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Gerber S, Jacques PF, Staffier KL, Karlsen MC, Roberts SB, Folta SC, Economos CD, McKeown NM. Scoring Adherence to Voluntary Restriction Diets (SAVoReD) in the ADAPT Study. Appetite 2025:108039. [PMID: 40345336 DOI: 10.1016/j.appet.2025.108039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 01/08/2025] [Accepted: 05/03/2025] [Indexed: 05/11/2025]
Abstract
Voluntary adoption of popular food-group-restricting diets like Paleo and plant-based diets (PBDs) are often health-motivated. However, unlike the theoretical design of these diets, different levels of dietary adherence may result in different diet quality and bodyweight in real-world settings-a limitation to the efficacy of dietary interventions. Scoring Adherence to Voluntary Restriction Diets (SAVoReD) is a metric to quantify and compare adherence across food-group-restricting diets. We applied the score to four diets, whole food plant-based (WFPB), vegan, vegetarian, and Paleo to examine associations between adherence and diet quality (Healthy Eating Index; HEI), body mass index (BMI), and diet duration. We also explored the independent associations of adherence and duration with BMI. Higher adherence to WFPB and vegan diets was significantly associated with lower BMI, but no association was observed for vegetarian or Paleo diet followers. For vegan and WFPB, greater adherence was associated with lower BMI among those following their diet >2 years compared to <2 years. Adherence was lowest in the diet with the most restrictions (WFPB); however, the stricter fully plant-based diets (WFPB and vegan) had the healthiest HEI scores and BMIs and many long-term followers. Our results suggest that identification with fully plant-based diets is associated with better diet quality and BMI. Vegan, vegetarian, and WFPB diets are often grouped as 'plant-based diets' despite the differing diet compositions, diet quality, adherence, and BMI of followers-thus, grouping them may distort findings. Individuals may benefit from encouragement following a fully plant-based diet, even without perfect adherence.
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Affiliation(s)
- Suzannah Gerber
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University. 150 Harrison Avenue, Boston, MA 02111. USA.
| | - Paul F Jacques
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University. 150 Harrison Avenue, Boston, MA 02111. USA; The Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. 711 Washington Street, Boston, MA 02111.
| | - Kara Livingston Staffier
- American College of Lifestyle Medicine. 1100 Town & Country Commons Dr Suite 6432, Chesterfield, MO 63017. USA.
| | - Micaela C Karlsen
- American College of Lifestyle Medicine. 1100 Town & Country Commons Dr Suite 6432, Chesterfield, MO 63017. USA; Applied Nutrition and Global Public Health Programs, University of New England, 11 Hills Beach Rd, Biddeford, ME 04005. USA.
| | - Susan B Roberts
- The Geisel School of Medicine, Dartmouth College. One Rope Ferry Road, Hanover, NH 03755. USA.
| | - Sara C Folta
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University. 150 Harrison Avenue, Boston, MA 02111. USA
| | - Christina D Economos
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University. 150 Harrison Avenue, Boston, MA 02111. USA
| | - Nicola M McKeown
- College of Health & Rehabilitation Sciences, Sargent College, Boston University, 635 Commonwealth Avenue, Boston, MA 02215. USA.
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Szulc P, Willich K, Gogga P. Association Between Orthorexia and Plant-Based Diets-Is There a Vicious Cycle? Nutrients 2025; 17:1337. [PMID: 40284202 PMCID: PMC12030501 DOI: 10.3390/nu17081337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2025] [Revised: 04/05/2025] [Accepted: 04/11/2025] [Indexed: 04/29/2025] Open
Abstract
Nowadays, social media and rapidly changing dietary trends encourage people to constantly-often excessively-control their diet, which leads to an increased risk of developing eating disorders, including orthorexia nervosa (ON). At the same time, more and more people reduce or give up consumption of meat and other animal products, adopting different types of plant-based (vegetarian) diets. The following paper aimed to demonstrate the significant similarities between orthorexia and plant-based diets and to highlight the necessity of developing new or adapting existing diagnostic tools for orthorexia considering the lifestyle characteristics of vegetarians, especially vegans. It remains unclear whether vegetarianism increases the risk of developing ON or whether the development of ON increases the chances of switching to a plant-based diet. However, based on the available literature, a positive association can be shown between the two. On the one hand, a vegetarian diet may be a cover for ON, but on the other, vegetarians, as a group avoiding specific food products, may be wrongly perceived as disordered. Thus, it is important to distinguish ON from the so-called healthy orthorexia (HO), which is a non-pathological interest in healthy eating, to avoid overdiagnosis and stigmatization of people using healthy alternative diets, including plant-based diets, since the mere fact of following them does not constitute evidence of orthorexia.
