Profiles of intuitive eating in adults: the role of self-esteem, interoceptive awareness, and motivation for healthy eating.

OBJECTIVE: Intuitive eating is an eating behavior that has recently come to use mainly in the young population. Knowing that the Lebanese cultural diet differs from other countries, the purpose of this study was to investigate if there is a relationship between self-esteem, interoceptive awareness, and motivation for healthy eating in a sample of Lebanese adults using a Latent Profile Analysis approach. DESIGN: Cross-sectional study. SETTING: Lebanese governorates. PARTICIPANTS: 359 Lebanese participants enrolled in this study (mean age: 22.75 ± 7.04 years, 40.1% males), through convenience sampling in several Lebanese governorates. Participants were asked to fill anonymously the following scales: The Intuitive Eating Scale (IES-2), the Rosenberg Self-Esteem Scale, the Multidimensional Assessment of Interoceptive Awareness Scale (MAIA), and the Motivation for Healthy Eating Scale (MHES). RESULTS: Our findings revealed four profiles: profile 1 (n = 67; 18.66%) characterized by high SE and intermediate interoceptive awareness and motivation for healthy eating; profile 2 (n = 86; 23.97%) presented high SE, interoceptive awareness, and motivation for healthy eating; profile 3 (n = 86; 23.96%) characterized by high SE, interoceptive awareness, and motivation for healthy eating; class 4 (n = 108; 30.08) described by low SE, intermediate interoceptive awareness, and motivation for healthy eating One-way analysis of variance did not observe a significant difference between the four profiles based on intuitive eating (F = 1.810; p = 0.145; ɳp2 = 0.015). CONCLUSIONS: Among a sample of Lebanese people, four profiles of interoceptive awareness, motivation for healthy eating, and self-esteem were observed, with no difference concerning intuitive eating.

Three reasons why parental burnout is more prevalent in individualistic countries: a mediation study in 36 countries.

PURPOSE: The prevalence of parental burnout, a condition that has severe consequences for both parents and children, varies dramatically across countries and is highest in Western countries characterized by high individualism. METHOD: In this study, we examined the mediators of the relationship between individualism measured at the country level and parental burnout measured at the individual level in 36 countries (16,059 parents). RESULTS: The results revealed three mediating mechanisms, that is, self-discrepancies between socially prescribed and actual parental selves, high agency and self-directed socialization goals, and low parental task sharing, by which individualism leads to an increased risk of burnout among parents. CONCLUSION: The results confirm that the three mediators under consideration are all involved, and that mediation was higher for self-discrepancies between socially prescribed and actual parental selves, then parental task sharing, and lastly self-directed socialization goals. The results provide some important indications of how to prevent parental burnout at the societal level in Western countries.

Comparative utility of the DSM-5 and ICD-11 diagnostic classifications of eating disorders of recurrent binge eating in an Australian community-based sample.

OBJECTIVE: The present study aimed to compare the estimated prevalence, sociodemographic features and impacts of Bulimia Nervosa (BN), Binge Eating Disorder (BED) and Other Specified Feeding or Eating Disorder (OSFED; BN or BED of low frequency and/or limited duration) when comparing the DSM-5 with the broader ICD-11 diagnostic criteria for size and specifiers of binge-eating episodes in a general population epidemiological sample. METHODS: 2977 individuals (1524 women and 1453 men) aged ≥15 years from randomly selected households in South Australia were interviewed in person. Participants were asked questions relating to sociodemographic features, symptoms of eating disorder pathology, physical and mental health-related quality of life (HRQoL; SF-12) and role impairment. RESULTS: The estimated prevalence of only one diagnosis, namely BED, was lower when applying DSM-5 criteria than when applying ICD-11 criteria, largely due to the Criterion B binge-eating specifiers of the DSM-5. There were no significant differences in participants' demographic features, HRQoL, or role impairment between the comparable diagnosis of either scheme. CONCLUSIONS: There were few differences in distribution and similar levels of health impacts when applying either diagnostic scheme in this epidemiological study. However, cases of BED may be missed when using the stricter criteria of DSM-5 in epidemiological surveys. Further studies are needed to assess the clinical utility of the DSM-5 and ICD-11 diagnostic specifiers of binge-eating.

