To explore the validity and recommend cut-off scores in an English-speaking sample for 9, 11, and 15-item versions of the ORTO measure for orthorexia, a proposed eating disorder characterised by a pathological obsession with consuming only ‘healthy’ foods.
Materials and methods
The sample comprised of 585 participants (82.4% female) who completed an online questionnaire containing the ORTO-15, Eating Attitudes test, Obsessive Compulsive Inventory Revised. A series of Confirmatory Factor Analyses were conducted to test model fit. Binary logistic linear regression and receiver-operating-characteristics (ROC) analyses were used to obtain cut-offs.
Results and conclusion
Results showed that none of the three published versions (9, 11, and 15-item) of the ORTO produced an acceptable model. Subsequent exploratory and confirmatory factor analyses yielded a seven-item version of the ORTO (ORTO-7) with a strong and stable factor structure. Analysis of cut-offs revealed that a cut-off score of equal or greater than 19 on the ORTO-7 represents probable orthorexia.
Level of evidence
Level V, descriptive study.
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Conflict of interest
The authors declare that this research was conducted in the absence of any 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.
Informed consent was obtained from all individual participants included in the study.
This article is part of the topical collection on Orthorexia Nervosa.
Please indicate the degree to which the following items apply to you.
1 = Always
2 = Often
3 = Sometimes
4 = Never
|1. When eating, do you pay attention to the calories of the food?||–––|
|2. In the last 3 months, did the thought of food worry you?||–––|
|3. Are your eating choices conditioned by your worry about your health status?||–––|
|4. Does the thought about food worry you for more than 3 h a day?||–––|
|5. Do you think your mood affects your eating behaviour?||–––|
|6. Do you think that the conviction to eat only healthy foods changes your lifestyle (frequency of eating out, friends, etc?)||–––|
|7. Do you feel guilty when transgressing?||–––|
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Cite this article
Moller, S., Apputhurai, P. & Knowles, S.R. Confirmatory factor analyses of the ORTO 15-, 11- and 9-item scales and recommendations for suggested cut-off scores. Eat Weight Disord 24, 21–28 (2019). https://doi.org/10.1007/s40519-018-0515-0
- Scale validation
- Confirmatory factor analysis
- Disordered eating