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Prevalence of orthorexia nervosa is less than 1%: Data from a US sample

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Purpose: Orthorexia nervosa, or pathological dieting based on being "healthy," has been of growing interest. Clinical data are limited to less than a half-dozen case studies reporting instances of medical problems due to healthful eating. However, more than a dozen studies using a measure to identify orthorexia, the ORTO-15, report very high prevalence rates in non-clinical samples. Point prevalence rates are reported from 6 % to nearly 90 %. Such variability could be due to cultural issues or psychometric problems with the instrument. This study examines prevalence rate of orthorexia in a US sample. Method: The ORTO-15 was administered to 275 US college students along with other questions regarding diet, exercise, and health. Results: While the ORTO-15 indicated a prevalence rate of 71 %, only 20 % of the sample endorsed a dietary practice of removing a particular food type (e.g. meat) from their diet. Those who endorsed following a vegan diet had the highest (less pathological) mean ORTO-15 score. Further, when classifying participants based on their seriousness about healthy eating and whether their diet had led to impairment in everyday activities and medical problems, less than 1 % of the sample fell into such a category. Conclusion: As in other countries, a large proportion of a non-clinical US sample scored in the orthorexia range on the ORTO-15. However, this instrument is likely unable to distinguish between healthy eating and pathologically healthful eating. Our estimate is that orthorexia nervosa like anorexia nervosa and bulimia nervosa, is not a common condition.
Prevalence of orthorexia nervosa is less than 1 %: data
from a US sample
Thomas M. Dunn
Josh Gibbs
Noelle Whitney
Amy Starosta
Received: 15 November 2015 / Accepted: 30 January 2016 / Published online: 22 February 2016
ÓSpringer International Publishing Switzerland 2016
Purpose Orthorexia nervosa, or pathological dieting
based on being ‘‘healthy,’’ has been of growing interest.
Clinical data are limited to less than a half-dozen case
studies reporting instances of medical problems due to
healthful eating. However, more than a dozen studies using
a measure to identify orthorexia, the ORTO-15, report very
high prevalence rates in non-clinical samples. Point
prevalence rates are reported from 6 % to nearly 90 %.
Such variability could be due to cultural issues or psy-
chometric problems with the instrument. This study
examines prevalence rate of orthorexia in a US sample.
Method The ORTO-15 was administered to 275 US
college students along with other questions regarding diet,
exercise, and health.
Results While the ORTO-15 indicated a prevalence rate
of 71 %, only 20 % of the sample endorsed a dietary
practice of removing a particular food type (e.g. meat) from
their diet. Those who endorsed following a vegan diet had
the highest (less pathological) mean ORTO-15 score.
Further, when classifying participants based on their seri-
ousness about healthy eating and whether their diet had led
to impairment in everyday activities and medical problems,
less than 1 % of the sample fell into such a category.
Conclusion As in other countries, a large proportion of a
non-clinical US sample scored in the orthorexia range on
the ORTO-15. However, this instrument is likely unable to
distinguish between healthy eating and pathologically
healthful eating. Our estimate is that orthorexia nervosa
like anorexia nervosa and bulimia nervosa, is not a com-
mon condition.
Keywords Orthorexia nervosa ORTO-15 Eating
disorders Pathological healthful eating
US physician Steven Bratman first made the remarkable
observation that some people were becoming so obsessive
about eating healthfully that they might be causing them-
selves harm [1]. Bratman coined the term ‘‘orthorexia
nervosa’’ (ON) to describe this fixation. He went on to
write a book, Health Food Junkies, about people whose
quest for the perfect healthy diet had become obsessional
and dysfunctional [2]. Despite a favorable book review in
the prestigious US medical journal JAMA supporting the
inclusion of ON in the medical lexicon [3], the disorder is
still not well understood [4]. The first peer-reviewed article
on ON appeared in the literature in 2004. Donini et al.
characterized ON as a ‘‘maniacal obsession’’ with the
pursuit of healthy eating [5]. However, the first formal
proposal for diagnostic criteria only appeared in 2015 [6].
While most of the literature is dominated with studies
regarding prevalence rates in non-clinical samples, con-
vincing case studies are also reported [69].
