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Rozmiarek M, Grajek M, Krupa-Kotara K, Malchrowicz-Mośko E. Orthorectic behavior among students and motivation for physical activity, dietary habits, and restrictive eating. Front Nutr 2024; 11:1367767. [PMID: 38887502 PMCID: PMC11180727 DOI: 10.3389/fnut.2024.1367767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/23/2024] [Indexed: 06/20/2024] Open
Abstract
Introduction Orthorexia lacks official recognition as an eating disorder; however, orthorexic behaviors, associated with a stringent selection of food, may serve as a predisposing factor to the development of eating disorders. It is characterized by an obsessive preoccupation with healthy eating and strict dietary standards, often prevalent in high-risk groups such as athletes and individuals concerned with their physical appearance. The objective of this study was to evaluate the incidence of orthorexia among students exhibiting varying lifestyles (including dietary habits and levels of physical activity, along with their respective motivational factors). The research involved 600 participants equally distributed between health-related (HRF) and non-health-related (NRF) academic categories, with the majority of participants in the HRF category being women. Methods Assessments included BMI calculations, dietary evaluation based on Polish standards, categorization of physical activity levels, the EMI-2 questionnaire on motivation to exercise, the DOS test for orthorexia propensity, and the TFEQ-13 questionnaire for eating behavior. Results and discussion Results showed that primary motivators for physical activity included disease prevention, health maintenance, strength/endurance, and physical appearance. Orthorexia tendencies were prevalent, particularly in the HRF group, linked to lower BMI, better diet quality, higher physical activity levels, and a higher prevalence of restrictive eating. In conclusion, students in health-related fields, driven by a strong health consciousness, are at risk of orthorexia. This emphasizes the need for balanced health education and support. Conclusion Orthorexic tendencies are associated with distorted perceptions of food portions and calories, underscoring the importance of awareness and intervention.
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Affiliation(s)
- Mateusz Rozmiarek
- Department of Sports Tourism, Faculty of Physical Culture Sciences, Poznan University of Physical Education, Poznan, Poland
| | - Mateusz Grajek
- Department of Public Health, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, Bytom, Poland
| | - Karolina Krupa-Kotara
- Department of Epidemiology, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, Bytom, Poland
| | - Ewa Malchrowicz-Mośko
- Department of Sports Tourism, Faculty of Physical Culture Sciences, Poznan University of Physical Education, Poznan, Poland
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Plichta M, Kowalkowska J. Orthorexic tendency and its association with weight control methods and dietary variety in Polish adults: a cross-sectional study. Front Nutr 2024; 11:1355871. [PMID: 38711530 PMCID: PMC11073497 DOI: 10.3389/fnut.2024.1355871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/02/2024] [Indexed: 05/08/2024] Open
Abstract
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.
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Affiliation(s)
- Marta Plichta
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), Warsaw, Poland
| | - Joanna Kowalkowska
- Department of Human Nutrition, Faculty of Food Science, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
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Huynh PA, Miles S, de Boer K, Meyer D, Nedeljkovic M. A systematic review and meta-analysis of the relationship between obsessive-compulsive symptoms and symptoms of proposed orthorexia nervosa: The contribution of assessments. EUROPEAN EATING DISORDERS REVIEW 2024; 32:257-280. [PMID: 37838984 DOI: 10.1002/erv.3041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/07/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to update the literature on orthorexia nervosa (ON), a proposed diagnosis of pathologically 'healthy' eating, by critically analysing the current evidence for the relationship between ON and obsessive-compulsive (OC) symptoms. Further, this paper aimed to compare the ON/OC relationship significance and strength based on when the ON measurement tool was developed. METHOD PsycINFO, PubMed and Web of Science databases were queried for quantitative, peer-reviewed studies recruiting adult participants, published in English up to April 2023. Studies not directly comparing ON and OC symptoms were excluded. After full-text review and quality assessment, 40 studies were included in the systematic review and 31 studies in the meta-analysis. RESULTS ON assessments created prior to the 2016 revised ON diagnostic criteria do not appear to fully capture OC symptoms. Studies using earlier developed ON assessments demonstrated inconsistent ON/OC relationships whereas studies implementing more recent assessments (from 2018 onwards) found consistently significant, larger relationships, highlighting a previously underrated OC component of ON. CONCLUSIONS Early ON studies, and studies utilising early ON assessments should be interpreted with caution, particularly in relation to OC symptom involvement in ON. Future research should validate novel ON assessments and investigate common underlying factors.
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Affiliation(s)
- Phillipa Ann Huynh
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Stephanie Miles
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Orygen, Melbourne, Victoria, Australia
| | - Kathleen de Boer
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Denny Meyer
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
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Ephrem C, Rizk R, Saadeh D, Hallit S, Obeid S, Martijn C. Orthorexia nervosa in dietitians and dietetics students-prevalence, risk factors, and interventions: a scoping review using a systematic approach. Nutr Rev 2024:nuae009. [PMID: 38381921 DOI: 10.1093/nutrit/nuae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
CONTEXT Orthorexia nervosa (ON) is characterized by compulsive behaviors and increased concerns about healthful eating. Dietitians appear to be especially vulnerable to ON, and it is still debatable whether the disordered eating behaviors motivate individuals to enroll in nutrition programs, or whether these behaviors result from an exaggerated preoccupation with healthy eating triggered during their nutrition studies. OBJECTIVE The aim was to provide an overview of the present state of knowledge about the prevalence, risk factors, and interventions addressing ON among dietitians and dietetics students. More specifically, it was examined whether dietitians and dietetics students differ from students attending different education programs or other health professionals with regard to the severity and risk factors of ON, and whether the extent of ON changes during the progression in the nutrition education years of study. DATA SOURCES MEDLINE (Ovid), PubMed, EMBASE (Ovid), PsycInfo (EBSCO), CINAHL (EBSCO), Cochrane, ProQuest Central, CABI, ProQuest Dissertations, Google Scholar, ScienceDirect, and SpringerLink were searched on May 8, 2021, and updated on November 12, 2022. DATA EXTRACTION Records were screened for eligibility; study characteristics, methodology, and findings of included articles were extracted; and the methodological quality assessed using the AXIS tool. Each step was preceded by a calibration exercise and conducted independently and in duplicate by pairs of 2 reviewers. Any disagreements were resolved through discussions. DATA ANALYSIS A narrative synthesis was performed, whereby the characteristics, methodologies, and results of included studies were compared. CONCLUSIONS Results were inconclusive; yet, a general status of the relatively "high" prevalence of ON among dietitians and dietetics students was established, stressing the need for systematic research to understand and mitigate orthorexic tendencies in this group. It is still too early to answer questions pertaining to prevalence, risk factors, interventions, and differences between dietetics students and other majors when it comes to severity and progress of ON throughout the continuing years of study, or between dietitians and other professional groups. SYSTEMATIC REVIEW REGISTRATION Open Science Framework Identifier: DOI 10.17605/OSF.IO/BY5KF.
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Affiliation(s)
- Chloe Ephrem
- Clinical Psychological Science-Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Rana Rizk
- Nutrition Program, Department of Natural Sciences, Lebanese American University, Byblos, Lebanon
- Institut National de Santé Publique, d'Epidemiologie Clinique, et de Toxicology (INSPECT-LB), Beirut, Lebanon
| | - Danielle Saadeh
- Institut National de Santé Publique, d'Epidemiologie Clinique, et de Toxicology (INSPECT-LB), Beirut, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Sahar Obeid
- Department of Social and Education Sciences, School of Arts and Sciences, Lebanese American University, Byblos, Lebanon
| | - Carolien Martijn
- Clinical Psychological Science-Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Huynh PA, Miles S, Nedeljkovic M. Perfectionism as a moderator of the relationship between orthorexia nervosa and obsessive-compulsive symptoms. Eat Weight Disord 2024; 29:6. [PMID: 38198059 PMCID: PMC10781834 DOI: 10.1007/s40519-023-01629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/27/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE Orthorexia nervosa (ON), a proposed disorder describing an obsessive focus on "healthy" eating, is characterised as having overlapping symptoms with obsessive-compulsive disorder. However, ON/obsessive-compulsive (OC) symptom relationships are inconsistently reported. The current study aimed to investigate if the contribution of OC symptoms and beliefs explain variability in ON symptoms and determine if perfectionism, a transdiagnostic factor, moderates the ON/OC symptom relationship. METHODS The study comprised 190 participants (Mage = 28.63, SDage = 9.88; 80% female) recruited via an undergraduate research programme, social media, advocacy organisations, and a participant registry. Participants completed an online questionnaire assessing ON, OC, and perfectionism symptoms. RESULTS A linear regression analysis found OC symptoms and beliefs explained 22.9% variability in ON symptoms (p < 0.001, f2 = 0.38) and perfectionism moderated the ON/OC symptom relationship, where higher levels of perfectionism with higher levels of OC symptoms was associated with higher levels of ON symptoms, explaining 2.2% variability (p = .01, f2 = 0.03). CONCLUSION OC symptoms appear more common in ON than previous studies indicate. However, the interaction between perfectionism and OC symptoms may drive obsessions in ON. Findings help refine our current understanding of ON phenomenology with implications for ON treatment development. Future research should further explore perfectionism in ON phenomenology. LEVEL OF EVIDENCE Level V (Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees).
