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Foyster M, Sultan N, Tonkovic M, Govus A, Burton-Murray H, Tuck CJ, Biesiekierski JR. Assessing the presence and motivations of orthorexia nervosa among athletes and adults with eating disorders: a cross-sectional study. Eat Weight Disord 2023; 28:101. [PMID: 38070009 PMCID: PMC10710386 DOI: 10.1007/s40519-023-01631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE Orthorexia nervosa involves restricting diet based on quality rather than quantity. Although orthorexia is well reported in many at-risk populations, limited data addresses its presence in individuals with eating disorder history (EDs) or athletes. We aimed to identify the presence and potential drivers of orthorexia in adults with EDs and endurance athletes, compared to control subjects. METHODS Participants ≥ 18y included: people with a diagnosed eating disorder (ED as per DSM-5); endurance athletes (training/competing ≥ 5 h/week); or control subjects. Participants (n = 197) completed an online survey assessing orthorexia (eating habits questionnaire, EHQ), eating motivations (TEMS-B) and compulsive exercise (CET). RESULTS ED had the highest orthorexia symptom severity (92.0 ± 3.02, n = 32), followed by athletes (76.2 ± 2.74, n = 54) and controls (71.0 ± 1.80, n = 111) (F (2) = 18.2, p < 0.001). A strong positive correlation existed between weight control motives and higher orthorexia symptom severity (r = 0.54, 95% CI [1.35, 2.36], p < 0.001), while a weak negative association existed between Hunger and Pleasure motives and higher orthorexia symptom severity (r = 0.23, 95% CI [- 2.24, - 0.34], p = 0.008; r = 0.26, 95% CI [- 2.11, - 0.47], p = 0.002, respectively). A moderate positive relationship was found between CET and orthorexia symptom severity (95% CI [1.52, 3.12], p < 0.001). CONCLUSION Adults with ED history and endurance athletes have greater orthorexia symptom severity compared to control. Clinicians working with at-risk populations should screen patients and be aware of red-flags of orthorexic traits, desire to control weight, and compulsive exercise behavior. LEVEL OF EVIDENCE III: Evidence obtained from cohort studies.
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Affiliation(s)
- Mandy Foyster
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Nessmah Sultan
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Matilda Tonkovic
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Andrew Govus
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
| | - Helen Burton-Murray
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Caroline J Tuck
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia
- Department of Nursing and Allied Health, Swinburne University, Hawthorn, VIC, Australia
| | - Jessica R Biesiekierski
- Department of Dietetics, Nutrition and Sport, La Trobe University, Bundoora, VIC, Australia.
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia.
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López-Gil JF, Tárraga-López PJ, Soledad Hershey M, López-Bueno R, Gutiérrez-Espinoza H, Soler-Marín A, Fernández-Montero A, Victoria-Montesinos D. Overall proportion of orthorexia nervosa symptoms: A systematic review and meta-analysis including 30 476 individuals from 18 countries. J Glob Health 2023; 13:04087. [PMID: 37917875 PMCID: PMC10622118 DOI: 10.7189/jogh.13.04087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Background To date, no previous meta-analysis has determined the overall proportion of orthorexia nervosa symptoms on a global scale. The aim of the present study was 2-fold: first, to establish the overall proportion of orthorexia nervosa symptoms on a global scale, assessed with the ORTO-15 questionnaire; and second, to determine the role of sex, type of population, mean age, body mass index, and the temporal trend in relation to orthorexia nervosa symptoms. Methods Four databases were searched (PubMed, Scopus, Web of Science, and Cochrane Database of Systematic Reviews) with date limits from January 2005 to June 2023. Studies assessing the proportion of orthorexia nervosa assessed using the ORTO-15 questionnaire with a cutoff of <35 or <40 points were included in this review. Results The overall proportion of orthorexia nervosa symptoms (using the cutoff <35 points) was 27.5% (95% confidence interval (CI) = 23.5-31.6, I2 = 97.0%). In addition, no significant differences were observed between females (34.6%, 95% CI = 29.5-39.8, I2 = 96.1%) and males (32.1%, 95% CI = 26.5-38.1, I2 = 93.1%). According to the type of population, the highest overall proportion was found in people focused on sports performance or body composition (34.5%, 95% CI = 23.1-47.0, I2 = 98.0%). Notwithstanding, caution should be exercised in interpreting this result, as reverse causality could be a potential pitfall in this relationship. Conclusions We found that approximately three out of 10 study participants showed orthorexia nervosa symptoms according to the ORTO-15 tool. This overall proportion was higher in those participants who were athletes or fitness practitioners. Over the years, the proportion of orthorexia nervosa symptoms seems to be increasing. These high percentages and their increase are worrisome from a public health perspective and highlight the need to develop psychometric instruments to aid in clinical diagnosis and treatment efficacy. Registration PROSPERO (CRD42022350873).
