A cross-sectional study on the prevalence of eating disorders in liver transplanted patients with type 2 diabetes and/or overweight/obesity.

Liver transplantation (LT) associates with weight gain and metabolic complications. However, risk of eating disorders post-transplantation and factors influencing their onset remain poorly understood. This study aimed to fill this knowledge gap by characterizing the risk of having eating disorders or Orthorexia Nervosa (ON) according to the EAT-26, BES and Bratman screening questionnaires in 104 liver transplant recipients (mean age 62.5 years; median time from LT 6 years) with type 2 diabetes and/or overweight/obesity. Eighty-two patients (78.9 %) had diabetes; mean BMI was 30.1 ± 5.9 kg/m2. Risk of eating disorders was observed in 6.9 %-10.8 % and the risk of orthorexia (Bratman test score > 4) was observed in 60.5 % of patients. A significant association was found between BMI and the likelihood of having eating disorders considering EAT-26 (OR = 0.17, p = .009). The absence of a direct link between diabetes and the risk of having eating disorders suggest multifactorial influences on post-transplant eating behaviors. The study highlights the importance of proactive screening to evaluate eating behaviors in liver transplant recipients to define tailored interventions and optimize post-transplant outcomes. Limitations refer to the observational nature of the study and the absence of pre-transplant data. Further research is warranted to validate these findings, elucidate temporal relationship between transplantation and the onset of eating disorders, and explore potential mechanisms underlying these associations. Such insights are crucial for developing effective strategies to mitigate the impact of eating disorders on post-transplant health and well-being.

Mindful eating and orthorexia nervosa: How do they interact?

The present study explored the associations between orthorexia nervosa, social media addiction, emotion regulation difficulties, perfectionism and BMI with four facets of mindful eating, using path analysis to assess these relationships. A sample of 551 students (127 males, 424 females, mean age = 22.6 years) completed an online self-report questionnaire evaluating these constructs. Analyses revealed that mindful eating contributed to emotion dysregulation and orthorexia nervosa and was related to social media addiction. Significant indirect paths were identified from mindful eating, social media addiction and adaptive perfectionism through emotion dysregulation to maladaptive perfectionism. While no direct paths were observed between mindful eating and perfectionism, a direct path was found between adaptive perfectionism and orthorexia nervosa. These findings suggest a more nuanced understanding of eating behaviours is required. Individuals susceptible to eating disorders should approach mindful eating with caution and seek support from healthcare providers to ensure it is used in a way that supports overall wellbeing. Future research should aim to replicate and further clarify these associations to reveal the long-term effects of mindful eating.

Is orthorexia nervosa a hidden threat impacting quality of life in IBS patients?

BACKGROUNDS: The potential link between functional gastrointestinal disorders and eating disorders has been reported recently. AIMS: The present study aimed to explore the relationship between orthorexic tendencies and irritable bowel syndrome (IBS)-related quality of life in IBS patients. METHOD: This cross-sectional study was conducted with 121 IBS patients. The data were collected using Orthorexia Nervosa-11 (ORTO-11) to assess orthorexic tendencies, Irritable Bowel Syndrome Quality of Life Scale (IBS-QoL) to measure quality of life, and Irritable Bowel Syndrome Symptom Severity Score (IBS-SSS) to measure IBS symptoms. Food consumption record was taken to assess diet quality with the Healthy Eating Index 2015 (HEI-2015). The relationship between measured variables was assessed. RESULTS: The mean ORTO-11 score of the patients was 24.76 ± 3.99. Most patients had poor diet quality (52.00%). A moderate positive correlation was found between ORTO-11 and IBS-QoL (model 0, p < 0.005 and model 1, p < 0.001) and a strong negative correlation between IBS-SSS and IBS-QoL (p < 0.001). CONCLUSIONS: In conclusion, we can conclude that both altered IBS symptoms and orthorexic tendencies affect the quality of life of irritable bowel patients independently of each other. These findings provide valuable insights into the treatment of IBS and inform clinicians and researchers in the fields of gastroenterology, nutrition, psychiatry,and psychology.

