The Type of Social Media is a Greater Influential Factor For Orthorexia Nervosa Than the Duration: A Cross-sectional Study

The Type of Social Media is a Greater Influential Factor For Orthorexia Nervosa Than the Duration: 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 The Type of Social Media is a Greater Influential Factor For Orthorexia Nervosa Than the Duration: A Cross-sectional Study Pınar Usta Ulutaş, Binnur Okan Bakır This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5075839/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Mar, 2025 Read the published version in BMC Public Health → Version 1 posted 4 You are reading this latest preprint version Abstract Background In the post-modern world, individuals tend to increase their awareness of healthy eating with the emergence of relevant concerns, various diseases, periodic eating trends, and the perceived importance of appearance. These aspects are also suggested to increase the Orthorexia Nervosa (ON) tendency. Health professionals, nutritionist dietitians, students receiving health education, individuals who do sports, adolescents, and performance artists are assumed to be in the risk group for ON. On the other hand, the use of social media, which may also induce the development of several eating disorders, has increased and become an important part of life. We aimed to determine the effect of the factors claimed to be influential on ON tendency. Method This study was conducted with a total of 892 voluntary undergraduate students aged 18 years and older, studying at a foundation university between January - March 2022 using questionnaire Orto-11 face-to-face. Data analysis was carried out with the SPSS 21.0 program. Results The prevalence of ON was found to be 23%. Being single, increased body mass index, studying nutrition and dietetics, undergoing medical nutrition therapy, following dietary restrictions within the last six months, increased physical activity, and purchasing foods with the influence of social media correlated with higher ON tendency (p < 0.05). Individuals who use Instagram, Pinterest, and TikTok, who follow someone to receive nutritional information, had a higher ON tendency (p < 0.05). Also, there was a significant difference regarding the profession of the ones followed by the participants (p < 0.05). Conclusions Since the diagnostic criteria have not been definitively determined, the findings about the influential factors are contradictory, and the prevalence is increasing daily; examining the influential factors with the general population is strongly recommended. Orthorexia Nervosa Social Media Visual-based platforms Orto-11 Dieting Figures Figure 1 Figure 2 Figure 3 INTRODUCTION In the Post-modern world, people increased their awareness of healthy eating with the emergence of nutritional concerns, lifestyle-related diseases, periodic eating trends, and the importance of physical appearance. While alterations in eating habits may lead to eating disorders, it is also suggested that it may increase the tendency to Orthorexia Nervosa (ON), a relatively new concept ( 1 ). Luckily, the diagnostic criteria and recommendations for treating eating disorders have been determined, and the treatment results have been successfully demonstrated. However, ON, a critical condition with a gradually increasing prevalence, is not yet accepted as an eating disorder in the Diagnostic and Statistical Manual of Mental Disorders -V (DSM-V) ( 2 ). ON is described as an obsession with healthy eating, and individuals with ON spend most of their time paying attention to whether their food is healthy or pure and make great efforts to do so ( 3 , 4 ). That is why they are obsessed with consuming foods that do not contain herbicides, pesticide residues, and artificial substances through healthy preparation methods, cooking, and storage ( 5 , 6 ). Health professionals, dietitians, health education students, sportspersons, adolescents, and performance artists are suggested as having a greater risk of developing ON ( 3 , 4 , 6 – 10 ). The prevalence of ON is determined as 60.1% in health professionals, 41.9% in dieticians, 56.4% in performance artists, and 43.6% in medical school students in cross-sectional studies in Turkey ( 4 , 7 , 9 ). On the other hand, studies conducted with the general population in Hungary and Italy showed that the prevalence of ON was 56.9% and 57.6% and revealed that the prevalence may vary as 35-57.8 among risky groups ( 11 , 12 ). While 34.5% of Australian dieticians were at high risk for ON ( 13 ), the prevalence of ON was detected as 88.7% among Brazilian women Nutrition and Dietetics (ND) students ( 14 , 15 ). Moreover, it is suggested by several studies that factors contributing to ON tendency include dietary restrictions, body weight status, sex, age, marital status, educational and employment status of parents, health education, class, and living environment ( 3 , 4 , 6 , 7 , 9 , 16 – 20 ). However, studies examined the ON commonly with limited sample sizes and included only a specific risk group and sex distributions were not homogeneous ( 3 , 4 , 6 , 19 , 20 ). Another limitation in the present literature is that such risk groups were examined separately and were not compared. On the other hand, in the last decades, internet use has become widespread and part of daily life as technology evolved, and time spent on social media (SM) also increased ( 21 ). While 89.42% of young adults used at least one SM regularly in 2014, this rate increased to 97.5% in 2016 ( 22 ), and daily time spent on SM by users increased from 91 min. to 147 min. in 2022 throughout ten years ( 23 ). A study investigating the time spent on SM found that university students spend more than 4 hours daily on SM ( 24 ). In addition to SM’s communication and socializing feature, users share information on various topics, especially diet, and health, without relying on a scientific basis. Studies revealed that awareness of diet, nutrients, and healthy eating increases with the use of SM and the internet ( 25 ), and university students follow health-related issues on media that may influence their eating habits ( 26 ). Research examining the effect of SM on body image and eating attitude among various sample groups is also present in the literature. However, a study evaluated the impact of SM use on ON tendency which found that SM affects eating habits and may increase the risk of ON ( 27 ). We aimed to determine the effects of all suggested influential factors in the current literature for ON tendency, including SM use among university students. MATERIAL and METHODS Participants and Data Collection A total of 892 voluntary participants were recruited from undergraduate students at a private university in Istanbul (the universe was 18,064, and the minimum sample size was 377 with an acceptable error of ± 5% at a 95% confidence level). Voluntary participants without psychiatric disorders between 18 and 65 years of age who met the inclusion criteria were included in the study between 20th May and 20th December 2021. The data was collected face-to-face (n = 643) and online (n = 249). Data collection forms included socio-demographic information, anthropometric measurements including body weight and height, and dietary restrictions. Physical Activity was classified according to the Worl Health Organization recommendations ( 28 ). Social Media Integration Use Scale (SMIU) with a maximum score of 60, indicating increased SM use with increased scores ( 29 , 30 ) was used, and the SM platforms, the durations spent, and preference for nutritional information sources on SM were also questioned. Their tendency for ON was evaluated with the Orto − 11 Scale ( 3 , 16 ). Data analysis was performed in the Windows environment with the SPSS (v.21.0) program. Quantitative data from the study were presented with mean, standard deviation, and minimum and maximum values. Qualitative data were presented with frequency and percentage values. Normality distribution is performed with the Kolmogorov-Smirnov test. The Mann-Whitney U test was used to compare the data of two groups, and the Kruskal-Wallis test was used to compare three or more groups. For the post hoc analysis, one-way ANOVA tests were used. Quantitative independent variables were compared with Spearman's correlation test. A p-value < 0.05 was accepted as significant. Ethics This study was performed with the ethical approval of the Non-Interventional Ethics Committee of Yeditepe University with the date 3.7.2021 and number 202105053. All experiments on human subjects were conducted under the Declaration of Helsinki, and all procedures were carried out with the subjects' adequate understanding and written consent. RESULTS