Orthorexia Nervosa: Prevalence and Associated Factors in Individuals Attending a Diet Outpatient Clinic: A Cross-Sectional Study

Orthorexia Nervosa: Prevalence and Associated Factors in Individuals Attending a Diet Outpatient Clinic: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Orthorexia Nervosa: Prevalence and Associated Factors in Individuals Attending a Diet Outpatient Clinic: A Cross-Sectional Study Fatma Ebru Atabay, Duygu Altin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6428857/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Orthorexia nervosa (ON) is characterized by an excessive preoccupation with consuming healthy foods, which may lead to dietary restrictions, psychological distress, and social isolation. Despite its increasing recognition, ON is not yet formally classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and its prevalence among individuals seeking dietary guidance remains underexplored. This study aims to evaluate the prevalence of ON and its associated factors among individuals attending a diet outpatient clinic. Methods: A cross-sectional study was conducted at the Yalova Governmental Hospital Outpatient Diet Polyclinic. A total of 265 participants were recruited using a convenience sampling method. Data were collected through a socio-demographic questionnaire and the ORTO-15 Scale, a validated tool for assessing ON tendencies. Statistical analyses were performed using SPSS 22.0, with chi-square tests and ANOVA applied to examine relationships between ON and Body Mass Index (BMI). A p-value < 0.05 was considered statistically significant. Results: The prevalence of ON among participants was 17%, exceeding the rates reported in the general population. No significant relationship was found between BMI and ON tendencies (p = 0.27), supporting previous research suggesting that ON is more concerned with food quality than body image. Demographic analysis revealed that ON prevalence was higher among females and those with higher educational attainment. Participants relied primarily on mass media and dietitians for nutritional information, indicating potential influences on dietary behaviors. Conclusions: This study highlights a high prevalence of ON among individuals seeking dietary counseling, underscoring the need for increased awareness and specific diagnostic criteria for ON. The absence of a correlation between BMI and ON supports the distinction of ON from other eating disorders like anorexia nervosa and bulimia nervosa. Multidisciplinary interventions involving dietitians, psychologists, and medical professionals are recommended to provide comprehensive care. Future research should explore longitudinal patterns of ON and assess the effectiveness of treatment modalities. Orthorexia Nervosa Eating Disorders Healthy Eating Obsession Dietary Behavior Body Mass Index (BMI) ORTO-15 Scale Plain English Summary Orthorexia nervosa (ON) is an unhealthy obsession with eating only "pure" or "healthy" foods. Unlike other eating disorders such as anorexia or bulimia, which focus on body weight and shape, ON is mainly about the quality of food. People with ON often avoid many foods they see as "unhealthy," which can lead to extreme dietary restrictions, anxiety, and social isolation. This study looked at 265 people attending a diet outpatient clinic to understand how common ON is and whether it is linked to body weight. The results showed that 17% of participants had ON, which is much higher than in the general population. However, there was no link between ON and Body Mass Index (BMI), meaning that ON is not necessarily connected to weight but rather to strict food choices. Since ON is not officially recognized as an eating disorder, it can be hard to diagnose and treat. This study highlights the need for more awareness among healthcare professionals and better guidelines to help those affected. Future research should explore why ON develops and how to create balanced, healthy eating habits without obsession. Introduction Orthorexia nervosa (ON) is a relatively recent concept that has garnered attention in both scientific communities and the general public. Defined as an excessive preoccupation with consuming healthy foods, ON differs significantly from other well-known eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN). While AN and BN are included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), ON has yet to be formally recognized ( 1 ). This emerging disorder is characterized by an obsession with the quality of food rather than the quantity, which is the primary concern in AN and BN ( 1 , 2 ). The term "orthorexia" was first coined by Steven Bratman in 1997. Derived from the Greek word "ortho," meaning "correct" or "true," the term was intended to describe a pathological fixation on healthy eating. Bratman's initial work on ON received widespread international attention, prompting further research and the publication of his book "Health Food Junkies" ( 3 ). Despite this growing interest, ON remains under-researched compared to AN and BN, with no established diagnostic criteria in the DSM. Individuals with ON are consumed by the desire to eat foods they consider pure, natural, and healthy. This obsession often leads to rigid dietary restrictions, social isolation, and psychological distress. Unlike AN and BN, where the focus is on the amount of food consumed, ON patients are fixated on the quality, content, and perceived health benefits of their food ( 4 ). Research on ON has primarily focused on specific populations, with varying results( 5 ), such as university students ( 6 , 7 , 8 ), adolescents ( 9 , 10 ), individuals involved in sports ( 11 ), dietitians ( 12 , 13 ) and dietetics students ( 12 , 14 , 15 ). Studies have found varying prevalence rates of ON in these groups, often higher than those in the general population. However, there is a significant gap in research on ON among individuals who seek dietary advice in clinical settings, such as diet outpatient clinics. This study aims to fill this gap by evaluating the prevalence of ON and associated factors, such as Body Mass Index (BMI), in patients attending a diet outpatient clinic. Methods Study Design and Setting This cross-sectional study was conducted at the Yalova Governmental Hospital Outpatient Diet Polyclinic. The study aimed to evaluate the prevalence of orthorexia nervosa (ON) and associated factors such as Body Mass Index (BMI) among individuals attending the clinic. Sample Size The sample size was calculated using Epi Info software, which determined a sample size of 265 participants