The Impact of Social Media and Socio-Cultural Attitudes toward Body Image on the Risk of Orthorexia among Female Football Players of Different Nationalities.

BACKGROUND/OBJECTIVES: Orthorexia Nervosa (ON) is an emerging behavioral pattern characterized by an obsessive focus on healthy eating. Despite its prevalence, ON lacks formal diagnostic criteria in major classification systems like the DSM-5 and the ICD-10. This study aims to investigate the impact of socio-cultural attitudes towards body image and the role of social media on the risk of ON among female football players from Poland, Turkey, and India. This study hypothesizes that socio-cultural pressures and media usage significantly influence the risk of developing ON, particularly in cultures more exposed to Western beauty ideals. METHODS: The study was conducted from May to August 2024, employing the Computer-Assisted Web Interview method. A total of 142 female football players aged 16-36 from Poland, Turkey, and India participated. Data were collected using a structured questionnaire that included demographic information and health metrics, the Socio-Cultural Attitudes Towards Appearance Questionnaire, and the Duesseldorf Orthorexia Scale. Statistical analyses included an ANOVA, the Kruskal-Wallis test, the chi-square test, and Pearson's correlation coefficient. RESULTS: The study found that nearly half of the participants were at risk of or presented with ON, with the highest prevalence being among Indian athletes. Statistically significant relationships were observed between the risk of ON and factors such as age, dietary exclusions, social media usage, and sources of nutritional information. However, no significant correlation was found between socio-cultural attitudes and the risk of ON, suggesting that other factors may play a more critical role. CONCLUSIONS: While socio-cultural pressures and media use are contributing factors to the risk of ON, psychological factors and individual behaviors appear to be equally, if not more, significant. This study highlights the importance of targeted educational programs and psychological support for young athletes, with a focus on promoting healthy dietary practices and positive body image perceptions across varying cultural contexts. Additionally, the results suggest the need for further research into the specific psychological and behavioral mechanisms underlying ON.

Striving for the perfect diet? The mediating role of perfectionism in the relationship between obsessive compulsive symptoms and traits of Orthorexia Nervosa.

BACKGROUND: Orthorexia Nervosa (ON) is a disordered eating style involving an unhealthy obsession with 'healthy' or 'clean' eating. Its aetiology is still poorly understood and is not yet recognised in diagnostic manuals. While ON has been associated with Obsessive Compulsive (OC) symptoms and perfectionism, no study to date has looked at the relationship between OC symptoms and ON tendencies via perfectionism, or the influence of two facets of perfectionism in this relationship, namely evaluative concern and achievement striving. Examining the potential role of perfectionism helps to understand the aetiology of ON as well as inform potential treatments tailored specifically for ON and comorbid OC symptoms. METHODS: In this cross sectional study, we tested 507 participants (n = 70 males, n = 69 at risk of ON) on questionnaires measuring OC symptoms, perfectionism and ON symptoms. We ran two mediation analyses to look at the overall relationship between perfectionism and OC and ON symptoms (Model 1) as well as the specific contribution of evaluative concern and achievement striving in the relationship between OC and ON symptoms (Model 2). RESULTS: We found that perfectionism partially mediated the relationship between OC and ON symptoms. Specifically, we found that while achievement striving and evaluative concern were associated with OC symptoms, only achievement striving was significantly associated with ON symptoms, mediating the relationship between OC and ON symptoms. CONCLUSIONS: This study highlighted the role of one key facet of perfectionism (achievement striving) in the aetiology of ON. The role of achievement striving was indicated as a transdiagnostic construct explaining the link between ON and OC symptoms. These findings are discussed in terms of their implications for treatment models, specifically in terms of the potential role of targeting perfectionism in ON treatment.