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Affiliation(s)
- José Francisco López-Gil
- Navarrabiomed, Hospital Universitario de Navarra, Universidad Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
- One Health Research Group, Universidad de Las Américas, Quito, Ecuador
| | - Pedro Juan Tárraga-López
- Departamento de Ciencias Médicas, Facultad de Medicina, Universidad Castilla-La Mancha, Albacete, Spain
| | - Maria Soledad Hershey
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
- University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, Pamplona, Spain
| | - Rubén López-Bueno
- Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
| | | | - Antonio Soler-Marín
- Faculty of Pharmacy and Nutrition, Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Alejandro Fernández-Montero
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Occupational Medicine, University of Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
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Hafstad SM, Bauer J, Harris A, Pallesen S. The prevalence of orthorexia in exercising populations: a systematic review and meta-analysis. J Eat Disord 2023; 11:15. [PMID: 36747235 PMCID: PMC9903632 DOI: 10.1186/s40337-023-00739-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/24/2023] [Indexed: 02/08/2023] Open
Abstract
AIM Orthorexia Nervosa (ON) describes a pathological obsession with proper and high-quality nutrition that is necessary to research further in order to elucidate its prevalence and correlates which may bear implications for prevention and treatment. The aim of this study was to review studies that report the prevalence of ON in people who exercise, calculate an overall prevalence through a random-effects meta-analysis approach and investigate the association of ON prevalence using a random-effects meta-regression. In addition, a sub-group-analysis based on ON-instruments and a sensitivity analysis excluding students samples, were conducted. METHOD Systematic searches were conducted in the following online databases: PubMed, Embase, Web of Science, PsychInfo, CINAHL, Google Scholar and OpenNet. The following search terms were used: Orthore* AND (prevalenc* OR incidenc* OR frequen* OR cut-off OR epidem*). A total of 613 unique hits were reviewed by two blinded authors, and 24 studies were coded and assessed for risk of bias (Holy et.al). The meta-regression included three independent variables (sex, type of sport, and sample size). RESULTS The overall prevalence of ON in the exercising population was 55.3% (95% CI 43.2-66.8). Cochran's Q was 11,436.38 (df = 23, p < 0.0000), and the I2 was 98.4%, indicating high heterogeneity across studies. The sensitivity showed an overall prevalence of 51.3% (95% CI 51.3-70.0). There was a significant difference in prevalence estimates based on the instruments used (Qbet = 33.6, df = 2, p < 0.01). DISCUSSION The overall prevalence of ON in exercising populations was very high. The between-study disparity was large and was partly explained by the ON-instrument administered. One fourth of the studies had a moderate risk of bias. The majority of the studies did not specify relevant demographic information about the sample, and information about the type of sport was frequently missing.
