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Food addiction, orthorexia, and food-related stress among dietetics students

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

Abstract

Purpose

Health sciences, and in particular Nutrition and Dietetics students, have been shown to exhibit an increased prevalence of disordered eating. The aim of the present cross-sectional study was to evaluate other specified feeding and eating disorders (OSFEDs), including stress-related eating, food addiction, and orthorexia, in relation to the dietary intake, among nutrition/dietetics students.

Methods

A total of 176 undergraduate students from a Department of Nutrition and Dietetics, in Greece, participated in the study. Dietary intake was recorded, and the prevalence of Eating and Appraisal Due to Emotion and Stress (EADES), food addiction (with the modified Yale Food Addition scale mYFAS), and orthorexia were assessed. Chi-square and t tests were performed between sexes, orthorexic and non-orthorexic students, as well as between food-addicted and non-addicted participants. Multiple linear regression analysis assessed relationships between energy intake, BMI or waist circumference, and the food-related psychometric scales.

Results

Among participating students, 4.5% had food addiction and 68.2% demonstrated orthorexia. No differences were observed between men and women, concerning the prevalence of food addiction and orthorexia, the sum of mYFAS symptoms, or individual EADES factors. Orthorexic students exhibited increased BMI, reduced energy, and saturated fat intake. In addition, orthorexic men consumed more vegetables. Multiple linear regression analysis revealed that orthorexic behavior was associated with increased BMI, waist circumference and energy intake. Lower BMI was associated with increasing ability to cope with emotion-and-stress-related eating and increasing appraisal of ability and resources to cope with emotions and stress. Emotion-and-stress-related eating was negatively associated with BMI. Appraisal of ability and resources to cope with emotions and stress was associated with the energy intake. Finally, age was positively correlated with the appraisal of outside stressors/influences, indicating increased ability to cope with outside stressors among older students.

Conclusions

The study shows that despite the suggested interventions, the problem of OSFEDs among nutrition and dietetics students is still valid. Regular screening, counseling, and education is needed to reduce its prevalence.

Level of evidence

Level V, cross-sectional descriptive study.

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References

  1. Tholking MM, Mellowspring AC, Eberle SG et al (2011) American Dietetic Association: standards of practice and standards of professional performance for registered dietitians (competent, proficient, and expert) in disordered eating and eating disorders (DE and ED). J Am Diet Assoc 111:1242–1249. https://doi.org/10.1016/j.jada.2011.05.021

    Article  PubMed  Google Scholar 

  2. Urquhart CS, Mihalynuk TV (2011) Disordered eating in women: implications for the obesity pandemic. Can J Diet Pract Res 72:e115–e125. https://doi.org/10.3148/72.1.2011.50

    Article  PubMed  Google Scholar 

  3. Lerma-Cabrera JM, Carvajal F, Lopez-Legarrea P (2016) Food addiction as a new piece of the obesity framework. Nutr J 15:5. https://doi.org/10.1186/s12937-016-0124-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Burmeister JM, Hinman N, Koball A, Hoffmann DA, Carels RA (2013) Food addiction in adults seeking weight loss treatment. Implications for psychosocial health and weight loss. Appetite 60:103–110. https://doi.org/10.1016/j.appet.2012.09.013

    Article  PubMed  Google Scholar 

  5. Canan F, Karaca S, Sogucak S, Gecici O, Kuloglu M (2017) Eating disorders and food addiction in men with heroin use disorder: a controlled study. Eat Weight Disord 22:249–257. https://doi.org/10.1007/s40519-017-0378-9

    Article  PubMed  Google Scholar 

  6. Bégin C, St-Louis ME, Turmel S, Tousignant B, Marion LP, Ferland F et al (2012) Does food addiction distinguish a specific subgroup of overweight/obese overeating women? Health 4:1492–1499. https://doi.org/10.4236/health.2012.412A214

    Article  Google Scholar 

  7. Meule A, von Rezori V, Blechert J (2014) Food addiction and bulimia nervosa. Eur Eat Disord Rev 22:331–337. https://doi.org/10.1002/erv.2306

    Article  PubMed  Google Scholar 

  8. Ozier AD, Kendrick OW, Knol LL et al (2007) The Eating and Appraisal Due to Emotions and Stress (EADES) Questionnaire: development and validation. J Am Diet Assoc 107:619–628. https://doi.org/10.1016/j.jada.2007.01.004

