Conceptualisations of health in orthorexia nervosa: a mixed-methods study

Abstract

Purpose Limited research has explored conceptualisations of health and healthy eating in orthorexia nervosa (ON). This mixed-methods study aimed to investigate how ‘health’ and ‘healthy eating’ are conceptualised by individuals at risk for ON. This study examined the potential relationships between health anxiety, beliefs about health controllability and orthorexic symptomatology in our broader sample. Methods A total of 362 participants took a survey on health anxiety (measured with the HAQ), beliefs about the controllability of one’s own health (IMHLC) and ON symptomatology (E-DOS and EHQ). Participants ‘at risk’ for ON (n = 141), also completed an online qualitative survey about conceptualisations of health and healthy eating. Qualitative data were analysed using thematic analysis (part A). The PROCESS macro for SPSS was used for the quantitative analysis (part B). Results Conceptualisations of health and healthy eating were complex. Four themes were generated from our qualitative data: ‘health is more than thin ideals’, ‘healthy food equals healthy mind’, ‘a body that works for you’ and ‘taking control of your body’. Our quantitative analysis revealed that health anxiety and beliefs in health controllability independently predicted ON symptomatology. Conclusion A richer understanding of what health means in the context of ON is important, given the centrality of this concept to the proposed classification of this disordered eating style. Our findings highlight that both health anxiety and health controllability are important targets for future investigation, given their potential relevance to the aetiology and treatment of ON. Level of evidence Level V, based on a descriptive study.

“Your struggles are valid, you are worthy of help and you deserve to recover”: Narratives of recovery from Orthorexia Nervosa

“…Users of #OrthorexiaReocovery were particularly critical of beliefs that were perceived to be rooted in diet culture, for example the idea that there are 'bad' foods that do not t within a healthy and balanced diet, and the belief that food consumption should not be enjoyable. Similar concerning conceptualisations of 'health' have been identi ed in a sample of people at risk of ON, in which respondents emphasised the importance of food being functional rather than enjoyable and described the dangers of 'wrong' foods [5].…”

“…One reason for our nding could be due to the representation of more general eating disorder discussions within this recovery space, as evidenced by the ndings of the hashtag analysis. However, the signi cance of tness and exercise has also been noted in other ON samples [23], in addition to the idealisation of thin and toned bodies [5]. Discussions of exercise may have been so prominent because it is so intimately intertwined with the concept of 'health'.…”

“…In ON, xation is on food quality or purity rather than quantity, with the aim of maximising one's health and wellbeing [2,3]. Despite aiming to boost health, ON has been associated with impairments in wellbeing [4], involving complex and often concerning conceptualisations of what constitutes 'health' and 'healthy eating' [5]. By re ning food consumption to a restricted number of 'clean' or 'healthy' foods, those with ON are at risk of facing adverse outcomes such as malnutrition, signi cant weight loss, psychological distress, and damaged social wellbeing [2,6].…”

“Thin and muscular”: A cross-sectional mixed methods study of people’s descriptions of health.

“…In all four studies, participants described weight status, body shape (e.g., “fat,” “skinny,” or “tone”), and health behaviors. Participants also acknowledged that health is complex, varied, and may look different for everyone (Cullin, 2021; Greville-Harris et al, 2022; Johnson et al, 2013). Additionally, the description of health may differ by sex, with young men focusing less on body shape than young women and more on a state of fitness that is important to engage in physical activities (Wright et al, 2006).…”

“…While self-rated health is frequently assessed as a predictor of mortality and associated with health behaviors (Manderbacka et al, 1999; Schnittker & Bacak, 2014), individual descriptions of health have been less studied. We identified four studies that asked participants to describe health or a healthy body (Cullin, 2021; Greville-Harris et al, 2022; Johnson et al, 2013; Wright et al, 2006). In all four studies, participants described weight status, body shape (e.g., “fat,” “skinny,” or “tone”), and health behaviors.…”