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Affiliation(s)
- Stine Marie Hafstad
- Department of Psychosocial Science, University of Bergen, Post Box 7807, 5020, Bergen, Norway.
| | - Jonas Bauer
- Department of Psychosocial Science, University of Bergen, Post Box 7807, 5020, Bergen, Norway
| | - Anette Harris
- Department of Psychosocial Science, University of Bergen, Post Box 7807, 5020, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Post Box 7807, 5020, Bergen, Norway.,Optentia, the Vaal Triangle Campus of the North-West University, Vanderbijlpark, South Africa
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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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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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6
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Forys WJ, Tokuhama-Espinosa T. The Athlete’s Paradox: Adaptable Depression. Sports (Basel) 2022; 10:sports10070105. [PMID: 35878116 PMCID: PMC9320389 DOI: 10.3390/sports10070105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 02/01/2023] Open
Abstract
We proposed that an athlete’s depressive symptoms may be different from the general population in etiology if considered from the context of a depressive disorder. By shifting focus from a limited notion of symptoms onto a comprehensive model of depression, the full scope of the phenomenon becomes clearer. This paper investigated the relationship between neurotransmitters and allostatic load to explain the incidence of depression among elite athletes. This literature review extensively analyzed exercise-induced neurohormonal imbalance resulting in depressive states among athletes. The research revealed that 5-HTTLPR polymorphism, brain-derived neurotrophic factor (BDNF), extensive psychological demands, social stigma, and overtraining syndrome (OTS) may all contribute to a unique version of depression. The research revealed that the biological standards of athletes differ from those of non-athletes, to the point that the new model may be useful, thereby introducing the new term “Adaptable Depression (AD)” to the literature. This framework suggests a new direction for future research to precisely measure the neurotransmitter-related brain changes that result in “Adaptable Depression” in athletes and to establish a better understanding of the depressive tipping point.
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Affiliation(s)
- Weronika Jasmina Forys
- Division of Continuing Education, Harvard University, 51 Brattle Street, Cambridge, MA 01238, USA
- Correspondence:
| | - Tracey Tokuhama-Espinosa
- Faculty of Arts and Sciences, Extension School, Harvard University, 51 Brattle Street, Cambridge, MA 01238, USA;
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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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Paludo AC, Magatão M, Martins HRF, Martins MVS, Kumstát M. Prevalence of Risk for Orthorexia in Athletes Using the ORTO-15 Questionnaire: A Systematic Mini-Review. Front Psychol 2022; 13:856185. [PMID: 35645852 PMCID: PMC9133840 DOI: 10.3389/fpsyg.2022.856185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
The article aims to summarize the literature about the profile of risk of orthorexia in athletes using the ORTO-15 questionnaire. The search was performed at PubMed, Embase, Web of Science, and Sport Discus databases, using the terms “orthorexia” AND “athletes” with the respective entry terms. A multistage process of selection followed the PRISMA 2020 recommendation. A total of 688 articles were identified, and six studies were available for the final process. The prevalence of risk for orthorexia was assessed by the articles by the ORTO-15 questionnaire and ranged between 38 and 35 points. The comparison between male and female athletes and, athletes and non-athletes was not significant in the six articles. In conclusion, the review highlights that athletes from different sports, included in the review, do not present a risk of orthorexia nervosa considering the cutoff of 40 points, but not 35 points. Also, athletes present the same orthorexic behavior compared to non-athletes, demonstrating that orthorexia is an issue that needs to be considered in the general population. Moreover, a special focus should be given on the ORTO-15 questionnaire, about the sensitivity to diagnose the prevalence of orthorexia, especially in athletes.