With increased interest in ON, many researchers have
sought to detect its prevalence in a number of different
samples. The first to do so was Donini and colleagues who
constructed the ‘‘ORTO-15,’’ a measure based on 10 yes/no
items originally constructed by Bratman in his 2000 book
[2,10]. Scores on the ORTO-15 of less than 40 are thought
&Thomas M. Dunn
School of Psychological Sciences, University of Northern
Colorado, Campus Box 94, Greeley, CO 80639-0094, USA
Behavioral Health Service, Denver Health Medical Center,
Denver, USA
Eat Weight Disord (2017) 22:185–192
DOI 10.1007/s40519-016-0258-8
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... The ORTO-15 has been accused of overestimating the prevalence of ON, because it incorrectly identifies dieting as unhealthy/harmful, without investigating its pathology [16]. It might be more likely that ORTO-15 is good at identifying people who are serious about eating healthy, but not good at identifying those whose healthful dietary choices are associated with pathology [17]. Validity, reliability and internal consistency have been questioned as well [18]. ...
... A recent meta-analysis showed a correlation of 0.12 between ON and exercise and a correlation of 0.29 between ON and exercise addiction [13]. Despite the fact that there is a link between exercise and ON /ON tendencies [28], prevalence studies of ON in sports and exercising populations present large discrepancies in terms of results [17]. ...
... Of the 24 included studies, publication years ranged from 2012 [70,71] to 2021 [69,72]. Studies were conducted in Portugal (k = 4: [34,68,73,74]), Italy (k = 3: [33,75,76]), the US (k = 3: [17,69,70]), Brazil (k = 2: [72,77]), Turkey (k = 2: [78,79]), Poland (k = 2: [16,80]), and one study each from the UK [4], Germany [81], Sweden [82], Denmark [71], Hungary [83], Lebanon [84], Spain [85], and Canada [86]. ...
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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 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.
... Furthermore, the ORTO-15 produces a wide range of prevalence rates. For example, using the ORTO-15 criteria, one study found a prevalence rate of ON of 71% among U.S. college students; however, when they considered whether participants' diets had led to impairment in everyday living or medical problems, they reported ON rates as less than 1% [22]. ...
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Purpose This study examined U.S. health professionals’ perspectives on the clinical utility, measurement, and etiology of orthorexia nervosa (ON). Methods Participants (n = 100) were U.S. health professionals with experience working clinically with eating disorders, including trainees, Ph.D. psychologists, social workers/mental health counselors, and medical health professionals. After reviewing the proposed ON criteria, participants responded to questions regarding the clinical utility, diagnosis, and measurement of ON, and sociocultural influence on the emergence of ON. Views of ON as a useful diagnostic category were examined as a function of participants’ current involvement in clinical versus research activities. Results Participants mostly (71.9%) agreed that ON should be a distinct clinical diagnosis. Participants who endorsed ON as a valid diagnosis spent more time on clinical work and less time engaged in research compared to participants who disagreed (both ps < 0.05). Approximately 27% of participants believed additional components should be added to the proposed ON diagnostic criteria. Participants indicated that sociocultural factors have considerable influence on the development of ON, namely the diet and weight loss industry, and the perceptions that biological/organic/vegan and low fat/low carb/gluten free food are the healthiest. Conclusion Professionals who spent more time working clinically with eating disorders were more likely to endorse ON as a unique disorder, and professionals who spent more time on research were more likely to disagree. To the extent that professionals who spend more time on research may shape the narrative around ON more visibly, this study underscores the importance of listening to practitioners' experiences in applied settings. Level of evidence: Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
... Moreover, exploring gender differences in orthorexia nervosa is important given evidence that men remain largely underrepresented in the literature on orthorexia nervosa (McComb & Mills, 2019), and that levels of eating disorder symptomatology are increasing at a faster rate among men then they are in women (Mitchison, Hay, Slewa-Younan, & Mond, 2014). The studies that have explored gender differences for orthorexia nervosa have produced mixed findings, with some documenting higher prevalence levels in men (Bratman & Knight, 2000), some reporting higher levels in women (Oberle, Samaghabadi, & Hughes, 2017;Rodgers et al., 2021), and others concluding that gender seems to be unrelated to orthorexia nervosa (Dunn, Gibbs, Whitney, & Starosta, 2017;Herranz Valera, Acuña Ruiz, Romero Valdespino, & Visioli, 2014;Oberle et al., 2017;Strahler, 2019). However, to the best of our knowledge, no study to date has explored gender differences based on healthy orthorexia and orthorexia nervosa. ...