The mean Orto-11 score of the participants (mean age 20.97 ± 2.26 years) was 27.44 ± 5.25, and Cronbach's alpha coefficient was found as 0.771. When the cut-off score of the Orto-11 was accepted as 25% (score of 24) quartile ( 3 ), the prevalence of ON tendency was found as 23% (n = 205). There was a significant difference between the ON scores of the participants regarding marital status, body weight status, department, receiving MNT, dieting in the last six months, shopping with the influence of SM, and physical activity (p < 0.05) (Table 1 ). Being single, increased body weight, studying ND, receiving MNT, dieting in the last six months, shopping with the influence of SM, and increased physical activity were related to increased ON tendency. However, no significance was found for sex, class, student club, income status, educational and occupational status of parents, living place, the person living with, supermarket shopping and cooking, having a chronic disease, smoking, and alcohol use (p > 0.05) (Table 1 ). There was a statistically significant correlation between the Orto-11 score and BMI (kg/m 2 ) (r = 0.166, p < 0.001), while no significance was found between the Orto-11 score and age (r = 0.023, p = 0.494). Table 1 Suggested Influential Factors and ON n (%) p * Sex Women 733 (82.2%) 0.111 Men 159 (17.8%) Marital Status Married 10 (1.1%) 0.028* Single 882 (98.9%) Body Weight Status Underweight 143 (16%) < 0.001* Normal 609 (68.3%) Overweight 113 (12.7%) Obese 27 (3%) Department ND 336 (37.7%) 0.013* Non-ND Health 320 (35.9%) Others 236 (26.4%) Living Place Home 773 (86.7%) 0.902 Dormitory 117 (13.1%) The Person Living with His/her-self 399 844.7%) 0.733 Friend 122 (13.7%) Family 339 838%) Other 32 (3.6%) Supermarket Shopping His / Her-self 530 (59.4%) 0.299 Other 362 (40.6%) Cooking Her / His-self 434 (48.7%) 0.069 Eating outside/ Ordering 130 (14.6%) Other 328 (36.8%) Status of Having a Chronic Disease Do not have any disease 747 (83.7%) 0.08 Disease need MNT 75 (8.4%) Diseases do not need MNT 70 (7.8%) Under MNT Yes 22 (2.5%) < 0.001* No 870 (97.5%) Dieting in the Last Six Months Yes 204 (22.9%) < 0.001* No 688 (77.1%) Shopping with the Influence of SM Yes 592 (66.4%) < 0.001* No 300 (33.6%) Smoking Yes 231 (25.9%) 0.962 No 661 (74.1%) Alcohol Consumption Do not consume 255 (28.6%) 0.737 Consuming 637 (71.4%) PA Any activity 391 (43.8%) 0.001* Below recommendations 141 (15.8%) Above recommendations 360 (40.4%) * p < 0.005 ND: Nutrition and Dietetics; MNT: Medical Nutrition Therapy; SM: Social Media; PA: Physical Activity The mean score of SMIU was 30.66 ± 8.84, the mean score of the sub-dimension of social integration and emotional connection was 14.52 ± 5.89, and the sub-dimension of integration with social routines was 16.14 ± 4.32. Regarding their SM use, only 4 participants (excluded data) mentioned that they do not use any SM platforms or spend no time on SM. The correlation between the Orto-11 scores and scores of SMIU and its sub-dimensions is shown in Fig. 1 . SMIU, social integration emotional connection, and integration with social routines showed significant correlation for ON tendency (r = 0.151; 0.147; 0.102, p = < 0.001; <0.001; 0.002, respectively). The mean total time spent on SM platforms per day was 396.78 ± 270.89 minutes (min.) (8-2520 min.). Instagram was the most popular SM platform. The only significance regarding ON tendency was observed for the use of TikTok, Pinterest, and Instagram (Fig. 2 ). While 9.1% of the participants did not follow someone on SM to have nutritional information, the rest followed at least one of the choices. The tendency for ON was significantly lower among the participants who were not following someone for nutritional information. Lastly, it has been observed that all follow-up options except following " family member/friends " increased the ON tendency significantly (Fig. 3 ). DISCUSSION & CONCLUSION Since ON is a new concept and its diagnostic criteria and treatment are unclear, it is crucial to determine the influential factors for ON tendency. The mean Orto-11 scores in the studies conducted in Turkey were similar to our findings, while the mean of the studies conducted with Orto-15 was higher, resulting from the higher maximum score of the scale ( 4 , 6 , 9 , 12 , 19 , 20 , 31 – 34 ). Several studies showed an ON prevalence among university students between 56.9–83% ( 11 , 12 ) and 43.6–45.5% in medical school and nursing students ( 9 , 11 , 19 , 31 ). As expected, ND students among our participants had a greater tendency for ON compared with the other departments (not the ones from non-ND health departments). Studies in the literature examined characteristics of ON among doctors/medical students, nurses/nursing students, and dieticians/ND students ( 4 , 9 , 13 , 19 , 31 ). However, we could not find a study that evaluated ON tendency characteristics among dentists/dentistry students, pharmacists/pharmacy students, and physiotherapists/physiotherapy and rehabilitation students; we found that ON prevalence among those is also remarkably high. While comparing ON tendency prevalence and mean scores of the studies, it is essential to note that different scales ( Orto-11 & Orto-15 ) and cut-off scores are used, which may affect the results. There are conflicting results in the literature regarding influential factors for ON tendency, including having a chronic disease ( 32 , 35 ), dieting ( 6 , 10 , 11 , 18 , 31 , 32 , 36 ), body weight status ( 3 , 4 , 6 , 7 , 9 , 16 , 31 – 33 , 37 ), sex ( 3 , 7 , 9 – 12 , 16 , 19 , 20 , 25 , 31 , 32 , 38 – 41 ), marital status ( 3 , 4 , 16 , 20 , 42 ), age ( 3 , 4 , 41 , 43 , 7 , 9 , 16 , 20 , 31 , 33 , 34 , 36 ), department ( 4 , 6 , 7 , 12 , 13 , 15 , 33 , 44 , 45 ), and class of the students ( 3 , 4 , 46 , 7 , 11 , 16 , 31 – 33 , 40 , 42 ), the status of cooking ( 6 , 32 ), and smoking ( 9 , 11 , 32 ). However, similar to our findings, studies revealed that being under MNT ( 3 , 4 ), and having higher PA ( 8 , 11 , 32 ) positively correlated with a higher ON tendency. However, alcohol consumption was found to be negatively correlated ( 32 ) with a higher ON tendency, while we could not find significant differences. Regarding the relationship between ON tendency and dieting and body weight status, it is unclear whether individuals diet because of health concerns and physical appearance or their interest in healthy eating is affected after diet history. We recommend questioning this paradox in further studies. Moreover, these conflicting results may be caused by dieting without the consultancy of a professional. Individuals may restrict themselves while dieting, which may result in unintended consequences. It is also believed that dieting individuals may become more authoritarian over time, which may have increased the tendency to have obsessive symptoms, a feature of ON ( 18 ). Similarly, the conflicting results on body weight status may result from individuals concerned about their physical appearance and trying to eat healthy to create a change, having obsessive symptoms over time. With these findings, we interpreted that ON tendency can be higher among those who are overweight and obese, and the underlying motivation of those can be increased health concerns with the rise in their body weight and risk of having morbidities. However, the underlying motivation of those must be clarified in the literature. On the other hand, having a disease that requires MNT and receiving MNT, which may require restrictions on certain kinds of food for consumption, offering meal consumption regularly and some guidance on nutrition, may tend to increase ON tendency parallel with the rise in health concerns, awareness on nutrition or foods. When characteristics of ON are considered, it is not surprising that individuals with MNT have an ON tendency compared to others. It might be a result of concerns about the desire to be healthy. This situation may lead to a rise in awareness of these individuals on nutrition, whether in a healthy way or not, and a rise in concerns about their health. With the change in the living style of men and the rise in the importance given to their physical appearance and health status, men are thought to be risky for developing ON also ( 39 ). Besides the greater ratio of women participants in our study compared to men, our result can be affected by the high level of education (compared to the studies conducted with the general population), and the sociocultural and economic status of the participants. Additionally, there is also a fact that men today care about their physical appearance and health status as much as women do. Since Ünalan et al. found that students who live in the dormitory have an increased risk