to achieve a 95% confidence interval. Participants were selected using a convenience sampling method from patients attending the outpatient clinic. Data Collection : Data were collected using two primary tools: Socio-Demographic Form This questionnaire, prepared by the researchers, gathered basic socio-demographic information (e.g., age, gender, marital status, education level) and health-related variables (e.g., BMI, presence of diagnosed diseases, medication use). ORTO-15 Scale The ORTO-15 scale, developed by Donini et al. in 2004, is a diagnostic tool for ON that includes 15 items rated on a 4-point Likert scale (never, sometimes, often, always) ( 16 ). Higher scores indicate more orthorexic behavior. The Turkish reliability and validity of the scale were confirmed by Arusoğlu with a Cronbach's alpha of 0.44 and a cut-off score of 33 ( 17 ). Statistical Analysis Data analysis was performed using SPSS software version 22.0. Continuous variables were expressed as means and standard deviations, while categorical variables were expressed as frequencies and percentages. The Chi-square test was used to evaluate the relationships between categorical variables. An ANOVA test was performed to examine the relationship between orthorexic tendencies (as measured by ORTO-15 scores) and BMI. Statistical significance was set at p < 0.05. Results The demographic characteristics of the participants are presented in Table 1 . The sample consisted of 265 individuals, with a higher proportion of female participants (61.9%) compared to males (38.1%). Regarding marital status, more than half of the participants (57.4%) were married, while 38.1% were single and 4.5% were divorced. In terms of educational background, the majority of participants (58.9%) held a university degree, followed by those with a high school education (26.8%). A smaller percentage of participants had completed only primary school (12.1%), while very few had obtained a master's degree (1.1%) or a PhD (0.4%). The occupational distribution of the sample revealed that the largest group consisted of students (23.8%), followed closely by housewives (20.4%). Retired individuals made up 7.9% of the sample, while civil servants and teachers accounted for 4.9% and 2.3%, respectively. Table 1 Socio-Demographic Characteristics Characteristic N % Gender Female 164 61.9 Male 101 38.1 Marital Status Married 152 57.4 Single 101 38.1 Divorced 12 4.5 Educational Status PhD 2 0.4 Master’s Degree 3 1.1 University Degree 156 58.9 High School 71 26.8 Primary School 32 12.1 Job Housewife 54 20.4 Student 63 23.8 Retired 21 7.9 Civil Servant 13 4.9 Teacher 6 2.3 The health-related characteristics of the participants are summarized in Table 2 . Among the participants, 46.8% reported having a diagnosed disease, while the majority (52.6%) indicated that they did not have any diagnosed medical conditions. Regarding medication use, 41.5% of the participants reported taking regular medication, whereas 58.5% did not use any medications on a regular basis. Similarly, adherence to diet treatment was relatively low, with only 35.1% of participants following a prescribed dietary regimen, while 64.9% reported not adhering to any specific dietary treatment. The use of vitamin supplements showed variability among participants. A significant proportion (44.2%) reported regularly taking vitamin supplements, while 34.0% stated that they did not use them at all. Additionally, 21.8% of participants reported taking vitamin supplements occasionally. Table 2 Health Status Health Status N % Diagnosed Disease Yes 124 46.8 No 141 52.6 Regular Medication Yes 110 41.5 No 155 58.5 Regular Diet Treatment Yes 93 35.1 No 172 64.9 Vitamin Supplements Yes 117 44.2 No 90 34.0 Sometimes 58 21.8 The distribution of sources from which participants obtain health-related information is presented in Table 3 . The most frequently reported source was mass media, including newspapers, magazines, television, and the internet, with 69.8% of participants relying on these platforms for health information. Dietitians also played a significant role in providing health-related guidance, with 63.4% of participants reporting them as an information source. Doctors were another commonly consulted source, with 45.7% of participants obtaining health information from medical professionals. In contrast, books, articles, and other written materials were used by a smaller proportion of participants (15.8%), indicating a lower preference for traditional academic sources. Health clubs, such as weight loss centers, were cited by 23.0% of participants, while information from personal social circles, including family and friends, was utilized by 27.5%. Additionally, 14.3% of participants reported obtaining health information from other sources not specified in the survey. Table 3 Access to Nutritional Information Source N % Mass Media (newspaper, magazine, TV, internet) 185 69.8 Books, articles, etc. 42 15.8 Dietitian 168 63.4 Doctor 121 45.7 Health Clubs (Weight loss centers, etc.) 61 23.0 Environment (family, friends, etc.) 73 27.5 Other 38 14.3 Prevalence of Orthorexia Nervosa The prevalence of ON among the participants was found to be 17%, with 45 out of 265 participants scoring above the cut-off value of 33 on the ORTO-15 scale. Relationship Between ON and BMI An ANOVA test was performed to examine the relationship between orthorexic tendencies and BMI. The results indicated that BMI did not significantly affect orthorexic tendencies, as measured by the ORTO-15 scores. This finding is consistent with previous research both in Turkey and internationally, suggesting that ON is more concerned with the quality of food rather than body image ( 10 ) (Table − 4). Table 4 ANOVA Test Results for the Relationship Between ON and BMI Source of Variation Sum of Squares df Mean Square F p-value Between Groups 432.25 1 432.25 1.23 0.27 Within Groups 92645.67 263 352.41 Total 93077.92 264 Discussion The findings of this study reveal that the prevalence of orthorexia nervosa (ON) among individuals attending a diet outpatient clinic is notably higher than that in the general population. Specifically, 17% of the participants in this study were identified as having ON, a figure that surpasses the prevalence rates reported in other studies, which range from 3.0–6.9% ( 16 , 18 , 19 , 20 ). This discrepancy underscores the importance of considering ON in clinical settings, particularly among individuals actively seeking dietary guidance. One significant finding of this study is the lack of a significant relationship between BMI and orthorexic