Vegetarian diet and orthorexia nervosa: a review of the literature



The number of individuals following a vegetarian diet has increased in the last 50 years. Although the causal connection between orthorexic behaviors and vegetarianism remains widely assumed, evidence in support of this assumption has been largely inconsistent.


The purpose of the study was to conduct a review of the relationship between vegetarian diet and orthorexic eating behavior and to give future directions in this area.


A search of the literature within PubMed/Medline was conducted. The search terms were “orthorexia”, “orthorexic”, “orthorexia and vegetarian”, “orthorexia and vegan” and “orthorexia and vegetarianism”. Out of 117 journal articles, 14 met the predefined inclusion criteria and were analyzed.


The results demonstrated that following a vegetarian diet was found to be related to orthorexic eating behaviors (in 11 out of 14 studies).


Further longitudinal research is needed to investigate whether following a vegetarian diet serves as a risk factor in the development of orthorexia nervosa.

Level of evidence

Level V, narrative review.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Leahy E, Lyons S, Tol RSJ (2010) An estimate of the number of vegetarians in the world. Papers WP340, Economic and Social Research Institute (ESRI), pp 1–45

  2. 2.

    Allès B, Baudry J, Méjean C, Touvier M, Péneau S, Hercberg S, Kesse-Guyot E (2017) Comparison of sociodemographic and nutritional characteristics between self-reported vegetarians, vegans, and meat-eaters from the NutriNet-Santé Study. Nutrients 9(9):1023.

    CAS  Article  PubMed Central  Google Scholar 

  3. 3.

    McEvoy CT, Temple N, Woodside JV (2012) Vegetarian diets, low-meat diets and health: a review. Public Health Nutr 15:2287–2294.

    Article  PubMed  Google Scholar 

  4. 4.

    The Vegetarian Society (2018) What is a vegetarian? Accessed 30 Apr 2018

  5. 5.

    Phillips F (2005) Vegetarian nutrition. Nutrition Bulletin 30:132–167

    Article  Google Scholar 

  6. 6.

    Le LT, Sabaté J, Singh PN, Jaceldo-Siegl K (2018) The design, development and evaluation of the vegetarian lifestyle index on dietary patterns among vegetarians and non-vegetarians. Nutrients 10:E542.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Heiss S, Coffino JA, Hormes JM (2017) Eating and health behaviors in vegans versus omnivores: dispelling common myths. Appetite 118:129–135.

    Article  PubMed  Google Scholar 

  8. 8.

    Brytek-Matera A, Czepczor-Bernat K, Jurzak H, Kornacka M, Kołodziejczyk N (2018) Strict health-oriented eating patterns (orthorexic eating behaviours) and their connection with a vegetarian and vegan diet. Eat Weight Disord.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Bratman S, Knight D (2000) Health food junkies: overcoming the obsession with healthful eating. Broadway Books, New York, pp 104–118. ISBN 0-7679-0585-7

    Google Scholar 

  10. 10.

    Bratman S (1997) Health food junkie. Yoga J 136:42–50

    Google Scholar 

  11. 11.

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

    Article  PubMed  Google Scholar 

  12. 12.

    Barnes A, Caltabiano ML (2017) The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eat Weight Disord 22(1):177–184.

    Article  PubMed  Google Scholar 

  13. 13.

    Heiss S, Coffino JA, Hormes JM (2019) What does the ORTO-15 measure? Assessing the construct validity of a common orthorexia nervosa questionnaire in a meat avoiding sample. Appetite 135:93–99.

    Article  PubMed  Google Scholar 

  14. 14.

    Luck-Sikorski C, Jung F, Schlosser K, Riedel-Heller SG (2018) Is orthorexic behavior common in the general public? A large representative study in Germany. Eat Weight Disord.

    Article  PubMed  Google Scholar 

  15. 15.

    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 22:185–192.

    Article  PubMed  Google Scholar 

  16. 16.

    Çiçekoğlu P, Tunçay GY (2018) A comparison of eating attitudes between vegans/vegetarians and nonvegans/nonvegetarians in terms of orthorexia nervosa. Arch Psychiatr Nurs 32:200–205.

    Article  PubMed  Google Scholar 

  17. 17.

    Barthels F, Poerschke S, Müller R, Pietrowsky R (2019) Orthorexic eating behavior in vegans is linked to health, not to animal welfare. Eat Weight Disord.

    Article  PubMed  Google Scholar 

  18. 18.

    Dell’Osso L, Abelli M, Carpita B, Massimetti G, Pini S, Rivetti L, Gorrasi F, Tognetti R, Ricca V, Carmassi C (2016) Orthorexia nervosa in a sample of Italian university population. Riv Psichiatr 51(5):190–196.

    Article  PubMed  Google Scholar 

  19. 19.

    Barnett MJ, Dripps WR, Blomquist KK (2016) Organivore or organorexic? Examining the relationship between alternative food network engagement, disordered eating, and special diets. Appetite 1(105):713–720.

    Article  Google Scholar 

  20. 20.

    Bardone-Cone AM, Fitzsimmons-Craft EE, Harney MB, Maldonado CR, Lawson MA, Smith R, Robinson DP (2012) The inter-relationships between vegetarianism and eating disorders among females. J Acad Nutr Diet 112(8):1247–1252.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Timko CA, Hormes JM, Chubski J (2012) Will the real vegetarian please stand up? An investigation of dietary restraint and eating disorder symptoms in vegetarians versus non-vegetarians. Appetite 58(3):982–990.