Orthorexia Nervosa (ON) is a disordered eating style involving an obsession with extreme 'healthy' eating, causing the person distress and impairment. People with ON are more likely to have symptoms of Obsessive Compulsive Disorder (OCD), such as obsessive thoughts that are reduced by repetitive behaviours. There is also evidence that perfectionism (e.g. having very high personal standards) plays an important role in both ON and OCD.Our study of 507 participants looked at whether two aspects of perfectionism: (1) concern about being evaluated negatively by others; 'evaluative concern', and: 2) striving for very high standards; 'achievement striving' were linked to higher levels of orthorexic and obsessive-compulsive symptoms. Our research also looked at whether these aspects of perfectionism explained the link between orthorexic and obsessive-compulsive symptoms.We found that both aspects of perfectionism were linked to obsessive-compulsive symptoms. However, achievement striving specifically helped to explain the link between orthorexic and obsessive-compulsive symptoms. These findings suggest that treatment focusing on achievement striving might be particularly useful for people with ON, and for those who have both orthorexic and obsessive-compulsive symptoms.

Are increased symptoms of orthorexia nervosa linked to self-perceived body image and nutritional adequacy of Turkish adults?

This cross-sectional study, conducted on 4003 participants aged between 18 and 45, aims to contribute to orthorexia nervosa (ON) research by examining the relationship between ON, body image and nutritional adequacy. The Orthorexia Nervosa-11 scale (ORTO-11) and body perception scale were applied to individuals, and food consumption records were taken with a 24-hour dietary recall method. The study found that more individuals with orthorexia nervosa (ON) considered themselves overweight compared to non-ON individuals. Evaluating diet quality, the mean adequacy ratio was significantly higher in ON individuals. Nutrient adequacy ratios for total fiber, magnesium, zinc, thiamine, folic acid, and vitamin C were higher, while those for carbohydrate and iron were lower in ON individuals. Additionally, increasing the number of snacks, protein, and total fiber adequacy decreased the ORTO-11 score. Distorted body image perception may be a risk factor for ON, but healthy eating fixation does not lead to nutrient inadequacy unless it involves progressive food restriction.

Psychometric Properties of Various Factorial Models of the ORTO-15 Tested With Brazilian Respondents.

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.

Exploration of the Mediating Role of Self-Compassion and Mindfulness on Orthorexia Nervosa and Perfectionism.

Orthorexia Nervosa (ON) is characterized by an excessive preoccupation with healthy eating, accompanied by increasingly restrictive dietary practices over time. In light of the increased attention to ON, it is noteworthy that the existing body of research, specifically with regard to mindfulness and self-compassion remains constrained in scope and depth. A total of 151 participants over the age of 18 completed scales measuring Orthorexia, Self-Compassion, Mindfulness, and Perfectionism. The findings revealed that individuals exhibiting high levels of ON tended to have low levels of self-compassion and mindfulness, along with high levels of perfectionism. Furthermore, the results indicated that self-compassion and mindfulness acted as mediators in the relationship between perfectionism and orthorexia nervosa. These findings deepen our comprehension of orthorexia and underscore the role of self-compassion and mindfulness, or their absence, as mediating factors in this context. The implications of these results and potential future directions are discussed.

The use of food barcode scanner app among women: Associations with orthorexia, diet and emotions.

This cross-sectional study investigated the relationship between the use of food barcode scanner app (FBSA) and orthorexia, diet and emotions. A total of 1610 women from the general population were included in this study, 388 of whom were FBSA users. Participants completed questionnaires assessing socio-demographic and health characteristics, food barcode scanner use (Food Barcode Scanner App Questionnaire), orthorexia (Teruel Orthorexia Scale), food choice motivations (Food Choice Questionnaire), health anxiety (Health Anxiety Questionnaire), and emotional competence (Profile of Emotional Competence). The results showed no difference in socio-demographic characteristics between FBSA users and FBSA non-users. However, FBSA users scored higher on healthy orthorexia and health anxiety than non-users. FBSA users' food choice motivations were also more focused on natural food content, health, weight control and ethical concerns than non-users. Although no difference was found between FBSA users and non-users for orthorexia nervosa, orthorexia nervosa and pathological FBSA use scores were positively correlated. Moreover, health anxiety scores were positively correlated with FBSAQ "pathological use" subscale. While FBSA use may promote the adoption of a healthy diet, vigilance is required for individuals with orthorexic symptoms and health concerns. These two dimensions could be risk factors for problematic FBSA use.

