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Donofre GS, Japur CC, Laus MF, Alvarenga MDS, Silva WRD. Psychometric Properties of Various Factorial Models of the ORTO-15 Tested With Brazilian Respondents. Percept Mot Skills 2024:315125241267134. [PMID: 39033355 DOI: 10.1177/00315125241267134] [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: 07/23/2024]
Abstract
The ORTO-15 is a commonly used screening instrument for symptoms of Orthorexia Nervosa (ON), an obsessive overconcern with healthy eating. However, its limitations have been evidenced in several published factorial models. We analyzed the psychometric properties of seven different ORTO-15 factorial models using data from Brazilian adult participants (n = 1455; 71.4% women; M age = 29.5, SD = 8.9 years) from the country's five macro-regions who answered online questions for sample characterization and completed the Portuguese version of the ORTO-15 containing 15 items. We tested the fit of each model separately, analyzing data for men and women with separate confirmatory factor analysis, and using the Weighted Least Squares Mean and Variance Adjusted estimation method and goodness-of-fit indices. We also calculated the average variance extracted and the alpha ordinal and omega coefficients to analyze the convergent validity and reliability of the factors. None of the models tested presented adequate properties of validity and reliability. Although we found some acceptable reliability coefficients, they do not guarantee the validity of the data. Future investigators should be cautious when choosing the ORTO-15 for ON screening.
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Affiliation(s)
- Giovanna Soler Donofre
- Graduate Program in Food, Nutrition and Food Engineering. School of Pharmaceutical Sciences of São Paulo State University (UNESP), Araraquara/SP, Brazil
| | - Camila Cremonezi Japur
- Department of Health Sciences. Ribeirão Preto Medical School. University of São Paulo (USP). Ribeirão Preto/SP, Brazil
| | - Maria Fernanda Laus
- Nutrition Course. University of Ribeirão Preto (UNAERP). Ribeirão Preto/SP, Brazil
- Department of Psychology. Faculty of Philosophy, Sciences and Letters of Ribeirao Preto, University of Sao Paulo (USP). Ribeirão Preto/SP, Brazil
| | - Marle Dos Santos Alvarenga
- Graduate Program in Public health Nutrition. School of Public Health. University of São Paulo (USP). São Paulo/SP, Brazil
| | - Wanderson Roberto da Silva
- Graduate Program in Food, Nutrition and Food Engineering. School of Pharmaceutical Sciences of São Paulo State University (UNESP), Araraquara/SP, Brazil
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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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Alshaibani L, Elmasry A, Kazerooni A, Alsaeed J, Alsendy K, Alaamer R, Buhassan Z, Alaqaili R, Ghazzawi H, Pandi-Perumal SR, Trabelsi K, Jahrami H. Reliability generalization meta-analysis of orthorexia nervosa using the ORTO-11/12/15/R scale in all populations and language versions. J Eat Disord 2024; 12:39. [PMID: 38504366 PMCID: PMC10949742 DOI: 10.1186/s40337-024-00997-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The ORTO scale was developed in 2004 as a self-report questionnaire to assess symptoms of orthorexia nervosa (ON). ON is an unhealthy preoccupation with eating healthy food. The scale aims to measure obsessive attitudes and behaviors related to the selection, purchase, preparation, and consumption of pure, healthy food. Since its development, the ORTO-15 has been adapted into several shorter versions. The objective was to conduct a reliability generalization meta-analysis of the ORTO scale and its variant versions in all populations and languages. METHODS A systematic literature search was conducted to identify studies reporting the internal consistency of ORTO. Random-effect models were used to evaluate summary statistics of reliability coefficients, weighting the coefficients by the inverse variance using the restricted maximum likelihood method. The heterogeneity among the reliability coefficients was evaluated and assessed using numerous statistical metrics. The tau (τ), tau2 (τ2), I2, H2, R2, df, and the Q-statistic are among those obtained. Meta-regression analyses were used to examine moderators such as age and sex. RESULTS Twenty-one studies (k = 21) involving 11,167 participants (n = 11,167) were analyzed. The overall effect estimate on internal consistency was 0.59 (95% CI 0.49-0.68), with a minimum reliability coefficient of 0.23 and a maximum reliability coefficient of 0.83. The heterogeneity statistics were found to have an I2 of 99.31%, which suggested high heterogeneity owing to a decrease in the confidence interval (95% CI) and an increase in variability. Sensitivity analysis revealed that a few studies strongly influenced the overall estimate. Egger's test suggested possible publication bias. Neither age nor sex significantly moderated reliability via meta-regression. CONCLUSIONS The ORTO scale has a relatively low pooled reliability coefficient. Alternative ON assessment tools with enhanced psychometric properties are needed. Clinicians should not base diagnoses or treatment decisions on ORTO alone. Comprehensive psychiatric assessment is essential for accurate ON evaluation.
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Affiliation(s)
- Leena Alshaibani
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Ahmed Elmasry
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Ahmed Kazerooni
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Joud Alsaeed
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Khalwa Alsendy
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Reem Alaamer
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Zainab Buhassan
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Raghad Alaqaili
- Department of Family and Community Medicine, School of Medicine, University of Jordan, Amman, Jordan
| | - Hadeel Ghazzawi
- Department of Nutrition and Food Technology, School of Agriculture, University of Jordan, Amman, Jordan
| | - Seithikurippu R Pandi-Perumal
- Division of Research and Development, Lovely Professional University, Phagwara, Punjab, 144411, India
- Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Khaled Trabelsi
- High Institute of Sport and Physical Education of Sfax, University of Sfax, 3000, Sfax, Tunisia
- Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, 3000, Sfax, Tunisia
| | - Haitham Jahrami
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.
- Government Hospitals, Manama, Bahrain.
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Karniej P, Pérez J, Juárez-Vela R, Santolalla-Arnedo I, Gea-Caballero V, del Pozo-Herce P, Dissen A, Czapla M. Orthorexia nervosa in gay men-the result of a spanish-polish eating disorders study. BMC Public Health 2023; 23:58. [PMID: 36624429 PMCID: PMC9830745 DOI: 10.1186/s12889-022-14943-7] [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: 06/14/2022] [Accepted: 12/26/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The purpose of this exploratory study was to identifying demographic factors and unique predictors of ON e.g., the use of pre-exposure prophylaxis (PrEP), the use of social media and the Grindr ® dating application among a sample group of Spanish and Polish identifying gay men. METHODS The study was conducted in Poland and Spain between March and June 2021 using questionary: ORTO-15. Data was collected using a three-section self-administered questionnaire. The first section contained demographic data, the second part was the Polish and Spanish version of the Orto-15, and the third part was the Polish and Spanish version of the EAT-26. RESULTS Total enrollment was 394 gay men. In regression proportional hazards single model, significant predictors of ON were: age (OR = 0.964, 95% CI, 0.944-0.984), BMI (OR = 0.895, 95% CI, 0.848-0.944), staying in an informal relationship compared to being single (OR = 2.138, 95%CI, 1.225-3.732), occasional use of Pre-exposure Prophylaxis (OR = 4.667, 95%CI, 1.186-18.362) and use of the Grindr application (OR = 5.312, 95%CI, 3.373-8.365). Instagram users had lower risk of ON (OR = 0.479, 95%CI, 0.279-0.822). The multivariate analysis showed that Grindr usages (OR = 4.72; 95%CI, 2.89-7.72) correlated with higher risk of ON. Higher BMI (OR = 0.913, 95%CI, 0.861-0.98) and daily use of Pre-exposure Prophylaxis (OR = 0.142, 95%CI, 0.03-0.674) is associated with lower risk of ON. CONCLUSIONS The most important predictors of orthorexia nervosa in gay men are: low BMI and the use of Grindr. The effect of daily usage of PrEP is associated with lower risk, and occasional use is associated with increased risk, of orthorexia nervosa.