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Affiliation(s)
| | | | - Patrycja Gogga
- Division of Food Commodity Science, Department of Clinical Nutrition, Faculty of Health Sciences, Medical University of Gdańsk, ul. Dębinki 7, 80-211 Gdańsk, Poland; (P.S.); (K.W.)
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Salvia MG, Onteeru M, Lipson SK, Quatromoni PA. Adopting vegetarian and vegan eating patterns: Associations with disordered eating behaviors among young adult college students. Eat Behav 2025; 57:101967. [PMID: 40157298 DOI: 10.1016/j.eatbeh.2025.101967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 03/11/2025] [Accepted: 03/14/2025] [Indexed: 04/01/2025]
Abstract
INTRODUCTION Vegan and vegetarian diets are increasingly popular, though there is concern that disordered eating can drive, emerge, or intensify from the choice to adopt dietary restrictions. OBJECTIVE We sought to ascertain whether disordered eating or weight-control behaviors are associated with newly adopting a vegetarian/vegan diet during college and to assess symptom awareness and treatment utilization. METHODS Data came from 11,503 students in the Healthy Minds Study spanning 2015-2021. We examined associations between (i) the SCOFF eating disorder screener and (ii) symptom-specific items from the Eating Disorder Examination Questionnaire, and recent adoption of a vegan/vegetarian diet. Participants' knowledge of eating disorder symptoms and experiences with treatment utilization were also assessed. RESULTS Five-hundred thirty-two participants (∼5 %) reported adopting a vegan/vegetarian diet. Compared to students who did not change eating patterns, those who adopted vegetarianism/veganism had higher past-month prevalence of binge eating (25 % vs, 16 %), compulsive exercise (18 % vs. 9 %), and fasting (12 % vs. 8 %). Each behavior was significantly associated with greater odds of having recently adopted a vegetarian/vegan diet. A positive SCOFF screen (2+ items) was associated with 1.79-times (95 % CI: 1.48, 2.16) greater odds of newly adopting a vegetarian/vegan diet. There were no observed differences between groups with respect to knowledge of eating disorder symptoms or treatment-seeking attitudes and behaviors. DISCUSSION Disordered eating or weight-control behaviors were prevalent in this population of young adults and were associated with adopting a vegetarian/vegan diet, though awareness and help-seeking were not elevated among those with higher eating disorder risk.
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Affiliation(s)
- Meg G Salvia
- Boston University, Sargent College of Health and Rehabilitation Sciences, Department of Health Sciences, 635 Commonwealth Ave, Boston, MA 02215, United States; Harvard University T.H. Chan School of Public Health, Department of Nutrition, 677 Huntington Ave., Boston, MA 02155, United States.