of developing ED ( 8 ), we examined the effect of the living environment and the person living with them. According to the characteristics of ON, we expected to observe a difference among those who shop and cook meals by themselves since individuals with ON have ritualized habits and are perfectionists in their foods and meals. However, shopping by themselves and cooking their meals are not the only way to have healthy food now; they can order them via applications. That choice also depends on their ability and availability for supermarket shopping and cooking. For a clear conclusion, these variables should be examined in detail. Our participants' living places and the people they lived with changed during the hybrid education system, so their answers might have been affected while the data were collected. Since parents or peers can influence students' nutrition, this issue should be examined. When the motivation of individuals with ON is considered, which is improving or maintaining their health status, PA results are expected ( 16 ). PA is one of the ways to improve and maintain health. Participants with increased PA (above the recommendations) had a higher ON tendency. Today, while SM has many benefits, it can also be harmful in many ways, including psychiatric disorders, ED, and so on ( 8 , 25 , 26 , 47 ). Surprisingly, it was found that people trust SM content, which can be used to be informed on health issues ( 26 ). Healthy eating , recipes , and weight loss are topics that people are primarily interested in. Thankfully, according to a study, media positively affected 64.7% of the participants' nutritional habits regarding water intake, fruit consumption, and packaged food consumption ( 26 ). As the media is a source of information and has become the most effective advertising tool, it affects the purchasing behavior of individuals. Similarly, it was observed that they shop and try green tea, whole wheat products, and chia seeds with the influence of SM ( 26 ). On the other hand, it was found that university students follow health-related issues on SM, and their awareness about diet, nutrients, and healthy eating increased ( 25 , 26 ). It was found that 20% of men's and 38.9% of women's food choices have been influenced by TV programs on healthy eating among medical school students ( 31 ). Although the effect of SM use on ED and eating habits is revealed by studies ( 26 , 47 – 52 ), there are limited studies in the literature that examine its effect on ON tendency, which previously showed a positive correlation similar to our results ( 12 , 27 , 36 , 41 , 53 , 54 ). As SM has become more popular, product ads have increasingly become a part of it. Naturally, high use of SM exposes people to uncontrolled content about healthy foods, nutrition facts, ingredients, the concept of "a fit body", recommendations about diseases and nutrition, and so on. Moreover, having advice about what to eat and not can be effective for shopping choices unconsciously. Besides, there is a paradox because it is unclear whether individuals with ON tendencies might be more likely to be influenced by SM or whether their tendency results from excess SM use and exposure to these kinds of contents. Although the SMIU score and ON tendency were positively correlated, no significant correlation was found between the total duration of SM use and ON tendency. Focusing on the type of platform, which is preferred predominantly, can be the primary determinant factor. Similar to the existing studies in the literatüre ( 27 , 36 , 41 , 53 ), increased Instagram use led to a higher ON tendency. According to Turner and Lefevre, several reasons make Instagram an influential factor for ON tendency ( 36 ). Firstly, it has an image-based structure aimed at the image superiority effect, which attracts people to remember images rather than words. Secondly, it was mentioned that individuals try to adapt their nutrition through the accounts of some people they are interested in, and finally, Instagram celebrities are considered experts even if they are not qualified to tell someone what to cook or what not to drink ( 36 ). Like Instagram, students' Pinterest and TikTok use also correlated with a higher ON tendency. Other than Instagram, explanations of Turner and Lefevre can be proper for Pinterest and TikTok since these platforms have an image-based structure, and celebrities can quickly contact hundreds of users through these platforms ( 36 ). Other platforms did not seem influential on ON tendency except for these SM platforms, resulting from their text-shaped content. In contrast to our result, Twitter use was found to have a weak protective association with ON tendency ( 36 ), but excess Facebook use was not correlated with ON tendency ( 51 , 52 ). Following someone (whether a nutrition expert or not) on SM to have nutritional information can contribute to ON tendency, which is also found by Turner and Lefevre ( 36 ). Participants can be influenced by whom they follow, and the ON tendency increases with these people's exposure to the contents of nutritional information. Although it is expected that participants prefer to follow dieticians to have nutritional information, it is a surprising result that people who are not experts in the field of nutrition are being followed by many individuals for the same purpose. Moreover, it is yet to be known whether family members/friends are being followed because they have identities such as dietitians or doctors. Although it is found that participants who use SM as a source of information about body weight loss have a higher ON tendency, we could not find any study conducted in the literature to discuss. While SM use has been linked to triggering many different mechanisms, such as social appearance anxiety, body image, self-anxiety, and eating attitude in individuals, a change in eating attitude might be the mechanism that affects individuals with ON ( 55 ). Because it is contradicted that physical appearance is not at the forefront in individuals with ON ( 16 ). Not the duration but the type of SM platforms, which are visual-based, are more likely to be striking. Furthermore, using these platforms to have nutritional information can also affect negatively and people they follow may be the reason for this change. The aim of using SM and the people they follow, rather than using SM and the duration, plays a significant role in the ON tendency. However, it is unclear whether people with health concerns or who want to maintain their health status already use SM for this aim or whether these contents trigger them and result in ON tendency. Besides the contents in the media, the high rate of SM use and consequences from exposure to these health and nutrition-related contents should not be underestimated, and protective interventions should be planned. Though controlling contents in SM is impossible, lectures about media awareness and nutrition knowledge to all students can be planned as an intervention. Moreover, the curriculum can offer psychology-based courses or approaches to protect ND students from various ED and ON. Since receiving MNT and diet restrictions also led to an increase in ON tendency, the psychological aspect of the therapy should always be considered during the care process. Strength & Limitations This study is one of the few studies in the literature investigating the effect of SM on ON tendency. This study was conducted with the students; the results of the general population will help to make a clear conclusion on chronic disease, gender, age, marital status, educational level, and income issues. Declarations Ethics approval and consent to participate This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving research study participants were approved by the by the Non-Interventional Ethics Committee of Yeditepe University with number 202105053 and 07.03.2021 date of approval. Written informed consent was obtained from all subjects/patients. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The researchers declare that they have no competing interests. Funding This research received no financial support. Authors' contributions Study design, visualization, methodology, resources, writing-original draft preparation; all authors; data collection and statistical analysis, P.U.U.; supervision, B.O.B.. 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Appetite. 2007;49(3):661–6. Özkan AN, Ülkücü A, Tapan ME, Turgutlugil B, Çaylan A. Evaluatıng Orthorexıa Tendency Among Trakya Unıversıty Medıcal School Students. Turkish Med Student J. 2015;2(1):1–4. Acar Tek N, Karaçil Ermumcu MŞ. Sağlık Profesyonellerinde Sağlıklı Beslenme Kaygısı: Ortoreksiya Nervoza (ON) Healthy Eating Concern in Health Professionals: Orthorexia Nervosa (ON). Gazi Üniversitesi Sağlık Bilimleri Dergisi. 