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Affiliation(s)
- Phillipa Ann Huynh
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn Campus, PO Box 218, Hawthorn, VIC, 3122, Australia.
| | - Stephanie Miles
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Orygen, Melbourne, VIC, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn Campus, PO Box 218, Hawthorn, VIC, 3122, Australia
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López-Gil JF, Tárraga-López PJ, Soledad Hershey M, López-Bueno R, Gutiérrez-Espinoza H, Soler-Marín A, Fernández-Montero A, Victoria-Montesinos D. Overall proportion of orthorexia nervosa symptoms: A systematic review and meta-analysis including 30 476 individuals from 18 countries. J Glob Health 2023; 13:04087. [PMID: 37917875 PMCID: PMC10622118 DOI: 10.7189/jogh.13.04087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Background To date, no previous meta-analysis has determined the overall proportion of orthorexia nervosa symptoms on a global scale. The aim of the present study was 2-fold: first, to establish the overall proportion of orthorexia nervosa symptoms on a global scale, assessed with the ORTO-15 questionnaire; and second, to determine the role of sex, type of population, mean age, body mass index, and the temporal trend in relation to orthorexia nervosa symptoms. Methods Four databases were searched (PubMed, Scopus, Web of Science, and Cochrane Database of Systematic Reviews) with date limits from January 2005 to June 2023. Studies assessing the proportion of orthorexia nervosa assessed using the ORTO-15 questionnaire with a cutoff of <35 or <40 points were included in this review. Results The overall proportion of orthorexia nervosa symptoms (using the cutoff <35 points) was 27.5% (95% confidence interval (CI) = 23.5-31.6, I2 = 97.0%). In addition, no significant differences were observed between females (34.6%, 95% CI = 29.5-39.8, I2 = 96.1%) and males (32.1%, 95% CI = 26.5-38.1, I2 = 93.1%). According to the type of population, the highest overall proportion was found in people focused on sports performance or body composition (34.5%, 95% CI = 23.1-47.0, I2 = 98.0%). Notwithstanding, caution should be exercised in interpreting this result, as reverse causality could be a potential pitfall in this relationship. Conclusions We found that approximately three out of 10 study participants showed orthorexia nervosa symptoms according to the ORTO-15 tool. This overall proportion was higher in those participants who were athletes or fitness practitioners. Over the years, the proportion of orthorexia nervosa symptoms seems to be increasing. These high percentages and their increase are worrisome from a public health perspective and highlight the need to develop psychometric instruments to aid in clinical diagnosis and treatment efficacy. Registration PROSPERO (CRD42022350873).
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Affiliation(s)
- José Francisco López-Gil
- Navarrabiomed, Hospital Universitario de Navarra, Universidad Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
- One Health Research Group, Universidad de Las Américas, Quito, Ecuador
| | - Pedro Juan Tárraga-López
- Departamento de Ciencias Médicas, Facultad de Medicina, Universidad Castilla-La Mancha, Albacete, Spain
| | - Maria Soledad Hershey
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
- University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, Pamplona, Spain
| | - Rubén López-Bueno
- Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
| | | | - Antonio Soler-Marín
- Faculty of Pharmacy and Nutrition, Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Alejandro Fernández-Montero
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Occupational Medicine, University of Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
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Athanasaki D, Lakoumentas J, Milani GP, Agostoni C, Berghea F, Ionescu MD, Vassilopoulou E. Maternal Bonding as a Protective Factor for Orthorexia Nervosa Risk in Dietetics Students. Nutrients 2023; 15:3577. [PMID: 37630767 PMCID: PMC10460006 DOI: 10.3390/nu15163577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/01/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
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.
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Affiliation(s)
- Dafni Athanasaki
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (D.A.); (J.L.); (E.V.)
| | - John Lakoumentas
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (D.A.); (J.L.); (E.V.)
| | - Gregorio Paolo Milani
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.P.M.); (C.A.)
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Carlo Agostoni
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.P.M.); (C.A.)
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Florian Berghea
- Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Spital Clinic Sf. Maria, Bd. Ion Mihalache 37-39, Et 1 Secretariat, 011172 Bucharest, Romania
| | - Marcela Daniela Ionescu
- Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- “Marie S. Curie” Emergency Children’s Clinical Hospital, 041451 Bucharest, Romania
| | - Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (D.A.); (J.L.); (E.V.)
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.P.M.); (C.A.)
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Yassıbaş E, Ayyıldız F. Turkish Version of the New Instrument for Orthorexia Nervosa-Test of Orthorexia Nervosa (TON-17): A Validity and Reliability Study. Nutrients 2023; 15:3178. [PMID: 37513596 PMCID: PMC10384101 DOI: 10.3390/nu15143178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
This study aimed to adapt the Test of Orthorexia Nervosa- (TON-17) into Turkish and verify its validity and reliability. The study included 539 adults with a mean age of 30.2 ± 12.26 years. A reliability analysis was performed, along with a confirmatory factor analysis to test its construct validity. The time-invariance of the scale was examined by test-retest analysis, and its convergent validity was evaluated by a correlation analysis conducted to test the relationships between the scale and Eating Attitudes Test-26 and Obsessive Beliefs Questionnaire-9. Analyses were conducted using SPSS Version 28 and the AMOS-24 software. The Cronbach's α internal consistency coefficient of the total scale was found to be 0.82, suggesting a strong internal consistency. The Cronbach's α values of its factors were 0.68 for the "control of food quality", 0.64 for the "fixation on health and a healthy diet", and 0.73 for the "disorder symptoms". In addition, the test-retest reliability was found to be 0.87 for the total scale, suggesting excellent reliability. Most of the fit indices (CMIN/df, RMSEA, AGFI, NFI, and TLI) of the scale were acceptable, and the GFI indicated a good model fit. This study shows that the Turkish version of TON-17, which is a new tool with a three-factor structure to evaluate orthorexia, is a valid and reliable scale.
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Affiliation(s)
- Emine Yassıbaş
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, 06490 Ankara, Turkey
| | - Feride Ayyıldız
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, 06490 Ankara, Turkey
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9
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Plichta M, Jezewska-Zychowicz M. Nutrition knowledge, diet quality and orthorexic behaviors in Polish students-a pre-post repeated cross-sectional study. PLoS One 2023; 18:e0287165. [PMID: 37315087 DOI: 10.1371/journal.pone.0287165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 05/31/2023] [Indexed: 06/16/2023] Open
Abstract
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.
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Affiliation(s)
- Marta Plichta
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), Warsaw, Poland
| | - Marzena Jezewska-Zychowicz
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), Warsaw, Poland
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10
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Duradoni M, Gursesli MC, Fiorenza M, Guazzini A. The Relationship between Orthorexia Nervosa and Obsessive Compulsive Disorder. Eur J Investig Health Psychol Educ 2023; 13:861-869. [PMID: 37232703 DOI: 10.3390/ejihpe13050065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
Orthorexia nervosa (ON) is characterized by an intense avoidance of foods considered unhealthy, obsession with healthy eating behaviors, and pathological fixation on healthy foods. Although there are still debates in the literature about the psychological factors and symptoms of ON, it should be noted that many of the symptoms share common features with obsessive compulsive disorder (OCD). The aim of the present study was to investigate the relationship between ON and OCD with its subtypes. In this framework, the cross-sectional study was conducted with an opportunistic sample of 587 participants (86% women and 14% men), with an average age of 29.32 (s.d. = 11.29; age range = 15-74). Our work showed that almost all OCD subtypes were largely correlated with ON. The lowest correlation was for "Checking" and the highest for "Obsession". Overall, the OCD subtypes (i.e., Indecisiveness, Just Right, Obsession, and Hoarding) were more strongly associated with ON measures, while subtypes Checking and Contamination, although positively associated, had lower correlation coefficients.