Higher orthorexia tendency among female fashion models: an empirical international study.

PURPOSE: Female fashion models are more at risk for developing eating disorders than non-models due to the intense occupational pressure they face. The present study focuses on assessing whether female models are more prone to report orthorexia nervosa signs and symptoms than non-models. METHODS: Female fashion models (n = 179, mean age: 25.9 SD = 4.40 years) and an age adjusted control group (n = 261, mean age: 25.0 SD = 4.97 years) were selected by snowball sampling. Participants filled out an online survey containing anthropometric questions and the 18-item Eating Habits Questionnaire. RESULTS: According to BMI, fashion models were underweight (mean BMI = 18.1 SD = 1.68) while control participants' BMI was in the normal range (mean = 22.1 SD = 4.23, p < 0.001). On all three of Eating Habits Questionnaire subscales fashion models showed significantly higher average value (Knowledge subscale: M = 2.42 among models versus M = 2.08 in the control group, p < 0.01, Cohen's d = 0.52; Problems subscale: M = 1.93 among models versus M = 2.61 in the control group, p < 0.01, Cohen's d = 0.49; Feelings subscale: M = 3.20 among models versus M = 2.96 in the control group, p < 0.01, Cohen's d = 0.38). Orthorexic tendencies were reported by 35.1% of the models versus 20.2% of controls. CONCLUSION: Fashion models are at risk for the development of eating disorders. Even though not yet included in the DSM-5, the assessment of orthorexia nervosa among fashion models seems to be important. It is suggested to take appropriate measures to prevent the spread of disordered eating habits among models as they can lead to the development of anorexia nervosa or bulimia nervosa. LEVEL OF EVIDENCE: Level III, well-designed cohort study.

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.

Unveiling Anxiety Factors in Orthorexia Nervosa: A Qualitative Exploration of Fears and Coping Strategies.

Orthorexia nervosa represents a controversial phenomenon in the realm of eating practices, characterized by an obsessive fixation on consuming only foods deemed 'healthy', and a preoccupation with food purity. While the existing literature has identified the presence of stressful behaviors among individuals with orthorexia, the precise factors and circumstances eliciting these stress-inducing emotions remain the subject of ongoing inquiry. This study aims to explore the triggers and situations that precipitate stressful beliefs and emotions among individuals who self-identify as preoccupied with healthy eating, as well as the coping mechanisms developed to manage these feelings. Through conducting one-to-one interviews with thirteen individuals, thematic analysis was employed to elucidate the nuances of their experiences. Participants articulated concerns regarding the contamination of foods available in supermarkets and restaurants, thereby prompting the meticulous selection of food sources and aversion to dining out. The prospect of trying new foods and engaging in social gatherings involving food emerged as anxiety-inducing scenarios, prompting individuals to adhere to monotonous dietary patterns and impose self-isolation. Additionally, medical appointments were perceived as stressful, driven by health concerns underpinning the adoption of stringent dietary practices. These findings underscore the spectrum of fears and coping mechanisms exhibited by individuals with orthorexia nervosa, which hold profound implications for their overall well-being.

Presence and characteristics of disordered eating and orthorexia in irritable bowel syndrome.

