Orthorexia and eating attitudes in health sciences students.

Background: The prevalence of eating disorders and orthorexia nervosa has steadily increased and this situation may lead to severe physical, psychological, and social disorders. Aim: The aim of this study was to investigate the prevalence of disordered eating attitudes and orthorexia tendencies among university students studying in various Health Sciences departments in Turkey. Subjects and Methods: The study subjects were selected from Health Sciences Faculty students. Among the students who accepted the study, 639 people were reached by simple random sampling method. The EAT-40 and ORTO-15 which are validated instruments for the screening of abnormal eating behaviors and orthorexia nervosa respectively, were used as measurement tools. Results: The majority of the students who participated in the study were found to exhibit orthorexic tendencies, and male students had a higher orthorexic tendency in comparison to female students (p = 0.022). More specifically, the students studying in the Department of Nutrition and Dietetics had lower orthorexic tendencies compared with the students from other departments. There was no significant relationship between BMI values and the mean ORTO-15 scores, whereas the mean EAT-40 score was found to increase statistically significantly with increased BMI (p = 0.038). There was a statistically significant difference between the departments and classes in terms of mean EAT-40 scores, whereas no difference was found regarding gender. Conclusion: Orthorexia nervosa is a common problem for university students studying in health-related departments. Interestingly, the orthorexic tendencies of girls and students studying in the Nutrition and Dietetics department were found to be lower in this study. It was determined that all students except the Nutrition and Dietetics department had orthorexia tendencies. More comprehensive studies are needed to better understand orthorexia nervosa and healthy lifestyle interaction.

Translation and validation of the Chinese version of the orthorexia nervosa assessment questionnaires among college students.

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).

Validation of the Greek ORTO-15 questionnaire for the assessment of orthorexia nervosa and its relation to eating disorders symptomatology.

PURPOSE: The aim of the study was the validation of the Greek version of the ORTO-15 questionnaire. An additional aim was to explore the relation between orthorexic and eating disorder behaviors in a sample of Greek students. METHODS: ORTO-15 was translated and adapted in the Greek language. After its final version was drafted, its test-retest reliability was checked. Then, the questionnaire was administered to 120 students of psychology along with EAT-26. Additionally, demographics, BMI and information related to eating disorders were collected. RESULTS: The Greek version of the ORTO-15 questionnaire showed acceptable internal consistency (Cronbach's a 0.7). Factor analysis produced a three-factor model similar to the original English version of the questionnaire. The correlation of ORTO-15 and EAT-26 revealed that higher measurements in the diet and bulimia EAT-26 scale were related to increased orthorexic symptomatology. Finally, there was no significant correlation between the 3 factors of the ORTO-15 (emotional, rational and behavioral) and age, education or Body Mass Index. CONCLUSIONS: This study is the first attempt to assess orthorexia nervosa in a Greek student population. ORTO-15 was found to be a reliable tool for the measurement of orthorexia in Greece. Finally, in accordance with other studies, orthorexic symptoms were partially related to eating disorder symptomatology, thus raising the question of possible similarities and overlap between the two clinical constructs. LEVEL OF EVIDENCE: Level V, Cross-sectional descriptive study.

Introducing ORTO-R: a revision of ORTO-15 : Based on the re-assessment of original data.

BACKGROUND: Orthorexia nervosa has attracted significant attention in the field, however, alongside increasing knowledge, more and more gaps are being identified. One of the fundamental problems concerns measurement of orthorexia nervosa. The most commonly used self-report measure, the ORTO-15, demonstrated an unstable factorial structure across different populations. Therefore, one might question whether the knowledge obtained from past research using ORTO-15 is valid or not. The aim of the present paper is to re-analyse original data used for the validation of ORTO-15 to assess its factorial structure and propose its revision, the ORTO-R. METHODS: The description of the sample and procedure corresponds to the one reported in Donini et al. (Eat Weight Disord 10:28-32, 2005). N = 525 subjects were enrolled. To evaluate whether the factorial structure of ORTO-15, we used confirmatory factor analysis. The results revealed that the ORTO-15 indeed does not capture the structure of orthorexia nervosa adequately and revision is needed. The ORTO-R contains six items from ORTO-15, which were identified as the best markers of orthorexia nervosa. DISCUSSION AND CONCLUSION: In the current paper, we present a refined measure of orthorexia nervosa-the ORTO-R. It is based on a frequently used ORTO-15, overcoming its main limitations. We strongly believe that the current work will act as a bridge, linking past with the future research, and that alongside a new measure, the field of research on orthorexia nervosa will move forward. LEVEL OF EVIDENCE: Level V, descriptive study.