    Article  PubMed  Google Scholar 

  9. Satherley RM, Higgs S, Howard R (2017) Disordered eating patterns in coeliac disease: a framework analysis. J Hum Nutr Diet 30:724–736. https://doi.org/10.1111/jhn.12475

    Article  PubMed  Google Scholar 

  10. Drummond D, Hare MS (2012) Dietitians and eating disorders: an international issue. Can J Diet Pract Res 73:86–90. https://doi.org/10.3148/73.2.2012.86

    Article  PubMed  Google Scholar 

  11. Larson BJ (1989) The new epidemic: ethical implications for nutrition educators. J Nutr Educ 21:101–103

    Article  Google Scholar 

  12. Mahn HM, Lordly D (2015) A Review of Eating Disorders and Disordered Eating amongst Nutrition Students and Dietetic Professionals. Can J Diet Pract Res 76:38–43. https://doi.org/10.3148/cjdpr-2014-031

    Article  PubMed  Google Scholar 

  13. Ozenoglu A, Unal G, Ercan A et al (2015) Are nutrition and dietetics students more prone to eating disorders related attitudes and comorbid depression and anxiety than non-dietetics students? Food Nutr Sci 6:1258–1266. https://doi.org/10.4236/fns.2015.614131

    Article  Google Scholar 

  14. Bratman S, Knight D (2000) Health food junkies: Orthorexia nervosa: overcoming the obsession with healthful eating. Broadway, New York

    Google Scholar 

  15. Bo S, Zoccali R, Ponzo V et al (2014) University courses, eating problems and muscle dysmorphia: are there any associations? J Transl Med 12:221. https://doi.org/10.1186/s12967-014-0221-2

    Article  PubMed  PubMed Central  Google Scholar 

  16. Korinth A, Schiess S, Westenhoefer J (2010) Eating behaviour and eating disorders in students of nutrition sciences. Public Health Nutr 13:32–37. https://doi.org/10.1017/S1368980009005709

    Article  PubMed  Google Scholar 

  17. Depa J, Schweizer J, Bekers SK et al (2017) Prevalence and predictors of orthorexia nervosa among German students using the 21-item-DOS. Eat Weight Disord 22:193–199. https://doi.org/10.1007/s40519-016-0334-0

    Article  PubMed  Google Scholar 

  18. Gkiouras K, Mavridis P, Tsakiri V, Theodoridis X, Gerontidis A, Grammatikopoulou MG, Chourdakis M (2018) Evaluation of orthorexia among dietetics students. Clin Nutr ESPEN 24:174–175. https://doi.org/10.1016/j.clnesp.2018.01.031

    Article  PubMed  Google Scholar 

  19. Brytek-Matera A, Donini LM, Krupa M et al (2016) Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students. J Eat Disord 4:16. https://doi.org/10.1186/s40337-015-0038-2

    Article  PubMed  PubMed Central  Google Scholar 

  20. Malmborg J, Bremander A, Olsson MC et al (2017) Health status, physical activity, and orthorexia nervosa: a comparison between exercise science students and business students. Appetite 109:137–143. https://doi.org/10.1016/j.appet.2016.11.028

    Article  PubMed  Google Scholar 

  21. Bağci Bosi AT, Camur D, Güler C (2007) Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey). Appetite 49:661–666

    Article  Google Scholar 

  22. Fidan T, Ertekin V, Işikay S et al (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 

  23. Bundros J, Clifford D, Silliman K et al (2016) Prevalence of Orthorexia nervosa among college students based on Bratman’s test and associated tendencies. Appetite 101:86–94. https://doi.org/10.1016/j.appet.2016.02.144

    Article  PubMed  Google Scholar 

  24. Harris C (2015) Changes in intuitive eating and orthorexia scores among female graduate students in dietetics. J Acad Nutr Diet 115:A30. https://doi.org/10.1016/j.jand.2015.06.100

    Article  Google Scholar 

  25. Garner DM, Garfinkel PE (1979) The eating attitudes test. An index of symptoms of anorexia nervosa. Psychol Med 9:273–279