The relationship between body mass index and food preoccupation in women: A moderated mediation of body-related self-conscious emotions and self-esteem.

OBJECTIVE: Individuals who are preoccupied with food are more likely to develop maladaptive eating behaviours and eating disorders. Thus, it is advisable to investigate the factors that increase vulnerability to food preoccupation (FP) to prevent its harmful impact on physical and mental health. Our objective in this study was to investigate the relationship between body mass index (BMI) and FP in Polish women (N = 407) and examine a possible pathway through body-related shame and body-related guilt and self-esteem. METHOD: Participants completed an abbreviated version of the Eating Attitudes Test-26, the Body and Appearance Self-Conscious Emotions Scale, and the Rosenberg Self-Esteem Scale. RESULTS: The findings demonstrated a positive indirect effect of BMI on FP through body-related shame and body-related guilt. However, this effect was moderated by self-esteem only for body-related shame; namely, in women with a low or average level of self-esteem, higher BMI was related to higher body-related shame, which, in turn, was associated with higher levels of FP. These associations were not observed in women with a high level of self-esteem. DISCUSSION: Body-related shame may help explain the relationship between BMI and FP. Moreover, self-esteem serves as a protective factor against body-related shame related to higher BMI and, as a result, against FP.

Reappraisal, social support, and parental burnout.

OBJECTIVES: Parental burnout is a prevalent condition that affects parents' functioning and health. While various protective factors have been examined, little is known about their interplay. In the current study, we examined the joint effect of two protective factors against parental burnout (one external-social support and one internal-cognitive reappraisal). We were specifically interested in whether the presence of one factor could compensate for the lack of the other. METHODS: To address this question, 1835 participants were drawn from five countries: United States, Poland, Peru, Turkey and Belgium. RESULTS: Results suggested that both social support and cognitive reappraisal were associated with lower parental burnout. An interaction was also found between the resource factors, such that the presence of cognitive reappraisal compensated for the absence of social support. CONCLUSIONS: These findings point to ways in which parental burnout could be reduced, especially in situations where social support is not easily available.

Orthorexia Nervosa and its association with obsessive-compulsive disorder symptoms: initial cross-cultural comparison between Polish and Italian university students.

There is limited evidence of a link between Orthorexia Nervosa (ON) and Obsessive-Compulsive Disorder (OCD), and no definitive conclusions can be drawn. The interplay between socio-cultural context and ON has been poorly investigated as well. Therefore, the objectives of the present study were: (1) to investigate the differences in ON and OCD symptoms and (2) to assess the relationship between ON and OCD symptoms among university students. Six hundred and sixty-six university students participated in the present study: 286 from Poland and 320 from Italy. No age, gender and marital status differences were identified between two samples of university students. However, on average, Polish university students had a higher Body Mass Index than Italian ones. Our findings showed that Polish students present more problems related to obsessive symptomatology, core beliefs of OCD, perfectionism traits, and a major ON symptomatology than Italian ones. Also, Polish students with a higher level of ON exhibited higher levels of OCD symptoms and parental expectations/parental criticism. While Italian students with a higher level of ON showed higher levels of perfectionism features (organization and concern over mistakes). In general, correlations were low as confirmation of partial independence ON from OCD symptoms and core beliefs of OCD in both Polish and Italian university students. The present results highlight a need for further investigation of the correlates of ON across different cultural groups. Future research may screen individuals with ON to determine the comorbidity between ON and OCD symptomology to facilitate appropriate treatment choices. LEVEL OF EVIDENCE: Level V, Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

A consensus document on definition and diagnostic criteria for orthorexia nervosa.