INTRODUCTION: Orthorexia, a harmful obsession with eating healthily, may develop from illnesses characterized by dietary restriction, including irritable bowel syndrome (IBS) and eating disorders (ED). Evidence of disordered eating in IBS exists, but orthorexia has not been assessed. This cross-sectional study in adults (≥18 years) assessed presence and characteristics of disordered eating and orthorexia in IBS, compared to control subjects (CS) and ED. METHODS: IBS participants met Rome IV, and ED participants met DSM-5 criteria. Disordered eating was assessed using "sick, control, one-stone, fat, food" (SCOFF, ≥2 indicating disordered eating), and orthorexia by the eating habits questionnaire (EHQ). Secondary measures included stress (PSS); anxiety (HADS-A); food-related quality of life (Fr-QoL), and dietary intake (CNAQ). KEY RESULTS: In 202 IBS (192 female), 34 ED (34 female), and 109 CS (90 female), more IBS (33%) and ED (47%) scored SCOFF≥2 compared to CS (16%, p < 0.001, chi-square). IBS and ED had higher orthorexia symptom severity compared to CS (EHQ IBS 82.9 ± 18.1, ED 90.1 ± 19.6, and CS 73.5 ± 16.9, p < 0.001, one-way ANOVA). IBS and ED did not differ for SCOFF or EHQ (p > 0.05). Those with IBS and disordered eating had higher orthorexia symptom severity (EHQ 78.2 ± 16.6 vs. 92.4 ± 17.5, p < 0.001, independent t-test), worse symptoms (IBS-SSS 211.0 ± 78.4 vs. 244.4 ± 62.5, p = 0.008, Mann-Whitney U test), higher stress (p < 0.001, independent t-test), higher anxiety (p = 0.002, independent t-test), and worse FR-QoL (p < 0.001, independent t-test). CONCLUSIONS AND INFERENCES: Disordered eating and orthorexia symptoms occur frequently in IBS, particularly in those with worse gastrointestinal symptoms, higher stress, and anxiety. Clinicians could consider these characteristics when prescribing dietary therapies.

Food Beliefs and the Risk of Orthorexia in Patients with Inflammatory Bowel Disease.

Patients with inflammatory bowel disease (IBD) believe that diet plays a significant role in the pathogenesis of their disease and the exacerbation of their symptoms. They often adopt restrictive diets that can lead to malnutrition, anxiety, and stress. Recent studies have found a correlation between IBD and eating disorders, such as anorexia nervosa and ARFID (Avoidant Restrictive Food Intake Disorder). None of these studies report an association with orthorexia nervosa, which is an obsession with healthy and natural foods. The aim of this study was to assess the risk of orthorexia nervosa in patients with IBD. A total of 158 consecutive subjects were recruited, including 113 patients with IBD and 45 controls. The standardized Donini questionnaire ORTO-15 was administered to assess the risk of orthorexia, and clinical and demographic data were collected. The results showed that patients with IBD had a risk of developing orthorexia nervosa of 77%. This was significantly higher than the 47% observed in the control group. In the patients with IBD, the risk of orthorexia was associated with a lower BMI, at least in patients older than 30 years, and it was also associated with marital status in patients younger than 30. In conclusion, many patients with IBD are at increased risk of developing orthorexia nervosa, which may have a negative impact on their psychological wellbeing and social sphere, expose them to a high risk of nutritional deficiencies, and affect their overall quality of life. Further high-quality studies are needed to assess the clinical impact of orthorexia and its correlation with clinical features and classified eating disorders.

The relationship between orthorexia nervosa and cyberchondria levels in nurses: A cross-sectional study.

PURPOSE: The study was conducted with the aim of investigating the relationship between orthorexia nervosa and cyberchondria levels among nurses. METHODS: This cross-sectional study was conducted with 399 nurses through face-to-face interviews. The data were collected using a participant information form, the Cyberchondria Severity Scale, and the Orthorexia Nervosa-11 scale (ORTO-11). RESULTS: The mean score of the nurses' cyberchondria severity scale was 73.95 ± 18.53, while the mean score of the Orthorexia Nervosa-11 scale was 28.23 ± 4.76. In the study, a low negative correlation was found between the cyberchondria and orthorexia nervosa levels (p < 0.05). CONCLUSIONS: The increase in the level of cyberchondria among nurses increases the risk of orthorexia nervosa. Therefore, it is recommended that nurses receive proper nutritional education and psychosocial support to reduce their tendency towards orthorexia nervosa and cyberchondria.

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.

Measuring Pathological and Nonpathological Orthorexic Behavior: Validation of the Teruel Orthorexia Scale (TOS) among Polish Adults.