| | - Manu Onteeru
- Dartmouth College, Hanover, NH 03755, United States
| | - Sarah K Lipson
- Boston University School of Public Health, Department of Health Law Policy and Management, 715 Albany St, Boston, MA 02118, United States
| | - Paula A Quatromoni
- Boston University, Sargent College of Health and Rehabilitation Sciences, Department of Health Sciences, 635 Commonwealth Ave, Boston, MA 02215, United States
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Nomamiukor FO, Smethurst MA, Franz MR, Hamilton EG, Garza A, Padilla-Medina D, Davis M, Taft CT. Is trauma associated with plant-based diet choice? Appetite 2025; 206:107841. [PMID: 39725065 PMCID: PMC11797213 DOI: 10.1016/j.appet.2024.107841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 12/04/2024] [Accepted: 12/23/2024] [Indexed: 12/28/2024]
Abstract
Examinations of links between plant-based diets (e.g., vegetarian and vegan diets) and indices of physical and mental health have received increased attention in the scientific literature in recent years. However, there has been little to no published research examining predictors of plant-based diet choice. Researchers have suggested that plant-based diets could be linked to trauma for a variety of reasons, including the idea that trauma can increase the risk for mental illnesses, and plant-based diets may be adopted to self-medicate mental illness and promote recovery. The current study examined the link between trauma across the lifespan and experiences of intimate partner violence (IPV) with adherence to a plant-based diet. Participants were a nationally representative United States sample of 1665 individuals who completed self-report questionnaires. Consistent with hypotheses, bivariate correlations indicated that all measures of trauma were associated with an increased likelihood of being plant-based. Findings from a logistic regression analysis indicated those with a history of IPV were 2.31 times more likely to be plant-based, and those with any experience of trauma more broadly were 1.09 times more likely to be plant-based. These results suggest the importance of considering the role of trauma and victimization when examining links between plant-based diet and other outcomes and point to a number of possible avenues for additional investigation to better understand these associations.
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Affiliation(s)
- Faith O Nomamiukor
- VA Boston Healthcare System, 150 South Huntington, Boston, MA, 02130, USA; National Center for PTSD, 150 South Huntington, Boston, MA, 02130, USA; Boston University School of Medicine, 72 East Concord St. Boston, MA, 02118, USA.
| | - Madeline A Smethurst
- VA Boston Healthcare System, 150 South Huntington, Boston, MA, 02130, USA; National Center for PTSD, 150 South Huntington, Boston, MA, 02130, USA.
| | - Molly R Franz
- University of Maryland, 1000 Hilltop Cir, Baltimore, MD, 21250, USA.
| | - Evelyn G Hamilton
- VA Boston Healthcare System, 150 South Huntington, Boston, MA, 02130, USA; National Center for PTSD, 150 South Huntington, Boston, MA, 02130, USA.
| | - Anissa Garza
- VA Boston Healthcare System, 150 South Huntington, Boston, MA, 02130, USA; National Center for PTSD, 150 South Huntington, Boston, MA, 02130, USA.
| | - Diana Padilla-Medina
- Beatriz Lassalle Graduate School of Social Work, University of Puerto Rico, Rio Piedras Campus, Rio Piedras, PR, 00197, USA.
| | - Maxine Davis
- The University of Texas at Arlington, School of Social Work, 501 W. Mitchell Street Arlington, TX, 76010, USA.
| | - Casey T Taft
- VA Boston Healthcare System, 150 South Huntington, Boston, MA, 02130, USA; National Center for PTSD, 150 South Huntington, Boston, MA, 02130, USA; Boston University School of Medicine, 72 East Concord St. Boston, MA, 02118, USA.
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McLean CP, de Boer K, Lee MF, McLean SA. The Treatment Experiences of Vegetarians and Vegans with an Eating Disorder: A Qualitative Study. Nutrients 2025; 17:345. [PMID: 39861476 PMCID: PMC11768365 DOI: 10.3390/nu17020345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 01/14/2025] [Accepted: 01/18/2025] [Indexed: 01/27/2025] Open
Abstract
BACKGROUND Vegetarianism and veganism have long been tied to disordered eating and are frequently considered to be methods of limiting available food choices. Health professionals specializing in eating disorder treatment may modify their treatment practices to support their vegetarian or vegan clients. However, there are no formally recognized clinical guidelines for the treatment of eating disorders in these groups. Moreover, no studies have yet explored the experiences of seeking and receiving eating disorder treatment while adhering to vegetarianism or veganism, which are needed to inform the development of guidelines. The present study aims to explore the lived experiences of vegetarians and vegans on eating disorder treatment through semi-structured interviews and reflexive thematic analysis. METHODS Seventeen participants (aged 19-48, 76% female, 41% vegan) with a history of receiving eating disorder treatment were recruited. RESULTS We identified five themes that participants described as important experiences for the treatment of their eating disorder when sought as a vegetarian or vegan: (1) Health professional perspectives, (2) The interaction of dietary status with treatment quality, (3) The give and take of treatment, (4) Lack of flexibility in treatment services, and (5) Current treatment approaches not well equipped to support dietary variations. CONCLUSIONS This paper identifies the complex relationship between eating disorders, veganism, and vegetarianism and the perceptions of treatment from the perspectives of those who have received treatment. Our findings suggest that acknowledgement and the flexibility to work with an individual's vegan and vegetarian values within treatment may contribute to enhanced outcomes and treatment experiences. Limitations include potential participation and response biases and a predominantly female-identifying sample. This study will contribute to the development of clinical guidelines when working with vegan and vegetarian clients.
