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

Abstract

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.

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Notes

  1. Brytek-Matera et al. [15] refer to the ORTO-15 as the “ORTHO-15” and do not give an explanation as to why. It is possible that this is an issue with translation.

References

  1. Bratman S (1997) The health food eating disorder. Yoga J 42–50

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

    Google Scholar 

  3. Fugh-Berman A (2001) Health food: health food junkies: orthorexia nervosa: overcoming the obsession with healthful eating. JAMA 285:2255–2256. doi:10.1001/jama.285.17.2255-JBK0502-2-1

    Article  Google Scholar 

  4. Dunn TM, Bratman S (2016) On orthorexia nervosa: a review of the literature and proposed diagnostic criteria. Eat Behav 21:11–17. doi:10.1016/j.eatbeh.2015.12.006

    Article  PubMed  Google Scholar 

  5. Donini L, Marsili D, Graziani M, Imbriale M, Cannella C (2004) Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eat Weight Disord ST 9:151–157. doi:10.1007/bf03325060

    CAS  Article  Google Scholar 

  6. 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 56:397–403. doi:10.1016/j.psym.2014.03.003

    Article  PubMed  Google Scholar 

  7. Zamora MLC, Bonaechea BB, Sánchez FG, Rial BR (2005) Orthorexia nervosa. A new eating behavior disorder? Actas Esp Psiquiatr 33:66–68

    Google Scholar 

  8. Park SW, Kim JY, Go GJ, Jeon ES, Pyo HJ, Kwon YJ (2011) Orthorexia nervosa with hyponatremia, subcutaneous emphysema, pneumomediastimum, pneumothorax, and pancytopenia. Electrolyte Blood Press 9:32–37. doi:10.5049/EBP.2011.9.1.32

    Article  PubMed  PubMed Central  Google Scholar 

  9. Saddichha S, Babu GN, Chandra P (2012) Orthorexia nervosa presenting as prodrome of schizophrenia. Schizophr Res 134:110. doi:10.1016/j.schres.2011.10.017

    Article  PubMed  Google Scholar 

  10. Donini L, Marsili D, Graziani M, Imbriale M, Cannella C (2005) Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord ST 10:e28–e32. doi:10.1007/bf03327537

    CAS  Article  Google Scholar 

  11. Ramacciotti C, Perrone P, Coli E, Burgalassi A, Conversano C, Massimetti G et al (2011) Orthorexia nervosa in the general population: a preliminary screening using a self-administered questionnaire (ORTO-15). Eat Weight Disord ST 16:e127–e130. doi:10.1007/bf03325318

    CAS  Article  Google Scholar 

  12. 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 ST 17:226–233. doi:10.3275/8272

    Article  Google Scholar 

  13. Bosi BAT, Çamur D, Güler Ç (2007) Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey). Appetite 49:661–666. doi:10.1016/j.appet.2007.04.007

    Article  Google Scholar 

  14. Alvarenga M, Martins M, Sato K, Vargas S, Philippi S, Scagliusi F (2012) Orthorexia nervosa behavior in a sample of Brazilian dietitians assessed by the Portuguese version of ORTO-15. Eat Weight Disord ST 17:e29–e35

    CAS  Article  Google Scholar 

  15. Brytek-Matera A, Krupa M, Poggiogalle E, Donini LM (2014) Adaptation of the ORTHO-15 test to Polish women and men. Eat Weight Disord ST 19:69–76. doi:10.1007/s40519-014-0100-0

    Article  Google Scholar 

  16. 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 3:1–8. doi:10.1186/s40337-015-0038-2

    Article  Google Scholar 

  17. Arusoğlu G, Kabakci E, Köksal G, Merdol TK (2008) Orthorexia nervosa and adaptation of ORTO-11 into Turkish. Turk Psikiyatri Derg 19:283–291. doi:10.1007/bf03327792

    Article  PubMed  Google Scholar 

  18. Fidan T, Ertekin V, Işikay S, Kırpınar I (2010) Prevalence of orthorexia among medical students in Erzurum, Turkey. Compr Psychiatry 51:49–54. doi:10.1016/j.comppsych.2009.03.001

    Article  PubMed  Google Scholar 

  19. Varga M, Thege BK, Dukay-Szabó S, Túry F, van Furth EF (2014) When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry 14:59–70. doi:10.1186/1471-244X-14-59

    Article  PubMed  PubMed Central  Google Scholar 

  20. Missbach B, Hinterbuchinger B, Dreiseitl V, Zellhofer S, Kurz C, König J (2015) When eating right, is measured wrong! A validation and critical examination of the ORTO-15 Questionnaire in German. PLoS One 10:1–15. doi:10.1371/journal.pone.0135772

    CAS  Article  Google Scholar 

  21. Smink FR, van Hoeken D, Hoek HW (2012) Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 14:406–414

    Article  Google Scholar 

  22. Jerez T, Lagos R, Valdés-Badilla P, Pacheco E, Pérez C (2015) Prevalencia de conducta ortoréxica en estudiantes de educación media de Temuco [Prevalence of orthorexic behaviour in high school students of Temuco]. Rev Chil Nutr 42:41–44. doi:10.4067/S0717-75182015000100005

    Article  Google Scholar 

  23. Spitzer RL, Wakefield JC (1999) DSM-IV diagnostic criterion for clinical significance: does it help solve the false positives problem? Am J Psychiatry 156:1856–1864

    CAS  PubMed  Google Scholar 

  24. Dunn TM, Bratman S (2016) On orthorexia nervosa: a review of the literature and proposed diagnoistic criteria. Eat Behav 21:11–17

    Article  Google Scholar 

  25. Lopes MR, Kirsten VR (2009) Comortamentos de ortorexia nervosa em mulheres jovens [Orthorexia nervosa behaviors in young women]. Disciplinarum Scientia 10:97–105

    Google Scholar 

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Acknowledgments

The authors wish to acknowledge Peter Ray Concepcion for his assistance in data collection.

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Correspondence to Thomas M. Dunn.

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Conflict of interest

The authors disclose that we have no conflicts of interest with this research and are not receiving any consideration with this work.

Ethical approval

Prior to data collection, this study was approved by our university’s institutional review board for the ethical treatment of human participants in research. The project was given “exempt” status.

Informed consent

All participants read informed consent statements. As our study consisted solely of anonymous questionnaires, and a signed consent statement would be the sole way to identify participants, they provided consent by taking the anonymous questionnaire.

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Dunn, T.M., Gibbs, J., Whitney, N. et al. Prevalence of orthorexia nervosa is less than 1 %: data from a US sample. Eat Weight Disord 22, 185–192 (2017). https://doi.org/10.1007/s40519-016-0258-8

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  • DOI: https://doi.org/10.1007/s40519-016-0258-8

Keywords

  • Orthorexia nervosa
  • ORTO-15
  • Eating disorders
  • Pathological healthful eating