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Affiliation(s)
- Mirko Duradoni
- Department of Education, Literatures, Intercultural Studies, Languages and Psychology, University of Florence, 50135 Firenze, Italy
| | - Mustafa Can Gursesli
- Department of Education, Literatures, Intercultural Studies, Languages and Psychology, University of Florence, 50135 Firenze, Italy
- Department of Information Engineering, University of Florence, 50139 Firenze, Italy
| | - Maria Fiorenza
- Department of Education, Literatures, Intercultural Studies, Languages and Psychology, University of Florence, 50135 Firenze, Italy
| | - Andrea Guazzini
- Department of Education, Literatures, Intercultural Studies, Languages and Psychology, University of Florence, 50135 Firenze, Italy
- Centre for the Study of Complex Dynamics, University of Florence, 50135 Firenze, Italy
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11
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Claudia C, Eleonora R, Laura P, Romina L, Campanino C, Valdo R, Edoardo M, Ilaria D, Rotella F. Orthorexia nervosa and type 1 diabetes: results of a cross-sectional study. Acta Diabetol 2023; 60:681-686. [PMID: 36806923 DOI: 10.1007/s00592-023-02044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023]
Abstract
AIM Orthorexia nervosa (ON) is a condition characterized by an excessive importance attributed to the intake of healthy foods. This study was aimed at investigating the prevalence of ON in subjects with type 1 diabetes (T1D) compared to control subjects. METHODS Patient with T1D using either flash glucose monitoring or continuous glucose monitoring were enrolled. For the selection of control group, each patient was asked to indicate one non-diabetic subject of their same sex and approximate age among colleagues at work and school. Patients and controls completed the following questionnaires: ORTO-15, Dusseldorf Orthorexie Scale (DOS), Eating Disorder Examination Questionnaire (EDE-Q) and Brief Symptom Inventory (BSI). The principal outcome was the prevalence of ON among T1D and control subjects. RESULTS We enrolled 44 patients with T1D aged 39.7 ± 15.7 years, with BMI 24.3 ± 4.3 kg/m2, and mean HbA1c 53.5 [49-57] mmol/mol. Control subjects were similar to T1D with respect to sex, age and BMI. Thirty-two [72%] and 29 [65%] subjects among patients and controls, respectively, had ORTO15 < 40 (between-group p = 0.48). Two (4.5%) and zero subjects among patients and controls, respectively, had DOS ≥ 30 (p = 0.29). Median scores of DOS, but not of ORTO-15, were significantly higher in patients than in controls. None of the metabolic variables showed a correlation with psychometric tests in T1D. CONCLUSION Although the prevalence of ON was not significantly higher in T1D than in controls, patients with T1D showed higher scores of some, but not all, tests assessing orthorexia, without any significant correlation with metabolic parameters.
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Affiliation(s)
| | - Rossi Eleonora
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Pala Laura
- Department of Diabetology, Careggi Hospital, Florence, Italy
| | - Lelmi Romina
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Morgagni 50, 50134, Florence, Italy
| | - Chiara Campanino
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Ricca Valdo
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Mannucci Edoardo
- Department of Diabetology, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Morgagni 50, 50134, Florence, Italy
| | - Dicembrini Ilaria
- Department of Diabetology, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Morgagni 50, 50134, Florence, Italy
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12
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Meseri R, Küçükerdönmez Ö, Akder RN. A factor that can yield to eating attitude disorders in university students: Self-esteem. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1053-1058. [PMID: 34242516 DOI: 10.1080/07448481.2021.1920598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/18/2020] [Accepted: 02/11/2021] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To determine prevalence of eating attitude disorder (EAD) and the effect of self-esteem on EAD in female university students. Study Design: In this cross-sectional study, female university students were included. The dependent variable was EAD determined by Eating Attitude Test-40. Socio-demographic characteristics, body perception, obesity, self-compassion and self-esteem were independent variables. Logistic regression (LR) models have been established to determine the associated factors of EAD. p < 0.05 was considered significant. Results: EAD were found in 3.3% (n = 20) of the participants (n = 600). 44.5% had low and medium self-esteem and %13.4 were overweight (body mass index (BMI) ≥ 25.0). According to LR models, after adjusted for age, increased self-esteem score (decreased self-esteem) (OR:1.8, 95%CI:1.063-3.303) and practicing popular diet (OR:12.6, 95%CI:4.439-35.904) increased the risk of EAD significantly. Conclusion: EAD were less than expected in this group of university students. Self-esteem is an important factor affecting EAD. Students with EAD may be recommended to get psychological support as well as nutritional counseling.
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Affiliation(s)
- Reci Meseri
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Ege University, Karşıyaka, İzmir
| | - Özge Küçükerdönmez
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Ege University, Karşıyaka, İzmir
| | - Rana Nagihan Akder
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Ege University, Karşıyaka, İzmir
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13
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Yilmaz FC. Orthorexia and eating attitudes in health sciences students. Niger J Clin Pract 2023; 26:502-507. [PMID: 37203117 DOI: 10.4103/njcp.njcp_507_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
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.
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Affiliation(s)
- F C Yilmaz
- Nutrition and Dietetic Department, Dicle University, Diyarbakır, Turkey
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14
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The effect of social media use on orthorexia nervosa: a sample from Turkey. NUTR HOSP 2023; 40:384-390. [PMID: 36880720 DOI: 10.20960/nh.04217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
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.
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15
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Diet Quality and Level of Nutrition Knowledge among Young People with Orthorexic Tendencies. Nutrients 2022; 14:nu14204333. [PMID: 36297017 PMCID: PMC9609964 DOI: 10.3390/nu14204333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/26/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022] Open
Abstract
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.
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16
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Novara C, Pardini S, Visioli F, Meda N. Orthorexia nervosa and dieting in a non-clinical sample: a prospective study. Eat Weight Disord 2022; 27:2081-2093. [PMID: 34993925 PMCID: PMC8739027 DOI: 10.1007/s40519-021-01353-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/21/2021] [Indexed: 12/23/2022] Open
Abstract
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).
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Affiliation(s)
- Caterina Novara
- Department of General Psychology, University of Padova, Via Venezia 8, 35131, Padova, Italy.
| | - Susanna Pardini
- Department of General Psychology, University of Padova, Via Venezia 8, 35131, Padova, Italy
| | - Francesco Visioli
- Department of Molecular Medicine, University of Padova, Viale G. Colombo 3, Padova, Italy.,IMDEA-Food, CEI UAM + CSIC, Carr. de Canto Blanco 8, E, Madrid, Spain
| | - Nicola Meda
- Department of Medicine, University of Padova, Via Giustiniani 2, Padova, Italy
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17
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Tuck CJ, Sultan N, Tonkovic M, Biesiekierski JR. Orthorexia nervosa is a concern in gastroenterology: A scoping review. Neurogastroenterol Motil 2022; 34:e14427. [PMID: 35811419 PMCID: PMC9541631 DOI: 10.1111/nmo.14427] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 12/13/2022]
Abstract
There is concern that use of restrictive therapeutic diets, such as those used in disorders of the gut-brain interaction (DGBI), may increase disordered eating. In this issue of Neurogastroenterology and Motility, Burton Murray et al. and Peters et al. both demonstrate a high prevalence of disordered eating in patients with gastrointestinal conditions, particularly those with DGBI. Given these findings, it is likely that orthorexia is common in this patient group, although this was not directly examined in these studies. Orthorexia nervosa is described as an obsessive and unsafe focus on eating foods perceived as healthy. This mini-review therefore focuses on orthorexia by conducting a scoping review, as per the PRISMA extension for scoping reviews, aimed to assess the prevalence of orthorexia, and associations between orthorexia and restrictive eating practices. While a wide range of orthorexia prevalence has been reported (0%-97%) across the 57 studies included, no studies assessed prevalence specifically in gastrointestinal conditions. Four of eight studies describing diseases associated with specific dietary patterns suggested that participants who followed a diet for "digestive issues" or "food intolerances" were at higher orthorexia risk. These results suggest that dietary modifications may be a factor contributing to orthorexia. Additionally, we provide a commentary on the clinical implications of the findings for gastrointestinal conditions including a clinical flow chart. Clinicians should consider if a restrictive diet is appropriate for individuals with DGBI and include screening for disordered eating prior to implementation of dietary modifications. Future prospective studies should evaluate orthorexia within this patient group.
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Affiliation(s)
- Caroline J. Tuck
- Department of Sport, Exercise and Nutrition SciencesLa Trobe UniversityBundooraVictoriaAustralia
| | - Nessmah Sultan
- Department of Sport, Exercise and Nutrition SciencesLa Trobe UniversityBundooraVictoriaAustralia
| | - Matilda Tonkovic
- Department of Sport, Exercise and Nutrition SciencesLa Trobe UniversityBundooraVictoriaAustralia
| | - Jessica R. Biesiekierski
- Department of Sport, Exercise and Nutrition SciencesLa Trobe UniversityBundooraVictoriaAustralia,Department of Nutrition, Dietetics and FoodMonash UniversityNotting HillVictoriaAustralia
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18
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Skella P, Chelmi ME, Panagouli E, Garoufi A, Psaltopoulou T, Mastorakos G, Sergentanis TN, Tsitsika A. Orthorexia and Eating Disorders in Adolescents and Young Adults: A Systematic Review. CHILDREN 2022; 9:children9040514. [PMID: 35455559 PMCID: PMC9030415 DOI: 10.3390/children9040514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- Panagiota Skella
- Strategies of Developmental and Adolescent Health, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (P.S.); (M.E.C.); (E.P.); (A.G.); (T.P.); (T.N.S.)
| | - Maria Eleni Chelmi
- Strategies of Developmental and Adolescent Health, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (P.S.); (M.E.C.); (E.P.); (A.G.); (T.P.); (T.N.S.)