2016;1(2):59–71. Öztürk ME, Ayhan N. Üniversite öğrencilerinde ortoreksiya nervoza görülme durumu ve sağlıklı yaşam biçimi davranışları ile ilişkisi. Akademik Sosyal Araştırmalar Dergisi. 2017;5(51):455–65. Brytek-Matera A. Orthorexia nervosa - An eating disorder, obsessive-compulsivedisorder or disturbed eating habit? Archives Psychiatry Psychother. 2012;14(1):55–60. Turner PG, Lefevre CE. (2017). Instagram use is linked to increased symptoms of orthorexia nervosa. Eat Weight Disorders, 22 (2). Karniej P, Perez J, Juarez-Vela R, Santolalla-Arnedo I, Gea-Caballero V, del Pozo-Herce P, Dissen A, Czapla M. Orthorexia nervosa in gay men – the result of a Spanish-Polish eating disorder study. BMC Public Health. 2023;23(1):58. O’dea JA JAAS. Food habits, body image, an weight control practices of young male and female adolescents. Australian J Nutr Diet. 1996;53:32–9. Mathieu J. (2005). What is orthorexia? J Am Diet Assoc, 105 (10). Ramacciotti CE, Perrone P, Coli E, Burgalassi A, Conversano C, Massimetti G, Dell’Osso L. (2011). Orthorexia nervosa in the general population: A preliminary screening using a self-administered questionnaire (ORTO-15). Eat Weight Disorders, 16 (2). Lanitis A, R. C. Is Social Media Contributing to an Unhealthy Fixation with Health? Internatıonal J Eatıng Weıght Dısorders. 2020;1(1):12–21. Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C. (2005). Orthorexia nervosa: Validation of a diagnosis questionnaire. Eat Weight Disorders, 10 (2). Cinosi E, Matarazzo I, Marini S, Acciavatti T, Lupi M, Corbo M, Santacroce R, Vellante F, Sarchione F, De Berardis D, Carano A, Di Iorio G, Martinotti G, Di Giannantonio M. (2015). Prevalence of Orthorexia Nervosa in a Population of Young Italian Adults. Eur Psychiatry, 30 (3). Sharma SV, Gernand AD, Day RS. (2008). Nutrition Knowledge Predicts Eating Behavior of All Food Groups Except Fruits and Vegetables among Adults in the Paso del Norte Region: Qué Sabrosa Vida. J Nutr Educ Behav, 40 (6). Wardle J, Parmenter K, Waller J. (2000). Nutrition knowledge and food intake. Appetite, 34 (3). Korinth A, Schiess S, Westenhoefer J. Eating behaviour and eating disorders in students of nutrition sciences. Public Health Nutr. 2010;13(1):32–7. Tuna Oran N, Toz H, Küçük T, Uçar V. Medyanin Kadinlarin Beslenme Alişkanliklari,Besi̇Seçi̇mi̇ VTüketi̇miÜzeri̇ndekiEtki̇leri̇. NWSA Acad Journals. 2017;12(1):1–13. Griffiths S, Murray SB, Krug I, McLean SA. The Contribution of Social Media to Body Dissatisfaction, Eating Disorder Symptoms, and Anabolic Steroid Use among Sexual Minority Men. Cyberpsychology Behav Social Netw. 2018;21(3):149–56. Klassen KM, Douglass CH, Brennan L, Truby H, Lim MSC. (2018). Social media use for nutrition outcomes in young adults: A mixed-methods systematic review. In International Journal of Behavioral Nutrition and Physical Activity (Vol. 15, Issue 1). Lin, L. Y., Sidani, J. E., Shensa, A., Radovic, A., Miller, E., Colditz, J. B., …Primack, B. A. (2016). Association between social media use and depression among US young adults. Depression and anxiety , 33(4), 323–331. Smith AR, Hames JL, Joiner TE Jr. Status update: Maladaptive Facebook usage predicts increases in body dissatisfaction and bulimic symptoms. J Affect Disord. 2013;149(1–3):235–40. Mabe AG, Forney KJ, Keel PK. Do you like my photo? Facebook use maintains eating disorder risk. Int J Eat Disord. 2014;47(5):516–23. ve Atik A B. Z. Sağlıklı beslenme takıntısı (ortoreksiya) kapsamında televizyon sağlık programlarının format yapılarının incelenmesi. Atatürk İletişim Dergisi. 2017;13:87–102. Gobin KC, Mills JS, McComb SE. The Effects of the COVID-19 Pandemic Lockdown on Eating, Body Image, and Social Media Habits Among Women With and Without Symptoms of Orthorexia Nervosa. Front Psychol. 2021;12:716998. Cena H, Barthels F, Cuzzolaro M, Bratman S, Brytek-Matera A, Dunn T, Varga M, Missbach B, Donini LM. Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature. Eating and Weight Disorders. Volume 24. Springer International Publishing; 2019. 2. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 Mar, 2025 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 16 Sep, 2024 Editor assigned by journal 13 Sep, 2024 Submission checks completed at journal 13 Sep, 2024 First submitted to journal 12 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-5075839","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":354631654,"identity":"ca5cfa87-1732-4b66-815e-5efe35eaa52d","order_by":0,"name":"Pınar Usta Ulutaş","email":"data:image/png;base64,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","orcid":"","institution":"Yeditepe University","correspondingAuthor":true,"prefix":"","firstName":"Pınar","middleName":"Usta","lastName":"Ulutaş","suffix":""},{"id":354631656,"identity":"3610108c-0385-4855-b2c8-5a88b785ffb5","order_by":1,"name":"Binnur Okan Bakır","email":"","orcid":"","institution":"Yeditepe University","correspondingAuthor":false,"prefix":"","firstName":"Binnur","middleName":"Okan","lastName":"Bakır","suffix":""}],"badges":[],"createdAt":"2024-09-12 07:56:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5075839/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5075839/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-21335-0","type":"published","date":"2025-03-01T15:56:55+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":69836206,"identity":"935ce96c-d4c4-4089-a70a-8de66ce0bece","added_by":"auto","created_at":"2024-11-25 16:18:58","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":135346,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSMIU Scale and its sub-dimensions for ON tendency (\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e: p\u0026lt;0.001; \u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eb\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e: p=0.002)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5075839/v1/1d6926a49513bdc1a1b11b61.jpg"},{"id":69836203,"identity":"891bd6ca-ae92-4772-8132-fd342a546fa3","added_by":"auto","created_at":"2024-11-25 16:18:57","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":214733,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe SM platforms are preferred by participants (multiple answers) and the duration (minutes) spent on them.\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e(\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e: p\u0026gt;0.05; \u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eb\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e: p=0.001; \u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ec\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e: p=0.006)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5075839/v1/6f7ba7bff1da932761b98633.jpg"},{"id":69836204,"identity":"6dc7068a-031d-4416-9170-7627b9706a50","added_by":"auto","created_at":"2024-11-25 16:18:57","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":205851,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eParticipants' preference for following someone on SM to have nutritional information (multiple answers).\u0026nbsp; (\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e: p\u0026lt;0.001; \u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eb\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e: p=0.600; \u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ec\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e: p=0.031; \u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ed\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e: p=0.019)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5075839/v1/0983f7b300d1369ac89909a8.jpg"},{"id":77622260,"identity":"a1492aa6-b1bc-4ff0-a5cd-4c69a58413a7","added_by":"auto","created_at":"2025-03-03 16:01:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1464419,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5075839/v1/b52cb7d4-989f-4b82-9d35-8d95fe2f55a3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Type of Social Media is a Greater Influential Factor For Orthorexia Nervosa Than the Duration: A Cross-sectional Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eIn the Post-modern world, people increased their awareness of healthy eating with the emergence of nutritional concerns, lifestyle-related diseases, periodic eating trends, and the importance of physical appearance. While alterations in eating habits may lead to eating disorders, it is also suggested that it may increase the tendency to Orthorexia Nervosa (ON), a relatively new concept (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Luckily, the diagnostic criteria and recommendations for treating eating disorders have been determined, and the treatment results have been successfully