Is orthorexic behavior common in the general public? A large representative study in Germany
Orthorexia is described as a strict, health-oriented eating pattern with clinically significant impairment in everyday life. Its prevalence varied widely in previous studies due to heterogenous assessment procedures. Determinants for the eating pattern and its prevalence have not been investigated in larger representative studies.
A population-based telephone survey in Germany was conducted in n = 1007 participants. The Dusseldorf Orthorexia Scale with a cut-off of 30 was used to assess orthorexic behavior. Determinants of orthorexia, including personal BMI, depressive symptoms Patient Health Questionnaire and socio-demographic variables were analyzed in multivariate regression.
The prevalence of orthorexic behavior was 6.9%. A higher rate of orthorexic behavior was observed in heavier, less educated, vegetarian and more depressed participants; in multivariate analysis only associations to lower educational attainment, a vegetarian diet and depressive symptoms remained. No gender or age differences were observed.
The study results show that orthorexic behavior may indeed by associated with significant strain and psychological distress. Current debates on the criteria of clinical significance of orthorexic behavior call for new instruments and further investigations, to elicit the prevalence of people with orthorexic behavior that classifies as a pathological eating disorder.
Level of evidence
Level V: descriptive study.
KeywordsOrthorexia Depression Prevalence Representative study Obesity
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict 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 board of Ethics at the Medical faculty (University of Leipzig, IORG0001320 and IRB00001750) approved the study protocol.
Informed consent was obtained from all individual participants included in the study.
- 1.Bratman S, Knight D (2000) Health food junkies: overcoming the obsession with healthful eating, 1st edn. Broadway Books, New YorkGoogle Scholar
- 14.Barthels F, Meyer F, Pietrowsky R (2015) Die Düsseldorfer Orthorexie Skala–Konstruktion und Evaluation eines Fragebogens zur Erfassung ortho-rektischen Ernährungsverhaltens. Zeitschrift für Klinische Psychologie Psychotherapie 44(2):97–105. https://doi.org/10.1026/1616-3443/a000310 CrossRefGoogle Scholar
- 15.World Health Organization (2000) Obesity. Preventing and managing the global epidcemic. WHO Technical Report Series 894Google Scholar
- 16.Spitzer RL, Kroenke K, Williams JB (1999) Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Quest JAMA 282(18):1737–1744Google Scholar
- 17.Barthels F (2014) [Orthorexia nervosa. Psychological studies on a new type of disorder]. https://docserv.uni-duesseldorf.de/servlets/DerivateServlet/Derivate-32606/Barthels_Friederike_Dissertation.pdf. Accessed 21 Sep 2017
- 18.StataCorp (2013) Stata statistical software: release 13Google Scholar
- 19.Federal Statistical Office (2017) Society and State. https://www.destatis.de/EN/FactsFigures/SocietyState/SocietyState.html. Accessed 20 Sep 2017
- 20.Barthels F, Meyer F, Pietrowsky R (2015) Orthorexic eating behavior—a new type of disordered eating. Ernahrungs Umschau 62(10):156–161Google Scholar
- 33.Dell’Osso L, Abelli M, Carpita B et al (2016) Historical evolution of the concept of anorexia nervosa and relationships with orthorexia nervosa, autism, and obsessive-compulsive spectrum. Neuropsychiatr Dis Treat 12:1651–1660. https://doi.org/10.2147/NDT.S108912 CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Gramaglia C, Brytek-Matera A, Rogoza R et al (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