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Orthorexia nervosa in a sample of Portuguese fitness participants

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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

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.

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References

  1. Bratman S (1997) Original essay on orthorexia. Retrieved January 2017 from http://www.orthorexia.com/original-orthorexia-essay/

  2. Brytek-Matera A, Rogoza R, Gramaglia C, Zeppegno P (2015) Predictors of orthorexic behaviours in patients with eating disorders: a preliminary study. BMC Psychiatry 15:1–8. https://doi.org/10.1186/s12888-015-0628-1

    Article  CAS  Google Scholar 

  3. Vandereycken W (2011) Media hype, diagnostic fad or genuine disorder? Professionals’ opinions about night eating syndrome, orthorexia, muscle dysmorphia and emetophobia. Eat Disord 19:145–155. https://doi.org/10.1080/10640266.2011.551634

    Article  PubMed  Google Scholar 

  4. Lovelady CA, Hunter CP, Geigerman C (2003) Effect of exercise on immunologic factors in breast milk. Pediatrics 111(2):148–152. https://doi.org/10.1542/peds.111.2.e148

    Article  Google Scholar 

  5. Koven NS, Abry AW (2015) The clinical basis of orthorexia nervosa: emerging perspectives. Dovepress 11:385–394. https://doi.org/10.2147/NDT.S61665

    Article  Google Scholar 

  6. Michalska A, Szejko N, Jakubczyk A, Wojnar M (2016) Nonspecific eating disorders—a subjective review. Psychiatr Pol 50(3):497–507. https://doi.org/10.12740/PP/59217

    Article  PubMed  Google Scholar 

  7. Setnick J (2013) The eating disorders clinical pocket guide, 2nd edn. TX Snack Time Press, Dallas.

    Google Scholar 

  8. Dunn TM, Bratman S (2016) Eating behaviors on orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eat Behav 21:11–17. https://doi.org/10.1016/j.eatbeh.2015.12.006

    Article  PubMed  Google Scholar 

  9. Barthels F, Meyer F, Huber T, Pietrowsky R (2017) Orthorexic eating behaviour as a coping strategy in patients with anorexia nervosa. Eat Weight Disord Stud Anorexia Bulim Obes 22(2):269–276. https://doi.org/10.1007/s40519-016-0329-x

    Article  Google Scholar 

  10. Barnes MA, Caltabiano ML (2016) The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eat Weight Disord. https://doi.org/10.1007/s40519-016-0280-x

    Article  PubMed  Google Scholar 

  11. Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C (2005) Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord 10:28–32. https://doi.org/10.1007/BF03327537

    Article  Google Scholar 

  12. de Souza QJOV, Rodrigues AM (2014) Risk behavior for orthorexia nervosa in nutrition students. Rev Chil Nutr 63(3):200–204. https://doi.org/10.1590/0047-2085000000026

    Article  Google Scholar 

  13. Behar R, Molinari D (2010) Dismorfia muscular, imagen corporal y conductas alimentarias en dos poblaciones masculinas. Rev Med Chile 138:1386–1394. https://doi.org/10.4067/S0034-98872010001200007

    Article  PubMed  Google Scholar 

  14. Danielsen M, Bjørnelv S, Rø Ø (2015) Validation of the exercise and eating disorders questionnaire. Int J Eat Disord 48(7):983–993. https://doi.org/10.1002/eat.22393

    Article  PubMed  PubMed Central  Google Scholar 

  15. McKinley NM, Hyde JS (1996) The objectified body consciousness scale: development and validation. Psychol Women Q 20(2):181–215. https://doi.org/10.1111/j.1471-6402.1996.tb00467.x

    Article  Google Scholar 

  16. Stice E, Agras WS (1998) Predicting the onset and remission of bulimic behaviours in adolescence: a longitudinal grouping analysis. Behav Ther 29:257–276

    Article  Google Scholar 

  17. Pope H, Phillips K, Olivardia R (2002) The adonis complex. Touchstone, New York

    Google Scholar 

  18. Varga M, Thege BK, Dukay-Szabó S, Túry F, Furth EF, Van (2014) When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry 14:1–11. https://doi.org/10.1186/1471-244X-14-59

    Article  Google Scholar 

  19. Stochel M, Janas-Kozik M, Zejd JE, Hyrnik J, Jelo I, Siw A (2015) Validation of ORTO-15 Questionnaire in the group of urban youth aged 15–21. Psychiatr Pol 49:119–134. https://doi.org/10.12740/PP/25962

    Article  PubMed  Google Scholar 

  20. Herranz Valera J, Acuña Ruiz P, Romero Valdespino B, Visioli F (2014) Prevalence of orthorexia nervosa among ashtanga yoga practitioners: a pilot study. Eat Weight Disord 19:469–472. https://doi.org/10.1007/s40519-014-0131-6

    Article  PubMed  Google Scholar 

  21. Bo S, Zoccali R, Ponzo V, Soldati L, De Carli L, Benso A et al. (2014) University courses, eating problems and muscle dysmorphia: are there any associations? J Transl Med. https://doi.org/10.1186/s12967-014-0221-2