tendencies, as indicated by the ANOVA results. This aligns with previous research both in Turkey ( 8 , 17 ) and internationally ( 16 , 21 , 22 ), which also did not find a significant correlation between BMI and ON. This finding is particularly interesting as it suggests that ON is more concerned with the perceived quality of food rather than body image, which is a primary concern in AN and BN ( 14 , 23 ). Consequently, individuals with ON may not exhibit the same physical symptoms typically associated with other eating disorders, making it more challenging to identify and diagnose. The high prevalence of ON observed in this study highlights the need for increased awareness and specialized treatment approaches. Currently, ON is not formally recognized in the DSM, which limits the ability of healthcare professionals to diagnose and treat it effectively. The development of specific diagnostic criteria and treatment protocols is essential to address this growing issue. Multidisciplinary approaches involving dietitians, psychologists, and medical doctors are recommended to provide comprehensive care for individuals with ON ( 17 , 24 , 25 ). Additionally, educational interventions aimed at promoting healthy eating habits without obsessiveness could be beneficial in preventing ON. One of the limitations of this study is the potential influence of confounding variables, such as gender, even though the literature presents mixed findings on these aspect ( 26 ). Another limitation is the lack of longitudinal data on the characteristics of ON, which has also been highlighted as a limitation in previous studies ( 27 ). Further research is necessary to explore the underlying psychological and social factors contributing to ON. Understanding these factors can help develop targeted interventions to reduce the prevalence and impact of ON. Given the higher prevalence rates observed in clinical settings, future studies should also examine the effectiveness of different treatment modalities in managing ON. Conclusions This study underscores the importance of recognizing orthorexia nervosa as a distinct and significant eating disorder. The findings indicate a high prevalence of ON among individuals seeking dietary advice, highlighting the need for specific diagnostic criteria and multidisciplinary treatment approaches. Addressing ON through education, awareness, and comprehensive care can improve the quality of life for affected individuals and reduce the burden of this emerging disorder. Abbreviations AN Anorexia nervosa BN Bulimia nervosa ON Orthorexia nervosa DSM Diagnostic and Statistical Manual of Mental Disorders Declarations Author contributions D.A. was involved in conceptualisation, methodology, software, formal analysis, investigation, data curation, writing original draft, writing—review and editing, supervision. F.E.A. was involved in methodology, software, formal analysis, data curation, writing original draft, writing—review and editing. Funding No funding was received to assist with the preparation of this manuscript. Availability of data and materials The datasets generated and analysed during the current study are not publicly available under the participant confidentiality conditions of ethics approval from the Yalova Governmental Hospital Ethics Committee. Declarations Ethics approval and consent to participate This study received approval from the Yalova Governmental Hospital Ethics Committee. Participants provided written and verbal consent. Consent for publication Consent for publication has been obtained. Competing interests The authors declare no competing interests. Author details 1 Yalova Governmental Hospital, Yalova, Turkey 2 Department of Psychology University of Amsterdam, Amsterdam, the Netherlands References Håman L, Barker-Ruchti N, Patriksson G, Lindgren EC. Orthorexia nervosa: An integrative literature review of a lifestyle syndrome. Int J Qual Stud Health Well-being. 2015;10:26799. doi: 10.3402/qhw.v10.26799 . PMID: 26282866; PMCID: PMC4539385. Varga M, Thege BK, Dukay-Szabó S, Túry F, van Furth EV. When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry. 2014;14:59. Bratman S. Health Food Junkies. 1997. McComb SE, Mills JS. Orthorexia nervosa: A review of psychosocial risk factors. Appetite. 2019;140:50–75. Niedzielski A, Kaźmierczak-Wojtaś N. Prevalence of Orthorexia Nervosa and Its Diagnostic Tools-A Literature Review. Int J Environ Res Public Health. 2021;18(10):5488. doi: 10.3390/ijerph18105488 . PMID: 34065506; PMCID: PMC8160773. Parra-Fernández M, Onieva-Zafra M, Fernández-Martínez E, Abreu-Sánchez A, Fernández-Muñoz JJ. Assessing the Prevalence of Orthorexia Nervosa in a Sample of University Students Using Two Different Self-Report Measures. Int J Environ Res Public Health. 2019;16:2459. Pehlivan E, Mete B, Fırıncı B, Doğan E. Üniversite Öğrencilerinde Ortoreksiya Nervoza Yayginliği Ve Sağlik Okuryazarliği İle İlişkisi. Estüdam Halk Sağlığı Dergisi. 2019;4(2):166–75. Oğur S. and A. Aksoy, “Üniversite Öğrencilerinde Ortoreksiya Nervoza Eğiliminin Belirlenmesi”, Bitlis Eren Üniversitesi Fen Bilimleri Dergisi, vol. 4, no. 2, 2015, doi: 10.17798/beufen.95626 . Uzdil Z, Kayacan, AG, Özyildirim, C, Kaya S, Kilinç GE, Asal Ulus C., … Sökülmez Kaya P. Adölesanlarda Ortoreksiya Nervoza Varliği Ve Yeme Tutumunun İncelenmesi. Samsun Sağlık Bilimleri Dergisi. 2019;4(1): 8–13. Łucka I, Domarecki P, Janikowska-Hołoweńko D, Plenikowska-Ślusarz T, Domarecka M. The prevalence and risk factors of orthorexia nervosa among school-age youth of Pomeranian and Warmian-Masurian voivodeships. Psychiatr Pol. 2019;53(2):383–398. Baysal I, Kızıltan G. Spor Yapan Bireylerin Ortoreksiya Nervoza Eğilimleri ile Beslenme Durumları Arasındaki İlişkinin Belirlenmesi. Başkent Üniversitesi Sağlık Bilimleri Fakültesi Dergisi. 2020; 5(3):204–214. Abdullah M, Al Hourani HM, Alkhatib BM. Prevalence of orthorexia nervosa among nutrition students and nutritionists: Pilot study. Clin Nutr ESPEN. 2020;40:144–148. Alvarenga MS, Martins MC, Sato KS, Vargas SV, Philippi ST, & Scagliusi FB. Orthorexia nervosa behavior in a sample of Brazilian dietitians assessed by the Portuguese version of ORTO-15. Eating and weight disorders: EWD.2012; 17(1), e29–e35. https://doi.org/10.1007/BF03325325 Garipoğlu G. Arslan M, Andaç Öztürk S. Beslenme ve Diyetetik Bölümü’nde Okuyan Kız Öğrencilerin Ortoreksiya Nervoza Eğilimlerinin Belirlenmesi. İstanbul Sabahattin Zaim Üniversitesi Fen Bilimleri Enstitüsü Dergisi.2019; 1(3), 23–27. Arusoğlu G. Beslenme ve Diyetetik Bölümü Erkek Öğrencilerinde Ortoreksiya Nervoza Eğiliminin Belirlenmesi. The Journal of Academic Social Science. 