Breast cancer is one of the most important health problems faced by women. No study was found in the world literature about the eating behavior of women with breast cancer. Therefore, the aim of this study was to determine whether breast cancer patients and healthy controls differ in their orthorexia nervosa levels and to determine any factors that affect orthorexia nervosa (socio-demographic variables and nutritional habits).
The data were collected using a face-to-face interview technique between May 2018 and March 2019 at outpatient clinics and a family health center in Turkey. The data of the study were collected using personal information form and the Orthorexia Nervosa Scale (ORTO-15). A linear regression analysis was performed to investigate the effects of socio-demographic variables and nutritional habits of women on the risk of orthorexia nervosa.
Breast cancer patients had significantly lower ORTO-15 scores (i.e., a higher orthorexia risk) than the healthy controls. For the cancer patients, a regression analysis revealed that ORTO-15 scores were significantly associated with education level, organic food consumption status, receipt of social support for care, and presence of a chronic disease other than cancer. In the healthy controls, body mass index and education level were the primary predictors of ORTO-15 scores.
The higher orthorexia risk of cancer patients has implications for these patients that could be improved through nutritional counseling.
Level of Evidence: III, case-control study.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
American Cancer Society. Breast cancer facts & figures 2017–2018. Atlanta: American Cancer Society, Inc.2017. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-andstatistics/breast-cancer-facts-andfigures/breast-cancer-facts-and-figures-2017-2018. pdf. Accessed 20 Sept 2018
National Cancer Institute (NCI). Research on Causes of Cancer, 2015. Available from https://www.cancer.gov/research/areas/causes Accessed 20 Sept 2018
World Health Organization (WHO). Cancer, 2018. http://www.who.int/news room/fact-sheets/detail/cancer. Accessed 20 Sept 2018
Cecchini RS, Costantino JP, Cauley JA et al (2012) Body mass index and the risk for developing invasive breast cancer among high-risk women in NSABP P-1 and STAR breast cancer prevention trials. Cancer Prev Res 5:583–592. https://doi.org/10.1158/1940-6207.CAPR-11-0482
Cancer Research UK. Definite breast cancer risks. N.D. Available from http://cancerhelp.cancerresearchuk.org/type/breast-cancer/about/risks/definite-breast-cancer-risks#weight. Accessed 5 July 2019
World Cancer Research Fund and American Institute for Cancer Research. Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective. Washington DC 2007. Available from: http://www.dietandcancerreport.org/cancer_resource_center/downloads/chapters/chapter_12.pdf. Accessed 5 July 2019
Sauter ER (2018) Breast cancer prevention: current approaches and future directions. Eur J Breast Health 14(2):64–71. https://doi.org/10.5152/ejbh.2018.3978
Grunfield EA, Ramirez AJ, Hunter MS, Richards MA (2002) Women’s knowledge and beliefs regarding breast cancer. Br J Cancer 86:1373–1378. https://doi.org/10.1038/sj.bjc.6600260
Ünsar S, Yıldız FÜ, Kurt S et al (2007) Home care and symptom control in cancer patients. Fırat Health Servi J 2(5):89–106
Piamjariyakul U, Williams PD, Prapakorn S et al (2010) Cancer therapy-related symptoms and self-care in Thailand. Eur J Oncol Nurs 14(5):387–394. https://doi.org/10.1016/j.ejon.2010.01.018
Gürsu RU, Kesmezacar Ö, Karaçetin D, Mermut Ö, Ökten B, Güner Şİ (2012) Istanbul research and training hospital oncology division: 18-month results of a newly formed unit. Istanb Med J 13(1):13–18. https://doi.org/10.5505/1304.8503.2012.55264j.eatbeh.2012.02.003
Demir Ç, Onat H (2011) Nutrition in a patient with cancer-I. In: Mandel NM, Onat H (eds) Approach to cancer patients: diagnosis, treatment, follow-up problems. 2. Nobel Medical Bookstore, Istanbul, pp 489–503