PURPOSE: Since the term orthorexia nervosa (ON) was coined from the Greek (ὀρθός, right and ὄρεξις, appetite) in 1997 to describe an obsession with "correct" eating, it has been used worldwide without a consistent definition. Although multiple authors have proposed diagnostic criteria, and many theoretical papers have been published, no consensus definition of ON exists, empirical primary evidence is limited, and ON is not a standardized diagnosis. These gaps prevent research to identify risk and protective factors, pathophysiology, functional consequences, and evidence-based therapeutic treatments. The aims of the current study are to categorize the common observations and presentations of ON pathology among experts in the eating disorder field, propose tentative diagnostic criteria, and consider which DSM chapter and category would be most appropriate for ON should it be included. METHODS: 47 eating disorder researchers and multidisciplinary treatment specialists from 14 different countries across four continents completed a three-phase modified Delphi process, with 75% agreement determined as the threshold for a statement to be included in the final consensus document. In phase I, participants were asked via online survey to agree or disagree with 67 statements about ON in four categories: A-Definition, Clinical Aspects, Duration; B-Consequences; C-Onset; D-Exclusion Criteria, and comment on their rationale. Responses were used to modify the statements which were then provided to the same participants for phase II, a second round of feedback, again in online survey form. Responses to phase II were used to modify and improve the statements for phase III, in which statements that met the predetermined 75% of agreement threshold were provided for review and commentary by all participants. RESULTS: 27 statements met or exceeded the consensus threshold and were compiled into proposed diagnostic criteria for ON. CONCLUSIONS: This is the first time a standardized definition of ON has been developed from a worldwide, multidisciplinary cohort of experts. It represents a summary of observations, clinical expertise, and research findings from a wide base of knowledge. It may be used as a base for diagnosis, treatment protocols, and further research to answer the open questions that remain, particularly the functional consequences of ON and how it might be prevented or identified and intervened upon in its early stages. Although the participants encompass many countries and disciplines, further research will be needed to determine if these diagnostic criteria are applicable to the experience of ON in geographic areas not represented in the current expert panel. LEVEL OF EVIDENCE: Level V: opinions of expert committees.

The effect of a web-based psychoeducation on emotional functioning, eating behaviors, and body image among premenopausal women with excess body weight.

The aims of this study were twofold: (1) to investigate the effectiveness of web-based psychoeducation for emotional functioning, eating behaviors, and body image among premenopausal women with excess body weight, and (2) to compare the efficacy of two types of web-based psychoeducation. Three hundred individuals were asked to volunteer in the present study. All participants were recruited in Poland from September 2017 to July 2019. Finally, a total of 129 premenopausal women took part in the research and signed informed consent. Their ages ranged between 18 and 48 years old (M = 32.28, SD = 7.65). Self-reported weight and height were recorded. BMI was calculated using self-reported data. Their average body mass index was 30.54 kg/m2 (SD = 3.69). In our randomized experiment, the participants were allocated into three groups: experimental group I (EG I, N = 43), experimental group II (EG II, N = 46), and wait list control group (CG, N = 40). Five questionnaires were included in the online survey at the baseline measurement (Day 0), at the end of psychoeducational intervention (Day 16) and 75 days from the start of the 15-day intervention (Day 76). Measurement tools included the Difficulties in Emotion Regulation Scale, the Positive and Negative Affect Schedule, the Mindful Eating Scale, the Three-Factor Eating Questionnaire, and the Body Attitude Test. Our eHealth web-based psychoeducation consisted of three modules: emotional functioning module (EG I: theoretically consistent approach (TCA) vs EG II: eclectic approach; EA), eating behaviors module (EG I, EG II: based on mindfulness-based eating training; MET), body image module (EG I, EG II: based on Cash's prevention of body image disturbances; CPBID). The first experimental group (EG I) had intervention containing TCA, MET, and CPBID, while the second experimental group (EG II) EA, MET, and CPBID. According to between-group comparison, both types of web-based psychoeducation led to an increase in adaptive emotion regulation (Day 16: EG I vs CG: p < 0.001, EG II vs CG: p < 0.001; Day 76: EG I vs CG: p < 0.01, EG II vs CG: p < 0.001). In EG I, the intervention resulted in a higher reduction (than in CG) in emotional eating (Day 16: p < 0.01, Day 76: p < 0.01), uncontrolled eating (Day 16: p < 0.05, Day 76: p < 0.05), and negative appreciation of body size (Day 16: p < 0.01, Day 76: p < 0.01). In EG II, a lower level of emotional eating was found on Day 76 (EG II vs CG: p < 0.05). Two months after completion of the 15-day intervention, no statistically significant reduction for BMI was observed in either experimental group (p > 0.05). The effectiveness of both types of web-based psychoeducation was also confirmed in within-group comparison (Day 0 vs Day 16 and Day 0 vs Day 76). There was a significant increase in emotion regulation and mindful eating, as well as a decrease in emotional eating, uncontrolled eating, negative appreciation of body size, lack of familiarity with one's body, and the experiencing of negative emotions in both experimental groups (EG I, EG II). Both types of web-based psychoeducation might have to be considered in creating future web-based psychoeducation among premenopausal women with excess body weight.

