Correlates of orthorexia nervosa among a representative sample of the Lebanese population
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Orthorexia nervosa (ON), or the pathological preoccupation and “fixation on healthy food” has been emerging as a new eating disorder. A limited amount of literature exists today on the prevalence of ON. The objective of the current study was to assess factors associated with ON tendencies and behaviors among a representative sample of the Lebanese population.
This was a cross-sectional study, conducted between January and May 2018, which enrolled 811 participants from all Lebanese governorates. The ORTHO-15 scale was used to evaluate ON tendencies and behaviors among participants. Scores below 40 indicate the presence of ON.
The results showed that 589 (75.2%) participants had ON tendencies and behaviors. The results of the multivariable analysis taking the ORTHO-15 score as the dependent variable, showed that female gender (Beta = − 0.739), starving to lose weight (Beta = − 0.859), convincing others to follow a diet (Beta = − 0.971), thinking that eating out is unhealthy (Beta = − 0.931) and increased EAT (eating attitudes test) scores (Beta = − 0.087) were associated with higher level of orthorexia tendencies and behaviors (lower ORTHO-15 scores).
A highly unexpected prevalence of ON tendencies and behaviors was found in our sample. The Lebanese population might have high preoccupation behavior towards healthy and proper nutrition. Social awareness and behavioral intervention programs are warranted to follow a healthy diet and lifestyle behaviors, and consequently overcome ON.
Level of evidence
Level 5, cross-sectional descriptive study.
KeywordsOrthorexia nervosa Healthy food Body image Eating habits Lifestyle habits
Compliance with ethical standards
Conflict of interest
The authors declare no conflicts of interest.
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. The Psychiatric Hospital of the Cross Ethics and Research Committee, in compliance with the Hospital’s Regulatory Research Protocol, approved this study protocol (HPC-020-2018).
Informed consent was obtained from all individual participants included in the study.
- 1.Bratman S, Yoga J (1997) Orthorexia nervosa. Yoga J. http://www.orthorexia.com/index.php?page=essay. Accessed 10 Aug 2018
- 5.Bratman S (2017) Orthorexia vs. theories of healthy eating. vol 22. Springer, New York, 381. https://doi.org/10.1007/s40519-017-0417-6
- 11.Bratman S, Knight D (2000) Health Food Junkies: orthorexia nervosa: overcoming the obsession with healthful eating. Broadway Books, New YorkGoogle Scholar
- 12.Elliott G (2014) Orthorexia. When healthy eating becomes an obsession. GRIN Verlag GmbH, Druck und Bindung: Books on Demand GmbH, NorderstedtGoogle Scholar
- 14.Olejniczak D, Bugajec D, Panczyk M, Brytek-Matera A, Religioni U, Czerw A, Grąbczewska A, Juszczyk G, Jabłkowska-Górecka K, Staniszewska A (2017) Analysis concerning nutritional behaviors in the context of the risk of orthorexia. Neuropsychiatr Dis Treat 13:543. https://doi.org/10.2147/NDT.S129660 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Gramaglia C, Brytek-Matera A, Rogoza R, Zeppegno P (2017) Orthorexia and anorexia nervosa: two distinct phenomena? A cross-cultural comparison of orthorexic behaviours in clinical and non-clinical samples. BMC Psychiatry 17(1):75. https://doi.org/10.1186/s12888-017-1241-2 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Moroze RM, Dunn TM, Holland JC, Yager J, Weintraub P (2015) Microthinking about micronutrients: a case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria. Psychosomatics 56(4):397–403. https://doi.org/10.1016/j.psym.2014.03.003 CrossRefPubMedGoogle Scholar
- 20.ÖZENOĞLU A, ÜNAL G (2016) The effect of self-esteem and incidence of orthorexia nervosa among university students of health education. J Int Res Med Pharm Sci 6(4):173–182Google Scholar
- 29.Bratman S, Knight D (2000) Health food junkies: overcoming the obsession with healthful eating. Broadway Books, Portland, 256Google Scholar
- 33.Garner DM (1991) Eating Disorder Inventory-2: Professional Kit. Psychological Assessment ResourcesGoogle Scholar
- 34.Van Strien T, Frijters JE, Van Staveren WA, Defares PB, Deurenberg P (1986) The predictive validity of the Dutch restrained eating scale. Int J Eat Disord 5(4):747–755. https://doi.org/10.1002/1098-108X(198605)5:4<747::AID-EAT2260050413>3.0.CO;2-6 CrossRefGoogle Scholar
- 35.Rosenberg M (1965) Rosenberg self-esteem scale (RSE). Accept Commit Therapy Meas Package 61:52Google Scholar
- 42.Greeno CG, Marcus MD, Wing RR (1995) Diagnosis of binge eating disorder: discrepancies between a questionnaire and clinical interview. Int J Eat Disord 17(2):153–160. https://doi.org/10.1002/1098-108X(199503)17:2<153::AID-EAT2260170208>3.0.CO;2-V CrossRefPubMedGoogle Scholar
- 43.Arnow B, Kenardy J, Agras WS (1995) The Emotional Eating Scale: the development of a measure to assess coping with negative affect by eating. Int J Eat Disord 18(1):79–90. https://doi.org/10.1002/1098-108X(199507)18:1<79::AID-EAT2260180109>3.0.CO;2-V CrossRefPubMedGoogle Scholar
- 49.Ramacciotti C, Perrone P, Coli E, Burgalassi A, Conversano C, Massimetti G, Dell’Osso L (2011) Orthorexia nervosa in the general population: a preliminary screening using a self-administered questionnaire (ORTO-15). Eat Weight Disord 16(2):e127–e130. https://doi.org/10.1007/BF03325318 CrossRefPubMedGoogle Scholar
- 52.Wellness and health in Lebanon: current status and potential for growth (2018). http://www.executive-magazine.com/special-report/wellness-and-health-in-lebanon-current-status-and-potential-for-growth. Accessed 23 Aug 2018
- 53.Trombetta L (2018) Lebanon-Media Landscape. European Journalism Centre (EJC). Available from: http://www.medialandscapes.org/
- 55.Maatouk KA (2008) Evaluation of obesity-oriented nutrition and lifestyle education tool kit for elementary school children in Lebanon-by Kholoud Ahmad Maatouk. Thesis (MS). American University of Beirut, Department of Nutrition and Food Science. 154.Google Scholar
- 56.Itani MM (2010) Impact of eight lessons intervention on fourth, fifth, and sixth grade students’ nutrition knowledge-by Maya Moustafa Itani. Thesis (MS). American University of Beirut, Dept. of Nutrition and Food ScienceGoogle Scholar
- 57.Arusoğlu G, Kabakçi E, Köksal G, Merdol TK (2008) Orthorexia Nervosa and Adaptation of ORTO-11 into Turkish. Turk J Psychiatry 19(3):283–291Google Scholar
- 60.Lewis DW (2012) Understanding prevalence and attitudes: dietary and exercise behaviors among African American collegiate athletes. Dissertation, University of Alabama LibrariesGoogle Scholar
- 69.Shah SM (2012) Orthorexia nervosa: Healthy eating or eating disorder?:Masters Theses, p 991Google Scholar