- Clinical Psychopathology, University of Macedonia, 546 36 Thessaloniki, Greece
| | - Eleni Panagouli
- Strategies of Developmental and Adolescent Health, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (P.S.); (M.E.C.); (E.P.); (A.G.); (T.P.); (T.N.S.)
| | - Anastasia Garoufi
- Strategies of Developmental and Adolescent Health, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (P.S.); (M.E.C.); (E.P.); (A.G.); (T.P.); (T.N.S.)
| | - Theodora Psaltopoulou
- Strategies of Developmental and Adolescent Health, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (P.S.); (M.E.C.); (E.P.); (A.G.); (T.P.); (T.N.S.)
- Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - George Mastorakos
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece;
| | - Theodoros N. Sergentanis
- Strategies of Developmental and Adolescent Health, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (P.S.); (M.E.C.); (E.P.); (A.G.); (T.P.); (T.N.S.)
- Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
- Department of Public Health Policy, University of West Attica, 122 43 Athens, Greece
| | - Artemis Tsitsika
- Strategies of Developmental and Adolescent Health, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece; (P.S.); (M.E.C.); (E.P.); (A.G.); (T.P.); (T.N.S.)
- Correspondence: ; Tel.: +30-216-0033788
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19
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Brytek-Matera A, Pardini S, Modrzejewska J, Modrzejewska A, Szymańska P, Czepczor-Bernat K, Novara C. Orthorexia Nervosa and its association with obsessive-compulsive disorder symptoms: initial cross-cultural comparison between Polish and Italian university students. Eat Weight Disord 2022; 27:913-927. [PMID: 34076878 PMCID: PMC8964579 DOI: 10.1007/s40519-021-01228-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/27/2021] [Indexed: 12/12/2022] Open
Abstract
There is limited evidence of a link between Orthorexia Nervosa (ON) and Obsessive-Compulsive Disorder (OCD), and no definitive conclusions can be drawn. The interplay between socio-cultural context and ON has been poorly investigated as well. Therefore, the objectives of the present study were: (1) to investigate the differences in ON and OCD symptoms and (2) to assess the relationship between ON and OCD symptoms among university students. Six hundred and sixty-six university students participated in the present study: 286 from Poland and 320 from Italy. No age, gender and marital status differences were identified between two samples of university students. However, on average, Polish university students had a higher Body Mass Index than Italian ones. Our findings showed that Polish students present more problems related to obsessive symptomatology, core beliefs of OCD, perfectionism traits, and a major ON symptomatology than Italian ones. Also, Polish students with a higher level of ON exhibited higher levels of OCD symptoms and parental expectations/parental criticism. While Italian students with a higher level of ON showed higher levels of perfectionism features (organization and concern over mistakes). In general, correlations were low as confirmation of partial independence ON from OCD symptoms and core beliefs of OCD in both Polish and Italian university students. The present results highlight a need for further investigation of the correlates of ON across different cultural groups. Future research may screen individuals with ON to determine the comorbidity between ON and OCD symptomology to facilitate appropriate treatment choices. LEVEL OF EVIDENCE: Level V, Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Affiliation(s)
- Anna Brytek-Matera
- Institute of Psychology, University of Wroclaw, Dawida 1, 50-527, Wroclaw, Poland.
| | - Susanna Pardini
- Department of General Psychology, University of Padova, Padova, Italy
| | - Justyna Modrzejewska
- Faculty of Humanities and Social Sciences, University of Bielsko-Biała, Bielsko-Biała, Poland
| | | | - Paulina Szymańska
- Institute of Psychology, University of Wroclaw, Dawida 1, 50-527, Wroclaw, Poland
| | | | - Caterina Novara
- Department of General Psychology, University of Padova, Padova, Italy
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20
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Use of online and paper-and-pencil questionnaires to assess the distribution of orthorexia nervosa, muscle dysmorphia and eating disorders among university students: can different approaches lead to different results? Eat Weight Disord 2022; 27:989-999. [PMID: 34110598 PMCID: PMC8190766 DOI: 10.1007/s40519-021-01231-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/28/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Administration of questionnaires to assess the diffusion of disordered eating behaviours via the web is becoming common today. The aim of this study is to assess whether two different approaches of administering a test to assess traits of eating disorders (EDs), orthorexia nervosa (ON) and muscle dysmorphia (MD) by email recruitment and online completion (web-based survey-WBS) and by in person recruitment and paper-and-pencil completion (paper-based survey-PBS), gives different results. METHODS During 2 consecutive academic years, a self-reported questionnaire consisting of questions about personal characteristics and three tests for the evaluation of ON (ORTO-15), MD (MDDI-ITA), and EDs (EAT-26) were administered to two groups of undergraduates, respectively, as a WBS and a PBS. RESULTS The WBS response rate was 6.7% (N = 137), and the PBS response rate was 86.5% (N = 372). The WBS group showed a statistically significant higher prevalence of students with eating disordered behaviours (21.2% vs 5.4%) and registered a higher mean score on the EAT-26 test (13.5 ± 11.1 vs 6.0 ± 8.0); no differences between the two groups emerged for ON and MD prevalence and test scores. Moreover, in the WBS group, the number of students with one or more tests with test scores above the cut-off values was significantly higher (46.0% vs 32.3%). CONCLUSION The choice of the approach to administer a questionnaire to assess the diffusion of EDs and related issues must take into account all the factors that can result in selection bias and that can affect the reliability of the results. LEVEL OF EVIDENCE Level V, descriptive cross-sectional survey.
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21
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Guglielmetti M, Ferraro OE, Gorrasi ISR, Carraro E, Bo S, Abbate-Daga G, Tagliabue A, Ferraris C. Lifestyle-Related Risk Factors of Orthorexia Can Differ among the Students of Distinct University Courses. Nutrients 2022; 14:nu14051111. [PMID: 35268086 PMCID: PMC8912801 DOI: 10.3390/nu14051111] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/21/2022] [Accepted: 03/04/2022] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Monica Guglielmetti
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
- Correspondence: (M.G.); (C.F.)
| | - Ottavia Eleonora Ferraro
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy;
| | | | - Elisabetta Carraro
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy; (I.S.R.G.); (E.C.)
| | - Simona Bo
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126 Turin, Italy;
| | - Giovanni Abbate-Daga
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy;
| | - Anna Tagliabue
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Cinzia Ferraris
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
- Correspondence: (M.G.); (C.F.)
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22
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Busatta D, Cassioli E, Rossi E, Campanino C, Ricca V, Rotella F. Orthorexia among patients with eating disorders, student dietitians and general population: a pilot study. Eat Weight Disord 2022; 27:847-851. [PMID: 33852153 DOI: 10.1007/s40519-021-01184-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/26/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Orthorexia is a recent construct describing an unhealthy and extreme concern for healthy food. To date, its relationship with other eating disorders (EDs) remains unclear, and little is known about the development of this condition. Current literature suggests that a thorough knowledge about nutrition and alimentation, as in the case of experts in the field of dietetics, could foster the development of orthorexic tendencies. The aim of this study was to compare orthorexia between ED patients, student dietitians and general population. METHODS A total of 90 female participants (age: 18-29 years) were recruited: 30 ED patients, 30 student dietitians and 30 control subjects, matched for age and sex. Orthorexia, ED-specific and general psychopathology were evaluated using self-report questionnaires (ORTO-15, Eating Disorder Examination Questionnaire and Symptom Checklist-90-Revised). RESULTS Eating disorder patients had significantly higher orthorexic tendencies than other groups (p < 0.001), while student dietitians and general population showed no difference between each other (p = 0.96). Moreover, orthorexia positively correlated to ED psychopathology in ED patients (p = 0.004), but not in control groups. CONCLUSION Our data do not confirm previous suggestions that experts in the field of dietetics may display a higher level of orthorexia. LEVEL OF EVIDENCE Level IV, cross-sectional observational study (case series).
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Affiliation(s)
- Daniele Busatta
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy.
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Chiara Campanino
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
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Zagaria A, Vacca M, Cerolini S, Ballesio A, Lombardo C. Associations between orthorexia, disordered eating, and obsessive-compulsive symptoms: A systematic review and meta-analysis. Int J Eat Disord 2022; 55:295-312. [PMID: 34921564 DOI: 10.1002/eat.23654] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 01/26/2023]
Abstract
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.
