Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity
Orthorexia nervosa in a sample of Portuguese ﬁtness participants
· Vânia Vieira Borba
· Lèlita Santos
Received: 27 December 2017 / Accepted: 14 May 2018
© Springer International Publishing AG, part of Springer Nature 2018
Purpose Orthorexia Nervosa (ON) is described as an obsessive behaviour motivated by great concern for following a healthy
diet. Although it was ﬁrst described in 1997, ON remains inconspicuous and poorly characterized in the literature. The aims
of this study were to evaluate the prevalence of ON in a sample of ambulatory individuals and to investigate their common
characteristics, attempting to better characterize this entity.
Methods A non-random sample of 193 adult gym members answered a questionnaire based on a Portuguese version of
ORTO-15, supplemented with additional questions. Possible associations between the diﬀerent variables and pathological
scores on ORTO-15 were analysed using logistic regression models.
Results ON behaviour was documented in 51.8% of the sample, mean age 30.96 years (± 1.03 years), and this condition
tended to be correlated with younger ages. Physical appearance and frequent exercising were also associated with ON, while
no correlation between orthorexic tendencies and both gender and educational ﬁeld was found. Furthermore, consumption of
special food, dissatisfaction with physical appearance and frequent exercising could predict the presence of ON in the sample.
Conclusions Despite the use of a convenience sample, results place us in a diﬀerent perspective, considering the idea that
orthorexic individuals are exclusively concerned about pursuing a pure diet. The presence of ON was associated with other
non-dietary behaviours allied to a healthy lifestyle and aesthetic concerns.
Level of evidence Level V: Descriptive study.
Keywords Orthorexia nervosa · ORTO-15 · Eating disorders · Lifestyle · Physical appearance · Exercise
The term “Orthorexia Nervosa” (ON) has been used to
describe an observed eating behaviour disorder, since it was
ﬁrst described by Bratman in 1997 . Originally deﬁned
as a “pathological obsession with eating healthy foods”, ON
may also include an obsessive focus on the perceived quality
of foods, e.g., those with only “pure” ingredients, result-
ing in food restriction, potential micro- and macro-nutrient
deﬁciency, and possible harmful long-term consequences [2,
3]. Some literature also includes an extreme concern with
physical activity or exercise in pursuit of health as a poten-
tial indicator of ON .
Although no consensus criteria exist for ON, it is gen-
erally diﬀerentiated from non-pathological, healthy eating
practices by the existence of obsessive thoughts, compulsive
behaviours, and negative physical, psychological and social
impact . Because ON is not listed in the Diagnostic and
Statistical Manual of Mental Disorders, 5th Edition (DSM-
5), individuals exhibiting these symptoms may be diagnosed
with avoidant/restrictive food intake disorder (ARFID), ano-
rexia nervosa (AN), obsessive–compulsive disorder (OCD),
or unspeciﬁed feeding or eating disorder (UFED) . The
lack of ON-speciﬁc diagnostic criteria and the correspond-
ing scarcity of investigative literature regarding incidence,
prevalence and symptomatology of ON hinders our under-
standing of this condition, as well as possible methods of
identiﬁcation, treatment and prevention.
The ﬁrst sample diagnostic criteria for ON were pre-
sented by Setnick (2013) in a self-published work , with
the goal of helping professionals to identify ON as separate
This article is part of topical collection on Orthorexia Nervosa.
* Carolina Almeida
Faculty of Medicine, University of Coimbra, Coimbra,
Internal Medicine A Department, Centro Hospitalar e
Universitário de Coimbra, Coimbra, Portugal