Current scholarship on orthorexia nervosa remains undecided about the role of body image in this novel eating disorder. This study aimed to explore the role of positive body image in differentiating between healthy orthorexia and orthorexia nervosa and assess how this might differ for men and women. A total of 814 participants (67.1% women; Mage = 40.3, SD = 14.50) completed the Teruel Orthorexia scale, as well as measures of embodiment, intuitive eating, body appreciation and functionality appreciation. A cluster analysis revealed four distinct profiles characterized by high healthy orthorexia and low orthorexia nervosa; low healthy orthorexia and low orthorexia nervosa; low healthy orthorexia and high orthorexia nervosa; and high healthy orthorexia and high orthorexia nervosa. A MANOVA identified significant differences for positive body image between these four clusters, as well as that there were no significant differences between men and women for healthy orthorexia and orthorexia nervosa, despite men scoring significantly higher than women on all measures of positive body image. Cluster × gender interaction effects were found for intuitive eating, functionality appreciation, body appreciation and experience of embodiment. These findings indicate that the role of positive body image in healthy orthorexia and orthorexia nervosa may differ for men and women, making these relationships worthy of further exploration.
... Moreover, having a history of an eating disorder seems to highly predict orthorexia nervosa. Within the literature, there is a continuing debate about the classification of orthorexia nervosa as a separate disorder [25], an alternative of an already established eating disorder or obsessive compulsive disorder (OCD) [26]. Some researchers propose that it could be a precursor for, or a residual of an eating disorder [27]. ...
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Background: The literature highly concentrates on disorders related to body image among women but only minimally when it comes to the male population; hence, in order to provide general practitioners, and primary care physicians in general, and psychiatrists in particular, with additional information concerning muscle dysmorphia among male university students in Lebanon, this study seemed essential, and was therefore conducted to (1) identify the prevalence of MDD, and (2) evaluate the indirect effect of eating attitudes in general and orthorexia nervosa in particular, in the association between perfectionism and muscle dysmorphic disorder (MDD) among a sample of male university students. Methods: In this cross-sectional study conducted between September 2021 and May 2022, 396 male university students from multiple universities in Lebanon filled the online Arabic questionnaire. Results: The results showed that 26 (6.6%) of the participants had MDD. Orthorexia nervosa and eating attitudes mediated the association between perfectionism and MDD; higher perfectionism was significantly associated with higher ON and more inappropriate eating; higher ON and more inappropriate eating were significantly associated with higher MDD, whereas perfectionism had a significant total direct effect on MDD. The high prevalence of MDD among male university students in Lebanon implies further investigation on the national level in the country. Conclusion: Awareness campaigns among the university students could be adopted at the national level to increase the level of knowledge on the concepts of obsessive self-destructive perfectionism, orthorexia nervosa and muscle dysmorphia.
... Of those who showed risk for ON, 56% were Polish, which tracks with previous literature which has shown higher rates of ON-related behaviors and practices among citizens of Western and European countries, where cultural concepts of health are more pervasive and potentially harmful in their influences on personal behaviors [25]. ON incidence in the general population is estimated to range from 6.9% to 57.6% [26,27]. The presence of symptoms in the Polish group (40%) was statistically significantly more frequent that in the Spanish group (28%) (Chi2 p = 0.031). ...
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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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Orthorexia nervosa (ON) is characterised by an obsessive focus on healthy eating, following restrictive dietary practices and dietary restrictions escalating over time. The aim of this study was to explore mindfulness, mindful eating, self-compassion and quality of life in a female population. Two hundred eighty-eight participants completed Orthorexia, Self-Compassion, Mindful eating, Mindfulness and Eating Disorder Quality of Life scales. The results indicated that there was a negative relationship between ON and mindfulness, self-compassion and mindful eating. Furthermore, the present study found a positive relationship between lower quality of life and ON, while findings indicated that self-compassion and the awareness facet of mindfulness moderated the relationship between ON and QOL. The present results contribute to a better understanding of orthorexic eating behaviours in a female population, and identify the moderating capacity of self-compassion and mindfulness. Further implications and future directions are discussed. Level of evidence Level V, cross-sectional descriptive study.