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Affiliation(s)
- Piotr Karniej
- grid.119021.a0000 0001 2174 6969Faculty of Health Sciences, Group of Research in Care (GRUPAC), University of La Rioja, 26004 Logroño, Spain ,grid.445642.50000 0004 0503 033XFaculty of Finance and Management, WSB University in Wrocław, 53-609 Wrocław, Poland
| | - Jesús Pérez
- grid.11762.330000 0001 2180 1817Institute of Biomedical Research of Salamanca (IBSAL), Psychiatry Unit, Department of Medicine, Universidad de Salamanca, Salamanca, Spain ,grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, UK ,grid.450563.10000 0004 0412 9303Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK ,grid.8273.e0000 0001 1092 7967Norwich Medical School, University of East Anglia, Norwich, UK
| | - Raúl Juárez-Vela
- grid.119021.a0000 0001 2174 6969Faculty of Health Sciences, Group of Research in Care (GRUPAC), University of La Rioja, 26004 Logroño, Spain , Group of Research in Sustainability of the Health System, Biomedical Research Center of La Rioja (CIBIR), La Rioja, Spain
| | - Iván Santolalla-Arnedo
- grid.119021.a0000 0001 2174 6969Faculty of Health Sciences, Group of Research in Care (GRUPAC), University of La Rioja, 26004 Logroño, Spain , Group of Research in Sustainability of the Health System, Biomedical Research Center of La Rioja (CIBIR), La Rioja, Spain
| | - Vicente Gea-Caballero
- grid.440832.90000 0004 1766 8613Faculty of Health Sciences, Valencian International University, Pintor Sorolla 21 46002, Valencia, Spain ,grid.440832.90000 0004 1766 8613 Research Group in Community Health and Care (SALCOM), Valencian International University, Valencia, Spain
| | - Pablo del Pozo-Herce
- Group of Research in Sustainability of the Health System, Biomedical Research Center of La Rioja (CIBIR), La Rioja, Spain ,grid.419651.e0000 0000 9538 1950Department of Psychiatry, Fundación Jiménez Díaz University Hospital, Madrid, Spain ,grid.419651.e0000 0000 9538 1950Health Research Institute, Fundación Jiménez Diaz, Madrid, Spain ,grid.419651.e0000 0000 9538 1950School of Nursing, Fundación Jiménez Diaz. Autonomous University, Madrid, Spain
| | - Anthony Dissen
- grid.262550.60000 0001 2231 9854Health Science Faculty, Stockton University, Stockton, New Jersey USA
| | - Michał Czapla
- grid.119021.a0000 0001 2174 6969Faculty of Health Sciences, Group of Research in Care (GRUPAC), University of La Rioja, 26004 Logroño, Spain ,grid.4495.c0000 0001 1090 049XDepartment of Emergency Medical Service, Wroclaw Medical University, 51-618 Wroclaw, Poland ,grid.412700.00000 0001 1216 0093Institute of Heart Disease, University Hospital, Wroclaw, Poland
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Li WL, Tan SX, Ouyang RQ, Cui YF, Ma JR, Cheng C, Mu YJ, Zhang SW, Zheng L, Xiong P, Ni WZ, Li LY, Fan LN, Luo YM, Yu YL, Wang ZM, Ding F, Pan QF, Jiang AY, Huang JM, Cao WT, Liu J, Ye YB, Zeng FF. Translation and validation of the Chinese version of the orthorexia nervosa assessment questionnaires among college students. Eat Weight Disord 2022; 27:3389-3398. [PMID: 36071328 DOI: 10.1007/s40519-022-01469-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/21/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The main objective of the study was to translate, validate, and compare the Chinese ORTO scales (ORTO-15 and ORTO-R). The secondary objective was to assess factors that may be related with risk of orthorexia nervosa (ON). METHODS Two cross-sectional surveys were conducted on March-to-June 2021 for ORTO-15 and April 2022 for ORTO-R. ORTO questionnaires were translated into Chinese using the forward-backward-forward method. Exploratory factor analysis (EFA), discriminant validity and confirmatory factor analysis (CFA) were used to examine the construct validity of the questionnaires. The internal consistency was assessed using the Cronbach alpha coefficient and the test-retest reliability. Multivariate linear regression analysis was used to explore potential factors related with ON scores. RESULTS Totally, 1289 and 1084 eligible participants were included for assessment of ORTO-15 and ORTO-R, with the mean age of 20.9 ± 2.0 years and 21.0 ± 2.3 years. The internal consistency of Chinese ORTO-15 scale and ORTO-R scale were both satisfactory (α = 0.79, ICC = 0.79; α = 0.77, ICC = 0.82). However, all ORTO-15 models showed a poor fit using CFA whereas the ORTO-R was characterized by acceptable goodness-of-fit. Multivariate linear regression indicated that physical activities and mental disorders were positively associated with ON risk assessed by both ORTO-R and ORTO-15. CONCLUSION The Chinese ORTO-R scale was a more reliable tool to screen for ON tendencies than the Chinese version of ORTO-15. Mental disorders and physical activities might be associated with the increased ON risk. LEVEL OF EVIDENCE Level V (descriptive cross-sectional study).
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Affiliation(s)
- Wan-Lin Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Si-Xian Tan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Rui-Qing Ouyang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Yun-Feng Cui
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Jun-Rong Ma
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Chen Cheng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Ying-Jun Mu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Shi-Wen Zhang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Lu Zheng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Peng Xiong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Wan-Ze Ni
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Lu-Yao Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Li-Na Fan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Yu-Mei Luo
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Ying-Lin Yu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Zi-Mo Wang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Fan Ding
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Qiao-Fei Pan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - An-Yi Jiang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Jing-Min Huang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Wen-Ting Cao
- Department of Medical Statistics and Epidemiology, School of Public Health, Hainan Medical University, Haikou, 571199, Hainan, China
| | - Jun Liu
- Department of Preventive Medicine Laboratory, School of Public Health, Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Yan-Bin Ye
- Department of Nutrition, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Fang-Fang Zeng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China.
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Alhaj OA, Fekih-Romdhane F, Sweidan DH, Saif Z, Khudhair MF, Ghazzawi H, Nadar MS, Alhajeri SS, Levine MP, Jahrami H. The prevalence and risk factors of screen-based disordered eating among university students: a global systematic review, meta-analysis, and meta-regression. Eat Weight Disord 2022; 27:3215-3243. [PMID: 35925546 PMCID: PMC9362208 DOI: 10.1007/s40519-022-01452-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/12/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE The purpose of this review was to estimate the prevalence of screen-based disordered eating (SBDE) and several potential risk factors in university undergraduate students around the world. METHODS An electronic search of nine data bases was conducted from the inception of the databases until 1st October 2021. Disordered eating was defined as the percentage of students scoring at or above established cut-offs on validated screening measures. Global data were also analyzed by country, research measure, and culture. Other confounders in this review were age, BMI, and sex. RESULTS Using random-effects meta-analysis, the mean estimate of the distribution of effects for the prevalence of SBDE among university students (K = 105, N = 145,629) was [95% CI] = 19.7% [17.9%; 21.6%], I2 = 98.2%, Cochran's Q p value = 0.001. Bayesian meta-analysis produced an estimate of 0.24, 95% credible intervals [0.20, 0.30], τ = 92%. Whether the country in which the students were studying was Western or non-Western did not moderate these effects, but as either the mean BMI of the sample or the percentage of the sample that was female increased, the prevalence of SBDE increased. CONCLUSIONS These findings support previous studies indicating that many undergraduate students are struggling with disordered eating or a diagnosable eating disorder, but are neither receiver effective prevention nor accessing accurate diagnosis and available treatment. It is particularly important to develop ever more valid ways of identifying students with high levels of disordered eating and offering them original or culturally appropriate and effective prevention or early treatment. LEVEL OF EVIDENCE I, systematic review and meta-analysis.