Vegetarian diet and orthorexia nervosa: a review of the literature.

BACKGROUND: The number of individuals following a vegetarian diet has increased in the last 50 years. Although the causal connection between orthorexic behaviors and vegetarianism remains widely assumed, evidence in support of this assumption has been largely inconsistent. OBJECTIVE: The purpose of the study was to conduct a review of the relationship between vegetarian diet and orthorexic eating behavior and to give future directions in this area. METHODS: A search of the literature within PubMed/Medline was conducted. The search terms were "orthorexia", "orthorexic", "orthorexia and vegetarian", "orthorexia and vegan" and "orthorexia and vegetarianism". Out of 117 journal articles, 14 met the predefined inclusion criteria and were analyzed. RESULTS: The results demonstrated that following a vegetarian diet was found to be related to orthorexic eating behaviors (in 11 out of 14 studies). CONCLUSION: Further longitudinal research is needed to investigate whether following a vegetarian diet serves as a risk factor in the development of orthorexia nervosa. LEVEL OF EVIDENCE: Level V, narrative review.

The Polish version of the Düsseldorf Orthorexia Scale (PL-DOS) and its comparison with the English version of the DOS (E-DOS).

PURPOSE: Although orthorexia nervosa, the fixation on health-conscious eating behaviour, was first described in the 90 s, there is no clear understanding whether existing ON measures are appropriate for its assessment. The objectives of the present study were to: (1) examine the psychometric properties of the Polish version of the DOS (PL-DOS) and to compare the PL-DOS with the English version of the DOS (E-DOS) as well as (2) evaluate the prevalence of ON among Polish university students and compare the prevalence rates of ON among Polish and U.S. students. METHODS: Four-hundred and twelve students (77.2% female) with a mean age of 24.62 years (SD = 6.86) participated in the present study. All participants completed the Polish version of the Düsseldorf Orthorexia Scale (PL-DOS), the Eating Habits Questionnaire (EHQ) and the Eating Disorder Inventory (EDI). RESULTS: Reliability analysis for the PL-DOS showed strong internal consistency with a Cronbach's alpha coefficient of 0.840 and a coefficient omega of 0.840, 95% CI [0.808, 0.866]. Significant correlation coefficients were found between the PL-DOS and all subscales of the EHQ. Confirmatory factor analysis showed that the one-factor model had poor fit. Polish students had an ON prevalence rate of 6.6%, lower than that of U.S. students (8%). CONCLUSIONS: Our findings validate the use of the PL-DOS as an appropriate ON measure for a Polish population. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

The impact of food-related behaviours and emotional functioning on body mass index in an adult sample.

PURPOSE: The aim of this study was to evaluate the impact of food-related behaviours (emotional eating, snacking) and emotional functioning (negative emotions, stress, emotional dysregulation) on body mass index in an adult sample. Direct and indirect relationships of the above-mentioned variables were examined. METHODS: The total sample comprised 298 adults. All participants completed the Difficulties in Emotion Regulation Scale, the Positive and Negative Affect Schedule, the Feeling of Stress Questionnaire and the Three-Factor Eating Questionnaire. RESULTS: Our findings showed that food-related behaviours and emotional functioning are related to body mass index in adults. In addition, emotional dysregulation and negative emotions did not have direct impact on snacking. Moreover, snacking did not have a direct impact on body mass index. However, snacking had an indirect effect on body mass index (through emotional eating). The other relationships were significant and consistent with the hypothesised positive direction. CONCLUSION: We found significant relationships among (almost all) food-related behaviours, emotional functioning and body mass index in adults. However, future research on pathways from negative emotions/emotional dysregulation to snacking and from snacking to BMI should be conducted. LEVEL OF EVIDENCE: Level V, descriptive study.

Rumination, mood, and maladaptive eating behaviors in overweight and healthy populations.