demonstrated. However, ON, a critical condition with a gradually increasing prevalence, is not yet accepted as an eating disorder in the Diagnostic and Statistical Manual of Mental Disorders -V (DSM-V) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eON is described as an obsession with healthy eating, and individuals with ON spend most of their time paying attention to whether their food is healthy or pure and make great efforts to do so (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). That is why they are obsessed with consuming foods that do not contain herbicides, pesticide residues, and artificial substances through healthy preparation methods, cooking, and storage (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Health professionals, dietitians, health education students, sportspersons, adolescents, and performance artists are suggested as having a greater risk of developing ON (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7 CR8 CR9\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe prevalence of ON is determined as 60.1% in health professionals, 41.9% in dieticians, 56.4% in performance artists, and 43.6% in medical school students in cross-sectional studies in Turkey (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). On the other hand, studies conducted with the general population in Hungary and Italy showed that the prevalence of ON was 56.9% and 57.6% and revealed that the prevalence may vary as 35-57.8 among risky groups (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). While 34.5% of Australian dieticians were at high risk for ON (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), the prevalence of ON was detected as 88.7% among Brazilian women Nutrition and Dietetics (ND) students (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Moreover, it is suggested by several studies that factors contributing to ON tendency include dietary restrictions, body weight status, sex, age, marital status, educational and employment status of parents, health education, class, and living environment (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17 CR18 CR19\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). However, studies examined the ON commonly with limited sample sizes and included only a specific risk group and sex distributions were not homogeneous (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Another limitation in the present literature is that such risk groups were examined separately and were not compared.\u003c/p\u003e \u003cp\u003eOn the other hand, in the last decades, internet use has become widespread and part of daily life as technology evolved, and time spent on social media (SM) also increased (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). While 89.42% of young adults used at least one SM regularly in 2014, this rate increased to 97.5% in 2016 (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), and daily time spent on SM by users increased from 91 min. to 147 min. in 2022 throughout ten years (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). A study investigating the time spent on SM found that university students spend more than 4 hours daily on SM (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). In addition to SM\u0026rsquo;s communication and socializing feature, users share information on various topics, especially diet, and health, without relying on a scientific basis. Studies revealed that awareness of diet, nutrients, and healthy eating increases with the use of SM and the internet (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), and university students follow health-related issues on media that may influence their eating habits (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Research examining the effect of SM on body image and eating attitude among various sample groups is also present in the literature. However, a study evaluated the impact of SM use on ON tendency which found that SM affects eating habits and may increase the risk of ON (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWe aimed to determine the effects of all suggested influential factors in the current literature for ON tendency, including SM use among university students.\u003c/p\u003e"},{"header":"MATERIAL and METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and Data Collection\u003c/h2\u003e \u003cp\u003eA total of 892 voluntary participants were recruited from undergraduate students at a private university in Istanbul (the universe was 18,064, and the minimum sample size was 377 with an acceptable error of \u0026plusmn;\u0026thinsp;5% at a 95% confidence level). Voluntary participants without psychiatric disorders between 18 and 65 years of age who met the inclusion criteria were included in the study between 20th May and 20th December 2021. The data was collected face-to-face (n\u0026thinsp;=\u0026thinsp;643) and online (n\u0026thinsp;=\u0026thinsp;249).\u003c/p\u003e \u003cp\u003eData collection forms included socio-demographic information, anthropometric measurements including body weight and height, and dietary restrictions. Physical Activity was classified according to the Worl Health Organization recommendations (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Social Media Integration Use Scale (SMIU) with a maximum score of 60, indicating increased SM use with increased scores (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) was used, and the SM platforms, the durations spent, and preference for nutritional information sources on SM were also questioned. Their tendency for ON was evaluated with the Orto \u0026minus;\u0026thinsp;11 Scale (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eData analysis was performed in the Windows environment with the SPSS (v.21.0) program. Quantitative data from the study were presented with mean, standard deviation, and minimum and maximum values. Qualitative data were presented with frequency and percentage values. Normality distribution is performed with the Kolmogorov-Smirnov test. The Mann-Whitney U test was used to compare the data of two groups, and the Kruskal-Wallis test was used to compare three or more groups. For the post hoc analysis, one-way ANOVA tests were used. Quantitative independent variables were compared with Spearman's correlation test. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was accepted as significant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eEthics\u003c/h2\u003e \u003cp\u003e This study was performed with the ethical approval of the Non-Interventional Ethics Committee of Yeditepe University with the date 3.7.2021 and number 202105053. All experiments on human subjects were conducted under the Declaration of Helsinki, and all procedures were carried out with the subjects' adequate understanding and written consent.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe mean Orto-11 score of the participants (mean age 20.97\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26 years) was 27.44\u0026thinsp;\u0026plusmn;\u0026thinsp;5.25, and Cronbach's alpha coefficient was found as 0.771. When the cut-off score of the Orto-11 was accepted as 25% (score of 24) quartile (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), the prevalence of ON tendency was found as 23% (n\u0026thinsp;=\u0026thinsp;205).\u003c/p\u003e \u003cp\u003eThere was a significant difference between the ON scores of the participants regarding marital status, body weight status, department, receiving MNT, dieting in the last six months, shopping with the influence of SM, and physical activity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Being single, increased body weight, studying ND, receiving MNT, dieting in the last six months, shopping with the influence of SM, and increased physical activity were related to increased ON tendency. However, no significance was found for sex, class, student club, income status, educational and occupational status of parents, living place, the person living with, supermarket shopping and cooking, having a chronic disease, smoking, and alcohol use (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). There was a statistically significant correlation between the Orto-11 score and BMI (kg/m\u003csup\u003e2\u003c/sup\u003e) (r\u0026thinsp;=\u0026thinsp;0.166, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while no significance was found between the Orto-11 score and age (r\u0026thinsp;=\u0026thinsp;0.023, p\u0026thinsp;=\u0026thinsp;0.494).\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\u003eSuggested Influential Factors and ON\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e733 (82.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e159 (17.