Quick VM, McWilliams R, Byrd-Bredbenner C (2012) Case–control study of disturbed eating behaviors and related psychographic characteristics in young adults with and without diet-related chronic health conditions. Eat Behav 13:207–213. https://doi.org/10.1016/j.eatbeh.2012.02.003
Grilo C (2006) Eating and weight disorders. Psychology Press, New York
Panjari M, Bell RJ, Davis SR (2011) Sexual function after breast cancer. J Sex Med 8:294–302. https://doi.org/10.1111/j.1743-6109.2010-02034.x
Wright CE, Harvie M, Howell A, Evans DG, Hulbert-Williams N, Donnelly LS (2015) Beliefs about weight and breast cancer: an interview study with high risk women following a 12 month weight loss intervention. Hered Cancer Clin Pract 13:1. https://doi.org/10.1186/s13053-014-0023-9
Oberguggenberger A, Meraner V, Sztankay M et al (2018) Health behavior and quality of life outcome in breast cancer survivors: prevalence rates and predictors. Clin Breast Cancer 18(1):38–44. https://doi.org/10.1016/j.clbc.2017.09.008
Fidan T, Ertekin V, Işıkay S, Kırkpınar I (2015) Prevelance of orthorexia among medical students in Erzurum Turkey. Compr Psychiatry 51(1):49–54. https://doi.org/10.1016/j.comppsych.2009.03.001
Chaki B, Pal S, Bandyopadhyay A (2013) Exploring scientific legitimacy of orthorexa nervosa: a newly emerging eating disorder. J Hum Sport Exerc (JHSE) 8:1045–1053. https://doi.org/10.4100/jhse.2013.84.14
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 28:14–59. https://doi.org/10.1186/1471-244X-14-59
Cena H, Barthels F, Cuzzolaro M et al (2019) Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature. Eat Weight Disord 24(2):209–246. https://doi.org/10.1007/S40519-018-0606-y
Dunn TM, Bratman S (2016) On orthorexia nervosa: a review of the literature and proposed diagnostic criteria. Eat Behav 21(11–17):70. https://doi.org/10.1016/j.eatbeh.2015.12.006
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub
Dunn TM, Gibbs J, Whitney N, Starosta A (2017) Prevalence of orthorexia nervosa is less than 1%: data from a US sample. Eat Weight Disord 22(1):185–192. https://doi.org/10.1007/s40519-016-0258-8
Rock CL, McEligot AJ, Flatt SW et al (2000) Eating pathology and obesity in women at risk for breast cancer recurrence. Int J Eat Disord 27:172–179. https://doi.org/10.1002/(SICI)1098-108X(200003)27:2%3CI172
Rock CL, Demark-Wahnefried W (2002) Nutrition and survival after the diagnosis of breast cancer: a review of the evidence. J Clin Oncol 20:3302–3316. https://doi.org/10.1200/JCO.2002.03.008
Cade JE, Burley VJ, Greenwood DC (2007) Dietary fibre and risk of breast cancer in the UK women’s cohort study. Int J Epidemiol 36:431–438. https://doi.org/10.1093/ije/dy1295
Blanchard CM, Denniston MM, Baker F et al (2003) Do adults change their lifestyle behaviors after a cancer diagnosis? Am J Health Behav 27(3):246–256. https://doi.org/10.5993/AJHB.27.3.6
Satia JA, Campbell MK, Galanko JA, James A, Carr C, Sandler RS (2004) Longitudinal changes in lifestyle behaviors and health status in colon cancer survivors. Cancer Epidemiol Biomark Prev 13(6):1022–1031 (http://cebp.aacrjournals.org/content/13/6/1022)
Donini LM, Marsilli D, Graziani MP, Imbriale M, Canella C (2005) Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord 10(2):e28–e32. https://doi.org/10.1007/BF03327537
Bratman S, Knight D (2000) Health food junkies: overcoming the obsession with healthful eating. Broadway Books, New York
Arusoğlu G, Kabakçi E, Köksal G, Merdol TK (2008) Orthorexia nervosa and adaptation of ORTO-11 into Turkish. Turk J Psychiatry 19:283–291
Atalay NG, Kızıltan G (2015) Determination of the relationship between orthorexia nervosa, eating behavior disorders in adult type 1 diabetic individuals under carbohydrate counting diet and biochemical and anthropometric measurements. Başkent University, Health Sciences Institute, Department of Nutrition and Dietetics. Doctoral Thesis, 2015. Ankara
Donini LM, Marsili D, Graziani MP, 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 9(2):151–157. https://doi.org/10.1007/BF03325060