2018; 56–71. Doi: 10.16992/Asos.14457 Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C. Orthorexia nervosa: A preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eat Weight Disord. 2004; 9(2):151–157. Arusoglu G, Kabakci E, Koksal G, Merdol, TK. Orthorexia nervosa and adaptation of ORTO-11 into Turkish. Turk. Psikiyatr. Derg. 2008; 19, 283–291 Strahler J, Hermann A, Walter B, Stark R. Orthorexia nervosa: A behavioral complex or a psychological condition? J. Behav. Addict. 2018: 7, 1143–1156. Dunn TM, Gibbs J, Whitney N, Starosta AJ. Prevalence of orthorexia nervosa is less than 1%: data from a US sample. Eat Weight Disord. 2017;22:185–192. Barthels, F.; Meyer, F.; Pietrowsky, R. Düesseldorf orthorexia scale–construction and evaluation of a questionnaire measuring orthorexic eating behavior. Z. Klin. Psychol. Psychother. 2015, 44, 97–105. Brytek-Matera A, Sacre H, Staniszewska A, Hallit S. The Prevalence of Orthorexia Nervosa in Polish and Lebanese Adults and Its Relationship with Sociodemographic Variables and BMI Ranges: A Cross-Cultural Perspective. Nutrients. 2020;12(12):3865. Published 2020 Dec 17. doi: 10.3390/nu1212386516 . Ferreira C, Coimbra M. To further understand orthorexia nervosa: DOS validity for the Portuguese population and its relationship with psychological indicators, sex, BMI and dietary pattern. Eat Weight Disord. 2020;26:2127–2134. Saraswati P, Nagendraswamy C. Orthorexia Nervosa: A Review. Int J Psychiatr Nurs. 2015;1:64–67. Koven NS, Abry AW. The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatr Dis Treat. 2015;11:385 – 94. doi: 10.2147/NDT.S61665. PMID: 25733839; PMCID: PMC4340368. Douma ER, Valente M, Syurina EV. Developmental pathway of orthorexia nervosa: Factors contributing to progression from healthy eating to excessive preoccupation with healthy eating. Experiences of Dutch health professionals. Appetite. 2021;158:105008. doi: 10.1016/j.appet.2020.105008 Lupi M, Carano A, Carlucci M, et al. Prevalence of Orthorexia Nervosa in a sample of italian young adults. Clin Ter. 2024;175(2):125–127. doi: 10.7417/CT.2024.5044 Novara C, Maggio E, Piasentin S, Pardini S, Mattioli S. Orthorexia Nervosa: differences between clinical and non-clinical samples. BMC Psychiatry. 2021;21(1):341. doi: 10.1186/s12888-021-03348-2 . PMID: 34238282; PMCID: PMC8265101.20. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6428857","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":449190206,"identity":"439ca9fb-2a32-4c11-8153-cfb424d0c63c","order_by":0,"name":"Fatma Ebru Atabay","email":"","orcid":"","institution":"Yalova Governmental Hospital","correspondingAuthor":false,"prefix":"","firstName":"Fatma","middleName":"Ebru","lastName":"Atabay","suffix":""},{"id":449190207,"identity":"5c0b9a1e-b691-446b-a6bb-935bc5c96030","order_by":1,"name":"Duygu Altin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAq0lEQVRIie3PoQ7CMBCA4SNNmGnmZ+AVjvBCkCVMLamcxGH2APAW3RtccqKmDzCBaEKC7gMgKMwgTyLuV3fiy7UAmvaPEawIEDbL5mQEiBD2y4ZiAnA8i0lNJnF2987PbTJOQhpaY3nYs/fzCc1VQrD8vRDufSQ0Vkaq/CEdxpClxH6vHDCMwisNW0cReXcLo2MRqcNlSsOLtzVX08MOAgLmZyYJ0DRN0wS9AaG8PIzV+qinAAAAAElFTkSuQmCC","orcid":"","institution":"University of Amsterdam","correspondingAuthor":true,"prefix":"","firstName":"Duygu","middleName":"","lastName":"Altin","suffix":""}],"badges":[],"createdAt":"2025-04-11 13:38:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6428857/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6428857/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85043917,"identity":"7debc21e-0f54-4203-a47e-f81005d9656d","added_by":"auto","created_at":"2025-06-20 09:54:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":732592,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6428857/v1/b62ce7de-d4ee-4dea-9885-33316065c06f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Orthorexia Nervosa: Prevalence and Associated Factors in Individuals Attending a Diet Outpatient Clinic: A Cross-Sectional Study","fulltext":[{"header":"Plain English Summary","content":"\u003cp\u003eOrthorexia nervosa (ON) is an unhealthy obsession with eating only \u0026quot;pure\u0026quot; or \u0026quot;healthy\u0026quot; foods. Unlike other eating disorders such as anorexia or bulimia, which focus on body weight and shape, ON is mainly about the quality of food. People with ON often avoid many foods they see as \u0026quot;unhealthy,\u0026quot; which can lead to extreme dietary restrictions, anxiety, and social isolation.\u003c/p\u003e\n\u003cp\u003eThis study looked at 265 people attending a diet outpatient clinic to understand how common ON is and whether it is linked to body weight. The results showed that 17% of participants had ON, which is much higher than in the general population. However, there was no link between ON and Body Mass Index (BMI), meaning that ON is not necessarily connected to weight but rather to strict food choices.\u003c/p\u003e\n\u003cp\u003eSince ON is not officially recognized as an eating disorder, it can be hard to diagnose and treat. This study highlights the need for more awareness among healthcare professionals and better guidelines to help those affected. Future research should explore why ON develops and how to create balanced, healthy eating habits without obsession.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eOrthorexia nervosa (ON) is a relatively recent concept that has garnered attention in both scientific communities and the general public. Defined as an excessive preoccupation with consuming healthy foods, ON differs significantly from other well-known eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN). While AN and BN are included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), ON has yet to be formally recognized (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This emerging disorder is characterized by an obsession with the quality of food rather than the quantity, which is the primary concern in AN and BN (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe term \"orthorexia\" was first coined by Steven Bratman in 1997. Derived from the Greek word \"ortho,\" meaning \"correct\" or \"true,\" the term was intended to describe a pathological fixation on healthy eating. Bratman's initial work on ON received widespread international attention, prompting further research and the publication of his book \"Health Food Junkies\" (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Despite this growing interest, ON remains under-researched compared to AN and BN, with no established diagnostic criteria in the DSM.