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Affiliation(s)
- Andrea Zagaria
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Silvia Cerolini
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Andrea Ballesio
- Department of Psychology, Sapienza University of Rome, Rome, Italy
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24
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Demir HP, Bayram HM. Orthorexia nervosa: The relationship with obsessive-compulsive symptoms and eating attitudes among individuals with and without healthcare professionals. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2022. [DOI: 10.3233/mnm-210015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Halime Pulat Demir
- Department of Nutrition and Dietetics, Istanbul Gelisim University, Istanbul, Turkey
| | - Hatice Merve Bayram
- Department of Nutrition and Dietetics, Istanbul Gelisim University, Istanbul, Turkey
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Obeid S, Hallit S, Akel M, Brytek-Matera A. Orthorexia nervosa and its association with alexithymia, emotion dysregulation and disordered eating attitudes among Lebanese adults. Eat Weight Disord 2021; 26:2607-2616. [PMID: 33570743 PMCID: PMC7877311 DOI: 10.1007/s40519-021-01112-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/13/2021] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Sahar Obeid
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon. .,INSPECT-LB, Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon.
| | - Souheil Hallit
- INSPECT-LB, Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon. .,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
| | - Marwan Akel
- INSPECT-LB, Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon.,School of Pharmacy, Lebanese International University, Beirut, Lebanon
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Gonidakis F, Poulopoulou C, Michopoulos I, Varsou E. Validation of the Greek ORTO-15 questionnaire for the assessment of orthorexia nervosa and its relation to eating disorders symptomatology. Eat Weight Disord 2021; 26:2471-2479. [PMID: 33475990 DOI: 10.1007/s40519-020-01080-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 11/22/2020] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Fragiskos Gonidakis
- Eating Disorders Unit, 1st Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Vas. Sofias 74 St., 11528, Athens, Greece.
| | - C Poulopoulou
- Eating Disorders Unit, 1st Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Vas. Sofias 74 St., 11528, Athens, Greece
| | - I Michopoulos
- Eating Disorders Unit, 2nd Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - E Varsou
- Eating Disorders Unit, 1st Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Vas. Sofias 74 St., 11528, Athens, Greece
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27
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Personality profiles in young adults with orthorexic eating behaviors. Eat Weight Disord 2021; 26:2727-2736. [PMID: 33620703 DOI: 10.1007/s40519-021-01124-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/20/2021] [Indexed: 02/01/2023] Open
Abstract
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.
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28
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Plasonja N, Décamps G. Validation française de l’échelle de mesure de l’orthorexie ORTO-15 et étude des liens avec les troubles des conduites alimentaires et l’image du corps. PSYCHOLOGIE FRANCAISE 2021. [DOI: 10.1016/j.psfr.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Novara C, Maggio E, Piasentin S, Pardini S, Mattioli S. Orthorexia Nervosa: differences between clinical and non-clinical samples. BMC Psychiatry 2021; 21:341. [PMID: 34238282 PMCID: PMC8265101 DOI: 10.1186/s12888-021-03348-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/26/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Orthorexia Nervosa (ON) is a construct characterized by behaviors, emotions, and beliefs on eating healthy food and excessive attention to diet; moreover, dieting has been considered a risk factor in ON symptoms development. The principal aim of this study was to investigate the differences in clinical and non-clinical groups most at risk of ON. Aspects that could be associated with ON (Eating Disorders [EDs], obsessive-compulsive symptomatology, perfectionistic traits, anxiety, depression, Body Mass Index [BMI]) were investigated in all groups. METHODS The sample consisted of 329 adults belonging to four different groups. Three were on a diet: Anorexia/Bulimia Nervosa group (N = 90), Obesity/Binge Eating Disorder group (N = 54), Diet group (N = 91). The Control group consisted of people who were not following a diet (N = 94). Participants completed several self-administered questionnaires (EHQ-21, EDI-3, OCI-R, MPS, BAI, BDI-II) to assess ON-related features in different groups. RESULTS Analyses highlighted higher orthorexic tendencies in Anorexia/Bulimia Nervosa, Obesity/BED, and Diet groups than in the Control group. Moreover, results have shown that in the AN/BN group, eating disorders symptomatology and a lower BMI were related to ON and that in Obesity/Binge Eating Disorder and Diet groups, perfectionism traits are associated with ON. CONCLUSION Individuals who pursue a diet share some similarities with those who have an eating disorder regarding emotions, behaviors, and problems associated with orthorexic tendencies. Moreover, perfectionistic traits seem to predispose to higher ON tendencies. In general, these results confirm the ON as an aspect of the main eating disorders category.
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Affiliation(s)
- C. Novara
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padova, Via Venezia 8, 35131 Padova, Italy
| | - E. Maggio
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padova, Via Venezia 8, 35131 Padova, Italy
| | - S. Piasentin
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padova, Via Venezia 8, 35131 Padova, Italy
| | - S. Pardini
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padova, Via Venezia 8, 35131 Padova, Italy
| | - S. Mattioli
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padova, Via Venezia 8, 35131 Padova, Italy
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30
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Mitrofanova E, Pummell EKL, Mulrooney HM, Petróczi A. Using Behavioural Reasoning Theory to Explore Reasons for Dietary Restriction: A Qualitative Study of Orthorexic Behavioural Tendencies in the UK. Front Psychol 2021; 12:685545. [PMID: 34305743 PMCID: PMC8295483 DOI: 10.3389/fpsyg.2021.685545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/27/2021] [Indexed: 11/20/2022] Open
Abstract
Orthorexia Nervosa (ON) has gained increased attention in academia since 1997. However, like other “Exia” conditions, there is debate around its inclusion in the Diagnostic and Statistical Manual of Mental Disorders. This study aimed to examine the experiences of those following a diet indicative of ON in the United Kingdom. This information is essential to the development of diagnostic criteria and classification of ON. Behavioural Reasoning Theory was used to explore reasons contributing to the development of ON. Ten individuals (two males and eight females), aged 23–35 years, took part in semi-structured interviews. Inductive thematic analysis was used to analyse the results. Four themes emerged from the data—journey, social, rules/control, and ethical considerations which highlighted contributing factors to the development of ON behaviours, the impact of these behaviours on individuals' social lives, and a strive for control. These findings are the first to suggest that ON involves a more complex set of behaviours than current definitions and proposed diagnostic criteria suggest and highlight the need to consider a variety of reasons for restricted diet when developing diagnostic criteria, screening tools, and classification in the DSM.
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Affiliation(s)
- Elina Mitrofanova
- Faculty of Science Engineering and Computing, Kingston University, Kingston upon Thames, United Kingdom
| | - Elizabeth K L Pummell
- Faculty of Science Engineering and Computing, Kingston University, Kingston upon Thames, United Kingdom
| | - Hilda M Mulrooney
- Faculty of Science Engineering and Computing, Kingston University, Kingston upon Thames, United Kingdom
| | - Andrea Petróczi
- Faculty of Science Engineering and Computing, Kingston University, Kingston upon Thames, United Kingdom
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Are orthorexia nervosa symptoms associated with deficits in inhibitory control? Eat Weight Disord 2021; 26:1553-1557. [PMID: 32767254 DOI: 10.1007/s40519-020-00979-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/29/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE This study explored whether inhibitory control is associated with symptoms of orthorexia nervosa, a condition that involves substantial behavioral control in regard to healthy eating. METHOD Participants (50 women, 13 men) completed the Eating Habits Questionnaire as a measure of orthorexia symptomatology, along with computerized versions of the Go/No-Go Task, Flanker Task, and Stroop Task. RESULTS Orthorexia symptomatology did not correlate with either percent error or response time for any of the three tasks (all p's > 0.10). CONCLUSION These results suggest that orthorexia is not associated with deficits or other differences in inhibitory control. LEVEL OF EVIDENCE Level V, descriptive cross-sectional study.
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32
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Niedzielski A, Kaźmierczak-Wojtaś N. Prevalence of Orthorexia Nervosa and Its Diagnostic Tools-A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105488. [PMID: 34065506 PMCID: PMC8160773 DOI: 10.3390/ijerph18105488] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/14/2021] [Accepted: 05/15/2021] [Indexed: 12/12/2022]
Abstract
The aim of this article is to present the up-to-date diagnostic tools of orthorexia and markers of its prevalence on the basis of the available literature. The authors searched PubMedCentral (PMC) and Google Scholar with the search entry of “orthorexia”, “orthorexia nervosa”, and “orthorexicbehaviours”. We describe the tools of evaluation of orthorexicbehaviour (i.e., orthorexia self-test—BOT, the ORTO-15 questionnaire, Eating Habits Questionnaire—EHQ, Düsseldorf Orthorexia Scale—DOS, Teruel Orthorexia Scale—TOS, Barcelona Orthorexia Scale—BOS, and Orthorexia Nervosa Inventory—ONI), and offer a review of the studies on orthorexia nervosa. We conclude that there are no reliable data regarding the prevalence of orthorexia nervosa. The available studies point to significant differences in the prevalence depending on the value of cut-off points and tools used. The prevalence varies across countries and across populations, ranging from 6.9% in the Italian population to 88.7% in the group of Brazilian students of dieting. Thus, it indicates that some groups seem to be susceptible to the risk of ON more than others. It is a challenge to determine the prevalence of orthorexia, and any obtained results should be treated with caution. Consequently, we claim that the use of the ORTO-15 questionnaire to diagnose orthorexia is questionable due to a high percentage of falsely positive results.