Does ORTO-15 produce valid data for 'Orthorexia Nervosa'? A mixed-method examination of participants' interpretations of the fifteen test items.

PURPOSE: Orthorexia Nervosa (ON) is defined as a pathological eating behaviour stemming from being "healthy" or "pure". Survey-based studies typically rely on the ORTO-15 questionnaire or its variations to detect orthorexia. However, frequent post-hoc adjustments to the ORTO-15 suggest psychometric problems. In this study, we explored people's cognitions about the ORTO-15 items to (1) identify problems specific to ORTO-15 items and (2) explore participants' understanding of ON symptoms. METHODS: Fifty adult participants (40% male, mean age = 34.0 ± 14.4 years) completed the ORTO-15, the Eating Attitudes Test (EAT-26) and the Obsessive-Compulsive Inventory-Revised edition (OCI-R). Qualitative data were collected using the modified "think aloud" protocol, which asked participants to 'verbalise' their responses to the ORTO-15 items. These qualitative responses were first analysed conjunctively with the quantitative responses; then subjected to thematic analysis. RESULTS: ORTO-15 identified 64% of the participants for orthorexic tendencies. In most cases (76%), participants reported no issues completing the ORTO-15. However, in some cases, qualitative responses differed from quantitative ones. When people encountered problems, it was because of poor psychometric construction: lack of clarity, ambiguous wording and multiple statements in a single item. Elaborations around the ORTO-15 items formed four major themes: "preoccupation with physical appearance", "control", "food is fuel" and "alone, not isolated". CONCLUSION: Even though in the majority of cases there were no issues with completing ORTO-15, thematic analysis revealed several discrepancies between our participants' perceptions of the ORTO-15 items and the previously proposed diagnostic criteria for ON. The results suggest that ORTO-15 is, at best, a mediocre screening tool for ON, which is sensitive to diet but fails to have sufficient level of specificity to detect the pathological stage. More accurate instruments are needed to further research on ON. LEVEL OF EVIDENCE: V (cross-sectional descriptive study with qualitative analysis).

Is orthorexia nervosa a feature of obsessive-compulsive disorder? A multicentric, controlled study.

PURPOSE: The term orthorexia nervosa (ON) was coined to describe altered thoughts and behaviours related to healthy eating. The prevalence of ON was found to scale up to almost 90% among high-risk populations (ballet dancers, athletes, and health workers). ON seem to share psychopathological aspects with both Eating Disorders (ED) and Obsessive-Compulsive Disorder (OCD). The aim of the study was to analyse the frequency and intensity of ON symptoms among subjects diagnosed with OCD, hypothesising that they would be higher than in two control groups (subjects with anxiety-depressive disorders and general population). METHODS: We conducted a multi-centre, observational, controlled study. Subjects filled in a socio-demographic questionnaire including questions related to life-style and two psychometric instruments: ORTO-15, for ON symptoms, and OCI-R, for OCD symptoms. Post hoc analysis of the dataset was performed using the revised version of ORTO-15, the ORTO-R. RESULTS: In the final sample of 328 subjects, the overall prevalence of ORTO-15-ON was 59.5%, mean score 37.9 ± 4.2. The mean score at the ORTO-R was 16.6 ± 4.6. No statistically significant differences were found in the prevalence of ON or in the mean ORTO-15 score among OCD patients and the two control groups, and this was confirmed by the multiple regression analysis. At the ORTO-R re-scoring, OCD patients scored significantly lower than the two clinical subgroups (p = .0005) and a lower ORTO-R score was associated to positivity at the OCI-R, confirming the initial hypothesis of the study. CONCLUSIONS: ON symptoms do seem to be more prevalent among subjects suffering from OCD. The psychometric properties of tools available to calculate ON symptoms, namely ORTO-15 vs. ORTO-R, play a relevant role in explaining such finding. ORTO-R seems to be a valid alternative able to overcome such difficulties, though further studies are needed to confirm this.

Orthorexia nervosa: examining the Eating Habits Questionnaire's reliability and validity, and its links to dietary adequacy among adult women.