    Article  CAS  Google Scholar 

  26. Donini LM, Marsili D, Graziani MP et al (2005) Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord 10:28–32

    Article  Google Scholar 

  27. Theodoridis X, Grammatikopoulou MG, Gkiouras K, Papadopoulou SE, Agorastou T, Gkika I, Maraki MI, Dardavessis T, Chourdakis M (2018) Food insecurity and mediterranean diet adherence among Greek university students. Nutr Metab Cardiovasc Dis. https://doi.org/10.1016/j.numecd.2018.02.007

    Article  PubMed  Google Scholar 

  28. Mealha V, Ferreira C, Guerra I, Ravasco P (2013) Students of dietetics and nutrition; a high risk group for eating disorders? Nutr Hosp 28:1558–1566. https://doi.org/10.3305/nh.2013.28.5.6695

    Article  PubMed  Google Scholar 

  29. Crockett SJ, Littrell JM (1985) Comparison of eating patterns between dietetic and other college students. J Nutr Educ Behav 17:47–50

    Article  Google Scholar 

  30. Missbach B, Barthels F (2017) Orthorexia nervosa: moving forward in the field. Eat Weight Disord 22:1. https://doi.org/10.1007/s40519-017-0365-1

    Article  PubMed  Google Scholar 

  31. Flint AJ, Gearhardt AN, Corbin WR et al (2014) Food addiction scale measurement in 2 cohorts of middle-aged and older women. Am J Clin Nutr 99:578–586. https://doi.org/10.3945/ajcn.113.068965

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Meule A, Gearhardt AN (2014) Five years of the Yale Food Addiction Scale: Taking stock and moving forward. Curr Addict Rep 1:193–205. https://doi.org/10.1007/s40429-014-0021-z

    Article  Google Scholar 

  33. Willett WC, Howe GR, Kushi LH (1997) Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr 65(4 Suppl):1220S–1228S; discussion 1229S–1231S

    Article  CAS  Google Scholar 

  34. World Health Organization (WHO) (2010) International statistical classification of diseases and related health problems, 10th revision. World Health Organization, Geneva

    Google Scholar 

  35. World Health Organization (WHO) (2011) Waist circumference and Waist-Hip Ratio, Report of a WHO Expert Consultation. World Health Organization, Geneva

    Google Scholar 

  36. Kuder GF, Richardson MW (1937) The theory of the estimation of test reliability. Psychometrika 2:151–160

    Article  Google Scholar 

  37. Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16:297–334

    Article  Google Scholar 

  38. Luck-Sikorski C, Jung F, Schlosser K, Riedel-Heller SG (2018) Is orthorexic behavior common in the general public? A large representative study in Germany. Eat Weight Disord. https://doi.org/10.1007/s40519-018-0502-5

    Article  PubMed  Google Scholar 

  39. Reinstein N, Koszewski WM, Chamberlin B et al (1992) Prevalence of eating disorders among dietetics students: does nutrition education make a difference? J Am Diet Assoc 92:949–953

    CAS  PubMed  Google Scholar 

  40. Barthels F, Meyer F, Pietrowsky R (2018) Orthorexic and restrained eating behaviour in vegans, vegetarians, and individuals on a diet. Eat Weight Disord 23:159–166. https://doi.org/10.1007/s40519-018-0479-0

    Article  PubMed  Google Scholar 

  41. Yu Z, Tan M (2016) Disordered eating behaviors and food addiction among nutrition major college students. Nutrients 8:673. https://doi.org/10.3390/nu8110673

    Article  PubMed Central  Google Scholar 

  42. Wiss DA, Brewerton TD (2017) Incorporating food addiction into disordered eating: the disordered eating food addiction nutrition guide (DEFANG). Eat Weight Disord 22:49–59. https://doi.org/10.1007/s40519-016-0344-y

    Article  PubMed  Google Scholar 

  43. Hughes R, Desbrow B (2005) Aspiring dietitians study: A pre-enrolment study of students motivations, awareness and expectations relating to careers in nutrition and dietetics. Nutr Diet 62:106–109

    Article  Google Scholar 

  44. Houston CA, Bassler E, Anderson J (2008) Eating disorders among dietetics students: an educator’s dilemma. J Am Diet Assoc 108:722–724