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Affiliation(s)
- Antoni Niedzielski
- Independent General Psychology Unit, Medical University in Lublin, 20-093 Lublin, Poland
- Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
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33
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AYHAN BAŞER D. The Assessment of the Orthorexia Nervosa Tendencies among Postpartum Women. KONURALP TIP DERGISI 2021. [DOI: 10.18521/ktd.777632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Worsfold KA, Sheffield JK. Practitioner eating disorder detection: The influence of health mindset, thin-ideal internalization, orthorexia and gender role. Early Interv Psychiatry 2021; 15:296-305. [PMID: 32196980 DOI: 10.1111/eip.12940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/19/2019] [Accepted: 01/27/2020] [Indexed: 11/27/2022]
Abstract
AIMS The current study sought to determine what factors inhibited psychologists, naturopaths and fitness instructors from detecting an eating disorder (ED), and the discipline differences across these factors. METHODS Participants of the online study were 115 health practitioners who consisted of 35 psychologists, 50 naturopathic and 30 fitness practitioners. A vignette describing a female experiencing a sub-threshold bulimic variant without purging was presented alongside ED mental health literacy items such as assessing one's ability to detect a problem. Additional items examined factors that may inhibit detection, including practitioners' level of: thin-ideal internalization, orthorexia, health or fitness mindset (a newly developed scale measuring health and fitness obsessiveness) and gender role identity. RESULTS A significant number of naturopaths and fitness instructors (20% and 33.3%, respectively) were found to have elevated orthorexia scores. Similarly, psychologists had the greatest tendency to internalize the thin-ideal (M = 3.60), which was comparable to levels seen in recent research for 20- to 21-year-old females with EDs. The two largest factors inhibiting ED detection were the strength of a health mindset and gender role identity. Practitioners who had higher health mindset scores or who associated with gender identities higher in masculinity traits (ie, either androgynous or masculine gender roles) were more likely to miss detecting an ED. CONCLUSIONS While many present ED studies focus upon assessing and changing client cognitions, this study emphasizes the need for further research regarding training interventions to address practitioner cognitions and gender role biases, which may in turn improve ED detection.
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Affiliation(s)
- Kate A Worsfold
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,Compass Health Group, Gold Coast, Queensland, Australia
| | - Jeanie K Sheffield
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
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Caferoglu Z, Toklu H. Orthorexia Nervosa in Turkish dietitians and dietetic students. Encephale 2021; 48:13-19. [PMID: 33814168 DOI: 10.1016/j.encep.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/21/2020] [Accepted: 12/02/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Orthorexia Nervosa (ON) is characterized by a pathological obsession with healthy eating, and dietetic majors may have a potential risk of developing ON due to their occupation that necessitates consideration of optimal food choices. This study aimed to determine the prevalence of ON among a large sample of dietitians and dietetic students in Turkey and to investigate the association of ON with socio-demographic features and eating attitudes within the whole sample. METHODS Participants (n=1429) completed a self-administered online survey that featured socio-demographic characteristics, the Orthorexia Nervosa Questionnaire (ORTO-11), and the Eating Attitudes Test-26 (EAT-26). Scores on the ORTO-11 and EAT-26 determined the prevalence of ON and disordered eating behaviors, respectively. RESULTS The prevalence of ON among Turkish dietetic majors was 59.8% with a higher ratio in dietetic students (63.8%) than dietitians (52.9%) (P<0.001). While graduation was associated with 33.1% lower odds of ON (P=0.006), eating disorders could increase the ON risk approximately five times (P<0.001). Furthermore, the greater total and subscale (dieting, bulimia, and oral control) scores of EAT-26 were associated with higher ON tendency (P<0.001), even after adjustment for potential confounders. CONCLUSIONS Our findings may shed light on the relevance of developing strategies to reduce the prevalence of ON in the dietetic population but need to be supported by further longitudinal and prospective studies.
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Affiliation(s)
- Z Caferoglu
- Erciyes University, Faculty of Health Sciences, Department of Nutrition and Dietetics, 38039 Kayseri, Turkey.
| | - H Toklu
- Erciyes University, Faculty of Health Sciences, Department of Nutrition and Dietetics, 38039 Kayseri, Turkey
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36
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Orthorexia nervosa in yoga practitioners: relationship with personality, attitudes about appearance, and yoga engagement. Eat Weight Disord 2021; 26:789-795. [PMID: 32356144 DOI: 10.1007/s40519-020-00911-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023] Open
Abstract
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.
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Oberle CD, De Nadai AS, Madrid AL. Orthorexia Nervosa Inventory (ONI): development and validation of a new measure of orthorexic symptomatology. Eat Weight Disord 2021; 26:609-622. [PMID: 32279201 DOI: 10.1007/s40519-020-00896-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/28/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To overcome the problems associated with existing measures of orthorexia, we assessed the reliability and validity of a new measure: the Orthorexia Nervosa Inventory (ONI). METHOD An online survey was completed by 847 people recruited from undergraduate nutrition and psychology courses and from advertisements in Facebook and Instagram targeting both healthy eaters (with keywords such as "clean eating" and "healthy eating") and normal eaters (with keywords such as "delicious food" and "desserts"). RESULTS Exploratory factor analysis revealed three factors with 9 items assessing behaviors and preoccupation with healthy eating, 10 items assessing physical and psychosocial impairments, and 5 items assessing emotional distress. With this sample, all scales demonstrated good internal consistency (Cronbach's α = 0.88-0.90) and 2-week test-retest reliability (r = 0.86- 0.87). Consistent with past research, ONI scores were significantly greater among vegetarians and vegans, and among those with higher levels of disordered eating, general obsessive-compulsive tendencies, and compulsive exercise. Additionally, whereas ONI scores did not significantly differ between men and women, the scores were negatively correlated with body mass index. CONCLUSION The ONI is the first orthorexia measure to include items assessing physical impairments that researchers and clinicians agree comprise a key component of the disorder. Additionally, at least for the current sample, the ONI is a reliable measure with expected correlations based on the past research. LEVEL OF EVIDENCE Level V, descriptive cross-sectional study.
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Affiliation(s)
- Crystal D Oberle
- Department of Psychology, Texas State University, 601 University Dr., San Marcos, TX, 78666, USA.
| | - Alessandro S De Nadai
- Department of Psychology, Texas State University, 601 University Dr., San Marcos, TX, 78666, USA
| | - Aspen L Madrid
- Department of Psychology, Texas State University, 601 University Dr., San Marcos, TX, 78666, USA
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Godefroy V, Trinchera L, Dorard G. Optimizing the empirical assessment of orthorexia nervosa through EHQ and clarifying its relationship with BMI. Eat Weight Disord 2021; 26:649-659. [PMID: 32346828 DOI: 10.1007/s40519-020-00909-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/17/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Orthorexia nervosa (ON) is described as an obsession for healthy eating with potentially debilitating consequences but little of its psychopathology is empirically supported. Using suitable validation methodologies, we wanted to optimize the empirical assessment of ON symptoms and investigate their unclear relationship with BMI. Our objective was, therefore, twofold: (1) Validation of a robust measurement model of ON dimensions using the Eating Habits Questionnaire (EHQ); (2) Validation of a structural model describing a mechanism of relationships between ON dimensions and BMI. METHODS A self-report questionnaire assessing BMI and ON through a French translation of the 21-item EHQ was administered to a large sample of French adults (N = 2065). We used Exploratory and Confirmatory Factor Analysis for objective no. 1 and Structural Equation Modeling for objective no. 2. RESULTS We validated a well-fitted (TLI = 0.98; RMSEA = 0.04) and conceptually consistent measurement model with 16 items for three ON dimensions: Rigid Eating Behavior (REB), Positive Feeling of Control (PFC) and Problems of Attention Control and Social Relationships (PACSR). We also validated a structural model (TLI = 0.96; RMSEA = 0.05) showing that: 1. REB strongly impacts both PFC and PACSR; 2. REB has a significant negative impact on BMI and BMI has a significant positive effect on PACSR but effect sizes are very small and globally ON dimensions are only marginally related to BMI. CONCLUSION Our study achieved an improved assessment method of ON, a clarification of its links with BMI and implications for the descriptive psychopathology of ON. LEVEL OF EVIDENCE V, Descriptive cross-sectional study.
