When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary Presented by: Lauren Walker, Andrews Dietetic Intern. April 2015 BMC Psychiatry Varga et al 2014

Orthorexia? Biologically Pure Food Obsessive Compulsive Behavior Judgment towards others Orthorexia Nervosa

Varga et al. When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry. 2014, 14:59

Orthorexia Nervosa Proposed obsessive compulsive psychological disorder Indentified within professional, type A personalities. Focused on Quality of food Not necessarily weight driven Anorexia Nervosa obsessive compulsive psychological disorder Indentified within professional, type A personalities. Focused on restricting calories with goal of losing weight

Aim of the Study Contribute Scientific Literature Assesment Validity Clinical Features

Hypothesis Individuals who have a tendency for Orthorexia Nervosa (ON), in addition to making healthier food choices, refuse to use drugs, alcohol, cigarettes, and take more nutritional supplements, engage in more sports activity and have more dietary restrictions that those without a tendency for ON.

Methods Online data collection 810 participants Females and Males Ages 20 to 70 Confirmatory factor analysis

Distribution of Participants

Males vs Females

ORTO multiple choice questions 4-point Likert scale (always, often, sometimes, never) Cognitive rational items Clinical items Emotional items

Lifestyle Sports Activity Dietary Restrictions Caffeine, Alcohol, Drugs Medication Use Supplement Use

Food Choices Daily, weekly, monthly, rarely. Health food stores

ORTO When eating, do you pay attention to the calories of the food? 2. When you go in a food shop do you feel confused? 3. In the last 3 months, did the thought of food worry you? 4. Are your eating choices conditioned by your worry about your health status?

ORTO Is the taste of the food more important than the quality when you evaluate food? 6. Are you willing to spend more money to have healthier food? 7. Does the thought about food worry you for more than three hours a day? 8. Do you allow yourself any eating transgression?

ORTO Do you think your mood affects your eating behavior? 10. Do you think that the conviction to eat only healthy food increases self esteem? 11. Do you think that eating healthy food changes your lifestyle (frequency of eating out, friends….)? 12. Do you think consuming healthy food may improve your appearance?

ORTO Do you feel guilty when transgressing? 14. Do you think that on the market there is also unhealthy food? 15. At present, are you alone when having meals?

Supplemental Orthorexia Questions 1. I consume only healthy foods 2. I always eat according to my eating schedule 3. Sexuality plays an important role in my life 4. Being overweight is a sign of weakness 5. I avoid food with specific colors

Supplemental Orthorexia Questions cont. 6. I disapprove of people who cannot overcome their desires. 7. I think most people can be blamed for their own diseases. 8. I always eat the same meals. 9. I am critical of people who don’t follow the rules of a healthy lifestyle. 10. I spend a large amount of time preparing my meals.

ORTO-11? Poor fit of data with the factor structure Item analysis conducted Omitted Question #5,#6,#8,#14 The lower the score, the higher the tendency for ON

Omitted Questions: 5. Is the taste of the food more important than the quality when you evaluate food? 6. Are you willing to spend more money to have healthier food? 8. Do you allow yourself any eating transgression? 14. Do you think that on the market there is also unhealthy food?

Results ORTO-11 Mean Score: with a standard deviation of 3.15 ORTO-15 Mean Score: with a standard deviation of 3.93 Original cut-off point of 40 yielded 74.2% tendency for ON using ORTO-15

Results No significant sex differences were found on ORTO-11 FemaleMale Mean Score Standard Deviation

Results Significant but weak correlation between orthorexia scores and age. (p<0.01) No significant association concerning body mass index. Participants engaged in sports, dieting and shopping at health food stores showed a higher tendency for ON, as expected.

Results No significant differences in scores with respect to: – Smoking – Caffeine use – Medicine use – Supplement use

Results Participants who encouraged friends and family to follow their healthy diet and lifestyle had ON tendencies. Registered Dietitians Physical Trainers Medical career field

In regards to food choices Frequent ON tendencies: – Whole wheat – Fruit and Vegetable – Strict eating schedule (same food every day, same time) – Specialty food stores

Strengths of the Study Large sample size Diverse population (Age, occupation)

Limitations of the Study Cultural differences Male under-representation No standardized criteria for ON Internet based sampling Self-reported data High cut off point on scale?

Clinical Relevance Inpatient – May be difficult for them to eat “hospital food.” Outpatient – Potential barrier to nutrient dense diet.

The Verdict ORTO-15 shows promise as a screening tool. Further research will be needed.

Questions?