\u003c/p\u003e \u003cp\u003eIndividuals with ON are consumed by the desire to eat foods they consider pure, natural, and healthy. This obsession often leads to rigid dietary restrictions, social isolation, and psychological distress. Unlike AN and BN, where the focus is on the amount of food consumed, ON patients are fixated on the quality, content, and perceived health benefits of their food (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eResearch on ON has primarily focused on specific populations, with varying results(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), such as university students (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), adolescents (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), individuals involved in sports (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), dietitians (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) and dietetics students (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Studies have found varying prevalence rates of ON in these groups, often higher than those in the general population. However, there is a significant gap in research on ON among individuals who seek dietary advice in clinical settings, such as diet outpatient clinics. This study aims to fill this gap by evaluating the prevalence of ON and associated factors, such as Body Mass Index (BMI), in patients attending a diet outpatient clinic.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e \u003cp\u003eThis cross-sectional study was conducted at the Yalova Governmental Hospital Outpatient Diet Polyclinic. The study aimed to evaluate the prevalence of orthorexia nervosa (ON) and associated factors such as Body Mass Index (BMI) among individuals attending the clinic.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSample Size\u003c/strong\u003e \u003cp\u003eThe sample size was calculated using Epi Info software, which determined a sample size of 265 participants to achieve a 95% confidence interval. Participants were selected using a convenience sampling method from patients attending the outpatient clinic.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003eData Collection\u003c/b\u003e:\u003c/h2\u003e \u003cp\u003eData were collected using two primary tools:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSocio-Demographic Form\u003c/strong\u003e \u003cp\u003eThis questionnaire, prepared by the researchers, gathered basic socio-demographic information (e.g., age, gender, marital status, education level) and health-related variables (e.g., BMI, presence of diagnosed diseases, medication use).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eORTO-15 Scale\u003c/strong\u003e \u003cp\u003eThe ORTO-15 scale, developed by Donini et al. in 2004, is a diagnostic tool for ON that includes 15 items rated on a 4-point Likert scale (never, sometimes, often, always) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Higher scores indicate more orthorexic behavior. The Turkish reliability and validity of the scale were confirmed by Arusoğlu with a Cronbach's alpha of 0.44 and a cut-off score of 33 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStatistical Analysis\u003c/strong\u003e \u003cp\u003eData analysis was performed using SPSS software version 22.0. Continuous variables were expressed as means and standard deviations, while categorical variables were expressed as frequencies and percentages. The Chi-square test was used to evaluate the relationships between categorical variables. An ANOVA test was performed to examine the relationship between orthorexic tendencies (as measured by ORTO-15 scores) and BMI. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe demographic characteristics of the participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The sample consisted of 265 individuals, with a higher proportion of female participants (61.9%) compared to males (38.1%). Regarding marital status, more than half of the participants (57.4%) were married, while 38.1% were single and 4.5% were divorced. In terms of educational background, the majority of participants (58.9%) held a university degree, followed by those with a high school education (26.8%). A smaller percentage of participants had completed only primary school (12.1%), while very few had obtained a master's degree (1.1%) or a PhD (0.4%). The occupational distribution of the sample revealed that the largest group consisted of students (23.8%), followed closely by housewives (20.4%). Retired individuals made up 7.9% of the sample, while civil servants and teachers accounted for 4.9% and 2.3%, respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-Demographic Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaster\u0026rsquo;s Degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity Degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eJob\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCivil Servant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeacher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe health-related characteristics of the participants are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Among the participants, 46.8% reported having a diagnosed disease, while the majority (52.6%) indicated that they did not have any diagnosed medical conditions. Regarding medication use, 41.5% of the participants reported taking regular medication, whereas 58.5% did not use any medications on a regular basis. Similarly, adherence to diet treatment was relatively low, with only 35.1% of participants following a prescribed dietary regimen, while 64.9% reported not adhering to any specific dietary treatment. The use of vitamin supplements showed variability among participants. A significant proportion (44.2%) reported regularly taking vitamin supplements, while 34.0% stated that they did not use them at all. Additionally, 21.8% of participants reported taking vitamin supplements occasionally.