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Affiliation(s)
- Omar A. Alhaj
- Department of Nutrition, Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
| | - Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- The Tunisian Center of Early Intervention Is Psychiatry, Department of Psychiatry “Ibn Omrane”, Razi Hospital, rue des orangers, Manouba, Tunisia
| | - Dima H. Sweidan
- Department of Nutrition, Faculty of Pharmacy and Medical Sciences, University of Petra, Amman, Jordan
| | | | - Mina F. Khudhair
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Hadeel Ghazzawi
- Nutrition and Food Science Department, Agriculture School, The University of Jordan, P.O.Box 11942, Amman, Jordan
| | - Mohammed Sh. Nadar
- Occasional Therapy Department, Faculty of Allied Health Sciences, Kuwait University, Kuwait City, Kuwait
| | | | - Michael P. Levine
- Emeritus Professor, Department of Psychology, Kenyon College, Gambier, OH 43022 USA
| | - Haitham Jahrami
- Ministry of Health, Manama, Bahrain
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
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7
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Samaha S, Azzi R, Rizk R, Sarray El Dine A, Malaeb D, Hallit S, Obeid S, Soufia M. Association between the bi-dimensional aspect of orthorexia and healthy behaviors among lebanese adolescents. BMC Psychiatry 2022; 22:725. [PMID: 36411409 PMCID: PMC9676759 DOI: 10.1186/s12888-022-04374-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recently, there has been a blooming focus on "eating healthy and clean", with the ideal of being healthy becoming a popular lifestyle trend. Previous research suggested the presence of two forms of orthorexia: Orthorexia Nervosa (OrNe) and Healthy Orthorexia (HeOr). Taking into consideration that orthorexia thoughts are led by the desire to reach an optimal physical health, the dedication to a healthy living may require healthy lifestyle habits: smoking cessation, moderate alcohol intake, and increased physical activity. The main study aim was to determine, among Lebanese adolescents, the association between healthy behaviors and the two likely forms of orthorexia (OrNe and HeOr), given that the adolescent phase is a risky period in the development of eating disorders. METHODS A cross-sectional study, conducted between January and April 2022, enrolled 444 adolescents aged between 14 and 18 years, with an equitable random sample from all the Lebanese governorates (mean age 16.23 ± 1.15 years; 60.1% females). The Teruel Orthorexia Scale (TOS) was used to assess orthorexic eating tendencies. The Lebanese Waterpipe Dependence Scale, the Fagerström Test for Nicotine Dependence and the Alcohol Use Disorder Identification Test scales, all validated in adolescents, were used to evaluate the association between orthorexia and healthy behaviors. RESULTS Higher TOS OrNe scores were significantly and highly correlated with the TOS HeOr scores (r = 0.68; p < 0.001). In the bivariate analysis, waterpipe smoking was weakly but significantly associated with more OrNe, whereas more physical activity was significantly and moderately associated with more HeOr. After adjusting over all sociodemographic characteristics, other behaviors and the other dimension of orthorexia, more alcohol use disorder was significantly but strongly associated with higher OrNe, whereas more physical activity remained significantly associated with higher HeOr. CONCLUSION In light of our results, OrNe and HeOr might be considered as different entities, mainly in their associations with alcohol consumption and physical activity. This supports the hypothesis of OrNe being a new form of eating disorder, whereas HeOr possibly showing protective characteristics. Orthorexia is still a topic of controversy, especially in the probable presence of two facets that are still difficult to differentiate.
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Affiliation(s)
- Serena Samaha
- grid.444434.70000 0001 2106 3658School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Reine Azzi
- grid.444434.70000 0001 2106 3658School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Rana Rizk
- grid.411323.60000 0001 2324 5973Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Byblos, Lebanon
| | - Abir Sarray El Dine
- grid.444421.30000 0004 0417 6142Department of Biomedical Sciences, School of arts and Sciences, Lebanese International University, Beirut, Lebanon
| | - Diana Malaeb
- grid.444421.30000 0004 0417 6142School of Pharmacy, Lebanese International University, Beirut, Lebanon ,grid.411884.00000 0004 1762 9788College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon. .,Applied Science Research Center, Applied Science Private University, 11931, Amman, Jordan. .,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
| | - Sahar Obeid
- grid.411323.60000 0001 2324 5973Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Michel Soufia
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
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8
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Hanras E, Dorard G, Boujut E. Une ou plusieurs orthorexies ? Conceptualisation, évaluation et enjeux sociétaux : une revue critique de la littérature. PSYCHOLOGIE FRANCAISE 2022. [DOI: 10.1016/j.psfr.2022.04.005] [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: 11/07/2022]
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Kaźmierczak-Wojtaś N, Niedzielski A, Drozd M. Orthorexic tendencies and the structure of achievement motivation in young people in Poland. Nutrition 2022; 103-104:111795. [DOI: 10.1016/j.nut.2022.111795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 11/30/2022]
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Gkiouras K, Grammatikopoulou MG, Tsaliki T, Ntwali L, Nigdelis MP, Gerontidis A, Taousani E, Tzimos C, Rogoza R, Bogdanos DP, Donini LM, Goulis DG. Orthorexia nervosa: replication and validation of the ORTO questionnaires translated into Greek in a survey of 848 Greek individuals. Hormones (Athens) 2022; 21:251-260. [PMID: 35092606 PMCID: PMC8799960 DOI: 10.1007/s42000-022-00351-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/17/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The present study aimed to validate the ORTO-15 questionnaire for orthorexia nervosa (ON), translated by our group into the Greek language, and replicate the findings of the recently proposed 6-item ORTO-R. METHODS The tool was translated into the Greek language (ORTO-15-GR) using the forward-backward-forward method. A total of 848 adults participated in the validation study by filling in the questionnaires and providing general characteristics (age, gender, educational level, body weight, and height). The internal consistency of the tool was assessed by the omega (ω) coefficient, and confirmatory factor analyses (CFA) examined its factorial structure. Using the original six items of the ORTO-15 tool, a separate CFA model examined the factorial structure of the proposed ORTO-R tool. Furthermore, regression models tested the association of ORTO-R with study variables. RESULTS For ORTO-15-GR, the omega coefficient was 0.70 and for the ORTO-R 0.65. For the latter, the CFA revealed acceptable goodness-of-fit (standardized factor loadings from 0.36 to 0.64); however, all ORTO-15 models were characterized by a poor fit. In addition, there was a negative association between ORTO-R score and female gender, body mass index (BMI), and having a nutrition-related health problem. CONCLUSION The replication of ORTO-R indicates that it is a reliable tool in the field of ON. Therefore, the use of a 6-item questionnaire for ON assessment appears promising in research and clinical settings.