OBJECTIVE: There has been increasing interest in identifying individuals with pathological healthy eating behaviours, or orthorexia nervosa (ON). This study aimed to investigate the validity (construct- and criterion-related) and reliability (internal consistency) of the Eating Habits Questionnaire (EHQ) as a measure of ON. A secondary aim was to examine how the EHQ would predict a distinct feature of ON, adequate dietary intake. DESIGN: Cross-sectional online questionnaire incorporating existing measures of ON and dietary intake. SETTING: Participants were recruited online via social media and a university's research webpage. PARTICIPANTS: Women (n 286) ranging in age from 17 to 73 years. RESULTS: Exploratory factor analysis established that the EHQ represented four ON dimensions (Healthy Eating Cognitions, Dietary Restriction, Diet Superiority and Social Impairment), inconsistent with the scale's original three dimensions (Problems, Knowledge and Feelings). Cronbach's α coefficients ranged from 0·72 to 0·80 for the four subscales and was 0·89 for the total EHQ scale. Criterion-related validity revealed a significant moderate to strong correlation (r = -0·54, P < 0·001) between the EHQ and ORTO-10 (a ten-item version of ORTO-15). The EHQ, particularly the EHQ-Diet superiority subscale, was found to be predictive of better, as opposed to, poorer dietary adequacy. CONCLUSIONS: Findings suggest that improvements still need to be made to the EHQ for it to be a valid and reliable measure of ON. Ideally, new assessment tools based on established diagnostic criteria are needed to advance our understanding of ON.

Validation of the Arabic version of the ORTO-15 questionnaire in a sample of the Lebanese population.

PURPOSE: The aim of the study was to develop an Arabic version of the ORTO-15 test and to examine the scale reliability and validity among a sample of the Lebanese population. METHODS: This was a cross-sectional study, conducted between January and May 2018, which enrolled 806 participants, divided into two equal samples, from all Lebanese governorates. The ORTO-15 scale was used to evaluate orthorexia nervosa (ON) tendencies and behaviors among participants. RESULTS: The factor analysis conducted on sample 1 suggested a three-factor structure for the ORTO-15 explaining a total of 50.59% of the variance. All items could be extracted from the list; none of the items was removed. The internal consistency of the measurement was adequate (Cronbach's alpha = 0.82). Higher body dissatisfaction (r = - 0.082), higher restrained eating (r = - 0.13) and higher eating attitudes (EAT score) (r = - 0.13) were significantly associated with higher levels of orthorexia tendencies and behaviors (lower ORTO-15 score). We could not detect any significant association between BMI and ORTO-15 test. A confirmatory factor analysis performed on sample 2 supported the three-factor structure of the ORTO-15 test obtained in the first sample. The following results were obtained: the Maximum Likelihood Chi Square = 22.0 and Degrees of Freedom = 9, which gave a × 2/df = 2.4. For non-centrality fit indices, the Steiger-Lind RMSEA was 0.10 [0.040-0.208]. Moreover, the Joreskog GFI equaled 0.926 and AGFI equaled 0.901. CONCLUSION: The Arabic version of the ORTO-15 test can be used to screen for ON tendencies and behaviors. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Selective attentional bias to food-related stimuli in healthy individuals with characteristics towards orthorexia nervosa.

PURPOSE: It has been argued that orthorexia nervosa (ON) is a unique type of disordered eating of food considered by the individual to be healthy. Given that in other eating disorder populations attentional preference for food-related cues influences eating behaviours, is it also likely that these biases may be a characteristic of ON tendency. METHODS: Eighty healthy individuals completed the ORTO-15 questionnaire (ON tendency), a modified Stroop task containing words related to healthy and unhealthy foods and perceived hunger levels pre- and post-testing. The ORTO-15 was used to identify participants within this sample who demonstrated more or less of the characteristics of ON. RESULTS: Results suggest that the presence of attentional bias to healthy, but not for unhealthy food-related stimuli independently predict increased ON tendency. Increased attentional bias towards healthy food-related stimuli is associated with increased scores on the ORTO-15. CONCLUSION: Attentional bias, as a deficit in information processing, towards healthy food-related stimuli accounts for variability in ON characteristics. LEVEL OF EVIDENCE: Level I, experimental study.

