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Optimizing the empirical assessment of orthorexia nervosa through EHQ and clarifying its relationship with BMI

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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Purpose

Orthorexia nervosa (ON) is described as an obsession for healthy eating with potentially debilitating consequences but little of its psychopathology is empirically supported. Using suitable validation methodologies, we wanted to optimize the empirical assessment of ON symptoms and investigate their unclear relationship with BMI. Our objective was, therefore, twofold: (1) Validation of a robust measurement model of ON dimensions using the Eating Habits Questionnaire (EHQ); (2) Validation of a structural model describing a mechanism of relationships between ON dimensions and BMI.

Methods

A self-report questionnaire assessing BMI and ON through a French translation of the 21-item EHQ was administered to a large sample of French adults (N = 2065). We used Exploratory and Confirmatory Factor Analysis for objective no. 1 and Structural Equation Modeling for objective no. 2.

Results

We validated a well-fitted (TLI = 0.98; RMSEA = 0.04) and conceptually consistent measurement model with 16 items for three ON dimensions: Rigid Eating Behavior (REB), Positive Feeling of Control (PFC) and Problems of Attention Control and Social Relationships (PACSR). We also validated a structural model (TLI = 0.96; RMSEA = 0.05) showing that: 1. REB strongly impacts both PFC and PACSR; 2. REB has a significant negative impact on BMI and BMI has a significant positive effect on PACSR but effect sizes are very small and globally ON dimensions are only marginally related to BMI.

Conclusion

Our study achieved an improved assessment method of ON, a clarification of its links with BMI and implications for the descriptive psychopathology of ON.

Level of evidence

V, Descriptive cross-sectional study.

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Notes

  1. This method is specifically designed for factor analysis involving ordinal data. Since our measures were observed on a 4-level Likert scale, Weighted Least Square is a more suitable estimator than classical Maximum Likelihood.

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Acknowledgements

The authors are grateful to Iris Bourguignon, Pauline Martins and Patricia Remblier for their assistance in the EHQ translation and in the data collection process.

Author information

Authors and Affiliations

  1. Inserm, U 1127, CNRS, UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, FRONTlab, 75013, Paris, France

    Valérie Godefroy

  2. Department of Information Systems, Supply Chain and Decisions, NEOMA Business School, 76100, Rouen, France

    Laura Trinchera

  3. Université de Paris, LPPS, 92100, Boulogne-Billancourt, France

    Géraldine Dorard

Authors
  1. Valérie Godefroy
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  2. Laura Trinchera
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  3. Géraldine Dorard
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Contributions

GD designed the research; GD conducted the research; VG and LT analysed the data; VG wrote the paper; GD and VG had primary responsibility for the final content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Valérie Godefroy.

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Conflict of interest

V. Godefroy declares that she has no conflict of interest. L. Trinchera declares that she has no conflict of interest. G. Dorard declares that she has no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments. This study was granted exemption from requiring ethics approval by the Ethics Committee for Research of Paris Descartes University (CER—Paris Descartes) for the following reasons: such clinical research using questionnaires is not obliged by the French law to be submitted to an ethical committee since it does not aim at introducing medical or therapeutic changes in the patient’s care and, in addition, it is without any risk for research participants.

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Informed consent was obtained from all individual participants included in the study.

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Godefroy, V., Trinchera, L. & Dorard, G. Optimizing the empirical assessment of orthorexia nervosa through EHQ and clarifying its relationship with BMI. Eat Weight Disord 26, 649–659 (2021). https://doi.org/10.1007/s40519-020-00909-4

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