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Affiliation(s)
- Konstantinos Gkiouras
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria G Grammatikopoulou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, Thessaloniki, Greece
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Tsampika Tsaliki
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, Thessaloniki, Greece
| | - Laurette Ntwali
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, Thessaloniki, Greece
| | - Meletios P Nigdelis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Gerontidis
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleftheria Taousani
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Midwifery, Faculty of Health Sciences, International Hellenic University, Alexander Campus, Thessaloniki, Greece
| | - Christos Tzimos
- Northern Greece Statistics Directorate, Hellenic Statistical Authority, Thessaloniki, Greece
| | - Radosław Rogoza
- Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
| | - Dimitrios P Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Lorenzo M Donini
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Rome, Italy
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Validation of the Arabic version of the Teruel Orthorexia Scale (TOS) among Lebanese adolescents. Eat Weight Disord 2022; 27:619-627. [PMID: 33939127 PMCID: PMC8091151 DOI: 10.1007/s40519-021-01200-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/16/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES This study aimed at examining the reliability and validity of the Teruel Orthorexia Scale (TOS) among a sample of Lebanese adolescents (15 to 18 years old). METHODS This is a cross-sectional study that was conducted between May and June 2020 and had enrolled 555 Lebanese adolescents. To assess the internal structure of the TOS scale, we administered the confirmatory factor analysis based on polychoric correlation matrix using Weighted Least Squares with Means and Variance Adjusted estimation (WLSMV) method in Mplus v 7.2 as suggested in the original validation paper. To assess the degree to which the Lebanese adaptation converges with the original scale, we have conducted the Multigroup Confirmatory Factor Analysis (MGCFA; estimated as CFA) between the data reported in the current paper and from the original validation paper. RESULTS The mean age of the participants was 16.66 ± 1.01 years, with 76.1% females. The bi-dimensional model fitted the data well (χ2(118) = 429.09; p < 0.001; CFI = 0.954; RMSEA = 0.069[0.062, 0.076]). The latent factors were highly correlated (ρ = 0.74; p < 0.001), and the strength of the standardized factor loadings was adequate on both factors (i.e., all > 0.60). The fit indices of the scalar model were at the boundary of the threshold and thus, with some pinch of caution, it might be interpreted as invariant (i.e., having equal item intercepts across groups). We have identified latent mean differences in orthorexia nervosa (0.30; p < 0.001), where Spanish individuals scored higher, but we did not find any differences in the healthy eating (0.03; p = 0.636). Higher DOS scores were significantly correlated with higher scores on the TOS subscale OrNe (r = 0.715; p < 0.001) as well as with higher scores on the TOS subscale HeOR (r = 0.754; p < 0.001). Higher ORTO-R scores were significantly associated with less TOS OrNe (r = - 0.437; p < 0.001) and TOS HeOr (r = - 0.305; p < 0.001) scores, respectively. CONCLUSION The Arabic version of the TOS can be considered a reliable valuable instrument to assess the ON tendencies and behaviors in Lebanese adolescents, emphasizing the fine contrast between ON's two dimensions: healthy vs. pathological. LEVEL V Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Bhattacharya A, Cooper M, McAdams C, Peebles R, Timko CA. Cultural shifts in the symptoms of Anorexia Nervosa: The case of Orthorexia Nervosa. Appetite 2021; 170:105869. [PMID: 34910984 DOI: 10.1016/j.appet.2021.105869] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/29/2021] [Accepted: 12/11/2021] [Indexed: 12/26/2022]
Abstract
Orthorexia Nervosa (ON) is a term describing a fixation on food purity, involving ritualized eating patterns and a rigid avoidance of "unhealthy foods." Those self-identified as having ON tend to focus on food composition and feel immense guilt after eating food deemed "unhealthy." Although not formally recognized as a psychiatric disorder by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), ON has received increasing attention since its identification in 1997. There is ongoing work to establish diagnostic and empirical tools for measuring ON; embedded in this is the question as to whether or not ON is a new eating disorder. In this paper, we argue ON is not a new psychiatric disorder but rather a new cultural manifestation of anorexia nervosa (AN). We begin by providing an overview of historical representations and classification of eating disorders, with a specific focus on AN. This is followed by discussion of the rise in diet culture and healthism since the 19th century. We conclude by examining the diagnostic validity and utility of ON through a discussion of empirical evidence. Classifying ON under the diagnostic umbrella of AN may improve our understanding of factors underlying restrictive eating behaviors.
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Affiliation(s)
- Anushua Bhattacharya
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19104, USA.
| | - Marita Cooper
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19104, USA.
| | - Carrie McAdams
- Department of Psychiatry, University of Texas Southwestern Medical School, 6363 Forest Park Road, Dallas, TX, 75390, USA.
| | - Rebecka Peebles
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, 800 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - C Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19104, USA; Department of Psychology in Psychiatry, Perelman School of Medicine at University of Pennsylvania, 800 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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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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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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The Spanish Version of the Eating Habits Questionnaire (EHQ-ES) and Its Links to Symptoms and Concerns Characteristic of Eating Disorders among Young Adults. Nutrients 2021; 13:nu13061993. [PMID: 34200562 PMCID: PMC8228523 DOI: 10.3390/nu13061993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023] Open
Abstract
The aim of the study was to investigate the psychometric properties (internal consistency, factor structure, and convergent validity) of the Spanish version of the Eating Habits Questionnaire (EHQ-ES) and its links to disordered eating in young adults. Two university student samples with a total of 487 participants (N1age = 21.75 ± 5.10; N2age = 21.17 ± 6.81) participated in the study. They filled out the Eating Habits Questionnaire and the Eating Attitudes Test. Our findings showed that the EHQ-ES demonstrated strong internal consistency, with a Cronbach’s α = 0.903 and ω = 0.939. The EHQ-ES consists of 20 items to measure problems associated with healthy eating (α = 0.855, ω = 0.879), knowledge of healthy eating (α = 0.783, ω = 0.826) and feeling positively about healthy eating (α = 0.775, ω = 0.773). In addition, subscales of the EHQ correlated with subscales of the EAT-26, showing that Orthorexia Nervosa is associated with disordered eating in a sample of university students. The current study is the first to describe a Spanish version of the EHQ. This demonstrates that EHQ-ES is a reliable screening tool for Spanish-speaking young adults. Moreover, the EHQ-ES can be a useful instrument for assessing ON in research and clinical practice.
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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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Prevalence and Characteristics of Orthorectic Disorders in Adolescence and Young People: Polish Preliminary Studies. Nutrients 2021; 13:nu13051568. [PMID: 34066985 PMCID: PMC8150448 DOI: 10.3390/nu13051568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/25/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022] Open
Abstract
The aim of this work was to assess orthorectic behaviors among young people and to evaluate their attitudes towards caring for their health. The study was conducted in 2019 on a group of 538 respondents aged 16–35. After analysis, 65 questionnaires were eliminated from further research, and the assessment of orthorectic disorders was performed using a method based on the modified ORTO-15 questionnaire on a group of 473 respondents. A large percentage of them exhibited an increased risk of orthorectic behaviors (32.8), which was higher among women than men (34.7% and 28.2%, respectively). People with higher risks of orthorectic disorders significantly more often reduced their consumption of foods high in fats and sugars. Attitudes of people with orthorectic disorders towards health care proved neutral, with a tendency to be positive. Nutritional behaviors observed in the studied group show some irregularities, which indicates the need for preventive and educational measures aimed at increasing awareness of the role of proper nutrition among young people. The obtained results may be the basis for further research on ON symptoms. One of the major areas of future research would be to create a reliable diagnostic tool which would allow for distinguishing between orthorexia and overdiagnosis.