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (1.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.028*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e882 (98.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eBody Weight Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnderweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e609 (68.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113 (12.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eDepartment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e336 (37.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e0.013*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-ND Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e320 (35.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e236 (26.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eLiving Place\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e773 (86.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.902\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDormitory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117 (13.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eThe Person Living with\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHis/her-self\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e399 844.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.733\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFriend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122 (13.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e339 838%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSupermarket Shopping\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHis / Her-self\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e530 (59.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.299\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e362 (40.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eCooking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHer / His-self\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e434 (48.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEating outside/ Ordering\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130 (14.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e328 (36.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eStatus of Having a Chronic Disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDo not have any disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e747 (83.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisease need MNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (8.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiseases do not need MNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (7.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eUnder MNT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e870 (97.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDieting in the Last Six Months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e204 (22.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e688 (77.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eShopping with the Influence of SM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e592 (66.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e300 (33.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e231 (25.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.962\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e661 (74.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAlcohol Consumption\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDo not consume\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e255 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.737\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConsuming\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e637 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAny activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e391 (43.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBelow recommendations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141 (15.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbove recommendations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e360 (40.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e*\u003c/sup\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.005\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eND: Nutrition and Dietetics; MNT: Medical Nutrition Therapy; SM: Social Media; PA: Physical Activity\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe mean score of SMIU was 30.66\u0026thinsp;\u0026plusmn;\u0026thinsp;8.84, the mean score of the sub-dimension of social integration and emotional connection was 14.52\u0026thinsp;\u0026plusmn;\u0026thinsp;5.89, and the sub-dimension of integration with social routines was 16.14\u0026thinsp;\u0026plusmn;\u0026thinsp;4.32. Regarding their SM use, only 4 participants (excluded data) mentioned that they do not use any SM platforms or spend no time on SM. The correlation between the Orto-11 scores and scores of SMIU and its sub-dimensions is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. SMIU, social integration emotional connection, and integration with social routines showed significant correlation for ON tendency (r\u0026thinsp;=\u0026thinsp;0.151; 0.147; 0.102, p\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.001; \u0026lt;0.001; 0.002, respectively).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe mean total time spent on SM platforms per day was 396.78\u0026thinsp;\u0026plusmn;\u0026thinsp;270.89 minutes (min.) (8-2520 min.). Instagram was the most popular SM platform. The only significance regarding ON tendency was observed for the use of TikTok, Pinterest, and Instagram (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWhile 9.1% of the participants did not follow someone on SM to have nutritional information, the rest followed at least one of the choices. The tendency for ON was significantly lower among the participants who were not following someone for nutritional information. Lastly, it has been observed that all follow-up options except following \"\u003cem\u003efamily member/friends\u003c/em\u003e\" increased the ON tendency significantly (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"DISCUSSION \u0026 CONCLUSION","content":"\u003cp\u003eSince ON is a new concept and its diagnostic criteria and treatment are unclear, it is crucial to determine the influential factors for ON tendency. The mean Orto-11 scores in the studies conducted in Turkey were similar to our findings, while the mean of the studies conducted with Orto-15 was higher, resulting from the higher maximum score of the scale (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Several studies showed an ON prevalence among university students between 56.9\u0026ndash;83% (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) and 43.6\u0026ndash;45.5% in medical school and nursing students (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). As expected, ND students among our participants had a greater tendency for ON compared with the other departments (not the ones from non-ND health departments). Studies in the literature examined characteristics of ON among doctors/medical students, nurses/nursing students, and dieticians/ND students (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). However, we could not find a study that evaluated ON tendency characteristics among dentists/dentistry students, pharmacists/pharmacy students, and physiotherapists/physiotherapy and rehabilitation students; we found that ON prevalence among those is also remarkably high. While comparing ON tendency prevalence and mean scores of the studies, it is essential to note that different scales (\u003cem\u003eOrto-11\u003c/em\u003e \u0026amp; \u003cem\u003eOrto-15\u003c/em\u003e) and cut-off scores are used, which may affect the results.\u003c/p\u003e \u003cp\u003eThere are conflicting results in the literature regarding influential factors for ON tendency, including having a chronic disease (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), dieting (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), body weight status (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), sex (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan additionalcitationids=\"CR39 CR40\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e), marital status (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e), age (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), department (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e), and class of the students (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e), the status of cooking (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), and smoking (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). However, similar to our findings, studies revealed that being under MNT (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), and having higher PA (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) positively correlated with a higher ON tendency. However, alcohol consumption was found to be negatively correlated (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) with a higher ON tendency, while we could not find significant differences.