    Article  PubMed  PubMed Central  Google Scholar 

  22. Segura-García C, Papaianni MC, Caglioti F, Procopio L, Nisticò CG, Bombardiere L et al (2012) Orthorexia nervosa: a frequent eating disordered behavior in athletes. Eat Weight Disord. https://doi.org/10.3275/8272

    Article  PubMed  Google Scholar 

  23. Aksoydan E, Camci N (2009) Prevalence of orthorexia nervosa among Turkish performance artists. Eat Weight Disord 14:33–37. https://doi.org/10.1007/BF03327792

    Article  CAS  PubMed  Google Scholar 

  24. Fidan T, Ertekin V, Sedat I, Ismet K (2010) Prevalence of orthorexia among medical students in Erzurum, Turkey. Compr Psychiatry 51:49–54. https://doi.org/10.1016/j.comppsych.2009.03.001

    Article  PubMed  Google Scholar 

  25. Missbach B, Hinterbuchinger B, Dreiseitl V, Zellhofer S. When eating right, is measured wrong! A validation and critical examination of the ORTO-15 Questionnaire in German. PLoS One. 2015;1–15. https://doi.org/10.1371/journal.pone.0135772

  26. Brytek-Matera A, Donini LM, Krupa M, Poggiogalle E, Hay P (2015) Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students. J Eat Disord 3:2. https://doi.org/10.1186/s40337-015-0038-2 1–8.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bosi A, Derya C, Çagatay G (2007) Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey). Appetite 49:661–666. https://doi.org/10.1016/j.appet.2007.04.007

    Article  Google Scholar 

  28. Brytek-Matera A, Fonte ML, Poggiogalle E, Donini L, Cena H (2017) Orthorexia nervosa: relationship with obsessive-compulsive symptoms, disordered eating patterns and body uneasiness among Italian university students. Eat Weight Disord 22(4):609–617. https://doi.org/10.1007/s40519-017-0427-4

    Article  PubMed  Google Scholar 

  29. Malmborg J, Bremander A, Olsson MC, Bergman S (2016) Health status, physical activity, and orthorexia nervosa: A comparison between exercise science students and business students. Appetite. https://doi.org/10.1016/j.appet.2016.11.028

    Article  PubMed  Google Scholar 

  30. Mathieu J (2005) What is orthorexia? J Am Diet Assoc 105:1510–1512. https://doi.org/10.1016/j.jada.2005.08.021

    Article  PubMed  Google Scholar 

  31. Moroze RM, Dunn TM, Holland JC, Yager J, Weintraub P (2014) Microthinking about Micronutrients: a case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria. Psychosomatics. https://doi.org/10.1016/j.psym.2014.03.003

    Article  PubMed  Google Scholar 

  32. Oberle CD, Watkins RS, Burkot AJ (2018) Orthorexic eating behaviors related to exercise addiction and internal motivations in a sample of university students. Eat Weight Disord 23(1):67–74. https://doi.org/10.1007/s40519-017-0470-1

    Article  Google Scholar 

  33. Rudolph S (2017) The connection between exercise addiction and orthorexia nervosa in German fitness sports. Eat Weight Disord. https://doi.org/10.1007/s40519-017-0437-2

    Article  PubMed  Google Scholar 

  34. Brierley M, Brooks KR, Mond J, Stevenson RJ (2016) The Body and the Beautiful: Health, Attractiveness and Body Composition in Men’s and Women’s Bodies. PLoS One. https://doi.org/10.1371/journal.pone.0156722

    Article  PubMed  PubMed Central  Google Scholar 

  35. Gómez-Ambrosi J, Silva C, Galofre JC, Escalada J, Santos S, Milla D et al (2012) Body mass index classification misses subjects with increased cardiometabolic risk factors related to elevated adiposity. Int J Obes 36:286–294. https://doi.org/10.1038/ijo.2011.100

    Article  CAS  Google Scholar 

  36. Dell’Osso L, Abelli M, Carpita B, Massimetti G, Pini S, Rivetti L et al (2016) Orthorexia nervosa in a sample of Italian university population. Riv Psichiatr 51(5):190–196. https://doi.org/10.1708/2476.25888

    Article  PubMed  Google Scholar 

  37. Ramacciotti CE, Perrone P, Coli E, Burgalassi A, Conversano C, Massimetti G (2011) Orthorexia nervosa in the general population: a preliminary screening using a self-administered questionnaire (ORTO-15). Eat Weight Disord 16:127–130. https://doi.org/10.1007/bf03325318

    Article  Google Scholar 

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Acknowledgements

We thank Emília Nogueira, Ph.D and Esmeralda Gonçalves, Ph.D for the statistical component of this study.

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Correspondence to Carolina Almeida.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

Additional information

This article is part of topical collection on Orthorexia Nervosa.

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Almeida, C., Vieira Borba, V. & Santos, L. Orthorexia nervosa in a sample of Portuguese fitness participants. Eat Weight Disord 23, 443–451 (2018). https://doi.org/10.1007/s40519-018-0517-y

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