Structural validation of the ORTO-12-FR questionnaire among a French sample as a first attempt to assess orthorexia nervosa in France.

PURPOSE: To the best of our knowledge, no scientific publications on orthorexia nervosa have been based on a French population. The goal of our study was to confirm the factor structure of the French version of the ORTO-15 questionnaire. METHODS: An online survey (N = 768) was conducted asking participants (84.77% were women) to answer several questions about their dietary habits and to assess orthorexia nervosa using the ORTO-15 scale. Confirmatory factor analysis (CFA) was used for the validation. RESULTS: Given our results, we deemed it necessary to adapt the French version of the ORTO-15 questionnaire by omitting three items. The CFA supported the ORTO-12-FR (composed of 12 items and addressing three domains: rational, emotional, and behavioral) as the better-fitting model, with an internal consistency of 0.73. The Comparative Fit Index value was 0.93, the Tucker-Lewis Index was 0.90, and the Root Mean-Square Error of Approximation was 0.05. CONCLUSIONS: Our results provide evidence for the reliability of ORTO-12-FR with a French population. LEVEL OF EVIDENCE: V, descriptive cross-sectional study.

Demographic characteristics, nutritional behaviors, and orthorexic tendencies of women with breast cancer: a case-control study.

PURPOSE: Breast cancer is one of the most important health problems faced by women. No study was found in the world literature about the eating behavior of women with breast cancer. Therefore, the aim of this study was to determine whether breast cancer patients and healthy controls differ in their orthorexia nervosa levels and to determine any factors that affect orthorexia nervosa (socio-demographic variables and nutritional habits). METHOD: The data were collected using a face-to-face interview technique between May 2018 and March 2019 at outpatient clinics and a family health center in Turkey. The data of the study were collected using personal information form and the Orthorexia Nervosa Scale (ORTO-15). A linear regression analysis was performed to investigate the effects of socio-demographic variables and nutritional habits of women on the risk of orthorexia nervosa. RESULTS: Breast cancer patients had significantly lower ORTO-15 scores (i.e., a higher orthorexia risk) than the healthy controls. For the cancer patients, a regression analysis revealed that ORTO-15 scores were significantly associated with education level, organic food consumption status, receipt of social support for care, and presence of a chronic disease other than cancer. In the healthy controls, body mass index and education level were the primary predictors of ORTO-15 scores. CONCLUSION: The higher orthorexia risk of cancer patients has implications for these patients that could be improved through nutritional counseling. LEVEL OF EVIDENCE: III, case-control study.

What does the ORTO-15 measure? Assessing the construct validity of a common orthorexia nervosa questionnaire in a meat avoiding sample.

Orthorexia nervosa (ON) is a proposed diagnostic category that captures a pathological need to eat healthfully. The ORTO-15 is a self-report measure ostensibly designed to assess ON, but its suitability for capturing symptoms of pathology has been questioned. Vegans differ from omnivores in their focus on health and present with similar or lowered endorsement of eating behaviors symptoms, making them an ideal group to assess the construct validity of the ORTO-15. We tested the hypothesis that the ORTO-15 captures normative, rather than pathological, health focus. In total, 106 omnivores, 34 meat reducers, 50 lacto-ovo-vegetarians, and 191 vegans completed the ORTO-15 to quantify the presence and severity of ON and the Eating Disorder Examination Questionnaire (EDE-Q) as an established measure of eating pathology. More than 75% of respondents met criteria for a diagnosis of ON per established ORTO-15 cutoffs. Respondents above the 2.50 EDEQ cutoff (suggesting the likely presence of an eating disorder) did not differ in ORTO-15 scores from those scoring below the cutoff. There was a univariate main effect of meat avoidance type on the EDE-Q global scale (p < .01), with vegans endorsing fewer symptoms on the EDE-Q than semi-vegetarians (post-hoc p < .05). Vegans were more likely to meet the clinical ON cutoff of 40 on the ORTO-15 compared to omnivores (omnibus p < .01; post-hoc p = .01). Based on the ORTO-15, vegans' scores should be indicative of pathological eating behavior, but EDE-Q scores instead indicate the lowest levels in this group. The ORTO-15 is able to differentiate between types of meat avoiders, but given the difference in health focus between groups, the scale may be tapping into a construct other than pathological eating beliefs and behaviors.

Investigating the structure of ORTO-15: a meta-analytical simulation study.

