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

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

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

On Orthorexia Nervosa: A Systematic Review of Reviews

INTRODUCTION

Orthorexia nervosa (ON), characterized by a pathological preoccupation with "extreme dietary purity," is increasingly observed as a mental health condition among young adults and the general population. However, its diagnosis is not formally recognized and has remained contentious.

OBJECTIVE

In this systematic review, we attempt to overview previous reviews on ON, focusing on the methodological and conceptual issues with ON. This would serve both as a summary and a way to highlight gaps in earlier research.

METHODS

This systematic review took reference from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, and using combinations of the search terms ("orthorexia" OR "orthorexia nervosa" OR "ON") AND ("review" OR "systematic review" OR "meta-analysis"), a literature search was performed on EMBASE, Medline and PsycINFO databases from inception up to October 31, 2023. Articles were included if (1) they were written or translated into English and (2) contained information pertaining to the diagnostic stability or validity of ON, or instruments used to measure ON symptoms and behaviors. Only review articles with a systematic literature search approach were included.

RESULTS

A total of 22 reviews were qualitatively reviewed. Several studies have reported variable prevalence of ON and highlighted the lack of thoroughly evaluated measures of ON with clear psychometric properties, with no reliable estimates. ORTO-15 and its variations such as ORTO-11, ORTO-12 are popularly used, although their use is discouraged. Existing instruments lack specificity for pathology and several disagreements on the conceptualization and hence diagnostic criteria of ON exist.

DISCUSSION

Previous reviews have consistently highlighted the highly variable (and contradictory) prevalence rates with different instruments to measure ON, lack of stable factor structure and psychometrics across ON measures, paucity of data on ON in clinical samples, and a need for a modern re-conceptualization of ON. The diagnosis of ON is challenging as it likely spans a spectrum from "normal" to "abnormal," and "functional" to "dysfunctional." "Non-pathological" orthorexia is not related to psychopathological constructs in the same way that ON is.

"In-between orthorexia" profile: the co-occurrence of pathological and healthy orthorexia among male and female non-clinical adolescents

BACKGROUND

The profile of adolescents with orthorexic eating behaviors remains to be explored. This study is the first to explore the typology of Lebanese adolescents from a large non-clinical sample based on orthorexia nervosa (ON) and healthy orthorexia (HO).

METHOD

A total of 555 adolescents (aged between 15 and 18 years) completed a set of questionnaires assessing orthorexic behaviors, self-esteem, stress, depressive and anxiety symptoms. Cluster analysis based on ON and HO scores was used to identify the typology of the sample. More precisely, this analysis was used to reveal and distinguish between naturally occurring subgroups of individuals with different orthorexic eating profiles, within the studied sample. Further, a series of one-way ANOVA was used to compare observed clusters based on their scores on used questionnaires. This analysis was used to capture the behavioral and psychological differences between previously yielded subgroups of individuals.

RESULTS

Cluster analysis based on ON and HO scores yielded 3 distinct groups: "Low orthorexia", "Moderate in-between orthorexia" and "High in-between orthorexia". While the first group represented individuals with no particular (healthy or pathological) interest in healthy eating, the two latter groups represented those with respectively moderate and high degrees of an interest in healthy eating that has both pathological and healthy aspects. Significant differences between clusters regarding their levels of stress, depression, anxiety and self-esteem was observed, yet they were found to be negligible due to poor effect sizes.

CONCLUSION

Findings from this study suggest that ON and HO can indeed co-occur among adolescents, that this co-occurrence can be experienced at different severity levels. Low effect sizes for ANOVA comparisons may suggest the possibility of the co-occurrence of ON and HO reducing the negative effects of ON behavior to some degree. The potential role of confusion around what constitutes "healthy eating" in the emergence of these "in-between orthorexia" profiles is put forward.