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ORIGINAL ARTICLE
Prevalence of orthorexia nervosa is less than 1 %: data
from a US sample
Thomas M. Dunn
1,2
•Josh Gibbs
1
•Noelle Whitney
1
•Amy Starosta
2
Received: 15 November 2015 / Accepted: 30 January 2016 / Published online: 22 February 2016
ÓSpringer International Publishing Switzerland 2016
Abstract
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
Introduction
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 [6–9].
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
thomas.dunn@unco.edu
1
School of Psychological Sciences, University of Northern
Colorado, Campus Box 94, Greeley, CO 80639-0094, USA
2
Behavioral Health Service, Denver Health Medical Center,
Denver, USA
123
Eat Weight Disord (2017) 22:185–192
DOI 10.1007/s40519-016-0258-8
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