\u003c/p\u003e \u003cp\u003eRegarding the relationship between ON tendency and dieting and body weight status, it is unclear whether individuals diet because of health concerns and physical appearance or their interest in healthy eating is affected after diet history. We recommend questioning this paradox in further studies. Moreover, these conflicting results may be caused by dieting without the consultancy of a professional. Individuals may restrict themselves while dieting, which may result in unintended consequences. It is also believed that dieting individuals may become more authoritarian over time, which may have increased the tendency to have obsessive symptoms, a feature of ON (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSimilarly, the conflicting results on body weight status may result from individuals concerned about their physical appearance and trying to eat healthy to create a change, having obsessive symptoms over time. With these findings, we interpreted that ON tendency can be higher among those who are overweight and obese, and the underlying motivation of those can be increased health concerns with the rise in their body weight and risk of having morbidities. However, the underlying motivation of those must be clarified in the literature. On the other hand, having a disease that requires MNT and receiving MNT, which may require restrictions on certain kinds of food for consumption, offering meal consumption regularly and some guidance on nutrition, may tend to increase ON tendency parallel with the rise in health concerns, awareness on nutrition or foods. When characteristics of ON are considered, it is not surprising that individuals with MNT have an ON tendency compared to others. It might be a result of concerns about the desire to be healthy. This situation may lead to a rise in awareness of these individuals on nutrition, whether in a healthy way or not, and a rise in concerns about their health.\u003c/p\u003e \u003cp\u003eWith the change in the living style of men and the rise in the importance given to their physical appearance and health status, men are thought to be risky for developing ON also (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Besides the greater ratio of women participants in our study compared to men, our result can be affected by the high level of education (compared to the studies conducted with the general population), and the sociocultural and economic status of the participants. Additionally, there is also a fact that men today care about their physical appearance and health status as much as women do.\u003c/p\u003e \u003cp\u003eSince \u0026Uuml;nalan et al. found that students who live in the dormitory have an increased risk of developing ED (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), we examined the effect of the living environment and the person living with them. According to the characteristics of ON, we expected to observe a difference among those who shop and cook meals by themselves since individuals with ON have ritualized habits and are perfectionists in their foods and meals. However, shopping by themselves and cooking their meals are not the only way to have healthy food now; they can order them via applications. That choice also depends on their ability and availability for supermarket shopping and cooking. For a clear conclusion, these variables should be examined in detail. Our participants' living places and the people they lived with changed during the hybrid education system, so their answers might have been affected while the data were collected. Since parents or peers can influence students' nutrition, this issue should be examined.\u003c/p\u003e \u003cp\u003eWhen the motivation of individuals with ON is considered, which is improving or maintaining their health status, PA results are expected (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). PA is one of the ways to improve and maintain health. Participants with increased PA (above the recommendations) had a higher ON tendency.\u003c/p\u003e \u003cp\u003eToday, while SM has many benefits, it can also be harmful in many ways, including psychiatric disorders, ED, and so on (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). Surprisingly, it was found that people trust SM content, which can be used to be informed on health issues (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). \u003cem\u003eHealthy eating\u003c/em\u003e, \u003cem\u003erecipes\u003c/em\u003e, and \u003cem\u003eweight loss\u003c/em\u003e are topics that people are primarily interested in. Thankfully, according to a study, media positively affected 64.7% of the participants' nutritional habits regarding water intake, fruit consumption, and packaged food consumption (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). As the media is a source of information and has become the most effective advertising tool, it affects the purchasing behavior of individuals. Similarly, it was observed that they shop and try green tea, whole wheat products, and chia seeds with the influence of SM (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). On the other hand, it was found that university students follow health-related issues on SM, and their awareness about diet, nutrients, and healthy eating increased (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). It was found that 20% of men's and 38.9% of women's food choices have been influenced by TV programs on healthy eating among medical school students (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Although the effect of SM use on ED and eating habits is revealed by studies (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan additionalcitationids=\"CR48 CR49 CR50 CR51\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e), there are limited studies in the literature that examine its effect on ON tendency, which previously showed a positive correlation similar to our results (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). As SM has become more popular, product ads have increasingly become a part of it. Naturally, high use of SM exposes people to uncontrolled content about healthy foods, nutrition facts, ingredients, the concept of \"a fit body\", recommendations about diseases and nutrition, and so on. Moreover, having advice about what to eat and not can be effective for shopping choices unconsciously. Besides, there is a paradox because it is unclear whether individuals with ON tendencies might be more likely to be influenced by SM or whether their tendency results from excess SM use and exposure to these kinds of contents.\u003c/p\u003e \u003cp\u003eAlthough the SMIU score and ON tendency were positively correlated, no significant correlation was found between the total duration of SM use and ON tendency. Focusing on the type of platform, which is preferred predominantly, can be the primary determinant factor. Similar to the existing studies in the literat\u0026uuml;re (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e), increased Instagram use led to a higher ON tendency. According to Turner and Lefevre, several reasons make Instagram an influential factor for ON tendency (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Firstly, it has an image-based structure aimed at the image superiority effect, which attracts people to remember images rather than words. Secondly, it was mentioned that individuals try to adapt their nutrition through the accounts of some people they are interested in, and finally, Instagram celebrities are considered experts even if they are not qualified to tell someone what to cook or what not to drink (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Like Instagram, students' Pinterest and TikTok use also correlated with a higher ON tendency. Other than Instagram, explanations of Turner and Lefevre can be proper for Pinterest and TikTok since these platforms have an image-based structure, and celebrities can quickly contact hundreds of users through these platforms (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Other platforms did not seem influential on ON tendency except for these SM platforms, resulting from their text-shaped content. In contrast to