Orthorexia nervosa is a concern in gastroenterology: A scoping review

Abstract

There is concern that use of restrictive therapeutic diets, such as those used in disorders of the gut‐brain interaction (DGBI), may increase disordered eating. In this issue of Neurogastroenterology and Motility, Burton Murray et al. and Peters et al. both demonstrate a high prevalence of disordered eating in patients with gastrointestinal conditions, particularly those with DGBI. Given these findings, it is likely that orthorexia is common in this patient group, although this was not directly examined in these studies. Orthorexia nervosa is described as an obsessive and unsafe focus on eating foods perceived as healthy. This mini‐review therefore focuses on orthorexia by conducting a scoping review, as per the PRISMA extension for scoping reviews, aimed to assess the prevalence of orthorexia, and associations between orthorexia and restrictive eating practices. While a wide range of orthorexia prevalence has been reported (0%–97%) across the 57 studies included, no studies assessed prevalence specifically in gastrointestinal conditions. Four of eight studies describing diseases associated with specific dietary patterns suggested that participants who followed a diet for “digestive issues” or “food intolerances” were at higher orthorexia risk. These results suggest that dietary modifications may be a factor contributing to orthorexia. Additionally, we provide a commentary on the clinical implications of the findings for gastrointestinal conditions including a clinical flow chart. Clinicians should consider if a restrictive diet is appropriate for individuals with DGBI and include screening for disordered eating prior to implementation of dietary modifications. Future prospective studies should evaluate orthorexia within this patient group.

The factors associated with orthorexia nervosa in type 2 diabetes and their effect on diabetes self-management scores

“…It is known that patients with T2DM have an increased risk of eating disorders. Although studies are limited, it is reported that the ON is also high in patients with T2DM [ 20 , 29 , 30 ]. We hypothesized that dieting may increase orthorexic behaviours.…”

“…Although there are studies investigating the relationship between eating disorders and T2DM [16][17][18][19], our knowledge about the relationship between ON and T2DM is limited. When the relationship between chronic diseases and the prevalence of ON was examined, it was found that the highest prevalence was seen in T2DM [20] with 65.5% [21]. Despite this reported high prevalence of ON in patients with T2DM, neither the factors affecting ON in these patients nor their effects on diabetes self-management have been studied.…”

Weighing the scales: Taking a balanced approach to diet therapies in pediatric inflammatory bowel disease

“…3,4 Orthorexia nervosa (an ED characterized by an obsessive and unsafe preoccupation with "clean" and healthy eating) is also observed in patients with IBD and irritable bowel syndrome. 5 EDs and DEBs may be underreported due to social desirability bias. 3 Many patients with IBD also adaptively restrict and/or over-restrict their diets due to disease symptoms and existing IBD ED research may overlook this nuance.…”

“…Literature has demonstrated that patients with IBD have an increased risk of body image and eating issues: adolescents with IBD experience body image dissatisfaction (30%), disordered eating (10%), and avoidant restrictive food intake disorder (10%) 3,4 . Orthorexia nervosa (an ED characterized by an obsessive and unsafe preoccupation with “clean” and healthy eating) is also observed in patients with IBD and irritable bowel syndrome 5 . EDs and DEBs may be underreported due to social desirability bias 3 .…”

Special Considerations for the Management of Disorders of Gut-Brain Interaction in Older Adults

“…There is increasing recognition of the importance of screening for and preventing the development of maladaptive dietary restriction in patients with DGBI as patients may develop orthorexia nervosa or avoidant/ restrictive food intake disorder (ARFID) [38]. The prevalence of ARFID in the older adult population has not been studied specifically but prevalence of disordered eating and ARFID ranges between 13 and 55% and 40% respectively in patients with DGBI [39,40].…”