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Prevalencija poremećaja hranjenja u mladih ljudi u stalnom je porastu, što dovodi u fokus ortoreksiju nervozu, osobito u razdobljima pandemije i stresa. Stoga je cilj ovog istraživanja bio utvrditi prevalenciju ortoreksije nervoze u mladih ljudi i povezati je s antropometrijskim parametrima, prehrambenim navikama i percepcijom tjelesnog izgleda. Ovo istraživanje uključivalo je 191 ispitanika u dobi od 18-24 godine, od čega je 85,9 % ženskog spola. Prikupljeni su podaci o tjelesnoj masi i visini ispitanika iz kojih je izračunat indeks tjelesne mase. Prevalencija ortoreksije nervoze procijenjena je pomoću upitnika ORTO-15, dok je upitnik PACS-R (eng. Physical Appearance Comparison Scale – Revised) korišten za procjenu tendencije usporedbe tjelesnog izgleda ispitanika s drugim osobama. Utvrđeno je da 38,2 % ispitanika ima ortoreksiju nervozu. Nije bilo statistički značajnih razlika u indeksu tjelesne mase između ispitanika s obzirom na ortoreksiju nervozu (p=0,276). Ipak, u skupini ispitanika bez utvrđene ortoreksije prevladavali su oni s adekvatnom tjelesnom masom (89,9 %), dok je među ispitanicima s utvrđenom ortoreksijom bio veći udio pothranjenih ispitanika (8,2 %) i onih s prekomjernom tjelesnom masom (15,1 %). Ispitanicima s ortoreksijom pravilna prehrana je važnija nego ispitanicima bez ortoreksije (p=0,001), dok statistički značajne razlike u samoprocjeni kvalitete prehrane nije bilo (p=0,815). Nadalje, utvrđena je statistički značajna negativna korelacija između rezultata PACS-R i ORTO-15 (p<0,01). U konačnici, postojala je statistički značajna razlika u rezultatima PACS-R između ispitanika obzirom na utvrđenu ortoreksiju (p=0,032). Ortoreksija nervoza utvrđena je kod velikog broja ispitanika. Iako su mlade osobe koje su razvile ortoreksiju nervozu uglavnom adekvatne tjelesne mase, imaju veću sklonost uspoređivati svoj fizički izgled s izgledom drugih, što upućuje na iskrivljenu percepciju vlastitog tijela. Ovime se skreće pozornost na važnost educiranja mladih osoba o pravilnoj prehrani, posebice žena, te se potvrđuje važnost interdisciplinarnog pristupa u liječenju ortoreksije nervoze, koja bi trebala uključivati i psihološkupodršku.
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Background There are several scales to evaluate orthorexia nervosa (ON), a pathological obsession, fixation or preoccupation with healthy foods. However, studies report that some of these scales have poor internal consistency and some do not have test-retest reliability, therefore new scales are needed to evaluate ON correctly. This study aims to adapt the Test of Orthorexia Nervosa-17 (TON-17) into Turkish and verify its validity and reliability. Methods The study included a total of 539 adults, 131 men (24.3%) and 408 women (75.7%), with a mean age of 30.2 ± 12.26 years. A reliability analysis was performed and a confirmatory factor analysis (CFA) to test its construct validity. Time invariance of the scale was examined by test-retest analysis, and its convergent validity was evaluated by a correlation analysis conducted to test relationships between the scale and other theoretically relevant instruments (EAT-26 and OBQ-9). Analyses were conducted using SPSS Version 23 and the AMOS program. Results The Cronbach's α internal consistency coefficient of the total scale was found to be 0.820, suggesting a strong internal consistency. The Cronbach's α values of its factors were 0.681 for the Factor 1, 0.643 for the Factor 2, and 0.726 for the Factor 3. In addition, the test-retest reliability was found as 0.868 for the total scale, suggesting an excellent reliability. The most of fit indices (CMIN/df, RMSEA, AGFI, NFI and TLI) of the scale were acceptable, and the GFI indicated a good model fit. Conclusion This study has shown that the Turkish version of TON-17, which is a new tool with three-factor structure to evaluate both healthy and unhealthy orthorexia, is valid and reliable scale. Studies of TON-17 on diverse cultures will contribute to the literature. Therefore, examining the validity and reliability of TON-17 in diverse cultures and populations may contribute to developing the gold standard scale for evaluating ON in future studies.