French SA, Perry CL, Leon GR, Fulkerson JA (1994) Food preferences, eating patterns, and physical activity among adolescents: correlates of eating disorders symptoms. J Adolesc Health 15:286–294. https://doi.org/10.1016/1054-139X(94)90601-7
Rabin C, Pinto B (2006) Cancer-related beliefs and health behavior change among breast cancer survivors and their first-degree relatives. Psychooncology 15:701–712. https://doi.org/10.1002/pon.1000
Thomson CA, Thompson PA (2009) Dietary patterns, risk and prognosis of breast cancer. Future Oncol 5:1257–1269. https://doi.org/10.2217/fon.09.86
Ramacciotti CE, Perrone P, Coli E et al (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
Aksoydan E, Camci N (2009) Prevalence of orthorexia nervosa among Turkish performance artists. Eat Weight Disord 14(1):33–37. https://doi.org/10.1007/BF03327792
McInerney-Ernst E M. Orthorexia nervosa: real construct or newest social trend? USA: ProQuest Information & Learning; 2012. Available from http://hdl.handle.net/10355/11200. Accessed 20 Sept 2018
Karakus B, Hidiroglu S, Keskin N, Karavus M (2017) Orthorexia nervosa tendency among students of the Department of Nutrition and Dietetics at a university in Istanbul. North Clin Istanb 4(2):117–123. https://doi.org/10.14744/nci.2017.20082
Bağcı Bosi AT, Çamur D, Güler C (2007) Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey). Appetite 49(3):661–666. https://doi.org/10.1016/j.appet.2007.04.007
Şahin D (1999) Support And Health. Edt., Okyayuz UH Health Psychology, 1st edn. Social Turkish Psychological Association Publications, Ankara, pp 79–106
Gülcivan G, Topçu B (2017) Quality of lıfe with breast cancer patıents and evaluatıon of healthy life behaviors. Namık Kemal Med J 5(2):63–74
Ansa B, Wonsuk Yoo W, Whitehead M, Coughlin S, Smith S (2016) Beliefs and behaviors about breast cancer recurrence risk reduction among African American breast cancer survivors. Int J Environ Res Public Health 13(46):2–11. https://doi.org/10.3390/ijerph13010046
Arslantaş H, Adana F, Öğüt S, Ayakdaş D, Korkmaz A (2017) Relationship between eating behaviors of nursing students and orthorexia nervosa (obsession with healthy eating): a cross-sectional study. J Psychiatr Nurs 8(3):137–144. https://doi.org/10.14744/phd.2016.36854
Oberguggenberger A, Meraner V, Sztankay M et al (2018) Health behavior and quality of life outcome in breast cancer survivors: prevalence rates and predictors. Clin Breast Cancer 18(1):38–44. https://doi.org/10.1016/j.clbcc2017c09.008
Hossein SA, Bahrami M, Mohamadirizi S, Paknaad Z (2015) Investigation of eating disorders in cancer patients and its relevance with body image. Iran J Nurs Midwifery Res 20:327–333. https://doi.org/10.4103/1735-9066.256650
Rabin C, Pinto B (2006) Cancer-related beliefs and health behavior change among breast cancer survivors and their first-degree relatives. Psycho-oncology 15(8):701–712. https://doi.org/10.1002/pon.1000
Lin A, Finch L, Stump T, Hoffman S, Spring B (2019) Cancer prevention beliefs and diet behaviors among females diagnosed with obesity-related cancers (FS13-06-19). Curr Dev Nutr. https://doi.org/10.1093/cdn/nzz030.FS13-06-19
Gezer C, Kabaran S (2013) The risk of orthorexia nervosa for female students studying nutrition and dietetics. SDU J Health Sci Inst 4(1):14–22
We would like to thank all the patients who participated voluntarily in this study conducted at the Medical Center the patients for the support showed research conducted.
Conflict of interest
No conflict of interest was declared by the authors.
This study, written permission was obtained from Health Sciences Scientific Research and Publication Ethics Committee (2018-21/15).
Informed consent was obtained from all the individual participants before they were included in this study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of topical collection on Orthorexia Nervosa.
About this article
Cite this article
Aslan, H., Aktürk, Ü. Demographic characteristics, nutritional behaviors, and orthorexic tendencies of women with breast cancer: a case–control study. Eat Weight Disord 25, 1365–1375 (2020). https://doi.org/10.1007/s40519-019-00772-y
- Eating disorders
- Orthorexia nervosa
- Breast Cancer