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHealth Status\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth Status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosed Disease\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRegular Medication\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRegular Diet Treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVitamin Supplements\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe distribution of sources from which participants obtain health-related information is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The most frequently reported source was mass media, including newspapers, magazines, television, and the internet, with 69.8% of participants relying on these platforms for health information. Dietitians also played a significant role in providing health-related guidance, with 63.4% of participants reporting them as an information source. Doctors were another commonly consulted source, with 45.7% of participants obtaining health information from medical professionals. In contrast, books, articles, and other written materials were used by a smaller proportion of participants (15.8%), indicating a lower preference for traditional academic sources. Health clubs, such as weight loss centers, were cited by 23.0% of participants, while information from personal social circles, including family and friends, was utilized by 27.5%. Additionally, 14.3% of participants reported obtaining health information from other sources not specified in the survey.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAccess to Nutritional Information\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSource\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMass Media (newspaper, magazine, TV, internet)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBooks, articles, etc.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDietitian\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDoctor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth Clubs (Weight loss centers, etc.)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEnvironment (family, friends, etc.)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePrevalence of Orthorexia Nervosa\u003c/b\u003e The prevalence of ON among the participants was found to be 17%, with 45 out of 265 participants scoring above the cut-off value of 33 on the ORTO-15 scale.\u003c/p\u003e \u003cp\u003e \u003cb\u003eRelationship Between ON and BMI\u003c/b\u003e An ANOVA test was performed to examine the relationship between orthorexic tendencies and BMI. The results indicated that BMI did not significantly affect orthorexic tendencies, as measured by the ORTO-15 scores. This finding is consistent with previous research both in Turkey and internationally, suggesting that ON is more concerned with the quality of food rather than body image (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) (Table \u0026minus;\u0026thinsp;4).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eANOVA Test Results for the Relationship Between ON and BMI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSource of Variation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSum of Squares\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean Square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBetween Groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e432.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e432.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWithin Groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92645.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e352.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e93077.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study reveal that the prevalence of orthorexia nervosa (ON) among individuals attending a diet outpatient clinic is notably higher than that in the general population. Specifically, 17% of the participants in this study were identified as having ON, a figure that surpasses the prevalence rates reported in other studies, which range from 3.0\u0026ndash;6.9% (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This discrepancy underscores the importance of considering ON in clinical settings, particularly among individuals actively seeking dietary guidance.\u003c/p\u003e \u003cp\u003eOne significant finding of this study is the lack of a significant relationship between BMI and orthorexic tendencies, as indicated by the ANOVA results. This aligns with previous research both in Turkey (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) and internationally (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), which also did not find a significant correlation between BMI and ON. This finding is particularly interesting as it suggests that ON is more concerned with the perceived quality of food rather than body image, which is a primary concern in AN and BN (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Consequently, individuals with ON may not exhibit the same physical symptoms typically associated with other eating disorders, making it more challenging to identify and diagnose.\u003c/p\u003e \u003cp\u003eThe high prevalence of ON observed in this study highlights the need for increased awareness and specialized treatment approaches. Currently, ON is not formally recognized in the DSM, which limits the ability of healthcare professionals to diagnose and treat it effectively. The development of specific diagnostic criteria and treatment protocols is essential to address this growing issue. Multidisciplinary approaches involving dietitians, psychologists, and medical doctors are recommended to provide comprehensive care for individuals with ON (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Additionally, educational interventions aimed at promoting healthy eating habits without obsessiveness could be beneficial in preventing ON.\u003c/p\u003e \u003cp\u003eOne of the limitations of this study is the potential influence of confounding variables, such as gender, even though the literature presents mixed findings on these aspect (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Another limitation is the lack of longitudinal data on the characteristics of ON, which has also been highlighted as a limitation in previous studies (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Further research is necessary to explore the underlying psychological and social factors contributing to ON. Understanding these factors can help develop targeted interventions to reduce the prevalence and impact of ON. Given the higher prevalence rates observed in clinical settings, future studies should also examine the effectiveness of different treatment modalities in managing ON.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study underscores the importance of recognizing orthorexia nervosa as a distinct and significant eating disorder. The findings indicate a high prevalence of ON among individuals seeking dietary advice, highlighting the need for specific diagnostic criteria and multidisciplinary treatment approaches. Addressing ON through education, awareness, and comprehensive care can improve the quality of life for affected individuals and reduce the burden of this emerging disorder.