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The characteristic trait of individuals developing a pathological obsession and preoccupation with healthy foods and a restrictive and avoidant eating behavior is described as orthor-exia nervosa (ON). For ON, neither universal diagnosis criteria nor valid tools for large-scale epidemiologic assessment are available in the literature. The aim of the current study is to analyze the psychometric properties of a translated German version of the ORTO-15 questionnaire. The German version of the ORTO-15, a eating behavior and dieting habits questionnaire were completed by 1029 German-speaking participants (74.6% female) aged between 19 and 70 years (M = 31.21 ± 10.43 years). Our results showed that after confirma-tory factor analysis, the best fitting model of the original version is a single-factor structure (9-item shortened version: ORTO-9-GE). The final model showed only moderate internal consistency (Cronbach's alpha = .67), even after omitting 40% of the original question. A total of 69.1% participants showed orthorectic tendencies. Orthorectic tendencies are associated with special eating behavior features (dieting frequency, vegetarian and vegan diet). Education level did not influence ON tendency and nutritional students did not show higher ON tendency compared to students from other disciplines. This study is the first attempt to translate and to evaluate the psychometric properties of a German version of the ORTO-15 questionnaire. The ORTO-9-GE questionnaire, however, is only a mediocre tool for assessing orthorectic tendencies in individuals and shows moderate reliability and internal consistency. Our research suggests, that future studies are needed to provide more reliable and valid assessment tools to investigate orthorexia nervosa.
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This research aims to determine the prevalence of orthorexic behavior in high school students from private and municipal schools located in Temuco, city Chile. The study had a non-experimental, descriptive, cross-sectional design with a quantitative approach. A non-probabilistic approach was used for selecting the sample, which included 205 students divided into 94 females and 111 males ranging from 16 to 18 years of age. The instrument used is called "ORTHO-15". The results indicate that 30.7% of students presented orthorexic behavior, and its prevalence was higher in the municipal school (35.3%) and men (35.1%). Finally the instrument should be applied in wider populations to confirm the presence of this behavior and eventually report its effects.
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The present study was designed to investigate orthorexia nervosa, or the phenomenon of being preoccupied with consuming healthy food. Specific aims were to explore relationships between orthorexia features and attitudes towards body image, fitness and health in normal weight female and male university students with high levels of healthy food preoccupation, i.e. orthorexia nervosa. Participants were 327 female (N = 283) and male (N = 44) students aged 18 to 25 years. All participants completed the Polish adaptation of the 15-item questionnaire assessing orthorexia eating behaviours (the ORTHO-15) and the Multidimensional Body-Self Relations Questionnaire (the MBSRQ). Relationships between scores on the ORTHO-15 and MBSRQ were explored in the 213 students who had high levels of preoccupation with a healthy food intake (68.55% women and 43.18% men, respectively). There were no statistically significant differences in the levels of orthorexia behaviours between females and males. In female students with orthorexia nervosa, preoccupation with consuming healthy food was significantly correlated with the MBSRQ subscale scores for overweight preoccupation, appearance orientation, fitness orientation, health orientation, body areas satisfaction and appearance evaluation. Conversely, in male students with orthorexia nervosa there were no correlations between orthorexic behaviours and the MBSRQ subscales. In female students with orthorexia nervosa multivariable linear regression analysis found high body areas (parts) satisfaction, low fitness orientation, low overweight preoccupation and low appearance orientation were independent predictors of greater fixation on eating healthy food. In male students, we found that aspects of body image were not associated with preoccupation with healthy eating. A strong preoccupation with healthy and proper food was not associated with an unhealthy body-self relationship among Polish female student with orthorexia nervosa.
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“Orthorexia nervosa” is a term introduced to describe disordered eating behavior with a pathological obsession for healthy nutrition which can result in insufficient diets and serious medical problems. Validated diagnostic criteria have not yet been developed for orthorexia nervosa and as a result, it has not been well studied. In this case, a patient with disordered eating closely resembling the current description for orthorexia nervosa and focused on the micronutrient content of his diet is successfully treated with olanzapine. A review of the literature and proposed diagnostic criteria for this disorder are also provided.