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Affiliation(s)
- Courtney P. McLean
- Department of Psychology, Counselling, and Therapy, La Trobe University, Melbourne, VIC 3083, Australia; (K.d.B.); (S.A.M.)
| | - Kathleen de Boer
- Department of Psychology, Counselling, and Therapy, La Trobe University, Melbourne, VIC 3083, Australia; (K.d.B.); (S.A.M.)
| | - Megan F. Lee
- Faculty of Society and Design, Bond University, Gold Coast, QLD 4229, Australia;
| | - Siân A. McLean
- Department of Psychology, Counselling, and Therapy, La Trobe University, Melbourne, VIC 3083, Australia; (K.d.B.); (S.A.M.)
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Lakritz C, Tête N, Iceta S, Lafraire J. Orthorexia nervosa tendencies and risk of eating disorders among culinary arts students: A comparative study with dietetics students. J Hum Nutr Diet 2024; 37:1547-1557. [PMID: 39363562 DOI: 10.1111/jhn.13368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 08/20/2024] [Accepted: 08/22/2024] [Indexed: 10/05/2024]
Abstract
BACKGROUND Students pursuing food-related academic fields such as dietetics have higher orthorexia nervosa (ON) tendencies and are at a greater risk of developing eating disorders (EDs). However, there is limited research available on ON tendencies and on the risk of EDs in the culinary arts field, which also revolves around food. The present study explored ON tendencies and the risk of EDs among culinary arts students and compared them with those of dietetics students. METHODS A cross-sectional study was conducted in France, using the eating habits questionnaire (EHQ) to measure ON tendencies, and the SCOFF as well as the eating disorders examination questionnaire (EDEQ) to evaluate the risk of EDs and ED symptoms. The study also included questions about sports practice. In total, 267 students participated in the study, including 144 culinary arts students (51 women, 92 men and one other) and 123 dietetics ones (106 women, 15 men and two others). RESULTS Culinary arts students exhibited similar means of EHQ scores as dietetics ones (32.99 vs. 33.34) but higher SCOFF scores (52.8% vs. 39.8%). In addition, a gender difference was evidenced: women in culinary arts showed higher EHQ, SCOFF and EDEQ scores than men in culinary arts. Linear regression models showed no effect of the type of academic field (culinary arts vs. dietetics) on the EDEQ score but revealed effects of gender, body mass index and hours of sports practice. CONCLUSIONS The study emphasises the need to monitor culinary students and implement interventions to prevent EDs. It also suggests a correlation between food-related education and the risk of EDs, which requires further research.