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Affiliation(s)
- Valérie Godefroy
- Inserm, U 1127, CNRS, UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, FRONTlab, 75013, Paris, France.
| | - Laura Trinchera
- Department of Information Systems, Supply Chain and Decisions, NEOMA Business School, 76100, Rouen, France
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Strahler J, Wachten H, Mueller-Alcazar A. Obsessive healthy eating and orthorexic eating tendencies in sport and exercise contexts: A systematic review and meta-analysis. J Behav Addict 2021; 10:456-470. [PMID: 33650987 PMCID: PMC8997206 DOI: 10.1556/2006.2021.00004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/14/2020] [Accepted: 12/27/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Orthorexia Nervosa (ON) and exercise addiction (ExAdd) are two phenomena believed to overlap. We conducted a meta-analysis exploring the link between ON and (addictive) exercise behaviors. METHODS A systematic review of major databases and gray literature was carried out for studies reporting on ON and (addictive) exercise behaviors. Random effects meta-analyses were undertaken calculating correlations between ON and (addictive) exercise behaviors. A sub-group analysis investigated gender differences. RESULTS Twenty-five studies with 10,134 participants (mean age = 25.21; 56.4% female) were included. Analyses showed a small overall correlation between ON and exercise (21 studies, r = 0.12, 95% CI |0.06-0.18|) and a medium overall correlation between ON and ExAdd (7 studies, r = 0.29, 95% CI |0.13-0.45|). Gender differences were negligible. CONCLUSIONS Orthorexic eating correlated slightly and moderately with exercise and ExAdd, respectively, expressing some unique and shared variance of these behaviors. While this does not suggest ON and addictive exercising to be independent, it does not indicate substantial comorbidity. Future research should focus on clinical relevance, underlying mechanisms, vulnerability, and risk factors.
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Affiliation(s)
- Jana Strahler
- Psychotherapy and Systems Neuroscience, Justus-Liebig-University Giessen, Giessen, Germany
| | - Hanna Wachten
- Psychotherapy and Systems Neuroscience, Justus-Liebig-University Giessen, Giessen, Germany
| | - Anett Mueller-Alcazar
- Department of Psychology, Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany
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Dajon M, Sudres JL. Orthorexie et troubles des conduites alimentaires : spécificité d’un profil ? ANNALES MEDICO-PSYCHOLOGIQUES 2021. [DOI: 10.1016/j.amp.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Brytek-Matera A, Sacre H, Staniszewska A, Hallit S. The Prevalence of Orthorexia Nervosa in Polish and Lebanese Adults and Its Relationship with Sociodemographic Variables and BMI Ranges: A Cross-Cultural Perspective. Nutrients 2020; 12:E3865. [PMID: 33348787 PMCID: PMC7767210 DOI: 10.3390/nu12123865] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Anna Brytek-Matera
- Institute of Psychology, University of Wroclaw, Dawida 1, 50-527 Wroclaw, Poland
| | - Hala Sacre
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon; (H.S.); (S.H.)
| | - Anna Staniszewska
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon; (H.S.); (S.H.)
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon
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Parra Carriedo A, Tena-Suck A, Barajas-Márquez MW, Bilbao y Morcelle GM, Díaz Gutiérrez MC, Flores Galicia I, Ruiz-Shuayre A. When clean eating isn't as faultless: the dangerous obsession with healthy eating and the relationship between Orthorexia nervosa and eating disorders in Mexican University students. J Eat Disord 2020; 8:54. [PMID: 33117538 PMCID: PMC7586686 DOI: 10.1186/s40337-020-00331-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 09/28/2020] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Orthorexia Nervosa is an eating disorder that has been scarcely studied in characteristics, causes and symptoms, as well as in consequences and the relationship with other eating disorders. The present study had as its main objective the analysis of said relationship and inquisition of the possibility of predicting the development of an eating disorder from the presence of orthorexia nervosa. Also, it analyzed the differences by sex in Mexican university students. METHODS The sample consisted of 911 university students (65.4% women and 34.6% men), between an age range of 18 to 28 years old (M = 21 and SD = 1.9). Two questionnaires were responded: the ORTO14MX, a version of the ORTO-15 instrument previously validated in Mexican students, and the EDE-Q in its short version. Besides, sociodemographic data of interest was obtained and used for this study. RESULTS The Pearson's correlation analysis demonstrated statistically significant relations, from mild to moderate, between the factors that make up both scales, while the linear regression analysis demonstrated that 40% of the variance is explained with the factors from the ORTO-14MX scale in the overall sample for the study. Additionally, statistically significant differences were found between men and women regarding all the subscales conforming the instruments that measured orthorexia and eating disorders. CONCLUSION These results show a moderate predictive degree, that as promising as it is, isn't conclusive. Likewise, it was confirmed that women are still more vulnerable to develop orthorexia or another eating disorder. It can be concluded that there's a vast necessity for more studies measuring the relationship between orthorexia nervosa and eating disorders, in Latinamerican samples with diverse characteristics in sociocultural backgrounds, and clinical samples.
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Prevalence of orthorexia nervosa among nutrition students and nutritionists: Pilot study. Clin Nutr ESPEN 2020; 40:144-148. [PMID: 33183528 DOI: 10.1016/j.clnesp.2020.09.175] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/01/2020] [Accepted: 09/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIMS Orthorexia Nervosa (ON) is defined as an excessive concern in choosing and preparing of meals according to strict rules. The aims of this study were to determine the prevalence of ON among nutrition students and nutritionists and to identify the related variables affected by the ON tendency. METHODS This cross-sectional study was carried out in July and August of 2019 among 421 nutrition students from six universities, in addition to nutritionists in Jordan. Participants completed questionnaire related to individual characteristics and the ORTO-15 scale. Orthorexia Nervosa (ON) tendency was measured using ORTO-15 questionnaire, referring to different diagnostic thresholds (40/35). p < 0.05 was accepted as statistically significant. RESULTS Orthorexia had 72.0% prevalence in our sample using the 40-point threshold; the figure was reasonably lower with the 35-point threshold (31.8%). Also, ON tendency was significantly affected by BMI categories (p = 0.007) and gender (p = 0.043) at 35-point threshold. Males have more tendency (39.4%) than females (28.6%) (p = 0.029). CONCLUSION The results of this study highlight the magnitude of ON in Jordan. Using cut-off at 35 is preferable than cut-off at 40 to identify factors influencing ON. Moreover, ON tendency is affected by gender and BMI and not affected by educational level.
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Gorrasi ISR, Bonetta S, Roppolo M, Abbate Daga G, Bo S, Tagliabue A, Ferraris C, Guglielmetti M, Arpesella M, Gaeta M, Gallé F, Di Onofrio V, Liguori F, Liguori G, Gilli G, Carraro E. Traits of orthorexia nervosa and muscle dysmorphia in Italian university students: a multicentre study. Eat Weight Disord 2020; 25:1413-1423. [PMID: 31529388 DOI: 10.1007/s40519-019-00779-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 09/06/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE This study aimed to evaluate the prevalence of traits of orthorexia nervosa (ON) and muscle dysmorphia (MD) in a group of undergraduates, investigate the associations between the risk of these conditions and the type of university course attended, the individual characteristics (gender, BMI, amount of physical activity, supplements and medicines use, dieting) and the risk of eating disorders (EDs). METHODS A self-reported questionnaire consisting of a socio-demographic section and three tests validated for the evaluation of a risk of ON (ORTO-15), MD (MDDI-ITA) and EDs (EAT-26) was completed by 918 students from three Italian universities. RESULTS 29.0% of participants demonstrated traits of ON and 5.0% of MD, without differences in prevalence in the three areas of study investigated (health-scientific, economic-humanistic, sport sciences); students of sport sciences exhibited a significantly higher score for MDDI-ITA (F = 6.493, p = 0.002). Participants with ON and MD traits were more on a diet (OR = 0.47, p ≤ 0.001 and OR = 0.428, p = 0.020, respectively) and showed a higher prevalence of EDs risk (OR = 3.55, p < 0.001 and OR = 10.23, p ≤ 0.001, respectively). The simultaneous presence of ON, MD, and EDs traits was seen in 5.4% of the students and the three test scores were correlated. CONCLUSIONS The prevalence of ON and MD traits was found similar to that reported in the literature on undergraduates. Some associations observed improvement in the knowledge about these conditions, especially the association of participants with ON and MD traits with dieting and EDs traits and the correlation of the three test scores suggests a connection among these potential conditions. LEVEL OF EVIDENCE Level V, descriptive cross-sectional survey.