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Rogoza R, Donini LM. Introducing ORTO-R: a revision of ORTO-15 : Based on the re-assessment of original data. Eat Weight Disord 2021; 26:887-895. [PMID: 32436165 PMCID: PMC8004519 DOI: 10.1007/s40519-020-00924-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 05/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Orthorexia nervosa has attracted significant attention in the field, however, alongside increasing knowledge, more and more gaps are being identified. One of the fundamental problems concerns measurement of orthorexia nervosa. The most commonly used self-report measure, the ORTO-15, demonstrated an unstable factorial structure across different populations. Therefore, one might question whether the knowledge obtained from past research using ORTO-15 is valid or not. The aim of the present paper is to re-analyse original data used for the validation of ORTO-15 to assess its factorial structure and propose its revision, the ORTO-R. METHODS The description of the sample and procedure corresponds to the one reported in Donini et al. (Eat Weight Disord 10:28-32, 2005). N = 525 subjects were enrolled. To evaluate whether the factorial structure of ORTO-15, we used confirmatory factor analysis. The results revealed that the ORTO-15 indeed does not capture the structure of orthorexia nervosa adequately and revision is needed. The ORTO-R contains six items from ORTO-15, which were identified as the best markers of orthorexia nervosa. DISCUSSION AND CONCLUSION In the current paper, we present a refined measure of orthorexia nervosa-the ORTO-R. It is based on a frequently used ORTO-15, overcoming its main limitations. We strongly believe that the current work will act as a bridge, linking past with the future research, and that alongside a new measure, the field of research on orthorexia nervosa will move forward. LEVEL OF EVIDENCE Level V, descriptive study.
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Affiliation(s)
- Radosław Rogoza
- Institute of Psychology, Community-Based Mental Health Center for Children and Adolescent: Warsaw-Bielany District, Cardinal Stefan Wyszyński University, Wóycickiego 1/3, 01-938, Warsaw, Poland.
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Pathological Preoccupation with Healthy Eating (Orthorexia Nervosa) in a Spanish Sample with Vegetarian, Vegan, and Non-Vegetarian Dietary Patterns. Nutrients 2020; 12:nu12123907. [PMID: 33371252 PMCID: PMC7766281 DOI: 10.3390/nu12123907] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 12/24/2022] Open
Abstract
Orthorexia nervosa (ON) has been defined as an obsessive and pathological attitude towards healthy nutrition. The aim of this study was to compare individuals who followed a vegan, vegetarian, and omnivore diet in terms of ON behaviors and to examine their prime motivations, attitudes, and behaviors towards food. The Spanish version of the ORTO-15 test — ORTO-11-ES — and the Food Choice Questionnaire (FCQ-SP) were used with a demographic questionnaire in an online survey disseminated among the social networks of different vegetarian associations and the general population. Of 466 individuals, 55% followed an omnivore diet, 23.5% were vegetarian and 21.7% were vegan. Results revealed relationships between type of diet and FCQ-SP dimensions for: health and natural content (H = 8.7, p < 0.05), sensory appeal (H = 11.4, p < 0.01), weight control (H = 40.4, p < 0.01), and familiarity (H = 37.3, p < 0.01). Our results confirm the findings of recent studies showing that individuals who follow a vegan or vegetarian diet are more likely to develop a pathological preoccupation with healthy eating versus omnivores. Further studies are required to determine the potential lines of action for the prevention of ON.
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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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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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Opitz MC, Newman E, Alvarado Vázquez Mellado AS, Robertson MDA, Sharpe H. The psychometric properties of Orthorexia Nervosa assessment scales: A systematic review and reliability generalization. Appetite 2020; 155:104797. [PMID: 32652100 DOI: 10.1016/j.appet.2020.104797] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/11/2022]
Abstract
The main objective of this systematic review was to provide a comprehensive overview of the psychometric properties of all available Orthorexia Nervosa (ON) assessment tools, in order to evaluate their scope of application for research and practice. Ten databases were searched for studies quantitatively assessing ON. The psychometric properties were evaluated according to specified quality criteria, focusing on the reliability, structural validity and construct validity of the scales. A meta-analytic approach was used to summarize eligible Cronbach's alpha coefficients between studies. Sixty-eight unique studies fulfilled the inclusion criteria for this systematic review. Ten discrete ON scales were identified. Half of the included studies exclusively utilized a version of the ORTO-15. The evaluation of all available ON measures raise issues regarding ON's dimensionality and conceptualization. Most of the identified scales require further validation. Based on the reported psychometric properties it is advised to re-evaluate existing tools and to focus on establishing consensus regarding the conceptualization of ON to establish a measure with sound psychometric properties.
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Affiliation(s)
- Marie-Christine Opitz
- Department of Clinical and Health Psychology, School of Health in Social Science, The University of Edinburgh, Teviot Place, EH8 9AG, Scotland, UK.
| | - Emily Newman
- Department of Clinical and Health Psychology, School of Health in Social Science, The University of Edinburgh, Teviot Place, EH8 9AG, Scotland, UK.
| | | | - MacKenzie D A Robertson
- Department of Clinical and Health Psychology, School of Health in Social Science, The University of Edinburgh, Teviot Place, EH8 9AG, Scotland, UK.
| | - Helen Sharpe
- Department of Clinical and Health Psychology, School of Health in Social Science, The University of Edinburgh, Teviot Place, EH8 9AG, Scotland, UK.
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Valente M, Syurina EV, Donini LM. Shedding light upon various tools to assess orthorexia nervosa: a critical literature review with a systematic search. Eat Weight Disord 2019; 24:671-682. [PMID: 31228168 PMCID: PMC6647444 DOI: 10.1007/s40519-019-00735-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/07/2019] [Indexed: 12/25/2022] Open
Abstract
AIM The aim of this literature review was to identify the tools developed and used to assess orthorexia nervosa (ON). METHODS A systematic search was executed in PubMed, Biomed Central, and PsycINFO. The final list included 70 articles that were critically analyzed. RESULTS A total of six tools were reported to assess ON: the BOT, the ORTO-15, the EHQ, the DOS, the BOS, and the TOS. The tools were based upon different conceptualizations of ON and of its diagnostic criteria. Although they were different, all the conceptualizations derived from the initial definition of ON provided by Bratman in 1997. None of the methodologies adopted for tool construction considered end users or client perspectives and, when carried out, the validations of the tools were fragmented and often based on specific populations. CONCLUSION This study may be a starting point for the construction of a new diagnostic tool for ON. Starting from the methodological weaknesses identified by this review, it was possible to derive some suggestions for future research: (a) developing a modern re-conceptualization of ON, comprehensive of end-user perspectives; (b) adopting qualitative data collection techniques to gain insights into how to diagnose ON; and (c) actively involving diverse stakeholders for constructing a new tool. LEVEL OF EVIDENCE Level of Evidence: I, systematic review.
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Affiliation(s)
- Martina Valente
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Elena V Syurina
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Farchakh Y, Hallit S, Soufia M. Association between orthorexia nervosa, eating attitudes and anxiety among medical students in Lebanese universities: results of a cross-sectional study. Eat Weight Disord 2019; 24:683-691. [PMID: 31183627 DOI: 10.1007/s40519-019-00724-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/30/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The objective of the study was to evaluate the association between orthorexia nervosa (ON) tendencies and behaviors, eating attitudes (EAT) and anxiety among a representative sample of medical students in the Lebanese universities. METHODS This cross-sectional study, conducted between May 2018 and January 2019, enrolled 627 medical students using a proportionate random sample from all seven faculties of medicine in Lebanon. The ORTO-15 scale was used to evaluate ON tendencies and behaviors among participants. Scores below 40 indicate the presence of ON. The Eating Attitude Test-26 and the Hamilton Anxiety Rating A (HAM-A) scales (yielding a psychic and a somatic subscale scores) were used to assess eating attitudes and anxiety, respectively. It is noteworthy that the sum of the EAT items 6, 7, 16 and 17 responses yielded the EAT score that would predict ON. RESULTS The results of a linear regression, taking the ORTO-15 score (15 items) as the dependent variable and the EAT total score, the summated score of the EAT items that predict ON and the psychic and somatic anxiety subscales scores as independent variables, showed that a higher EAT score (β = - 0.094) was significantly associated with lower ORTO-15 scores (more orthorexia tendencies and behaviors); whereas, a higher psychic anxiety subscale score (β = 0.117) was significantly associated with higher ORTO-15 scores (lower orthorexia tendencies and behaviors). CONCLUSION This suggests a link between eating disorders and ON which is beyond ON tendencies observed in eating disorders but ON individuals simultaneously have lesser psychological distress and anxiety. LEVEL OF EVIDENCE Level 5, cross-sectional descriptive study.