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Affiliation(s)
- Ana Carolina Paludo
- Incubator of Kinanthropology Research, Faculty of Sport Studies, Masaryk University, Brno, Czechia
- *Correspondence: Ana Carolina Paludo,
| | - Marina Magatão
- Department of Physical Education, Universidade Estadual do Centro-Oeste, Guarapuava, Brazil
| | - Hilana Rickli Fiuza Martins
- Department of Physical Therapy, Universidade Estadual do Centro-Oeste, Guarapuava, Brazil
- Department of Physical Therapy, UniGuairacá, Guarapuava, Brazil
| | | | - Michal Kumstát
- Department of Health Promotion, Faculty of Sport Studies, Masaryk University, Brno, Czechia
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9
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Yılmaz MN, Dundar C. The relationship between orthorexia nervosa, anxiety, and self-esteem: a cross-sectional study in Turkish faculty members. BMC Psychol 2022; 10:82. [PMID: 35361269 PMCID: PMC8974066 DOI: 10.1186/s40359-022-00796-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Orthorexia nervosa (ON) may be a disorder on the spectrum of obsessive-compulsive disorders, maybe a separate eating disorder, or it may be an eating disorder on the spectrum of other eating disorders. We aimed to explore how anxiety and self-esteem affect the orthorectic tendency among higher-educated groups. METHODS This cross-sectional study was conducted on 248 faculty members selected by stratified sampling method from Ondokuz Mayis University in Samsun, Turkey. Data were collected by face-to-face interview method using Ortho-15, Rosenberg self-esteem, and Beck Anxiety scales. RESULTS The study group consisted of 144 (58.1%) males and 104 (41.9%) females, and the mean age was 42.5 ± 6.3 years. We found a tendency for orthorexia nervosa in 47 (19%) participants. The mean scores were 41.0 ± 2.6 for the Ortho-15 scale, 0.7 ± 1.2 for the Self-esteem scale, and 5.9 ± 5.8 for the Beck Anxiety Scale. Self-esteem scores were low, and anxiety scores were high in participants who tended to orthorexia (p < 0.001). Logistic regression analysis showed that the high self-esteem scores decrease the orthorectic tendency, while high anxiety scores increase the tendency. CONCLUSIONS We found a significant relationship between anxiety, low self-esteem and orthorexia nervosa. This result can be considered as a preliminary finding leading to further research. Further clinical and longitudinal studies are needed to determine the characteristics of individuals with orthorexia nervosa and identify the cause and effect relationship with psychiatric comorbidities.
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Affiliation(s)
- Maide Nur Yılmaz
- Department of Public Health, Faculty of Medicine, Ondokuz Mayis University, 55139, Atakum, Samsun, Turkey
| | - Cihad Dundar
- Department of Public Health, Faculty of Medicine, Ondokuz Mayis University, 55139, Atakum, Samsun, Turkey.
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Jagim AR, Fields J, Magee MK, Kerksick CM, Jones MT. Contributing Factors to Low Energy Availability in Female Athletes: A Narrative Review of Energy Availability, Training Demands, Nutrition Barriers, Body Image, and Disordered Eating. Nutrients 2022; 14:nu14050986. [PMID: 35267961 PMCID: PMC8912784 DOI: 10.3390/nu14050986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 12/28/2022] Open
Abstract
Relative Energy Deficiency in sport is experiencing remarkable popularity of late, particularly among female athletes. This condition is underpinned by low energy availability, which is a byproduct of high energy expenditure, inadequate energy intake, or a combination of the two. Several contributing factors exist that may predispose an athlete to low energy availability, and therefore a holistic and comprehensive assessment may be required to identify the root causes. The focus of the current narrative review is to discuss the primary contributing factors as well as known risk factors for low energy availability among female athletes to help practitioners increase awareness on the topic and identify future areas of focus.
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Affiliation(s)
- Andrew R. Jagim
- Sports Medicine, Mayo Clinic Health System, La Crosse, WI 54601, USA
- Exercise & Sport Science Department, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
- Patriot Performance Laboratory, Frank Pettrone Center for Sports Performance, Intercollegiate Athletics, George Mason University, Fairfax, VA 22030, USA; (J.F.); (M.K.M.); (M.T.J.)
- Correspondence: ; Tel.: +1-608-392-5280
| | - Jennifer Fields
- Patriot Performance Laboratory, Frank Pettrone Center for Sports Performance, Intercollegiate Athletics, George Mason University, Fairfax, VA 22030, USA; (J.F.); (M.K.M.); (M.T.J.)
- Exercise Science and Athletic Training, Springfield College, Springfield, MA 01109, USA
| | - Meghan K. Magee
- Patriot Performance Laboratory, Frank Pettrone Center for Sports Performance, Intercollegiate Athletics, George Mason University, Fairfax, VA 22030, USA; (J.F.); (M.K.M.); (M.T.J.)