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Affiliation(s)
- Clara Lakritz
- Centre de recherche et d'innovation de l'Institut Lyfe, Ecully, France
- Health, Systemic, Process UR 4129 Research Unit, University Claude Bernard, University of Lyon, Lyon, France
- Département de psychiatrie et de neurosciences, Université Laval, Québec City, QC, Canada
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec City, QC, Canada
| | - Nicolas Tête
- Centre de recherche et d'innovation de l'Institut Lyfe, Ecully, France
| | - Sylvain Iceta
- Département de psychiatrie et de neurosciences, Université Laval, Québec City, QC, Canada
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec City, QC, Canada
| | - Jérémie Lafraire
- Centre de recherche et d'innovation de l'Institut Lyfe, Ecully, France
- Laboratoire CHArt, Cognitions Humaine et ARTificielle, École Pratique des Hautes Études-Paris Sciences Lettres, Campus Condorcet, Aubervilliers, France
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Draganidis A, Fernando AN, West ML, Sharp G. Social media delivered mental health campaigns and public service announcements: A systematic literature review of public engagement and help-seeking behaviours. Soc Sci Med 2024; 359:117231. [PMID: 39278158 DOI: 10.1016/j.socscimed.2024.117231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 08/07/2024] [Accepted: 08/11/2024] [Indexed: 09/17/2024]
Abstract
Social media (SM) is increasingly utilised to disseminate mental health (MH) public service announcements (PSAs) and campaigns, connecting the public with support or resources. However, the effectiveness of MH campaigns/PSAs is often overlooked, and actions following exposure are rarely measured. We aimed to i) systematically review research on MH campaigns/PSAs disseminated via SM to determine their efficacy in eliciting engagement, help-seeking/behavioural change and ii) identify components that may facilitate engagement, help-seeking/behavioural change. The review followed PRISMA guidelines. Fourteen studies were eligible. The campaigns/PSAs targeted various MH concerns and country dissemination was diverse. Twitter/X was the most prevalent SM platform (n = 11), followed by Facebook (n = 8). All campaigns/PSAs generated engagement although engagement level benchmarks were inconsistent or absent, a proportion measured formal help-seeking behaviours (n = 1) or behavioural/language/knowledge change (n = 8). Components influencing engagement included videos/live streams, relatable content, the organisation/account disseminating the content, how information was conveyed, and external events. We highlight the heterogeneity of research in SM MH campaign/PSA evaluation and identify commonalities across studies potentially responsible for eliciting engagement, behavioural change and/or help-seeking in future campaigns/PSAs.
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Affiliation(s)
- Adriana Draganidis
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne Nileshni Fernando
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Madeline L West
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gemma Sharp
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
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Białek-Dratwa A, Stoń W, Staśkiewicz-Bartecka W, Grajek M, Krupa-Kotara K, Kowalski O. The Psychosocial Aspects of Vegetarian Diets: A Cross-Sectional Study of the Motivations, Risks, and Limitations in Daily Life. Nutrients 2024; 16:2504. [PMID: 39125383 PMCID: PMC11314235 DOI: 10.3390/nu16152504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 07/28/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION The popularity of vegetarian and vegan diets is linked to various motivations, such as health, ethics, ecology, and social and religious influence. India has the highest proportion of vegetarians and vegans. The practise of these diets is linked to moral and health reasons and environmental concerns. Vegetarianism may also be associated with eating disorders such as orthorexia (ON). AIM The main aim of this study was to determine the psychosocial aspects of vegetarian diets. Understanding these aspects is crucial for identifying potential risks and developing effective interventions. This study investigated the reasons for following vegetarian diets, the duration of dietary adherence, the occurrence of feelings of restriction in selected situations, and the risk of orthorexia and other eating disorders. METHODS A questionnaire survey was conducted among 186 individuals (82 vegetarians and 104 traditional dieters) between October 2023 and April 2024. The survey was administered via a Computer-Assisted Web Interview (CAWI) using Google Forms, distributed through social media, forums, and private messages. The inclusion criteria for the study group included consent, an age over 18, and a vegetarian diet, excluding those with eating disorders or diseases requiring strict diet therapy. The control group criteria were similar, excluding vegetarians and those requiring special diets. Four unreliable questionnaires were excluded from the analysis. The survey consisted of four sections: metric data, the ORTO-15 questionnaire, the EAT-26 questionnaire, and the TFEQ-13 questionnaire. RESULTS The main motivations for following vegetarian diets were ethical and environmental (86.9%) and health (32.1%) reasons. Over half of the vegetarians had been following a plant-based diet for over five years. Vegetarians were more likely to feel restricted in restaurants and when grocery shopping. The ORTO-15 results indicate a higher risk of orthorexia among vegetarians (48.8% vs. 29.4% in the control group; p = 0.00673). The EAT-26 questionnaire showed a higher, but not statistically significant, risk of eating disorders among vegetarians (23.8% vs. 14.7%; p = 0.11391). The TFEQ-13 showed no significant differences between groups (Subscale 1: food restriction, p = 0.77279; Subscale 2: lack of control in overeating, p = 0.91935; Subscale 3: eating under the influence of emotions, p = 0.16612). CONCLUSIONS This study concluded that ethical and environmental considerations and a belief in health benefits mainly drive vegetarians. An analysis of BMI revealed no significant differences between groups. The ORTO-15 results suggest a higher risk of orthorexia among vegetarians. The EAT-26 indicated a higher, but not statistically significant, risk of eating disorders among vegetarians and vegans. The TFEQ-13 showed no significant differences in restrictive eating, lack of control in overeating, and emotional eating. Vegetarians were likelier to encounter dietary difficulties in restaurants and shopping but less likely to feel socially excluded.