PURPOSE: The literature suggests that rumination (i.e., repetitive thinking about 1 or more negative concerns that is perceived as difficult to control) is linked to impaired emotional regulation and increases negative affect. Not only individuals suffering from overweight or obesity, but also healthy individuals might use emotional eating as a coping strategy to deal with negative affect caused by rumination. The aim of the present study was to determine the link between rumination and maladaptive eating strategies in participants with normal weight and overweight/obesity using trait and ecological momentary measures. METHOD: In Study 1, 88 individuals from overweight/obese (N = 33) and control group (N = 50) filled in a series of questionnaires assessing trait rumination, and eating behaviors. In Study 2 momentary affect, rumination and eating behavior of 26 participants were assessed using ecological momentary assessment (EMA) methodology. RESULTS: In Study 1, the moderated mediation model revealed that emotional eating mediates the link between rumination and uncontrolled eating or snacking, but only in healthy participants and not in the participants with overweight. The results of Study 2 suggest that when both momentary rumination and sad mood are entered into the model predicting momentary daily emotional eating, only rumination remains a significant predictor of emotional eating. This relationship is not modified by the fact that the participants are from healthy controls or the overweight/obese group. DISCUSSION: Study 1 provided evidence on the differential role of emotional eating in participants with normal weight and with overweight. Study 2 provided initial insights into the role of momentary mood and momentary repetitive thinking in the use of emotional eating in participants' everyday lives. The differences in group effect in trait and EMA measures indicated also the importance of considering the consciousness of using rumination and emotional eating, while studying those processes in individuals with overweight. LEVEL OF EVIDENCE: Level III, case-control analytic study.

Orthorexia nervosa and its association with alexithymia, emotion dysregulation and disordered eating attitudes among Lebanese adults.

OBJECTIVE: This study aims to explore whether orthorexia nervosa, like other eating disorders, is associated with difficulties identifying, describing, and regulating one's own emotions among a sample of Lebanese adults. METHODS: A cross-sectional study was conducted during October 2020, during the lockdown period imposed by the government for the COVID-19 pandemic. All participants above 18 years of age were allowed to participate in this study. A total of 787 Lebanese adults out of 920 (85.54%) completed an online survey including Arabic versions of the ORTO-R measure of orthorexia, the Toronto Alexithymia Scale, the Difficulty in Emotion Regulation Scale, and the Eating Attitudes Test. RESULTS: After making sure that all norms are verified, hierarchical linear regressions were conducted to evaluate the association between disordered eating attitudes (EAT scores) and ON (model 1), and after controlling for difficulties in emotion regulation (DERS score) (model 2). Model 1 accounted for 15.1% of the variance of ON (adj. R2 = 0.151, F(1, 786) = 140.06, p < 0.001) and showed that higher levels of disordered eating (higher EAT scores) (ß = 0.15) were significantly associated with more ON tendencies and behaviors. When adding the DERS total score to the model, Model 2 was a much better fit with 17.7% of the variance of ON (adj. R2 = 0.177, F(2, 786) = 84.44, p < 0.001), with higher levels of emotion dysregulation (higher DERS scores) (ß = 0.06) and more disordered eating attitudes (higher EAT scores) (ß = 0.13) were associated with higher levels of ON (Table 5). CONCLUSION: The present research suggests that people with high ON tendencies experience troubles recognizing, regulating, and describing their emotions, similarly to other disordered eating. LEVEL OF EVIDENCE: 5.

The moderating effects of mindful eating on the relationship between emotional functioning and eating styles in overweight and obese women.

PURPOSE: The aim of the current study was to examine the moderating effect of mindful eating on the relationship between emotional functioning and eating styles in overweight and obese women. METHODS: One hundred and eighty four overweight and obese adult women (BMI 30.12 ± 3.77 kg/m2) were assessed with the Difficulties in Emotion Regulation Scale, the Positive and Negative Affect Schedule, the Three Factor Eating Questionnaire and the Mindful Eating Scale. RESULTS: Mindful eating significantly moderated several of the relationships between emotional functioning and eating styles. At all levels of mindful eating, emotion dysregulation and negative affect are both associated with greater emotional eating, but with stronger associations for high levels of mindful eating. For people low in mindful eating, both emotion dysregulation and negative affect are associated with lower restrictive eating, and neither of them are associated with uncontrolled eating. For people high in mindful eating, neither emotion dysregulation nor negative affect are associated with restrictive eating, and only negative affect is associated with greater uncontrolled eating. CONCLUSION: When mindful eating techniques are included as part of an intervention for overweight or obese individuals, it is even more important that those interventions should also include techniques to reduce emotion dysregulation and negative affect. LEVEL OF EVIDENCE: Level V, descriptive study.