Measuring orthorexia nervosa is challenging due to the use of various existing tools and problems with sample representativeness. Another challenge for the Polish population is the adaptation of existing research tools and the evaluation of their relevance and research reliability. Our research aimed to adapt the TOS to the Polish language and measure pathological and nonpathological orthorexic behavior among the Polish population. The adaptation of the PL-TOS has high psychometric value and allows us to assess healthy and nervous orthorexia levels. This scale can be used not only for further research but also for diagnostic purposes in the daily work of clinicians and psychologists. Our results obtained in the present study indicate a correlation between TOS and both the use of supplements and diet. Higher TOS, ORTO_R and KZZJ_Diet Restrictions scores were obtained for individuals using dietary supplements than for those not using dietary supplements. In the future, it is worth conducting research aimed at various risk groups of individuals with orthorexia to confirm the psychometric properties of this adaptation of the TOS.

Orthorexia nervosa in dietitians and dietetics students-prevalence, risk factors, and interventions: a scoping review using a systematic approach.

CONTEXT: Orthorexia nervosa (ON) is characterized by compulsive behaviors and increased concerns about healthful eating. Dietitians appear to be especially vulnerable to ON, and it is still debatable whether the disordered eating behaviors motivate individuals to enroll in nutrition programs, or whether these behaviors result from an exaggerated preoccupation with healthy eating triggered during their nutrition studies. OBJECTIVE: The aim was to provide an overview of the present state of knowledge about the prevalence, risk factors, and interventions addressing ON among dietitians and dietetics students. More specifically, it was examined whether dietitians and dietetics students differ from students attending different education programs or other health professionals with regard to the severity and risk factors of ON, and whether the extent of ON changes during the progression in the nutrition education years of study. DATA SOURCES: MEDLINE (Ovid), PubMed, EMBASE (Ovid), PsycInfo (EBSCO), CINAHL (EBSCO), Cochrane, ProQuest Central, CABI, ProQuest Dissertations, Google Scholar, ScienceDirect, and SpringerLink were searched on May 8, 2021, and updated on November 12, 2022. DATA EXTRACTION: Records were screened for eligibility; study characteristics, methodology, and findings of included articles were extracted; and the methodological quality assessed using the AXIS tool. Each step was preceded by a calibration exercise and conducted independently and in duplicate by pairs of 2 reviewers. Any disagreements were resolved through discussions. DATA ANALYSIS: A narrative synthesis was performed, whereby the characteristics, methodologies, and results of included studies were compared. CONCLUSIONS: Results were inconclusive; yet, a general status of the relatively "high" prevalence of ON among dietitians and dietetics students was established, stressing the need for systematic research to understand and mitigate orthorexic tendencies in this group. It is still too early to answer questions pertaining to prevalence, risk factors, interventions, and differences between dietetics students and other majors when it comes to severity and progress of ON throughout the continuing years of study, or between dietitians and other professional groups. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework Identifier: DOI 10.17605/OSF.IO/BY5KF.

The various facets of orthorexic eating behavior: five case reports of individuals with supposed orthorexia nervosa.

BACKGROUND: Orthorexia nervosa, defined as a fixation on eating healthy according to subjective criteria, is recently being discussed as another variant of disordered eating behavior. Further characteristics are rigid adherence to nutritional rules, anxieties and avoidance behavior in the context of eating as well as a focus on health, not on body shape or weight loss, which is supposed to differentiate orthorexic from other disordered eating behavior. Although diagnostic criteria have been suggested, they have rarely been used in case reports published to date. Hence, the aim of this study was to present five individuals with supposed orthorexia nervosa, using preliminary diagnostic criteria to assess their eating behavior. CASE PRESENTATION: The five cases (three females, two males) reveal the great variety of disordered eating behavior. Fear of unhealthy overweight (case A), supposed orthorexic eating behavior as a coping strategy for anorexia nervosa (case B), the exclusive consumption of animal products with a total exclusion of fruits and vegetables (case C), the fixation on exercise and athletic goals (case D) as well as a focus on a vegan diet and unprocessed foods (case E) are facets of orthorexia nervosa with varying degrees of impairment. CONCLUSIONS: It is concluded that orthorexia nervosa manifests itself in very different ways and that more research is needed in order to determine whether it could be a useful additional category of disordered eating behavior.