    Article  Google Scholar 

  45. American Dietetic Association (ADA) (1999) Code of ethics for the profession of dietetics. J Am Diet Assoc 99:109–113

    Article  Google Scholar 

  46. Bassler E (2001) Challenging future nutritionists to promote normal eating. Healthy Weight J 15:45–46

    Google Scholar 

  47. Hickson M, Child J, Collinson A (2018) Future Dietitian 2025: informing the development of a workforce strategy for dietetics. J Hum Nutr Diet 31:23–32. https://doi.org/10.1111/jhn.12509

    Article  CAS  PubMed  Google Scholar 

  48. Bacopoulou F, Foskolos E, Stefanaki C, Tsitsami E, Vousoura E (2017) Disordered eating attitudes and emotional/behavioral adjustment in Greek adolescents. Eat Weight Disord. https://doi.org/10.1007/s40519-017-0466-x

    Article  PubMed  Google Scholar 

  49. Tan Ș (2009) Misuses of KR-20 and Cronbach’s Alpha reliability coefficients. Educ Sci 34:101–112

    Google Scholar 

  50. Zinbarg R, Yovel I, Revelle W, McDonald R (2006) Estimating generalizability to a universe of indicators that all have an attribute in common: a comparison of estimators for alpha. Appl Psychol Measur 30:121–144

    Article  Google Scholar 

  51. Lazarevich I, Irigoyen-Camacho ME, Velazquez-Alva Mdel C et al (2015) Psychometric characteristics of the eating and appraisal due to emotions and stress questionnaire and obesity in Mexican university students. Nutr Hosp 31:2437–2444. https://doi.org/10.3305/nh.2015.31.6.8960

    Article  PubMed  Google Scholar 

  52. Van Diepen S, Scholten AM, Korobili C, Kyrli D, Tsigga M, Van Dieijen T, Kotzamanidis C, Grammatikopoulou MG (2011) Greater mediterranean diet adherence is observed in Dutch compared with Greek university students. Nutr Metab Cardiovasc Dis 21:534–540

    Article  Google Scholar 

  53. Bratman S (2017) Orthorexia vs. theories of healthy eating. Eat Weight Disord 22:381. https://doi.org/10.1007/s40519-017-0417-6

    Article  PubMed  Google Scholar 

  54. Moller S, Apputhurai P, Knowles SR (2018) Confirmatory factor analyses of the ORTO 15-, 11- and 9-item scales and recommendations for suggested cut-off scores. Eat Weight Disord. https://doi.org/10.1007/s40519-018-0515-0

    Article  PubMed  Google Scholar 

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Acknowledgements

The research team would like to extend our thanks to the participating dietetics students.

Funding

No funding was secured for the present study.

Author information

Authors and Affiliations

  1. Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Maria G. Grammatikopoulou, Theodore Dardavessis & Michael Chourdakis

  2. Department of Nutrition and Dietetics, Alexander Technological Educational Institute, Thessaloniki, Greece

    Maria G. Grammatikopoulou, Xenophon Theodoridis, Vasiliki Tsakiri & Pantelis Mavridis

  3. Laboratory of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Konstantinos Gkiouras

  4. Department of Nutrition and Dietetics, Technological Educational Institute of Crete, Sitia, Greece

    Anastasia Markaki

  5. Department of Medicine, Faculty of Health Sciences, University of Thessaly, Larisa, Greece

    Xenophon Theodoridis

  6. Department of Psychology, American College of Greece, Athens, Greece

    Vasiliki Tsakiri

Authors
  1. Maria G. Grammatikopoulou
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  2. Konstantinos Gkiouras
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  3. Anastasia Markaki
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  4. Xenophon Theodoridis
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  5. Vasiliki Tsakiri
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  6. Pantelis Mavridis
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  7. Theodore Dardavessis
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  8. Michael Chourdakis
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Corresponding author

Correspondence to Michael Chourdakis.

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The authors declare that they have no conflicts 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.

Informed consent

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

Additional information

This article is part of the topical collection on Orthorexia Nervosa.

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Grammatikopoulou, M.G., Gkiouras, K., Markaki, A. et al. Food addiction, orthorexia, and food-related stress among dietetics students. Eat Weight Disord 23, 459–467 (2018). https://doi.org/10.1007/s40519-018-0514-1

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