- Sport, Recreation, and Tourism Management, George Mason University, Manassas, VA 22030, USA
| | - Chad M. Kerksick
- Exercise & Performance Nutrition Laboratory, Lindenwood University, St. Charles, MO 63301, USA;
| | - Margaret T. Jones
- Patriot Performance Laboratory, Frank Pettrone Center for Sports Performance, Intercollegiate Athletics, George Mason University, Fairfax, VA 22030, USA; (J.F.); (M.K.M.); (M.T.J.)
- Sport, Recreation, and Tourism Management, George Mason University, Manassas, VA 22030, USA
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11
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Martinovic D, Tokic D, Martinovic L, Vilovic M, Vrdoljak J, Kumric M, Bukic J, Ticinovic Kurir T, Tavra M, Bozic J. Adherence to Mediterranean Diet and Tendency to Orthorexia Nervosa in Professional Athletes. Nutrients 2022; 14:nu14020237. [PMID: 35057417 PMCID: PMC8779465 DOI: 10.3390/nu14020237] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/02/2022] [Accepted: 01/03/2022] [Indexed: 12/12/2022] Open
Abstract
Among many lifestyle components that professional athletes have to follow, nutrition is gradually growing to be one of the key factors for achieving and maintaining optimal sport performance. The Mediterranean diet (MD) is recognized as one of the healthiest dietary patterns worldwide; however, data regarding adherence to the MD among professional athletes are still scarce. Moreover, with the imposed need for a healthy diet among professional athletes, orthorexia nervosa (ON) could become a rising issue. This cross-sectional study included 150 professional athletes and 150 matched recreational athletes from Croatia. Four questionnaires were used for the assessment: general information, a test for the diagnosis of ON (ORTO-15), the International Physical Activity Questionnaire (IPAQ) and the Mediterranean Diet Serving Score (MDSS). Significantly more professional athletes were adherent to the MD (p < 0.001) and had a tendency to ON (p < 0.001). Moreover, there was a significant negative correlation between the ORTO-15 score and the total MET min/week score (r = −0.524, p < 0.001) and a significant positive correlation between the MDSS score and the total MET min/week score in the professional athlete group (r = 0.478, p < 0.001). All of these results imply that professional athletes are more concentrated on their dietary patterns than recreational athletes, and that due to this dedication, they possibly have a higher adherence to the MD but also possibly a higher risk for developing ON. However, the association between ON and the MD should be further addressed in the future.
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Affiliation(s)
- Dinko Martinovic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (D.M.); (L.M.); (M.V.); (J.V.); (M.K.); (T.T.K.)
| | - Daria Tokic
- Department of Anesthesiology and Intensive Care, University Hospital of Split, 21000 Split, Croatia;
| | - Lovre Martinovic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (D.M.); (L.M.); (M.V.); (J.V.); (M.K.); (T.T.K.)
| | - Marino Vilovic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (D.M.); (L.M.); (M.V.); (J.V.); (M.K.); (T.T.K.)
| | - Josip Vrdoljak
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (D.M.); (L.M.); (M.V.); (J.V.); (M.K.); (T.T.K.)
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (D.M.); (L.M.); (M.V.); (J.V.); (M.K.); (T.T.K.)
| | - Josipa Bukic
- Department of Pharmacy, University of Split School of Medicine, 21000 Split, Croatia;
| | - Tina Ticinovic Kurir
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (D.M.); (L.M.); (M.V.); (J.V.); (M.K.); (T.T.K.)
| | - Marino Tavra
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia;
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (D.M.); (L.M.); (M.V.); (J.V.); (M.K.); (T.T.K.)