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnorexia nervosa\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBulimia nervosa\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eON\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOrthorexia nervosa\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDSM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDiagnostic and Statistical Manual of Mental Disorders\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eD.A. was involved in conceptualisation, methodology, software, formal analysis, investigation, data curation, writing original draft, writing\u0026mdash;review and editing, supervision. F.E.A. was involved in methodology, software, formal analysis, data curation, writing original draft, writing\u0026mdash;review and editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Funding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received to assist with the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analysed during the current study are not publicly available under the participant confidentiality conditions of ethics approval from the Yalova Governmental Hospital Ethics Committee.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Ethics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received approval from the Yalova Governmental \u0026nbsp;Hospital Ethics Committee. Participants provided written and verbal consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent for publication has been obtained.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e 1 Yalova Governmental Hospital, Yalova, Turkey 2 Department of Psychology University of Amsterdam, Amsterdam, the Netherlands\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eH\u0026aring;man L, Barker-Ruchti N, Patriksson G, Lindgren EC. Orthorexia nervosa: An integrative literature review of a lifestyle syndrome. Int J Qual Stud Health Well-being. 2015;10:26799. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3402/qhw.v10.26799\u003c/span\u003e\u003cspan address=\"10.3402/qhw.v10.26799\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 26282866; PMCID: PMC4539385.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVarga M, Thege BK, Dukay-Szab\u0026oacute; S, T\u0026uacute;ry F, van Furth EV. When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry. 2014;14:59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBratman S. Health Food Junkies. 1997.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcComb SE, Mills JS. Orthorexia nervosa: A review of psychosocial risk factors. Appetite. 2019;140:50\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNiedzielski A, Kaźmierczak-Wojtaś N. Prevalence of Orthorexia Nervosa and Its Diagnostic Tools-A Literature Review. Int J Environ Res Public Health. 2021;18(10):5488. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph18105488\u003c/span\u003e\u003cspan address=\"10.3390/ijerph18105488\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 34065506; PMCID: PMC8160773.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParra-Fern\u0026aacute;ndez M, Onieva-Zafra M, Fern\u0026aacute;ndez-Mart\u0026iacute;nez E, Abreu-S\u0026aacute;nchez A, Fern\u0026aacute;ndez-Mu\u0026ntilde;oz JJ. Assessing the Prevalence of Orthorexia Nervosa in a Sample of University Students Using Two Different Self-Report Measures. Int J Environ Res Public Health. 2019;16:2459.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePehlivan E, Mete B, Fırıncı B, Doğan E. \u0026Uuml;niversite \u0026Ouml;ğrencilerinde Ortoreksiya Nervoza Yayginliği Ve Sağlik Okuryazarliği İle İlişkisi. Est\u0026uuml;dam Halk Sağlığı Dergisi. 2019;4(2):166\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOğur S. and A. Aksoy, \u0026ldquo;\u0026Uuml;niversite \u0026Ouml;ğrencilerinde Ortoreksiya Nervoza Eğiliminin Belirlenmesi\u0026rdquo;, Bitlis Eren \u0026Uuml;niversitesi Fen Bilimleri Dergisi, vol. 4, no. 2, 2015, doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.17798/beufen.95626\u003c/span\u003e\u003cspan address=\"10.17798/beufen.95626\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUzdil Z, Kayacan, AG, \u0026Ouml;zyildirim, C, Kaya S, Kilin\u0026ccedil; GE, Asal Ulus C., \u0026hellip; S\u0026ouml;k\u0026uuml;lmez Kaya P. Ad\u0026ouml;lesanlarda Ortoreksiya Nervoza Varliği Ve Yeme Tutumunun İncelenmesi. Samsun Sağlık Bilimleri Dergisi. 2019;4(1): 8\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eŁucka I, Domarecki P, Janikowska-Hołoweńko D, Plenikowska-Ślusarz T, Domarecka M. The prevalence and risk factors of orthorexia nervosa among school-age youth of Pomeranian and Warmian-Masurian voivodeships. Psychiatr Pol. 2019;53(2):383\u0026ndash;398.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaysal I, Kızıltan G. Spor Yapan Bireylerin Ortoreksiya Nervoza Eğilimleri ile Beslenme Durumları Arasındaki İlişkinin Belirlenmesi. Başkent \u0026Uuml;niversitesi Sağlık Bilimleri Fak\u0026uuml;ltesi Dergisi. 2020; 5(3):204\u0026ndash;214.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdullah M, Al Hourani HM, Alkhatib BM. Prevalence of orthorexia nervosa among nutrition students and nutritionists: Pilot study. Clin Nutr ESPEN. 2020;40:144\u0026ndash;148.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlvarenga MS, Martins MC, Sato KS, Vargas SV, Philippi ST, \u0026amp; Scagliusi FB. Orthorexia nervosa behavior in a sample of Brazilian dietitians assessed by the Portuguese version of ORTO-15. Eating and weight disorders: EWD.2012; 17(1), e29\u0026ndash;e35. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/BF03325325\u003c/span\u003e\u003cspan address=\"10.1007/BF03325325\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGaripoğlu G. Arslan M, Anda\u0026ccedil; \u0026Ouml;zt\u0026uuml;rk S. Beslenme ve Diyetetik B\u0026ouml;l\u0026uuml;m\u0026uuml;\u0026rsquo;nde Okuyan Kız \u0026Ouml;ğrencilerin Ortoreksiya Nervoza Eğilimlerinin Belirlenmesi. İstanbul Sabahattin Zaim \u0026Uuml;niversitesi Fen Bilimleri Enstit\u0026uuml;s\u0026uuml; Dergisi.2019; 1(3), 23\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArusoğlu G. Beslenme ve Diyetetik B\u0026ouml;l\u0026uuml;m\u0026uuml; Erkek \u0026Ouml;ğrencilerinde Ortoreksiya Nervoza Eğiliminin Belirlenmesi. The Journal of Academic Social Science. 2018; 56\u0026ndash;71. Doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.16992/Asos.14457\u003c/span\u003e\u003cspan address=\"10.16992/Asos.14457\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonini LM, Marsili D, Graziani MP, Imbriale M, Cannella C. Orthorexia nervosa: A preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eat Weight Disord. 