Overlap of orthorexia, eating attitude and psychological distress in some Italian and Spanish university students

Abstract

BACKGROUND Orthorexia nervosa (ON) is the persistent concern of maintaining the self-imposed diet to improve one's health. Many factors have been associated to ON in univ-ersity students. AIM To assess the prevalence of ON in Italian and Spanish university students in relation to eating attitude and psychological distress, and the possible overlaps between ON (evaluated with different scored questionnaires from the originally proposed ORTO-15), distress and risk of eating disorders. METHODS This study was carried out on 160 students recruited at La Sapienza University of Rome and at the Catholic University of Murcia. Questionnaires were administered to evaluate ON (ORTO-15 and sub-scores), body concerns (Multidimensional Body-Self Relations Questionnaire, MBSRQ, and Body Uneasiness test, BUT), psychological distress (Kessler Psychological Distress Scale, K10), physical activity (International Physical Activity Questionnaire, IPAQ), eating attitude (Eating Attitudes Test, EAT-26) and malnutrition (Starvation Symptom Inventory, SSI). Sex differences, within the same country, and differences between Italian and Spanish students, within the same sex, were evaluated. RESULTS The ORTO-15 positive subjects, assessed with the originally proposed cut-off, were above 70% in both Italian and Spanish students, with a higher prevalence in the Spanish sample (Italian females 76.3%, Italian males 70.7%; Spanish females 97.0%, Spanish males 96.3%). According to ORTO-7, about 30% of Italian and 48% of Spanish students were positive to ON with no significant sex differences. When excluding students underweight (UW), overweight (OW) or obese (OB), as well as those potentially at risk of eating disorders or presenting mild, moderate and severe distress, in the resultant normal weight (NW)-K10 neg -EAT-26 neg subgroup, we did not find many correlations observed in the whole sample, including those between ORTO scores and BUT, SSI, Total MBSRQ and some of its components. Moreover, ORTO-7 resulted in the only ON score unrelated with Body Mass Index, MBSRQ components and IPAQ-assessed intense activity, in the NW-K10 neg -EAT-26 neg subgroup. After this sort of “exclusion diagnosis”, the prevalence of ON of these students on the overall sample resulted in 16.9%, 12.2%, 15.2% and 25.9% for Italian females, Italian males, Spanish females and Spanish males, respectively. CONCLUSION In some university students ON could be a symptom of other conditions related to body image concerns and distress, as well as to high physical activity and appearance, fitness, health or illness orientation (from MBSRQ). However, ORTO-7 became independent from these confounding variables, after the exclusion of UW, OW, OB and students positive to EAT-26 and K10, suggesting the possibility of identifying orthorexic subjects wit...

Overall proportion of orthorexia nervosa symptoms: A systematic review and meta-analysis including 30 476 individuals from 18 countries

“…In this systematic review and meta-analysis, 34 studies used the <35 cutoff point [ 20 , 29 , 30 , 33 , 37 , 38 , 40 , 41 , 46 , 49 , 55 , 56 , 59 , 60 , 64 - 67 , 69 - 71 , 73 - 77 , 81 - 84 , 88 , 90 , 92 , 93 , 96 ], 64 studies used the <40 cutoff point [ 10 , 20 , 29 - 39 , 42 - 45 , 47 - 54 , 56 - 58 , 61 - 65 , 68 , 70 , 72 - 76 , 78 - 101 ], and 23 studies used both cutoff points [ 20 , 29 , 30 , 33 , 38 , 49 , 56 , 64 , 65 , 70 , 73 - 76 , 81 - 84 , 88 , 90 , 92 , 93 , 96 ]. Based on the <35 cutoff point, all the studies were cross-sectional.…”

“…Two studies did not specify the country since it was performed via social media [ 64 , 92 ]. Two studies were conducted in two countries [ 30 , 69 ].…”

“…The remaining 73 studies were deemed to be at low risk of bias, presenting scores between zero and three points. 19 studies presented three points [ 30 , 31 , 38 - 40 , 42 , 46 , 50 - 52 , 54 , 55 , 57 , 59 , 64 , 67 , 76 , 86 , 90 ]. The main sources of bias were related to the representativeness of the analysed sample [ 10 , 20 , 30 - 52 , 54 - 60 , 63 - 68 , 70 - 76 , 78 - 80 , 82 , 84 - 93 , 95 - 101 ].…”

Progress in research on orthorexia nervosa is still hampered by the use of the ORTO–15 and its modifications

“…Lakritz et al (2022) used the ORTO–15 but did not use the original scoring procedure proposed by Donini et al (2005) but scored items based on the factor analysis reported by Meule et al (2020). These inconsistencies are particularly crucial when studies provide prevalence estimates of ON, which have been found to be unrealistically high and very different across studies that used the ORTO–15 and its derivatives (e.g., Aiello et al, 2022; Bergonzi & Massarollo, 2022; Kujawowicz et al, 2022). Thus, even when using short forms of the ORTO–15 or different scoring procedures leads to better psychometric properties in terms of internal reliability and factorial validity, this does not mean that this leads to an improved, growing knowledge about ON as findings cannot be accumulated across different studies.…”

Progress in research on orthorexia nervosa is still hampered by the use of the ORTO–15 and its modifications

“…Lakritz et al (2022) used the ORTO-15 but did not use the original scoring procedure proposed by Donini et al (2005) but scored items based on the factor analysis reported by Meule et al (2020). These inconsistencies are particularly crucial when studies provide prevalence estimates of ON, which have been found to be unrealistically high and very different across studies that used the ORTO-15 and its derivatives (e.g., Aiello et al, 2022;Bergonzi & Massarollo, 2022;Kujawowicz et al, 2022). Thus, even when using short forms of the ORTO-15 or different scoring procedures leads to better psychometric properties in terms of internal reliability and factorial validity, this does not mean that this leads to an improved, growing knowledge about ON as findings cannot be accumulated across different studies.…”