our result, Twitter use was found to have a weak protective association with ON tendency (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), but excess Facebook use was not correlated with ON tendency (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFollowing someone (whether a nutrition expert or not) on SM to have nutritional information can contribute to ON tendency, which is also found by Turner and Lefevre (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Participants can be influenced by whom they follow, and the ON tendency increases with these people's exposure to the contents of nutritional information. Although it is expected that participants prefer to follow dieticians to have nutritional information, it is a surprising result that people who are not experts in the field of nutrition are being followed by many individuals for the same purpose. Moreover, it is yet to be known whether family members/friends are being followed because they have identities such as dietitians or doctors. Although it is found that participants who use SM as a source of information about body weight loss have a higher ON tendency, we could not find any study conducted in the literature to discuss. While SM use has been linked to triggering many different mechanisms, such as social appearance anxiety, body image, self-anxiety, and eating attitude in individuals, a change in eating attitude might be the mechanism that affects individuals with ON (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). Because it is contradicted that physical appearance is not at the forefront in individuals with ON (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNot the duration but the type of SM platforms, which are visual-based, are more likely to be striking. Furthermore, using these platforms to have nutritional information can also affect negatively and people they follow may be the reason for this change. The aim of using SM and the people they follow, rather than using SM and the duration, plays a significant role in the ON tendency. However, it is unclear whether people with health concerns or who want to maintain their health status already use SM for this aim or whether these contents trigger them and result in ON tendency. Besides the contents in the media, the high rate of SM use and consequences from exposure to these health and nutrition-related contents should not be underestimated, and protective interventions should be planned. Though controlling contents in SM is impossible, lectures about media awareness and nutrition knowledge to all students can be planned as an intervention. Moreover, the curriculum can offer psychology-based courses or approaches to protect ND students from various ED and ON. Since receiving MNT and diet restrictions also led to an increase in ON tendency, the psychological aspect of the therapy should always be considered during the care process.\u003c/p\u003e\n\u003ch3\u003eStrength \u0026 Limitations\u003c/h3\u003e\n\u003cp\u003eThis study is one of the few studies in the literature investigating the effect of SM on ON tendency.\u003c/p\u003e \u003cp\u003eThis study was conducted with the students; the results of the general population will help to make a clear conclusion on chronic disease, gender, age, marital status, educational level, and income issues.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving research study participants were approved by the by the Non-Interventional Ethics Committee of Yeditepe University with number 202105053 and 07.03.2021 date of approval. Written informed consent was obtained from all subjects/patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThis research received no financial support.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy design, visualization, methodology, resources, writing-original draft preparation; all authors; data collection and statistical analysis, P.U.U.; supervision, B.O.B.. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNone.\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMichalska A, Szejko N, Jakubczyk A, Wojnar M. Niespecyficzne zaburzenia odzywiania siȩ - subiektywny przeglad. Psychiatr Pol. 2016;50(3):497\u0026ndash;507.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. \u003cem\u003eAmerican Psychiatric Association\u003c/em\u003e, \u003cem\u003eFifth Edition(DSM-5)\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArusoǧlu G, Kabak\u0026ccedil;i E, K\u0026ouml;ksal G, Merdol TK. Ortoreksiya nervoza ve Orto-11\u0026rsquo;in t\u0026uuml;rk\u0026ccedil;eye uyarlama \u0026ccedil;alişmasi. 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The Effects of the COVID-19 Pandemic Lockdown on Eating, Body Image, and Social Media Habits Among Women With and Without Symptoms of Orthorexia Nervosa. Front Psychol. 2021;12:716998.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCena H, Barthels F, Cuzzolaro M, Bratman S, Brytek-Matera A, Dunn T, Varga M, Missbach B, Donini LM. Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature. Eating and Weight Disorders. Volume 24. Springer International Publishing; 2019. 2.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Orthorexia Nervosa, Social Media, Visual-based platforms, Orto-11, Dieting","lastPublishedDoi":"10.21203/rs.3.rs-5075839/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5075839/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIn the post-modern world, individuals tend to increase their awareness of healthy eating with the emergence of relevant concerns, various diseases, periodic eating trends, and the perceived importance of appearance. These aspects are also suggested to increase the Orthorexia Nervosa (ON) tendency. Health professionals, nutritionist dietitians, students receiving health education, individuals who do sports, adolescents, and performance artists are assumed to be in the risk group for ON. On the other hand, the use of social media, which may also induce the development of several eating disorders, has increased and become an important part of life. We aimed to determine the effect of the factors claimed to be influential on ON tendency.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eThis study was conducted with a total of 892 voluntary undergraduate students aged 18 years and older, studying at a foundation university between January - March 2022 using questionnaire Orto-11 face-to-face. Data analysis was carried out with the SPSS 21.0 program.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe prevalence of ON was found to be 23%. Being single, increased body mass index, studying nutrition and dietetics, undergoing medical nutrition therapy, following dietary restrictions within the last six months, increased physical activity, and purchasing foods with the influence of social media correlated with higher ON tendency (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Individuals who use Instagram, Pinterest, and TikTok, who follow someone to receive nutritional information, had a higher ON tendency (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Also, there was a significant difference regarding the profession of the ones followed by the participants (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eSince the diagnostic criteria have not been definitively determined, the findings about the influential factors are contradictory, and the prevalence is increasing daily; examining the influential factors with the general population is strongly recommended.\u003c/p\u003e","manuscriptTitle":"The Type of Social Media is a Greater Influential Factor For Orthorexia Nervosa Than the Duration: A Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-25 16:18:52","doi":"10.21203/rs.3.rs-5075839/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-16T11:07:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-13T09:27:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-13T09:26:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-09-12T07:54:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5bbdd780-24a3-43e6-afe2-094c1f884a4d","owner":[],"postedDate":"November 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-03T15:58:40+00:00","versionOfRecord":{"articleIdentity":"rs-5075839","link":"https://doi.org/10.1186/s12889-025-21335-0","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-03-01 15:56:55","publishedOnDateReadable":"March 1st, 2025"},"versionCreatedAt":"2024-11-25 16:18:52","video":"","vorDoi":"10.1186/s12889-025-21335-0","vorDoiUrl":"https://doi.org/10.1186/s12889-025-21335-0","workflowStages":[]},"version":"v1","identity":"rs-5075839","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5075839","identity":"rs-5075839","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}