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Affiliation(s)
- Agnieszka Białek-Dratwa
- Department of Human Nutrition, Department of Dietetics, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, ul. Jordana 19, 41-808 Zabrze, Poland
| | - Wiktoria Stoń
- Department of Human Nutrition, Department of Dietetics, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, ul. Jordana 19, 41-808 Zabrze, Poland
| | - Wiktoria Staśkiewicz-Bartecka
- Department of Food Technology and Quality Assessment, School of Public Health in Bytom, Medical University of Silesia in Katowice, ul. Jordana 19, 41-808 Zabrze, Poland;
| | - Mateusz Grajek
- Department of Public Health, School of Public Health in Bytom, Medical University of Silesia in Katowice, ul. Piekarska 18, 41-902 Bytom, Poland
| | - Karolina Krupa-Kotara
- Department of Epidemiology, School of Public Health in Bytom, Medical University of Silesia in Katowice, ul. Piekarska 18, 41-902 Bytom, Poland
| | - Oskar Kowalski
- Department of Human Nutrition, Department of Dietetics, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, ul. Jordana 19, 41-808 Zabrze, Poland
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9
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Saintila J, Carranza-Cubas SP, Serpa-Barrientos A, Carranza Esteban RF, Cunza-Aranzábal DF, Calizaya-Milla YE. Depression, Anxiety, Emotional Eating, and Body Mass Index among Self-Reported Vegetarians and Non-Vegetarians: A Cross-Sectional Study in Peruvian Adults. Nutrients 2024; 16:1663. [PMID: 38892596 PMCID: PMC11174459 DOI: 10.3390/nu16111663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Vegetarianism is commonly associated with various health benefits. However, the association between this dietary regimen and aspects of mental health remains ambiguous. This study compared the symptoms of depression and anxiety, emotional eating (EmE), and body mass index (BMI) in Peruvian vegetarian and non-vegetarian adults. Methods: A cross-sectional study was conducted on 768 Peruvian adults, of whom 284 (37%) were vegetarians and 484 (63%) were non-vegetarians. The Depression Patient Health Questionnaire-2 (PHQ-2), Generalized Anxiety Disorder Scale-2 (GAD-2), and an EmE questionnaire were applied; additionally, the BMI was calculated. Simple and multiple linear regression and Poisson regression models with robust variance were used to evaluate the association between depression, anxiety, EmE, and BMI with dietary patterns. Results: The vegetarians (Adjusted Prevalence Ratio [PR] = 0.24, 95% CI 0.16-0.31; p < 0.001) reported more depressive symptoms than the non-vegetarians. This trend persisted for anxiety, with an adjusted PR of 0.17 (95% CI: 0.01-0.29; p = 0.012). However, the vegetarians (adjusted PR = -0.38, 95% CI: -0.61--0.14; p < 0.001) reported lower EmE scores compared to the non-vegetarians. Likewise, the vegetarians had a lower mean BMI than the non-vegetarians (B = -0.16, 95% CI: -0.21--0.08; p < 0.001). Conclusions: Vegetarian diets are associated with increased symptoms of depression and anxiety, as well as lower EmE and BMI scores. Further longitudinal studies are needed to elucidate these associations and determine causality and the underlying mechanisms involved.