2004; 9(2):151\u0026ndash;157.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArusoglu G, Kabakci E, Koksal G, Merdol, TK. Orthorexia nervosa and adaptation of ORTO-11 into Turkish. Turk. Psikiyatr. Derg. 2008; 19, 283\u0026ndash;291\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStrahler J, Hermann A, Walter B, Stark R. Orthorexia nervosa: A behavioral complex or a psychological condition? J. Behav. Addict. 2018: 7, 1143\u0026ndash;1156.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDunn TM, Gibbs J, Whitney N, Starosta AJ. Prevalence of orthorexia nervosa is less than 1%: data from a US sample. Eat Weight Disord. 2017;22:185\u0026ndash;192.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarthels, F.; Meyer, F.; Pietrowsky, R. D\u0026uuml;esseldorf orthorexia scale\u0026ndash;construction and evaluation of a questionnaire measuring orthorexic eating behavior. Z. Klin. Psychol. Psychother. 2015, 44, 97\u0026ndash;105.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrytek-Matera A, Sacre H, Staniszewska A, Hallit S. The Prevalence of Orthorexia Nervosa in Polish and Lebanese Adults and Its Relationship with Sociodemographic Variables and BMI Ranges: A Cross-Cultural Perspective. Nutrients. 2020;12(12):3865. Published 2020 Dec 17. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/nu1212386516\u003c/span\u003e\u003cspan address=\"10.3390/nu1212386516\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerreira C, Coimbra M. To further understand orthorexia nervosa: DOS validity for the Portuguese population and its relationship with psychological indicators, sex, BMI and dietary pattern. Eat Weight Disord. 2020;26:2127\u0026ndash;2134.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaraswati P, Nagendraswamy C. Orthorexia Nervosa: A Review. Int J Psychiatr Nurs. 2015;1:64\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoven NS, Abry AW. The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatr Dis Treat. 2015;11:385\u0026thinsp;\u0026ndash;\u0026thinsp;94. doi: 10.2147/NDT.S61665. PMID: 25733839; PMCID: PMC4340368.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDouma ER, Valente M, Syurina EV. Developmental pathway of orthorexia nervosa: Factors contributing to progression from healthy eating to excessive preoccupation with healthy eating. Experiences of Dutch health professionals. Appetite. 2021;158:105008. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.appet.2020.105008\u003c/span\u003e\u003cspan address=\"10.1016/j.appet.2020.105008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLupi M, Carano A, Carlucci M, et al. Prevalence of Orthorexia Nervosa in a sample of italian young adults. Clin Ter. 2024;175(2):125\u0026ndash;127. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7417/CT.2024.5044\u003c/span\u003e\u003cspan address=\"10.7417/CT.2024.5044\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNovara C, Maggio E, Piasentin S, Pardini S, Mattioli S. Orthorexia Nervosa: differences between clinical and non-clinical samples. BMC Psychiatry. 2021;21(1):341. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12888-021-03348-2\u003c/span\u003e\u003cspan address=\"10.1186/s12888-021-03348-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 34238282; PMCID: PMC8265101.20.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Orthorexia Nervosa, Eating Disorders, Healthy Eating Obsession, Dietary Behavior, Body Mass Index (BMI), ORTO-15 Scale","lastPublishedDoi":"10.21203/rs.3.rs-6428857/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6428857/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOrthorexia nervosa (ON) is characterized by an excessive preoccupation with consuming healthy foods, which may lead to dietary restrictions, psychological distress, and social isolation. Despite its increasing recognition, ON is not yet formally classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and its prevalence among individuals seeking dietary guidance remains underexplored. This study aims to evaluate the prevalence of ON and its associated factors among individuals attending a diet outpatient clinic.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional study was conducted at the Yalova Governmental Hospital Outpatient Diet Polyclinic. A total of 265 participants were recruited using a convenience sampling method. Data were collected through a socio-demographic questionnaire and the ORTO-15 Scale, a validated tool for assessing ON tendencies. Statistical analyses were performed using SPSS 22.0, with chi-square tests and ANOVA applied to examine relationships between ON and Body Mass Index (BMI). A p-value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of ON among participants was 17%, exceeding the rates reported in the general population. No significant relationship was found between BMI and ON tendencies (p = 0.27), supporting previous research suggesting that ON is more concerned with food quality than body image. Demographic analysis revealed that ON prevalence was higher among females and those with higher educational attainment. Participants relied primarily on mass media and dietitians for nutritional information, indicating potential influences on dietary behaviors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study highlights a high prevalence of ON among individuals seeking dietary counseling, underscoring the need for increased awareness and specific diagnostic criteria for ON. The absence of a correlation between BMI and ON supports the distinction of ON from other eating disorders like anorexia nervosa and bulimia nervosa. Multidisciplinary interventions involving dietitians, psychologists, and medical professionals are recommended to provide comprehensive care. Future research should explore longitudinal patterns of ON and assess the effectiveness of treatment modalities.\u003c/p\u003e","manuscriptTitle":"Orthorexia Nervosa: Prevalence and Associated Factors in Individuals Attending a Diet Outpatient Clinic: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-02 08:19:45","doi":"10.21203/rs.3.rs-6428857/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a582c4e0-7c77-4445-a29a-df72fdda32c8","owner":[],"postedDate":"May 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-20T09:53:58+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-02 08:19:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6428857","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6428857","identity":"rs-6428857","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}