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Affiliation(s)
- Youssef Farchakh
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.
| | - Michel Soufia
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
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Parra-Fernández ML, Onieva-Zafra MD, Fernández-Martínez E, Abreu-Sánchez A, Fernández-Muñoz JJ. Assessing the Prevalence of Orthorexia Nervosa in a Sample of University Students Using Two Different Self-Report Measures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142459. [PMID: 31373283 PMCID: PMC6678205 DOI: 10.3390/ijerph16142459] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/28/2019] [Accepted: 07/09/2019] [Indexed: 02/01/2023]
Abstract
In recent decades, orthorexia nervosa (ON) has increased presence in society. It is related with beliefs and attitudes towards eating and is characterized by an obsessive behavior toward heathy eating. The prevalence of ON has been reported by numerous researchers, with rates varying considerably according to the tool used to evaluate the same parameter. The aim of this study was to compare the prevalence of ON in a single population using two different questionnaires. The test for the diagnosis of orthorexia (ORTO-11-ES) assessment tool for orthorexia nervosa and the Düsseldorfer Ortorexie Skala (DOS-ES), constitute brief self-report assessment tools which measure the risk of suffering ON. A sample of 492 students from the University of Castilla la Mancha (Spain) participated in this study, of whom 43.1% were male and 56.9% were female. The findings show that, according to the DOS-ES, only 10.5% of students displayed ON whereas, with the ORTO-11-ES, the prevalence of ON increased to 25.2%. The tendency towards orthorexic behavior is more closely associated with the female gender. The Body Mass Index (BMI) had no influence on the tendency for ON. This study provides valuable information on the usefulness of both questionnaires and the possible limitations associated with the use of these tools in the general population.
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Affiliation(s)
- María Laura Parra-Fernández
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing of Ciudad Real, Universidad de Castilla-La-Mancha, 13071 Ciudad Real, Spain
| | - María Dolores Onieva-Zafra
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing of Ciudad Real, Universidad de Castilla-La-Mancha, 13071 Ciudad Real, Spain.
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Sex differences in orthorexic eating behaviors: A systematic review and meta-analytical integration. Nutrition 2019; 67-68:110534. [PMID: 31525607 DOI: 10.1016/j.nut.2019.06.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Other than the ongoing debate about the epidemiologic and clinical relevance of pathologically healthful eating, a phenomenon called orthorexia nervosa, there is not much consensus about sex differences in prevalence rates. The aim of this study was to provide a systematic review and meta-analytical combination of derived data to better conceptualize the presence and size of sex differences in the prevalence and levels of orthorexic eating behaviors and orthorexia nervosa. METHODS Sixty-seven publications were included in the synthesis providing data from k = 89 subsamples (39 255 participants, 67.7% women) for meta-analytical procedures. Separate analyses were conducted for each measurement tool. The impact of four moderators proposed to explain sex differences was examined: sample composition (general population versus special interest in health population; subgroup analysis), and in a meta-regression sample's mean age, year of publication, and sex distribution. RESULTS The results showed significant sex differences in only one of four instruments in use. Studies measuring orthorexic behaviors showed that women were significantly more likely to report pathologically healthful eating than men (small effect size). Studies employing tools to assess tendencies toward healthy eating indicated similar levels in women and men. Subgroup and moderator analyses showed comparable effects sizes in general population and high-risk samples, and that the sex difference was inconsistently and minimally related to the sample's mean age, year of publication, or sex distribution. CONCLUSIONS The findings indicate that, depending on the instrument in use, tendencies toward healthy eating are comparable between the genders, although pathologically healthful eating is slightly more pronounced in women. Future studies will have to adopt valid criteria for diagnosing Orthorexia nervosa and investigate additional factors contributing to pathologic healthful eating and orthorexia nervosa.
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Clifford T, Blyth C. A pilot study comparing the prevalence of orthorexia nervosa in regular students and those in University sports teams. Eat Weight Disord 2019; 24:473-480. [PMID: 30264390 PMCID: PMC6531385 DOI: 10.1007/s40519-018-0584-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/17/2018] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Orthorexia nervosa (ON) is a pattern of eating characterized by a pathological fixation on restricting foods based on their perceived health. Like many eating disorders, ON is thought to be more prevalent in athletes. This was a preliminary study to explore the prevalence of ON in University students to determine whether those who compete in University sports have higher orthorexic tendencies. METHODS 116 male and female student athletes (age 21 ± 1 years) and 99 non-athlete controls (21 ± 2) from Universities in the North East of the UK completed the ORTO-15 test (≤ 40 being the cutoff) used to screen individuals for ON. RESULTS ON symptoms were high in all students (76%); there was no difference in ORTO-15 scores between the athletes (36.6 ± 3.9) and non-athlete controls (37.2 ± 3.8; P = 0.279). There was a difference in scores between those who completed ≥ 10 h of exercise per week (36.65 ± 4.38) and those who do ≤ 10 h a week (37.38 ± 3.65) (P = 0.008; ES = 0.43). ORTO-15 scores were not higher in athletes competing in aesthetic and weight dependent sports (P > 0.05). CONCLUSIONS Being a student athlete for a University sports team did not affect ON prevalence; however, there appears to be a greater risk for students in general, and for athletes who undertake high volumes of exercise. Nonetheless, the high prevalence of ON symptoms may be attributed to flaws in the ORTO-15 questionnaire, and therefore, future studies should focus on developing a more valid method for ON diagnosis. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- Tom Clifford
- Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK. .,Faculty of Medical Sciences, School of Biomedicine, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK.
| | - Charlotte Blyth
- School of Biomedical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
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He J, Ma H, Barthels F, Fan X. Psychometric properties of the Chinese version of the Düsseldorf Orthorexia Scale: prevalence and demographic correlates of orthorexia nervosa among Chinese university students. Eat Weight Disord 2019; 24:453-463. [PMID: 30796740 DOI: 10.1007/s40519-019-00656-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/13/2019] [Indexed: 02/01/2023] Open
Abstract
PURPOSE As there is no measure available in Chinese for assessing orthorexia nervosa (ON), and as the Düsseldorf Orthorexia Scale (DOS) has demonstrated to be a valid measure for such a purpose, the current study aimed to obtain a Chinese version of the DOS (C-DOS), to evaluate psychometric properties of the C-DOS in a sample of Chinese university students, and to explore the prevalence of ON among the participants. METHODS According to standard procedures, the C-DOS was obtained and administered to 1075 mainland Chinese university students (52.7% female) recruited from two provinces in mainland China. To examine the factor structure of the C-DOS, the total sample was split into two halves, one for exploratory factor analysis, and the other for confirmatory factor analysis. The ordinal alpha and test-retest reliability were examined. Convergent and divergent validity was assessed by conducting Pearson correlation analyses between the C-DOS and other theoretically related/unrelated measures. Prevalence of ON was estimated based on the total score of the C-DOS with the cutoff value of 30. RESULTS A three-factor structure was revealed for the C-DOS. The C-DOS showed good internal consistency with an ordinal alpha of 0.80, and it also had good test-retest reliability of 0.77. The total scores of the C-DOS had strong and statistically significant positive correlations with eating inflexibility, while the total scores had weak correlations with other eating disturbances. Strong measurement invariance across gender groups was also supported. The prevalence of ON was 7.8% with males showing higher rates of ON than females (10.6% vs. 5.3%). CONCLUSIONS The Chinese version of the DOS (C-DOS) was psychometrically adequate for the sample of Chinese students. Given the high prevalence of ON found in the current study, more attention to ON, as well as further research and potential interventions, are warranted in China. LEVEL OF EVIDENCE Descriptive (cross-sectional) study, Level V.