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For a better differential diagnosis of eating disorders, it is necessary to investigate their subtypes and develop specific assessment tools to measure their specific symptoms. Orthorexia nervosa is an alleged eating disorder in which the person is excessively preoccupied with healthy food. The ORTO-15, designed by Donini and colleagues, is the first and only at least partially validated instrument to measure this construct. The aims of the present study were to examine the psychometric properties of its Hungarian adaptation (ORTO-11-Hu), and to investigate its relationship to food consumption and lifestyle habits in order to contribute to a better description of the phenomenon. The ORTO-11-Hu, a lifestyle habits questionnaire, a food choice list indicating foods the participants choose to consume, and ten additional orthorexia-related questions were administered to a group of 810 Hungarian participants (89.4% female) aged between 20 and 70 (M = 32.39 +/- 10.37 years). Confirmatory factor analysis suggested a single factor structure for the 11-item shortened version of the instrument. Internal consistency of the measure was adequate (Cronbach's alpha = 0.82). No significant differences were found between males and females on the ORTO-11-Hu. Age and body mass index were significantly associated with a tendency towards orthorexia nervosa. Additional orthorexia-related features were significantly correlated with ORTO-11-Hu scores: orthorexia nervosa tendency was associated not only with healthier food choices (eating more whole wheat cereals, less white wheat cereals, more fruit and vegetables) but with shopping in health food stores, as well as with some healthy lifestyle habits (more sports activity, specific dietary behaviors, and less alcohol intake). Individuals with higher orthorexia nervosa tendency also reported a greater tendency to advocate their healthy diet to their friends and family members. These results provide evidence for the reliability of ORTO-11-Hu and some support for the construct validity of the instrument. The present study also contributes to the establishment of (diagnostic) criteria for this new subtype of eating disorders.
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There is a lack of Polish tools to measure behaviour related to orthorexia nervosa. The purpose of the present study was to validate the Polish version of the ORTHO-15 test. 341 women and 59 men (N = 400) were recruited, whose age ranged from 18 to 35 years. Mean age was 23.09 years (SD = 3.14) in women and 24.02 years (SD = 3.87) in men. The ORTHO-15 test and the EAT-26 test were used in the present study. Factor analysis (exploratory and confirmatory analysis) was used in the present study. Exploratory factor analysis performed on the initial 15 items from a random split half of the study group suggested a nine-item two-factor structure. Confirmatory factor analysis performed on the second randomly selected half of the study group supported this two-factor structure of the ORTHO-15 test. The Polish version of the ORTHO-15 test demonstrated an internal consistency (Cronbach's alpha) equal to 0.644. The Polish version of the ORTHO-15 test is a reliable and valuable instrument to assess obsessive attitudes related to healthy and proper nutrition in Polish female and male population.
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Orthorexia nervosa (ON) is described as an obsessive pathological behavior characterized by a strong preoccupation with healthy eating and the avoidance of foods or ingredients considered unhealthy by the subject. Although it is still not officially recognized as an eating disorder, previous studies have discussed its frequency in some groups and a fifteen-question test (ORTO-15) was developed elsewhere to assess ON behavior. The present study aimed to evaluate ON behavior in a sample of Brazilian dietitians after testing the psychometric properties of the Portuguese version of ORTO-15. A total of 392 dietitians answered an online version of the test. The answers were analyzed regarding ON tendency, according with the scoring grid proposed by its authors. Exploratory factor analysis was performed and internal consistency was assessed. It was found that three questions of the test presented loadings lower than 0.5. The 12 remaining question formed 3 factors with internal consistency of -0.51, 0.63 and 0.47. The answers of the participants to these questions revealed a tendency to orthorexic behavior, mainly regarding aspects such as: making food choices conditioned by worry about health status, evaluating food rather from nutritional quality than from its taste, believing that consuming healthy food may improve appearance, discrediting the influence of mood on eating behavior and banning food choices considered by them as eating transgressions. There is no evidence of the validity and reliability of the ORTO-15 with the initial psychometric evaluation performed. Further analyses are needed. Nevertheless, it was possible to observe a high frequency of orthorexic behavior among the studied Brazilian dietitians. However, additional studies are needed to completely understand dietitians behavior toward ON.
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Eating disorders are relatively rare among the general population. This review discusses the literature on the incidence, prevalence and mortality rates of eating disorders. We searched online Medline/Pubmed, Embase and PsycINFO databases for articles published in English using several keyterms relating to eating disorders and epidemiology. Anorexia nervosa is relatively common among young women. While the overall incidence rate remained stable over the past decades, there has been an increase in the high risk-group of 15-19 year old girls. It is unclear whether this reflects earlier detection of anorexia nervosa cases or an earlier age at onset. The occurrence of bulimia nervosa might have decreased since the early nineties of the last century. All eating disorders have an elevated mortality risk; anorexia nervosa the most striking. Compared with the other eating disorders, binge eating disorder is more common among males and older individuals.