health concerns, belief in food as medicine, past trauma, personality (e.g. obsessive, perfectionist), exposure to extreme views and behaviours while growing up and moral concerns. External influences included parents, partners and relational groups (e.g. fitness or clean eating groups). Societal influences included aestheticism, moral citizenship and social media. We conclude that ON is more than an individual pathology, it is symptomatic of our 'orthorexic society': where hyper-reflexivity around food choices, conflicting information regarding the correct diet, preoccupation with appearance, and emphasis on individual (not collective) responsibility for health combine with individual susceptibilities and ecological/moral concerns, to predispose toward pathological 'healthy' eating.

"Keep Yourself Alive": From Healthy Eating to Progression to Orthorexia Nervosa A Mixed Methods Study among Young Women in the Netherlands

This study aimed to understand the factors influencing people's choice to follow a diet considered healthy, and if and how these factors may contribute progress toward a higher (unhealthy) degree of preoccupation with healthy eating: orthorexia nervosa. This was achieved through mixed methods (interviews, n = 12; questionnaire, n = 82). The target group was young females in the Netherlands. Several biological, psychological, and social factors contribute to people's healthy eating. Having concerns about chronic conditions were found to be significantly associated with a higher degree of preoccupation with healthy eating, resulting implicated in the possible onset of orthorexia nervosa.

Relationship between Psychosocial Impairment, Food Choice Motives, and Orthorexic Behaviors among Polish Adults

Orthorexic behaviors correlate not only with health motives when choosing food but may also coexist with psychosocial impairment. The aim of this study was to assess the motives of food choice and psychosocial impairment among adults with orthorexic behaviors through the use of ORTO-15 and ORTO-7. The data for the study were collected from a sample of 1007 Polish adults through a cross-sectional quantitative survey conducted in 2019. The respondents were asked to complete the ORTO-15 questionnaire, the Food Choice Questionnaire (FCQ), and the Clinical Impairment Assessment (CIA). Orthorexic behaviors were measured using both the 15-item and the shorter 7-item version of the ORTO questionnaire. To determine the factors coexisting with the orthorexic behaviors, linear regression models were developed. The scores of both ORTO-15 and ORTO-7 correlated positively with the global CIA scores and the scores of personal, cognitive, and social impairments, but compared to the ORTO-7 scores, the ORTO-15 scores showed weaker correlations with the global CIA score and individual CIA scales. Orthorexic behaviors measured with ORTO-15 correlated positively with such food choice motives as health, natural content, and weight control; whereas orthorexic behaviors measured with ORTO-7 showed positive bivariate correlations only with two food choice motives: health and weight control. In regression models, sensory appeal, age, and education lower than secondary were associated inversely with orthorexic behaviors measured by both the ORTO-15 and the ORTO-7. In conclusion, the obtained results confirm that orthorexic behaviors are associated with a higher score regarding health motivation and cause an increase in psychosocial impairment. In addition, orthorexic behaviors are associated with greater importance of body weight control, which confirms the relationship between orthorexic behaviors and other eating disorders (ED), such as anorexia nervosa (AN) and bulimia nervosa (BN). However, similar motives for food choice displayed by the groups with higher scores of the ORTO-15 and the ORTO-7 and strong correlation between results obtained from both tools confirmed the similarity between these two questionnaires, thus revealing the weak psychometric properties also of the shorter seven-item version of the ORTO. Future studies on food motives, psychosocial impairment, and orthorexic behaviors should consider using other tools for measuring orthorexic behaviors.

Orthorexic tendencies are linked with difficulties with emotion identification and regulation

BACKGROUND

Orthorexia nervosa (ON) is characterised by an unhealthy obsession with healthy eating and while it is not recognised as an eating disorder (or any disorder), current research is exploring similarities and differences with such disorders. The literature has shown that individuals with eating disorders have difficulties identifying and describing emotions (known as alexithymia) as well as regulating them. However no research to date has looked at whether people with orthorexic tendencies also suffer from difficulties with emotions. In this paper, we refer to people with orthorexic tendencies but do not assume that their healthy eating is at a pathological level needing clinical attention.

METHODS

The current study examined this by asking 196 healthy adults with an interest in healthy eating to complete four questionnaires to measure ON (ORTO-15 - reduced to ORTO-7CS), eating psychopathology (EAT-26), alexithymia (TAS-20) and emotion dysregulation (DERS-16).

RESULTS

We found that difficulties identifying and regulating emotions was associated with symptoms of ON, similar to what is found in other eating disorders. We suggest that ON behaviours may be used as a coping strategy in order to feel in control in these participants who have poor emotion regulation abilities.

CONCLUSIONS

Our results show that individuals with ON tendencies may share similar difficulties with emotions compared to other eating disorders. While important, our results are limited by the way we measured ON behaviours and we recommend that further research replicate our findings once a better and more specific tool is developed and validated to screen for ON characteristics more accurately.

Cross-cultural differences in orthorexic eating behaviors: Associations with personality traits

OBJECTIVES

Sociocultural factors and personality traits play key roles in determining dietary behaviors. Orthorexia nervosa (ON), the pathologic obsession with healthy eating, is increasingly receiving scientific attention. However, mechanisms and risk factors are not completely understood. The aims of this study were to compare the prevalence of orthorexic eating attitudes among adults in Germany and Lebanon, and to examine the relationship with primary facets of personality and maladaptive personality traits.