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Affiliation(s)
- Jinbo He
- Educational Science Research Institute, Hunan University, Changsha, 410000, Hunan, China.
- School of Humanities and Social Science, Chinese University of Hong Kong (Shenzhen), Shenzhen, Guangdong, China.
| | - Hongzhi Ma
- Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Friederike Barthels
- Heinrich-Heine-Universität, Düsseldorf, Universitätsstaße 1, 40225, Düsseldorf, Germany
| | - Xitao Fan
- School of Humanities and Social Science, Chinese University of Hong Kong (Shenzhen), Shenzhen, Guangdong, China
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Parra-Fernández ML, Onieva-Zafra MD, Fernández-Muñoz JJ, Fernández-Martínez E. Adaptation and validation of the Spanish version of the DOS questionnaire for the detection of orthorexic nervosa behavior. PLoS One 2019; 14:e0216583. [PMID: 31063479 PMCID: PMC6504074 DOI: 10.1371/journal.pone.0216583] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/25/2019] [Indexed: 02/03/2023] Open
Abstract
Introduction Orthorexia nervosa, a term used to describe an obsession with healthy eating, has been shown to have major health implications for those affected. The aim of this study was to validate a Spanish version of the Düsseldorfer Ortorexie Skala (DOS), a questionnaire for the detection of orthorexic behavior. Methods A cross-sectional study comprising a total sample of 492 Spanish participants recruited from the University of Castilla-La Mancha, Spain, and randomly divided into two groups. The following tools were applied: the DOS and the Eating Disorder Inventory (EDI-2). The factorial structures were analyzed using exploratory and confirmatory factorial analysis. Results The internal consistency of the DOS-ES was α = .841. The exploratory factor analysis has revealed the existence of a single factor with factor loadings ranging from .508 to .802. A confirmatory factor analysis was applied to the second half of the random sample in order to confirm the factor solution. Conclusion The Spanish adaptation of the DOS-ES is proven to be a reliable and valid questionnaire for evaluating the obsessive tendency towards healthy eating among university students.
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Affiliation(s)
- María Laura Parra-Fernández
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La-Mancha, Ciudad Real, Spain
| | - María Dolores Onieva-Zafra
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La-Mancha, Ciudad Real, Spain
- * E-mail:
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Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature. Eat Weight Disord 2019; 24:209-246. [PMID: 30414078 DOI: 10.1007/s40519-018-0606-y] [Citation(s) in RCA: 196] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/24/2018] [Indexed: 12/28/2022] Open
Abstract
AIM In some cases, detrimental consequences on health are generated by self-imposed dietary rules intended to promote health. The pursuit of an "extreme dietary purity" due to an exaggerated focus on food may lead to a disordered eating behavior called "orthorexia nervosa" (ON). ON raises a growing interest, but at present there is no universally shared definition of ON, the diagnostic criteria are under debate, and the psychometric instruments used in the literature revealed some flaws. This narrative review of the literature aims at assessing state of the art in ON definition, diagnostic criteria and related psychometric instruments and provides research propositions and framework for future analysis. METHODS The authors collected articles through a search into Pubmed/Medline, Scopus, Embase and Google Scholar (last access on 07 August 2018), using "orthorexia", "orthorexia nervosa" and "obsessive healthy eating" as search terms, and filled three tables including narrative articles (English), clinical trials (English), and articles in languages different from English. The data extrapolated from the revised studies were collected and compared. In particular, for each study, the diagnostic criteria considered, the specific psychometric instrument used, the results and the conclusions of the survey were analyzed. RESULTS The terms employed by the different authors to define ON were fixation, obsession and concern/preoccupation. Several adjectives emphasized these expressions (e.g. exaggerated/excessive, unhealthy, compulsive, pathological, rigid, extreme, maniacal). The suitable food and the diet were defined in different ways. Most of the papers did not set the diagnostic criteria. In some cases, an attempt to use DSM (edition IV or 5) criteria for anorexia nervosa, or avoidant/restrictive food intake disorder, or body dysmorphic disorder, was done. Specific diagnostic criteria proposed by the authors were used in few studies. All these studies indicated as primary diagnostic criteria: (a) obsessional or pathological preoccupation with healthy nutrition; (b) emotional consequences (e.g. distress, anxieties) of non-adherence to self-imposed nutritional rules; (c) psychosocial impairments in relevant areas of life as well as malnutrition and weight loss. The ORTO-15 and the Orthorexia Self-Test developed by Bratman were the most used psychometric tools. CONCLUSIONS The present review synopsizes the literature on the definition of ON, proposed diagnostic criteria and psychometric instruments used to assess ON attitudes and behaviors. This work represents a necessary starting point to allow a further progression of the studies on the possible new syndrome and to overcome the criticisms that have affected both research and clinical activity until now. LEVEL OF EVIDENCE Level V, narrative review.
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Plichta M, Jezewska-Zychowicz M. Eating behaviors, attitudes toward health and eating, and symptoms of orthorexia nervosa among students. Appetite 2019; 137:114-123. [PMID: 30840875 DOI: 10.1016/j.appet.2019.02.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/24/2019] [Accepted: 02/27/2019] [Indexed: 02/06/2023]
Abstract
The adoption of a balanced diet positively affects the state of human health; however, excessive focus on proper eating may lead to obsession about foods, described as orthorexia nervosa (ON). The aim of the study was to assess eating behaviors and concerns regarding health and eating among students with symptoms of ON. The participants were 1120 college students from seven universities in Poland enrolled in health-related majors (n = 547) and other majors (n = 573). The students completed the ORTO-15 test, Health Concern Scale (HCS) and Food Frequency Questionnaire (FFQ-6). Afterwards, eight dietary patterns were derived based on principal component analysis (PCA) ('Sweets & snacks', 'Legumes & nuts', 'Fruits & vegetables', 'Refined bread & animal fats', 'Dairy products & eggs', 'Fish', 'Meat', 'Fruit & vegetable juices'). Pearson's correlation, chi-square test, Student's t-test and one-way analysis of variance ANOVA were used for further analyses. The mean ORTO-15 score was 36.6 ± 4.2. Students of health-related majors were characterized by significantly lower ORTO-15 scores than students of majors not related to health (p < 0.001). The symptoms of ON were not determined by gender and BMI. The higher symptoms of ON were associated with more frequent consumption of vegetables, fruits, nuts, legumes and meat, and less frequent consumption of sweets, snacks, refined bread and animal fats. Students with an 'ON score <35' were characterized by lower eating concerns than students with an 'ON score between 35 and 39' (p = 0.044). There was no significant association between symptoms of ON and health concerns. Nevertheless, in order to confirm this result, research should be continued with the use of other scales measuring health attitudes and symptoms of ON.