Orthorexia nervosa, eating patterns and personality traits: a cross-cultural comparison of Italian, Polish and Spanish university students.

BACKGROUND: The amount of research about orthorexic attitudes and behaviours has increased in the last five years, but is still mainly based on descriptive and anecdotal data, yielding a variety of prevalence data and inconsistent results. The interplay between socio-cultural context and orthorexia has been poorly investigated and is still far from being understood. METHOD: Multicentre, cross-sectional study involving Italian (N = 216), Polish (N = 206) and Spanish (N = 242) university students, assessed through a protocol including informed consent, socio-demographic and anamnestic data sheet and self-administered questionnaires (ORTO-15, Eating Attitudes Test- 26 [EAT-26], Temperament and Character Inventory [TCI]). RESULTS: Higher prevalence of orthorexia (as described by the ORTO-15 cutoff) was found in Poland. Female gender, Body Mass Index (BMI), current Eating Disorder, dieting, EAT-26 score ≥ 20 and low/medium Persistence were associated with orthorexia in the whole sample. The cross-cultural comparison showed several differences among the three subgroups of students. CONCLUSIONS: The associations found between orthorexic attitudes, self-reported current eating disorder, BMI and adherence to a dieting need to be supported by further research. The differences among students from the three countries seem to suggest a possible rolve for cultural elements in the construct of orthorexia.

Strict health-oriented eating patterns (orthorexic eating behaviours) and their connection with a vegetarian and vegan diet.

PURPOSE: Although research on vegetarianism is becoming more prevalent, to date, only a few research has been conducted on relationship between vegetarian diet and orthorexia nervosa (ON). The objective of the present study was to examine the orthorexic dietary patterns and eating behaviours among individuals following a vegetarian, vegan, and meat diet. We examined the moderating role of ethical and health reasons for following a meat-free diet on the relation between vegan versus vegetarian diet and eating behaviours and ON. The study aimed to determine the predictors of ON in individuals with differential food preferences. METHODS: Seventy-nine individuals following a meat-free diet and 41 individuals following an omnivore diet completed the EHQ and the TFEQ-R18. RESULTS: Our findings indicated that individuals following a vegan diet showed a higher level of knowledge of healthy eating than those who followed a vegetarian diet and those who followed an omnivore diet. Participants maintaining a vegan diet for health reasons were more likely to have greater knowledge about healthy eating. Cognitive restraint was a predictor of ON among a sample following a meat-free diet. CONCLUSIONS: Our results could contribute to identify potential risk factors for strict health-oriented eating patterns and to gain a better insight into ON. LEVEL OF EVIDENCE: Level V, descriptive study.

Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature.