METHODS

The German sample comprised 391 adults, of which 314 were women (80.3%) and the mean age was 27 y. The Lebanese sample comprised 519 adults, of which 283 were women (56%) and the mean age was 36 y. In addition to sociodemographic data, participants completed the Dusseldorf Orthorexia Scale (DOS), the Teruel Orthorexia Scale (TOS), the Big Five Inventory, and the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.

RESULTS

Generally higher levels of healthy orthorexia among women and higher levels of ON according to the TOS-ON and DOS scores were found in Lebanon. In the Lebanese sample, 8.4% presented a high risk for ON, whereas this was true for only 4.9% of the German sample. Some associations between DOS/TOS scores and personality traits appeared but coefficients were generally low. Hierarchical multiple regression showed that the negative association between ON and the traits agreeableness and negative affectivity was clearly evident in the Lebanese sample but less so in the German sample. Age, body mass index, marital status, and subjective social status were not relevant moderators of effects. Comparison by country indicated higher prevalence of pathologic healthful eating and ON in the Lebanese sample compared with the German group. Personality traits, but not sociodemographic variables, partly contributed to this difference.

CONCLUSION

The present results suggested the importance of sociocultural factors in the development of eating pathologies and proposed specific personality traits as important associated factors.

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.

Orthorexic Tendency and Eating Disorders Symptoms in Polish Students: Examining Differences in Eating Behaviors

Orthorexia nervosa (ON) may precede, ensue, or coexist with eating disorders (ED) and also affect eating behaviors. The aim of this study was to explore the dietary patterns (DPs) and other eating habits of people showing ON tendency, ED symptoms, and both ON tendency and ED symptoms, as well as those not showing either. The data for the study were collected from a sample of 1120 Polish college students through a cross-sectional survey in 2017. The questionnaire used in the survey included the ORTO-15, the Eating Disorder Screen for Primary Care (ESP), and the Food Frequency Questionnaire (FFQ-6), and the students were also asked questions about their eating habits and special diets. A factor analysis was conducted to identify the following five DPs: "high-sugar products and refined products," "meat and meat products," "alcohol," "high-fiber products and nuts," and "dairy products and whole-meal bread." Univariate logistic regression analyses were carried out to verify the associations between the variables. Students in the "ON and without ED" group were found to exhibit more healthy eating habits than the students in the "ED and without ON" group. The use of a special diet in the past and currently increased the risk of displaying ON tendency and ED symptoms. Students in the "ON and without ED" and "ON and ED" groups were characterized by less frequent consumption of high-sugar and refined products. Students who rarely consumed meat and related products were found to be less likely to display "ON and ED." In conclusion, different eating habits shown by people with ON tendency and ED symptoms confirmed the difference between ON and ED. However, the simultaneous displaying of ON and ED leads to the overlapping of specificity of eating habits, which can make the diagnosis based only on the eating habits difficult. Thus, there is still a need for further research involving the use of more sensitive tools that can better identify ON tendency and ED symptoms, as well as DPs.

Assessing the Prevalence of Orthorexia Nervosa in a Sample of University Students Using Two Different Self-Report Measures

In recent decades, orthorexia nervosa (ON) has increased presence in society. It is related with beliefs and attitudes towards eating and is characterized by an obsessive behavior toward heathy eating. The prevalence of ON has been reported by numerous researchers, with rates varying considerably according to the tool used to evaluate the same parameter. The aim of this study was to compare the prevalence of ON in a single population using two different questionnaires. The test for the diagnosis of orthorexia (ORTO-11-ES) assessment tool for orthorexia nervosa and the Düsseldorfer Ortorexie Skala (DOS-ES), constitute brief self-report assessment tools which measure the risk of suffering ON. A sample of 492 students from the University of Castilla la Mancha (Spain) participated in this study, of whom 43.1% were male and 56.9% were female. The findings show that, according to the DOS-ES, only 10.5% of students displayed ON whereas, with the ORTO-11-ES, the prevalence of ON increased to 25.2%. The tendency towards orthorexic behavior is more closely associated with the female gender. The Body Mass Index (BMI) had no influence on the tendency for ON. This study provides valuable information on the usefulness of both questionnaires and the possible limitations associated with the use of these tools in the general population.

Orthorexia nervosa and healthy orthorexia as new eating styles

It was recently proposed that healthy orthorexia (HeOr) and orthorexia nervosa (OrNe) should be differentiated. The aim of the present study was to analyze whether the two dimensions of orthorexia can be considered new eating styles or basically equivalent to restrained eating behavior. Two samples of university students (sample 1, n = 460; sample 2, n = 509) completed the Teruel Orthorexia Scale (TOS), the Dutch Eating Behavior Questionnaire (DEBQ), and the Positive and Negative Affect Schedule (PANAS). Factor analysis with the TOS and DEBQ items together revealed an adequate fit for the preexisting five-factor solution (TOS: OrNe and HeOr; DEBQ: Restrained Eating, Emotional Eating, and External Eating). This result points out that these factors are conceptually distinguishable. Moreover, we tested whether the different eating styles presented different patterns of correlations with gender, body mass index (BMI), and age, and whether OrNe and HeOr predicted Positive and Negative Affect after controlling for Restrained, Emotional, and External Eating. Whereas Restrained and Emotional Eating were higher for women and increased with BMI in both samples, HeOr and OrNe presented much lower associations with these variables. OrNe was positively related to Negative Affect and negatively to Positive Affect, whereas HeOr was positively related to Positive Affect. Again, this result supports the assumption that OrNe is a new variant of disordered eating, whereas HeOr could possibly be seen as a protective behavior.