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Affiliation(s)
- Marta Plichta
- Department of Organization and Consumption Economics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences, Nowoursynowska, 159C, 02-776, Warsaw, Poland.
| | - Marzena Jezewska-Zychowicz
- Department of Organization and Consumption Economics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences, Nowoursynowska, 159C, 02-776, Warsaw, Poland.
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An unhealthy health behavior: analysis of orthorexic tendencies among Hungarian gym attendees. Eat Weight Disord 2019; 24:13-20. [PMID: 30343447 DOI: 10.1007/s40519-018-0592-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/01/2018] [Indexed: 02/07/2023] Open
Abstract
AIM In the present study, we aim to assess the prevalence and certain psychological and other correlates of orthorexic tendencies: health and exercise behaviors and demographic variables among gym attendees in Hungary. METHODS Altogether, responses of 207 gym attendees who filled out an online questionnaire (03/2017-10/2017) were analyzed. The mean age was 31.9 years; most were female and college educated, and about half resided in the capital city. Frequencies and means were calculated for the sample; and univariate linear regression and ANOVA were carried out. Finally, multivariate linear regression was used to assess the relationship between the dependent variable (Orto-11-Hu) and the independent variables (Eating Disorder Inventory, Maudsley Obsessional-Compulsive Inventory, health and exercise habits, and demographics). RESULTS The mean score for the Orto-11-Hu was 27.7. In the multivariate analysis, two eating disorder characteristics (drive for thinness and interpersonal distrust), age, exercising more than once a day, and yoga practice were significantly associated with higher orthorexic tendencies. There was a lack of correlation between any obsessive-compulsive traits. CONCLUSIONS Our data suggest and overlap between certain eating disorder traits, and a link between ON and frequent exercising and younger age. Further research is needed to investigate whether these correlates are found not only in a specific fitness-oriented population, but also in the general population. LEVEL OF EVIDENCE Level V, descriptive cross-sectional study.
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Parra-Fernandez ML, Rodríguez-Cano T, Perez-Haro MJ, Onieva-Zafra MD, Fernandez-Martinez E, Notario-Pacheco B. Structural validation of ORTO-11-ES for the diagnosis of orthorexia nervosa, Spanish version. Eat Weight Disord 2018; 23:745-752. [PMID: 30196527 PMCID: PMC6244547 DOI: 10.1007/s40519-018-0573-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The ORTO-11-ES questionnaire is a tool to assess the pathological obsession displayed by some individuals regarding healthy eating. The aims of this study were (1) to confirm the factor structure of the Spanish version of ORTO-11-ES using confirmatory factor analysis (CFA) and (2) to examine the possible association between the ORTO-11-ES score, gender and body mass index (BMI). METHODS The sample comprised 492 students from the University of Castilla la Mancha, Spain. Of these, 280 were women (56.9%). Participants were surveyed using the ORTO-11-ES questionnaire. RESULTS The confirmatory factor analysis (CFA) supported the 11 elements and 3 domains of this tool as the better fitting model; for the Comparative Fit Index (CFI) and the Tucker-Lewis Index (TLI), the values were 0.94 and 0.91, respectively, and the Root Mean-Square Error of Approximation (RMSEA) was 0.058. The tendency towards orthorexic behavior is more associated with the female gender. The BMI had no influence on the tendency for ON. CONCLUSIONS This study is the first attempt to confirm the three-factor structure of a Spanish version of the ORTO-15 questionnaire. These findings suggest that the ORTO-11-ES may be a valuable tool for identifying subjects with specific eating behavior patterns. This information may be useful for health professionals involved in the research, development and implementation of interventions catered to individuals suffering from this eating disorder. LEVEL OF EVIDENCE Level V, descriptive cross-sectional study.
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Affiliation(s)
| | | | - Maria José Perez-Haro
- Biostatech Advice, Training and Innovation in Biostatistics, S.L Santiago de Compostela, A Coruña, Spain
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Parra-Fernández ML, Rodríguez-Cano T, Onieva-Zafra MD, Perez-Haro MJ, Casero-Alonso V, Fernández-Martinez E, Notario-Pacheco B. Prevalence of orthorexia nervosa in university students and its relationship with psychopathological aspects of eating behaviour disorders. BMC Psychiatry 2018; 18:364. [PMID: 30424750 PMCID: PMC6234674 DOI: 10.1186/s12888-018-1943-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/25/2018] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Orthorexia nervosa (ON) is characterized by an obsession with healthy eating, which may lead to severe physical, psychological and social disorders. It is particularly important to research this problem in populations that do not receive clinical care in order to improve early detection and treatment. OBJECTIVE The aim of this study was to research the prevalence of ON in a population of Spanish university students and to analyze the possible associations between ON and psychological traits and behaviors that are common to ED. METHOD A cross-sectional study with 454 students from the University of Castilla La Mancha, Spain. In total, 295 women and 159 men participated, aged between 18 and 41 years. The ORTO-11-ES questionnaire and the Eating Disorder Inventory (EDI-2) were used for this study. The chi squared test was used to compare the homogeneity among the different groups. RESULTS The scores on the ORTO-11-ES suggested that 17% of students were at risk of ON. The scores on the EDI-2 for the group at risk of ON were significant, compared to the remaining individuals, regarding their drive for thinness (17.1% vs 2.1%), bulimia (2.6% vs 0%), body dissatisfaction (26.3% vs. 12.4%), perfectionism (14.5% vs 4.8%), interoceptive awareness (13.2% vs 1.3%), asceticism (15.8% vs 3.7%) and impulsiveness (9.2% vs 1.9%). DISCUSSION AND CONCLUSION These findings suggest that many of the psychological and behavioral aspects of ED are shared by people who are at risk of ON. Future research should use longitudinal data, examining the temporal relationship among these variables or other underlying variables that may contribute to the concurrence of ED and ON.
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Affiliation(s)
| | | | | | - María José Perez-Haro
- Biostatech Advice, Training and Innovation in Biostatistics, S.L Santiago de Compostela, A Coruña, Spain
| | - Víctor Casero-Alonso
- School of Industrial Engineers, University of Castilla-La Mancha, Ciudad Real, Spain
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Reynolds R. Is the prevalence of orthorexia nervosa in an Australian university population 6.5%? Eat Weight Disord 2018; 23:453-458. [PMID: 29956098 DOI: 10.1007/s40519-018-0535-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 06/19/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To survey Australian adults at a Sydney university about: their tendencies towards the proposed health food eating disorder, orthorexia nervosa (and to estimate the prevalence of this condition), their eating behaviours, and their body image. METHODS A pilot, cross-sectional and descriptive online survey was conducted on staff and students at the University of New South Wales, Sydney. The primary outcome was the score on the most commonly used and validated measure of orthorexic behaviours, the ORTO-15. The point prevalence of orthorexia nervosa was estimated using the ORTO-15 cut-off score of < 35. Other outcomes were the Eating Attitudes Test-26 and the Body Shape Questionnaire-34. RESULTS In the sample of 92 Australian adults recruited at a university, there was a point prevalence rate for orthorexia nervosa of 21% when using the ORTO-15 cut-off value of < 35. If criteria A and B of proposed diagnostic criteria for the condition were also taken into consideration (i.e. someone with orthorexia nervosa would display disordered healthy eating tendencies; as well as were: underweight, or had marked concern with their body shape, or had significant impairment of functioning in work life or social life), the true prevalence rate could be considered to be 6.5%. CONCLUSIONS Using the ORTO-15 tool alone may overestimate the true prevalence of orthorexia nervosa. Further research into the accurate diagnosis and treatment of orthorexia nervosa is needed. LEVEL OF EVIDENCE Level V, descriptive study.
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Affiliation(s)
- Rebecca Reynolds
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, 2052, Australia.
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