AIM: In some cases, detrimental consequences on health are generated by self-imposed dietary rules intended to promote health. The pursuit of an "extreme dietary purity" due to an exaggerated focus on food may lead to a disordered eating behavior called "orthorexia nervosa" (ON). ON raises a growing interest, but at present there is no universally shared definition of ON, the diagnostic criteria are under debate, and the psychometric instruments used in the literature revealed some flaws. This narrative review of the literature aims at assessing state of the art in ON definition, diagnostic criteria and related psychometric instruments and provides research propositions and framework for future analysis. METHODS: The authors collected articles through a search into Pubmed/Medline, Scopus, Embase and Google Scholar (last access on 07 August 2018), using "orthorexia", "orthorexia nervosa" and "obsessive healthy eating" as search terms, and filled three tables including narrative articles (English), clinical trials (English), and articles in languages different from English. The data extrapolated from the revised studies were collected and compared. In particular, for each study, the diagnostic criteria considered, the specific psychometric instrument used, the results and the conclusions of the survey were analyzed. RESULTS: The terms employed by the different authors to define ON were fixation, obsession and concern/preoccupation. Several adjectives emphasized these expressions (e.g. exaggerated/excessive, unhealthy, compulsive, pathological, rigid, extreme, maniacal). The suitable food and the diet were defined in different ways. Most of the papers did not set the diagnostic criteria. In some cases, an attempt to use DSM (edition IV or 5) criteria for anorexia nervosa, or avoidant/restrictive food intake disorder, or body dysmorphic disorder, was done. Specific diagnostic criteria proposed by the authors were used in few studies. All these studies indicated as primary diagnostic criteria: (a) obsessional or pathological preoccupation with healthy nutrition; (b) emotional consequences (e.g. distress, anxieties) of non-adherence to self-imposed nutritional rules; (c) psychosocial impairments in relevant areas of life as well as malnutrition and weight loss. The ORTO-15 and the Orthorexia Self-Test developed by Bratman were the most used psychometric tools. CONCLUSIONS: The present review synopsizes the literature on the definition of ON, proposed diagnostic criteria and psychometric instruments used to assess ON attitudes and behaviors. This work represents a necessary starting point to allow a further progression of the studies on the possible new syndrome and to overcome the criticisms that have affected both research and clinical activity until now. LEVEL OF EVIDENCE: Level V, narrative review.

Food-related behaviours among individuals with overweight/obesity and normal body weight.

BACKGROUND: Emotional eating is a factor associated with a negative body image and other problematic eating behaviours. In this context little is known about differences between individuals with overweight and obesity and those with normal body weight. The main aim of the study was to evaluate the role of emotional eating in the relationship between the desire to consume chocolate and the wish to avoid social situations related to food and body exposures. For this purpose, we tested the direct, indirect and buffer effects. In addition, we used moderated mediation by introducing snacking into the model. METHODS: The study included 123 outpatients with excessive body weight and 123 individuals with normal weight. The mean of body mass index (BMI) in the first group was 30.19 kg/m2 (SD = 4.37) and, in the second, it was 23.02 kg/m2 (SD = 1.20). The Three-Factor Eating Questionnaire, the Attitudes to Chocolate Questionnaire and the Body Image Avoidance Questionnaire were used. RESULTS: Results show that in all individuals, the greater emotional eating is, the greater the desire for chocolate consumption and avoidance of social situations related to food and body exposures are. In addition, the desire for chocolate consumption are positively associated with avoidance of social situations related to food and body exposures in both group. Among individuals with excessive and normal body weight, emotional eating is a significant mediator in the relationship between desire for chocolate consumption and avoidance of social situations related to food and body exposures. However, it does not moderate the relationship between these variables. Outcomes show that there is a significant model of moderated mediation of the link between social situation-avoidance related to food and body exposure and the desire to consume chocolate through emotional eating, moderated by snacking among individuals with normal body weight. A similar effect has not been discovered in the group with excessive body weight. CONCLUSION: The presented results show that among people with varied BMI categories, emotional eating is connected to craving chocolate and avoidance of social situations related to food and body exposure that plays only the role of mediation. In addition, snacking is crucial for this relationship among the group with normal body weight.

Orthorexia nervosa: relationship with obsessive-compulsive symptoms, disordered eating patterns and body uneasiness among Italian university students.

INTRODUCTION: The present study aimed to investigate the relationship between ORTO-15 score and obsessive-compulsive symptoms, disordered eating patterns and body uneasiness among female and male university students and to examine the predictive model of ORTO-15 in both groups. METHODS: One hundred and twenty students participated in the present study (mean age 22.74 years, SD 7.31). The ORTO-15 test, the Maudsley Obsessive-Compulsive Questionnaire, the Eating Attitudes Test-26 and the Body Uneasiness Test were used for the present study. RESULTS: Our results revealed no gender differences in ORTO-15 score. Our results show, rather unexpectedly, that in female students lower scores, corresponding to greater severity, were related to less pathological body image discomfort and obsessive-compulsive signs, while in male students, lower ORTO-15 scores were related to less pathological eating patterns, as behaviors and symptoms. CONCLUSION: Further studies regarding the relationship between ON and anorexia nervosa, as well as obsessive-compulsive symptoms, are needed to better understand the causality. Level of Evidence Level V, descriptive study.