Missbach et al. (Appetite 108:521-524, https://doi.org/10.1016/j.appet.2016.07.010 , 2016) argued that there is a critical need to develop new tools assessing orthorexia nervosa (ON), as the existing measure (i.e., ORTO-15; Donini, Eat Weight Disord 10:28-32, https://doi.org/10.1007/BF03327537 , 2005) is an unvalidated measure, which fails to adequately assess the prevalence rate of ON. We believe that ignoring past data from ORTO-15 and going in the "baby with the bath water" direction will not catalyse but inhibit ON research. Using data from the review of the psychometric studies analysing the structure of ORTO-15 provided in Missbach et al. (2016), we selected six items, which were present in each study, and estimated effect sizes for the factor loadings. The effect sizes were used in a Monte Carlo simulation study with N = 100, 500, and 1000 to test whether the analysed model is valid. The obtained results confirmed that the six-item version of ORTO-15 is a valid and reliable measure of ON. Although new measures of ON are needed, the past data also provide valuable insight into a better understanding of ON.

A pilot study comparing the prevalence of orthorexia nervosa in regular students and those in University sports teams.

PURPOSE: Orthorexia nervosa (ON) is a pattern of eating characterized by a pathological fixation on restricting foods based on their perceived health. Like many eating disorders, ON is thought to be more prevalent in athletes. This was a preliminary study to explore the prevalence of ON in University students to determine whether those who compete in University sports have higher orthorexic tendencies. METHODS: 116 male and female student athletes (age 21 ± 1 years) and 99 non-athlete controls (21 ± 2) from Universities in the North East of the UK completed the ORTO-15 test (≤ 40 being the cutoff) used to screen individuals for ON. RESULTS: ON symptoms were high in all students (76%); there was no difference in ORTO-15 scores between the athletes (36.6 ± 3.9) and non-athlete controls (37.2 ± 3.8; P = 0.279). There was a difference in scores between those who completed ≥ 10 h of exercise per week (36.65 ± 4.38) and those who do ≤ 10 h a week (37.38 ± 3.65) (P = 0.008; ES = 0.43). ORTO-15 scores were not higher in athletes competing in aesthetic and weight dependent sports (P > 0.05). CONCLUSIONS: Being a student athlete for a University sports team did not affect ON prevalence; however, there appears to be a greater risk for students in general, and for athletes who undertake high volumes of exercise. Nonetheless, the high prevalence of ON symptoms may be attributed to flaws in the ORTO-15 questionnaire, and therefore, future studies should focus on developing a more valid method for ON diagnosis. LEVEL OF EVIDENCE: III, case-control study.

Orthorexia nervosa in a sample of Portuguese fitness participants.

PURPOSE: Orthorexia Nervosa (ON) is described as an obsessive behaviour motivated by great concern for following a healthy diet. Although it was first described in 1997, ON remains inconspicuous and poorly characterized in the literature. The aims of this study were to evaluate the prevalence of ON in a sample of ambulatory individuals and to investigate their common characteristics, attempting to better characterize this entity. METHODS: A non-random sample of 193 adult gym members answered a questionnaire based on a Portuguese version of ORTO-15, supplemented with additional questions. Possible associations between the different variables and pathological scores on ORTO-15 were analysed using logistic regression models. RESULTS: ON behaviour was documented in 51.8% of the sample, mean age 30.96 years (± 1.03 years), and this condition tended to be correlated with younger ages. Physical appearance and frequent exercising were also associated with ON, while no correlation between orthorexic tendencies and both gender and educational field was found. Furthermore, consumption of special food, dissatisfaction with physical appearance and frequent exercising could predict the presence of ON in the sample. CONCLUSIONS: Despite the use of a convenience sample, results place us in a different perspective, considering the idea that orthorexic individuals are exclusively concerned about pursuing a pure diet. The presence of ON was associated with other non-dietary behaviours allied to a healthy lifestyle and aesthetic concerns. LEVEL OF EVIDENCE: Level V: Descriptive study.

Determining the relationship between body mass index, healthy lifestyle behaviors and social appearance anxiety.