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Affiliation(s)
| | | | | | - Renzo Felipe Carranza Esteban
- Grupo de Investigación Avances en Investigación Psicológica, Facultad de Ciencias de la Salud, Universidad San Ignacio de Loyola, Lima 15024, Peru;
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Brewerton TD, Dennis K, Wiss DA. Dismantling the myth of "all foods fit" in eating disorder treatment. J Eat Disord 2024; 12:60. [PMID: 38760858 PMCID: PMC11102136 DOI: 10.1186/s40337-024-01017-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
We call for a reevaluation of the long-standing dogmatic nutritional principle that "all foods fit" for all cases of eating disorders (EDs) and its corollary, "there are no bad foods" (for anyone ever) during ED treatment. Based on accumulated scientific research, we challenge these ideologies as outdated, confusing, and potentially harmful to many patients. We review the evidence that indicates the folly of these assumptions and show there are a variety of exceptions to these rules, including (1) food allergies, sensitivities, and intolerances, (2) religious and spiritual preferences or doctrines, and (3) the ubiquitous emergence and widespread availability of ultra-processed foods leading to the potential development of addiction-like eating and a higher prevalence of various medical and psychiatric comorbidities, as well as higher mortality. This evidence supports a nutritional psychiatry approach that should be integrated into (rather than dissociated from) ED treatment research and practice.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
| | - Kim Dennis
- SunCloud Health, Chicago, IL, USA
- Department of Psychiatry, University of Illinois Chicago College of Medicine, Chicago, IL, USA
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Dai X, Leung AKY. Motivations matter: moral and health-related motives indirectly relate to differential psychological health indicators among vegetarians. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:56. [PMID: 38664782 PMCID: PMC11046848 DOI: 10.1186/s41043-024-00534-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/03/2024] [Indexed: 04/28/2024]
Abstract
Due to rising popularity of vegetarianism in recent years, research interest has surged in examining the relationship between vegetarianism and psychological health. However, given inconsistent findings in prior research, the answer to whether practicing vegetarianism is associated with better or worse psychological health is still elusive. The present investigation aimed to demonstrate that vegetarians are not homogeneous in terms of psychological experiences, such that it is crucial to consider the motives behind vegetarians' dietary choice when examining their psychological health. In a survey study with 266 vegetarians and 104 omnivores, it was shown that health vegetarians displayed higher levels of disordered eating as compared to moral vegetarians and omnivores. Mediation analyses further revealed that, among vegetarians, health motivation was positively correlated with disordered eating tendencies, indirectly linking it with poorer psychological health; moral motivation was positively correlated with prosocial behavior, which in turn predicted better psychological health. These findings have implications for understanding the psychological health of vegetarians with different dietary motives and for developing interventions to promote their psychological health.
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Affiliation(s)
- Xiaoyu Dai
- School of Social Sciences, Singapore Management University, 10 Canning Rise, #04-11, Singapore, 178973, Singapore.
| | - Angela K-Y Leung
- School of Social Sciences, Singapore Management University, 10 Canning Rise, #04-11, Singapore, 178973, Singapore
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Ng QX, Lee DYX, Yau CE, Han MX, Liew JJL, Teoh SE, Ong C, Yaow CYL, Chee KT. On Orthorexia Nervosa: A Systematic Review of Reviews. Psychopathology 2024; 57:1-14. [PMID: 38432209 PMCID: PMC11326525 DOI: 10.1159/000536379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/15/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Orthorexia nervosa (ON), characterized by a pathological preoccupation with "extreme dietary purity," is increasingly observed as a mental health condition among young adults and the general population. However, its diagnosis is not formally recognized and has remained contentious. OBJECTIVE In this systematic review, we attempt to overview previous reviews on ON, focusing on the methodological and conceptual issues with ON. This would serve both as a summary and a way to highlight gaps in earlier research. METHODS This systematic review took reference from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, and using combinations of the search terms ("orthorexia" OR "orthorexia nervosa" OR "ON") AND ("review" OR "systematic review" OR "meta-analysis"), a literature search was performed on EMBASE, Medline and PsycINFO databases from inception up to October 31, 2023. Articles were included if (1) they were written or translated into English and (2) contained information pertaining to the diagnostic stability or validity of ON, or instruments used to measure ON symptoms and behaviors. Only review articles with a systematic literature search approach were included. RESULTS A total of 22 reviews were qualitatively reviewed. Several studies have reported variable prevalence of ON and highlighted the lack of thoroughly evaluated measures of ON with clear psychometric properties, with no reliable estimates. ORTO-15 and its variations such as ORTO-11, ORTO-12 are popularly used, although their use is discouraged. Existing instruments lack specificity for pathology and several disagreements on the conceptualization and hence diagnostic criteria of ON exist. DISCUSSION Previous reviews have consistently highlighted the highly variable (and contradictory) prevalence rates with different instruments to measure ON, lack of stable factor structure and psychometrics across ON measures, paucity of data on ON in clinical samples, and a need for a modern re-conceptualization of ON. The diagnosis of ON is challenging as it likely spans a spectrum from "normal" to "abnormal," and "functional" to "dysfunctional." "Non-pathological" orthorexia is not related to psychopathological constructs in the same way that ON is.