- Correspondence: ; Tel.: +385-21-557-871; Fax: +385-21-557-905
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12
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Uriegas NA, Winkelmann ZK, Pritchett K, Torres-McGehee TM. Examining Eating Attitudes and Behaviors in Collegiate Athletes, the Association Between Orthorexia Nervosa and Eating Disorders. Front Nutr 2021; 8:763838. [PMID: 34859033 PMCID: PMC8632486 DOI: 10.3389/fnut.2021.763838] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/06/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose: Orthorexia nervosa (Orthorexia) is an eating attitude and behavior associated with a fixation on healthy eating, while eating disorders (EDs) are clinically diagnosed psychiatric disorders associated with marked disturbances in eating that may cause impairment to psychosocial and physical health. The purpose of this study was to examine risk for Orthorexia and EDs in student-athletes across sex and sport type and determine the association between the two. Methods: Student-athletes (n = 1,090; age: 19.6 ± 1.4 years; females = 756; males = 334) completed a survey including demographics, the ORTO-15 test (<40 and <35 threshold values), the Eating Attitudes Test-26 (EAT-26; >20 score), and additional questions about pathogenic behaviors to screen for EDs. Results: Using a <40 threshold value for the ORTO-15, 67.9% were at risk for Orthorexia, a more restrictive threshold value of <35 determined 17.7% prevalence across student-athletes with significant differences across sex [ <40: χ(1,1,090)2 = 4.914, p = 0.027; <35: χ(1,1,090)2 = 5.923, p = 0.015). Overall, ED risk (EAT-26 and/or pathogenic behavior use) resulted in a 20.9% prevalence, with significant differences across sex (χ2 = 11.360, p < 0.001) and sport-type category (χ2 = 10.312, p = 0.035). Multiple logistic regressions indicated a significant association between EAT-26 subscales scores and Orthorexia, and between Orthorexia positivity, ORTO-15 scores, and risk for EDs. Conclusions: Risk for Orthorexia and ED is present in collegiate student-athletes. While healthy and balanced eating is important, obsessive healthy eating fixations may increase the risk for EDs in athletes. More education and awareness are warranted to minimize the risk for Orthorexia and EDs in student-athletes.
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Affiliation(s)
- Nancy A Uriegas
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Zachary K Winkelmann
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Kelly Pritchett
- Department of Health Sciences, Central Washington University, Ellensburg, WA, United States
| | - Toni M Torres-McGehee
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
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13
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Strahler J, Wachten H, Mueller-Alcazar A. Obsessive healthy eating and orthorexic eating tendencies in sport and exercise contexts: A systematic review and meta-analysis. J Behav Addict 2021; 10:456-470. [PMID: 33650987 PMCID: PMC8997206 DOI: 10.1556/2006.2021.00004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/14/2020] [Accepted: 12/27/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Orthorexia Nervosa (ON) and exercise addiction (ExAdd) are two phenomena believed to overlap. We conducted a meta-analysis exploring the link between ON and (addictive) exercise behaviors. METHODS A systematic review of major databases and gray literature was carried out for studies reporting on ON and (addictive) exercise behaviors. Random effects meta-analyses were undertaken calculating correlations between ON and (addictive) exercise behaviors. A sub-group analysis investigated gender differences. RESULTS Twenty-five studies with 10,134 participants (mean age = 25.21; 56.4% female) were included. Analyses showed a small overall correlation between ON and exercise (21 studies, r = 0.12, 95% CI |0.06-0.18|) and a medium overall correlation between ON and ExAdd (7 studies, r = 0.29, 95% CI |0.13-0.45|). Gender differences were negligible. CONCLUSIONS Orthorexic eating correlated slightly and moderately with exercise and ExAdd, respectively, expressing some unique and shared variance of these behaviors. While this does not suggest ON and addictive exercising to be independent, it does not indicate substantial comorbidity. Future research should focus on clinical relevance, underlying mechanisms, vulnerability, and risk factors.
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Affiliation(s)
- Jana Strahler
- Psychotherapy and Systems Neuroscience, Justus-Liebig-University Giessen, Giessen, Germany
| | - Hanna Wachten
- Psychotherapy and Systems Neuroscience, Justus-Liebig-University Giessen, Giessen, Germany
| | - Anett Mueller-Alcazar
- Department of Psychology, Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany
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