The Barcelona Orthorexia Scale (BOS): development process using the Delphi method

  • Stefan M. Bauer
  • Adela Fusté
  • Ana Andrés
  • Carmina SaldañaEmail author
Original Article
Part of the following topical collections:
  1. Orthorexia Nervosa



Orthorexia nervosa is a currently investigated eating disorder proposed by US physician Steve Bratman, defined as pathological fixation on eating healthy food. This study aimed to develop, by consensus of experts, the basic items for a new questionnaire to evaluate some defining psychological features of orthorexia nervosa in English and Spanish language, the so-called Barcelona Orthorexia Scale (BOS).


The initial item pool was composed of 105 items divided into six different content areas. To analyse the content of the items, a three-round Delphi study was developed, in which participants had to evaluate the representativeness and clarity of each item. Participants were chosen because of their knowledge on orthorexia and/or eating disorders.


58 experts, from 17 different countries, participated in the initial round and 30 in the last round. Items were added, rephrased, changed into another content area, modified or eliminated according to the participants’ suggestions, partly due to the group’s response, analysed statistically, and partly due to participants’ recommendations.


64 items were obtained, with two versions in Spanish and English. The future BOS aims to provide a possible solution to the shortage of valid instruments to evaluate psychological features of orthorexia and to promote research on this field. Further analysis regarding validity and reliability is necessary to prove the BOS’ value on this matter.


Orthorexia Delphi Expert consensus Content validity BOS 



We would like to thank all the experts participating in this study. Participants appear in alphabetical order (only those who agreed to publish their name): Aksoydan, E. (Turkey); Alvarenga, M. (Brasil); Barthels, F. (Germany); Bratman, S. (USA); Brytek-Matera, A. (Poland); Burnell, J. (USA); Canalda, G. (Spain); Cerniglia Utiu, L. (Italy); Clifford, D. (USA); Díaz-Tendero, D. (Chile); Duarte, C. (Portugal); Fidan, T. (Turkey); Flores Robaina, N. E. (Spain); García Dantas, A. (Spain); Håman, L. (Sweden); Herrin, M. (USA); Kachani, A. (Brasil); Lagos Hernandez, R. I. (Chile); López Medina, Mª. D. (Spain); Meule, (A) (Austria); Murawski, (B) M. (Argentina); Pérez, (C) (Chile); Ruiz, I. (Spain); Sánchez Carracedo, (D) (Spain); Setnick, J. (USA); Shin, J. (Republic of Korea); Ströbele-Benschop, N. (Germany); Torres, I. (Spain); Trujano, P. (México.) We apologize to all the experts who were not invited, having desired to participate in the study if they had known it. We had knowledge of them when already had finished the first round or the study had ended.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this kind of study, formal consent is not required.

Supplementary material

40519_2018_556_MOESM1_ESM.pdf (555 kb)
Supplementary material 1 (PDF 555 KB)


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Clinical Psychology and PsychobiologyUniversitat de BarcelonaBarcelonaSpain
  2. 2.Faculty of Psychology, Education Sciences and Sport BlanquernaUniversitat Ramon LlullBarcelonaSpain
  3. 3.Institut de NeurociènciesUniversitat de BarcelonaBarcelonaSpain

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