The aim of this study was to describe the relationship between nutritional status, healthy lifestyle behaviors and social appearance anxiety of individuals aged 20-65 (n = 500). A significant, positive relationship was seen between body mass index and nutrition, and negative relationship between body mass index and spiritual development, interpersonal relations, stress management. There was a negative relationship between the ORTO-15 score and health responsibility, physical activity, nutrition, spiritual development, interpersonal relationships, stress management. There was also a negative relationship between the Social Appearance Anxiety Scale and spiritual development, interpersonal relationships.

Orthorexia and anorexia nervosa: two distinct phenomena? A cross-cultural comparison of orthorexic behaviours in clinical and non-clinical samples.

BACKGROUND: Orthorexia nervosa (ON) is defined as pathological healthful eating. The aim of this study was to investigate whether there is any difference in orthorexic behaviours between clinical and non-clinical groups, and in different cultural contexts. . METHODS: Recruitment involved both female patients with anorexia nervosa (AN) and healthy controls (HC) from Italy and Poland (N = 23 and N = 35 AN patients; and N = 39 and N = 39 HCs, in Italy and Poland, respectively). Assessment of orthorexic behaviours was performed with the ORTO-15 test. RESULTS: Statistically significant differences were found between Italian women in the AN and HC group, whereas no difference between Polish women in the AN and HC group was found. Both Italian groups scored significantly higher than the Polish ones on the ORTO-15. CONCLUSIONS: Differences have been found between the Italian and Polish samples, both in the percentage of individuals with orthorexic behaviours as suggested by an ORTO 15 score below the cutoff, and in the mean ORTO 15 scores in the AN and HC groups, suggesting cross-cultural differences in orthorexic behaviours, whose meaning is currently difficult to understand.

The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style.

PURPOSE: We investigated whether perfectionism, body image, attachment style, and self-esteem are predictors of orthorexia nervosa. METHODS: A cohort of 220 participants completed a self-administered, online questionnaire consisting of five measures: ORTO-15, the Multidimensional Perfectionism Scale (MPS), the Multidimensional Body-Self Relations Questionnaire-Appearance Scale (MBSRQ-AS), the Relationship Scales Questionnaire (RSQ), and Rosenberg's Self-Esteem Scale (RSES). RESULTS: Correlation analysis revealed that higher orthorexic tendencies significantly correlated with higher scores for perfectionism (self-oriented, others-oriented and socially prescribed), appearance orientation, overweight preoccupation, self-classified weight, and fearful and dismissing attachment styles. Higher orthorexic tendencies also correlated with lower scores for body areas satisfaction and a secure attachment style. There was no significant correlation between orthorexia nervosa and self-esteem. Multiple linear regression analysis revealed that overweight preoccupation, appearance orientation and the presence of an eating disorder history were significant predictors of orthorexia nervosa with a history of an eating disorder being the strongest predictor. CONCLUSIONS: Orthorexia nervosa shares similarities with anorexia nervosa and bulimia nervosa with regards to perfectionism, body image attitudes, and attachment style. In addition, a history of an eating disorder strongly predicts orthorexia nervosa. These findings suggest that these disorders might be on the same spectrum of disordered eating.

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

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.

The Risk of Orthorexia and the Prevalence of Emotional Eating Behaviours among Polish Military Flying Personnel in Relation to Body Mass Index (BMI) and Sociodemographic Factors.

BACKGROUND: Proper nutrition has a positive impact on health. Paradoxically, excessive preoccupation with healthy eating may lead to the emergence of abnormal eating behaviours and increase the risk of developing disorders. The aim of this study was to assess the risk of orthorexia (ON) and the prevalence of emotional eating (EE) in military flying personnel of the Polish Air Force in relation to BMI and sociodemographic factors. METHODS: This study included 760 soldiers (including 60 females) taking part in the National Health Programme 2021-2025. The ORTO-15 questionnaire and EEQ were used to assess the risk of ON and EE. RESULTS: The risk of ON occurred in 28.9% of military flying personnel and was significantly more frequent in soldiers with a normal weight (46.4%), under 40 years of age (42.7%), and with higher education (42.7%). The prevalence of EE was found in approximately 12.3% of the respondents and was significantly more common in soldiers with diagnosed obesity (17.5%), women (21.7%), and soldiers with higher education (13.6). Other sociodemographic variables did not differentiate the results of the ORTO-15 questionnaire and EEQ. CONCLUSIONS: The obtained results indicate that the problem of eating disorders also occurs in military populations. The necessity of continuing research in this area is discussed.