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Affiliation(s)
| | - Silvia Bonetta
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5bis, 10126, Turin, Italy
| | - Mattia Roppolo
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5bis, 10126, Turin, Italy
| | - Giovanni Abbate Daga
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Simona Bo
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - Anna Tagliabue
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100, Pavia, Italy
| | - Cinzia Ferraris
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100, Pavia, Italy
| | - Monica Guglielmetti
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100, Pavia, Italy
| | - Marisa Arpesella
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100, Pavia, Italy
| | - Maddalena Gaeta
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100, Pavia, Italy
| | - Francesca Gallé
- Department of Movement and Wellbeing Sciences, University of Naples "Parthenope", Via Medina, 40, 80133, Naples, Italy
| | - Valeria Di Onofrio
- Department of Sciences and Technologies, University of Naples "Parthenope", Business District, Block C4, 80143, Naples, Italy
| | - Fabrizio Liguori
- Department of Movement and Wellbeing Sciences, University of Naples "Parthenope", Via Medina, 40, 80133, Naples, Italy
| | - Giorgio Liguori
- Department of Movement and Wellbeing Sciences, University of Naples "Parthenope", Via Medina, 40, 80133, Naples, Italy
| | - Giorgio Gilli
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5bis, 10126, Turin, Italy
| | - Elisabetta Carraro
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5bis, 10126, Turin, Italy
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Albery IP, Michalska M, Moss AC, Spada M. Selective attentional bias to food-related stimuli in healthy individuals with characteristics towards orthorexia nervosa. Eat Weight Disord 2020; 25:1225-1233. [PMID: 31352617 PMCID: PMC7508954 DOI: 10.1007/s40519-019-00755-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/18/2019] [Indexed: 02/01/2023] Open
Abstract
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.
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Affiliation(s)
- Ian P Albery
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK.
| | - Monika Michalska
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK
| | - Antony C Moss
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK
| | - Marcantonio Spada
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK
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Walker-Swanton FE, Hay P, Conti JE. Perceived need for treatment associated with orthorexia nervosa symptoms. Eat Behav 2020; 38:101415. [PMID: 32805628 DOI: 10.1016/j.eatbeh.2020.101415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 02/03/2023]
Abstract
Orthorexia Nervosa is characterised by a pathological fixation on food purity and nutrition, coupled with a severely restricted diet and avoidance of food believed to be unhealthy. Little is known about the risk factors associated with the condition or if the condition should be treated in a similar way to other eating disorders or whether distinct interventions are required. This study aimed to identify (1) putative variables of the need for treatment in those with orthorexia symptomology and (2) assess whether comorbid psychological symptomologies were associated with orthorexia nervosa. An online cross-sectional self-report survey was developed and the data of 130 participants analysed using regression analyses. As predicted, individuals with higher levels of orthorexic symptomology, eating disorder symptomology and those who identified their healthy eating as problematic were significantly more likely to have a perceived need for treatment, however those who self-identified as having a current or past eating disorder were not. Orthorexic symptomatology was significantly correlated with eating disorder symptomatology, obsessive-compulsive symptoms, anxiety, and depression, however in the regression analysis, eating disorder symptomatology was the only significant variable. These findings highlight the need to consider orthorexic symptoms in people with eating disorders and that this inter-relationship and the ego-syntonicity of symptoms may reduce help-seeking.
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Affiliation(s)
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Janet E Conti
- School of Psychology, Western Sydney University, Sydney, Australia.
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Validation of the Arabic version of the ORTO-15 questionnaire in a sample of the Lebanese population. Eat Weight Disord 2020; 25:951-960. [PMID: 31119588 DOI: 10.1007/s40519-019-00710-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/21/2019] [Accepted: 05/07/2019] [Indexed: 01/31/2023] Open
Abstract
PURPOSE The aim of the study was to develop an Arabic version of the ORTO-15 test and to examine the scale reliability and validity among a sample of the Lebanese population. METHODS This was a cross-sectional study, conducted between January and May 2018, which enrolled 806 participants, divided into two equal samples, from all Lebanese governorates. The ORTO-15 scale was used to evaluate orthorexia nervosa (ON) tendencies and behaviors among participants. RESULTS The factor analysis conducted on sample 1 suggested a three-factor structure for the ORTO-15 explaining a total of 50.59% of the variance. All items could be extracted from the list; none of the items was removed. The internal consistency of the measurement was adequate (Cronbach's alpha = 0.82). Higher body dissatisfaction (r = - 0.082), higher restrained eating (r = - 0.13) and higher eating attitudes (EAT score) (r = - 0.13) were significantly associated with higher levels of orthorexia tendencies and behaviors (lower ORTO-15 score). We could not detect any significant association between BMI and ORTO-15 test. A confirmatory factor analysis performed on sample 2 supported the three-factor structure of the ORTO-15 test obtained in the first sample. The following results were obtained: the Maximum Likelihood Chi Square = 22.0 and Degrees of Freedom = 9, which gave a × 2/df = 2.4. For non-centrality fit indices, the Steiger-Lind RMSEA was 0.10 [0.040-0.208]. Moreover, the Joreskog GFI equaled 0.926 and AGFI equaled 0.901. CONCLUSION The Arabic version of the ORTO-15 test can be used to screen for ON tendencies and behaviors. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Mitrofanova E, Mulrooney H, Petróczi A. Assessing psychological and nutritional impact of suspected orthorexia nervosa: a cross-sectional pilot study. J Hum Nutr Diet 2020; 34:42-53. [PMID: 33216395 DOI: 10.1111/jhn.12797] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
| | - H Mulrooney
- Kingston University, Kingston upon Thames, UK
| | - A Petróczi
- Kingston University, Kingston upon Thames, UK
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Lorenzon LFL, Minossi PBP, Pegolo GE. Ortorexia nervosa e imagem corporal em adolescentes e adultos. JORNAL BRASILEIRO DE PSIQUIATRIA 2020. [DOI: 10.1590/0047-2085000000266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
RESUMO Objetivo Identificar a frequência do comportamento de risco para ortorexia nervosa em uma amostra de indivíduos com idades entre 18 e 60 anos e associar com o estado nutricional (classificação do peso corporal) variáveis sociodemográficas e imagem corporal. Métodos Trata-se de um estudo transversal constituído por indivíduos de ambos os sexos. Utilizou-se o questionário ORTO-15 (com pontos de corte < 40 e < 35) para a identificação de comportamentos de risco para ortorexia e a Escala de Silhuetas para a imagem corporal. O estado nutricional foi avaliado por meio do índice de massa corporal, com peso e altura autorreferidos. Para a análise dos dados, aplicou-se o teste qui-quadrado, com nível de significância de 5%. Resultados Participaram 430 indivíduos, sendo 56,7% (n = 244) mulheres, com idade para ambos os sexos entre 18,1 e 59,9 anos. Constatou-se maior número de participantes com risco para ortorexia ao utilizar o ponto de corte < 40 (91,4%, n = 393) quando comparado ao ponto de corte < 35 (54,4%, n = 234) (p < 0,0001). O estado nutricional não esteve associado ao comportamento ortoréxico (< 35, p = 0,68; < 40, p = 0,69), bem como à imagem corporal, em ambos os sexos (< 40 e < 35). A idade entre 40 e 60 anos associou-se com a presença de ortorexia (< 35) (p = 0,0005), enquanto não houve associação com as variáveis sexo, escolaridade, estado civil e renda (< 40 e < 35). Conclusão Os resultados do presente estudo indicam alta frequência de comportamento de risco para ortorexia. Sugerimos a investigação da frequência nos diversos segmentos populacionais e dos fatores associados ao desenvolvimento de atitudes ortoréxicas.
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Voglino G, Parente E, Bert F, Lo Moro G, Corradi A, Lapiccirella M, Gualano MR, Siliquini R. Orthorexia Nervosa, a challenging evaluation: analysis of a sample of customers from organic food stores. PSYCHOL HEALTH MED 2020; 26:478-486. [PMID: 32449870 DOI: 10.1080/13548506.2020.1771386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
An excessive control of quality of food can turn into Orthorexia Nervosa (ON). The organic store customers (OSCs) can be apopulation at risk for ON. The aims of this study were to assess ON symptoms prevalence among them, comparing them with non-OSCs and investigate potential predictors of ON. Across-sectional survey was carried among 121 OSCs and 119 non-OSCs. The questionnaire assessed socio-demographic characteristics and investigated current dietary habits. The main outcome measures used were ORTO-15 and Eating Habits Questionnaire (EHQ). Chi-squared analyses were performed to assess differences between groups (OSCs and non-OSCs). Logistic and linear regressions were performed to evaluate potential predictors of ON symptoms and to compare questionnaires. As main results, OSCs had ahigher probability to result positive at ORTO-15 compared to non-OSCs. The prevalence among OSCs was 69.4% and 23.1% (using ORTO-15 with 40 and 35 cut-offs). Higher EHQ scores were reported among OSCs (p < 0.001). Potential predictors were mainly being an OSC or following food restrictions. Predictors varied using different cut-offsof ORTO-15 and EHQ. These results suggest the association between OSCs and ON symptoms. Some differences were found between ORTO-15 and EHQ. Further studies need to be performed to improve diagnostic tools.
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Affiliation(s)
- Gianluca Voglino
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | | | - Fabrizio Bert
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | | | - Alessio Corradi
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | | | | | - Roberta Siliquini
- Department of Public Health Sciences, University of Turin, Turin, Italy
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