Validation of the Arabic version of the Teruel Orthorexia Scale (TOS) among Lebanese adolescents

Abstract

Objectives This study aimed at examining the reliability and validity of the Teruel Orthorexia Scale (TOS) among a sample of Lebanese adolescents (15 to 18 years old). Methods This is a cross-sectional study that was conducted between May and June 2020 and had enrolled 555 Lebanese adolescents. To assess the internal structure of the TOS scale, we administered the confirmatory factor analysis based on polychoric correlation matrix using Weighted Least Squares with Means and Variance Adjusted estimation (WLSMV) method in Mplus v 7.2 as suggested in the original validation paper. To assess the degree to which the Lebanese adaptation converges with the original scale, we have conducted the Multigroup Confirmatory Factor Analysis (MGCFA; estimated as CFA) between the data reported in the current paper and from the original validation paper. Results The mean age of the participants was 16.66 ± 1.01 years, with 76.1% females. The bi-dimensional model fitted the data well (χ 2 (118) = 429.09; p < 0.001; CFI = 0.954; RMSEA = 0.069[0.062, 0.076]). The latent factors were highly correlated ( ρ = 0.74; p < 0.001), and the strength of the standardized factor loadings was adequate on both factors (i.e., all > 0.60). The fit indices of the scalar model were at the boundary of the threshold and thus, with some pinch of caution, it might be interpreted as invariant (i.e., having equal item intercepts across groups). We have identified latent mean differences in orthorexia nervosa (0.30; p < 0.001), where Spanish individuals scored higher, but we did not find any differences in the healthy eating (0.03; p = 0.636). Higher DOS scores were significantly correlated with higher scores on the TOS subscale OrNe ( r = 0.715; p < 0.001) as well as with higher scores on the TOS subscale HeOR ( r = 0.754; p < 0.001). Higher ORTO-R scores were significantly associated with less TOS OrNe ( r = − 0.437; p < 0.001) and TOS HeOr ( r = − 0.305; p < 0.001) scores, respectively. Conclusion The Arabic version of the TOS can be considered a reliable valuable instrument to assess the ON tendencies and behaviors in Lebanese adolescents, emphasizing the fine contrast between ON’s two dimensions: healthy vs. pathological. Level V Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Validation of the Arabic version of the ORTO-R among a sample of Lebanese young adults

“…Higher scores are reflective of more ON tendencies. The Arabic version of TOS has been validated in Lebanese adolescents [ 33 ] and adults [ 34 ] (α = 0.91 for the OrNe subscale and α = 0.88 for the HeOr subscale).…”

Association between impulsivity and orthorexia nervosa / healthy orthorexia: any mediating effect of depression, anxiety, and stress?

“…The second part included the Teruel Orthorexia Scale (TOS) [11], a relatively new tool consisting of 17 items rated on a 4-point Likert scale ranging from 0 (completely disagree) to 3 (completely agree). Validated in Lebanon [47,48], this scale yields two subscale scores with related statements: HeOr (e. g., "My interest in healthy food is an important part of the way I am, of how I understand the world") and ON (e.g., "I am concerned about the possibility of eating unhealthy foods"), with higher scores indicating higher orthorexia nervosa/ healthy orthorexia.. Reliability was very good for both subscales (α Cronbach = 0.87).…”

Validation of the Arabic version of the Dusseldorf Orthorexia Scale (DOS) among Lebanese adolescents

“…The Teruel Orthorexia Scale (TOS), validated in Lebanon [ 45 , 46 ], is a 17-item instrument that assesses ON with two separate dimensions [ 23 ]: 9 items for Healthy Orthorexia or “HeOr” (e.g., “I mainly eat foods that I consider healthy”) and 8 items for Orthorexia Nervosa or “OrNe” (e.g., “Thoughts about healthy eating do not let me concentrate on other tasks”). Responses are provided on a four-point Likert-type scale ranging from 0 = strongly disagree to 3 = strongly agree.…”

“…So far, ON is not acknowledged as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) [ 5 ] or in the International Classification of Diseases, Eleventh Revision (ICD-11) [ 6 ]; however, a significant number of patients seek support from healthcare specialists for ON-related impairments [ 7 – 10 ]. Four criteria for ON have been suggested [ 11 – 15 ] and are summarized as follows: (a) obsession and concern for healthy eating, which consists in following a restrictive and 'pure' eating regimen; (b) excessive emotional distress accompanied by emotional state of guilt, shame and/or concern once the restrictive dietary rules followed by the subject have been violated; (c) physical impairments, more particularly nutritious scarcities may result in noteworthy weight loss, malnourishment and/or physical health complications; and (d) psychosocial impairments in social, professional and/or educational functioning.…”