    Article  PubMed  Google Scholar 

  22. 22.

    Haddad C, Obeid S, Akel M, Honein K, Akiki M, Azar J, Hallit S (2019) Correlates of orthorexia nervosa among a representative sample of the Lebanese population. Eat Weight Disord 24(3):481–493.

    Article  PubMed  Google Scholar 

  23. 23.

    Dittfeld A, Gwizdek K, Jagielski P, Brzęk J, Ziora K (2017) A study on the relationship between orthorexia and vegetarianism using the BOT (Bratman Test for Orthorexia). Psychiatr Pol 51:1133–1144.

    Article  PubMed  Google Scholar 

  24. 24.

    Barthels F, Meyer F, Pietrowsky R (2018) Orthorexic and restrained eating behaviour in vegans, vegetarians, and individuals on a diet. Eat Weight Disord 23:159–166.

    Article  PubMed  Google Scholar 

  25. 25.

    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:e0135772.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Valera JH, Ruiz PA, Valdespino BR, Visioli F (2014) Prevalence of orthorexia nervosa among ashtanga yoga practitioners: a pilot study. Eat Weight Disord 19:469–472.

    Article  Google Scholar 

  27. 27.

    Dell’Osso L, Carpita B, Muti D, Cremone IM, Massimetti G, Diadema E, Gesi C, Carmassi C (2018) Prevalence and characteristics of orthorexia nervosa in a sample of university students in Italy. Eat Weight Disord 23(1):55–65.

    Article  PubMed  Google Scholar 

  28. 28.

    Turner PG, Lefevre CE (2017) Instagram use is linked to increased symptoms of orthorexia nervosa. Eat Weight Disord 22(2):277–284.

    Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Chard CA, Hilzendegen C, Barthels F, Stroebele-Benschop N (2018) Psychometric evaluation of the English version of the Düsseldorf Orthorexie Scale (DOS) and the prevalence of orthorexia nervosa among a US student sample. Eat Weight Disord.

    Article  PubMed  Google Scholar 

  30. 30.

    Singer JD, Willett JB (2003) Applied longitudinal data analysis—modeling change and event occurrence. Oxford University Press, New York

    Google Scholar 

  31. 31.

    Lim LS, Pullenayegum E, Moineddin R, Gladman DD, Silverman ED, Feldman BM (2017) Methods for analyzing observational longitudinal prognosis studies for rheumatic diseases: a review and worked example using a clinic-based cohort of juvenile dermatomyositis patients. Pediatr Rheumatol Online J 15(1):18.

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C (2005) Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord 10:28–32.

    Article  Google Scholar 

  33. 33.

    Rogoza R (2019) Investigating the structure of ORTO-15: a meta-analytical simulation study. Eat Weight Disord 24(2):363–365.

    Article  PubMed  Google Scholar 

  34. 34.

    Gleaves DH, Graham EC, Ambwani S (2013) Measuring, “orthorexia:” development of the Eating Habits Questionnaire. Int J Educ Psychol Assess 12:1–18

    Google Scholar 

  35. 35.

    Barthels F, Meyer F, Pietrowsky R (2015) Die Düsseldorfer Orthorexie Skala-Konstruktion und Evaluation eines Fragebogens zur Erfassung ortho-rektischen Ernährungsverhaltens. Z Klin Psychol Psychother 44(2):97–105.

    Article  Google Scholar 

  36. 36.

    Barrada JR, Roncero M (2018) Bidimensional structure of the orthorexia: development and initial validation of a new instrument. An Psicol 34(2):283–291.

    Article  Google Scholar 

  37. 37.

    Sizochenko N, Gajewicz A, Leszczynski J, Puzyn T (2016) Causation or only correlation? Application of causal inference graphs for evaluating causality in nano-QSAR models. Nanoscale 8(13):7203–7208.

    CAS  Article  PubMed  Google Scholar 

  38. 38.

    Valente M, Syurina EV, Donini LM (2019) Shedding light upon various tools to assess orthorexia nervosa: a critical literature review with a systematic search. Eat Weight Disord 24(4):671–682.

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Depa J, Barrada JR, Roncero M (2019) Are the motives for food choices different in orthorexia nervosa and healthy orthorexia? Nutrients 11(3):697.

    Article  PubMed Central  Google Scholar 

  40. 40.

    Barthels F, Barrada JR, Roncero M (2019) Orthorexia nervosa and healthy orthorexia as new eating styles. PLoS One 14(7):e0219609.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

Download references


The preparation of this paper was supported by the National Science Centre (NCN), Poland, Grant number 2017/01/X/HS6/00007.

Author information



Corresponding author

Correspondence to Anna Brytek-Matera.

Ethics declarations

Conflict of interest

No conflict of interest to declare.

Ethical approval

Ethical approval was not required because the paper was a literature review.

Informed consent

Not applicable.

Additional information

Publisher's Note

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.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Brytek-Matera, A. Vegetarian diet and orthorexia nervosa: a review of the literature. Eat Weight Disord 26, 1–11 (2021).

Download citation


  • Orthorexia nervosa
  • Vegetarian diet
  • Vegan diet
  • Eating behaviors