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Affiliation(s)
- Qin Xiang Ng
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Dawn Yi Xin Lee
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Chun En Yau
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ming Xuan Han
- Department of Paramedicine, Monash University, Melbourne, VIC, Australia
| | - Jacqueline Jin Li Liew
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Seth En Teoh
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Clarence Ong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Clyve Yu Leon Yaow
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kuan Tsee Chee
- Department of General and Community Psychiatry, Institute of Mental Health, Singapore, Singapore
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McLean CP, Chen Z, Fielding J, Sharp G. Preliminary identification of clinical cut-off of the vegetarian vegan eating disorder screener (V-EDS) in a community and self-reported clinical sample of vegetarians and vegans. J Eat Disord 2024; 12:17. [PMID: 38268035 PMCID: PMC10809464 DOI: 10.1186/s40337-024-00969-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND The vegetarian vegan eating disorder screener (V-EDS) is an 18-item self-report screening tool designed to assess the unique elements of eating disorder symptomology in vegetarians and vegans. Previous results have suggested strong initial psychometric properties in non-clinical community samples of vegetarians and vegans. The present study sought to identify a preliminary threshold cut-off score to discriminate eating disorder pathology in a self-reported clinical and community sample. METHODS This study involved secondary analysis using data collected in McLean et al. (Development and preliminary validation of a novel eating disorder screening tool for vegetarians and vegans: the V-EDS, 2023), comprising 599 non-clinical participants and 51 self-reported clinical participants. Receiver operating characteristic (ROC) curve analysis was used to compute possible cut-off values for the V-EDS. RESULTS ROC analysis indicated good performance of the V-EDS (area under the curve = 0.87), with integration of the Youden index demonstrating a global score of ≥ 18 to be optimal in predicting clinical caseness with good sensitivity (0.804) and specificity (0.843). CONCLUSIONS The present study fills an important gap as the first to investigate an optimal V-EDS score to discriminate level of impairment from eating disorder pathology in a sample of vegetarian and vegan community and self-reported clinical participants. We extend the utility of the V-EDS in discovering good discrimination power in classifying clinical caseness with a cut-off score of 18 shown to optimise the trade-off between sensitivity and specificity. Future research should focus on expanding the psychometric properties of the V-EDS in larger and more diverse participant groups, including gender, age, cultural identity, and eating disorder history.
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Affiliation(s)
- Courtney P McLean
- Department of Neuroscience, Monash University, 99 Commercial Rd, Melbourne, VIC, Australia.
| | - Zhibin Chen
- Department of Neuroscience, Monash University, 99 Commercial Rd, Melbourne, VIC, Australia
| | - Joanne Fielding
- Department of Neuroscience, Monash University, 99 Commercial Rd, Melbourne, VIC, Australia
| | - Gemma Sharp
- Department of Neuroscience, Monash University, 99 Commercial Rd, Melbourne, VIC, Australia
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McLean CP, Chen Z, Song R, Le J, Fielding J, Sharp G. Development and preliminary validation of a novel eating disorder screening tool for vegetarians and vegans: the V-EDS. J Eat Disord 2024; 12:4. [PMID: 38195575 PMCID: PMC10775595 DOI: 10.1186/s40337-024-00964-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 01/03/2024] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Eating disorders have one of the highest mortality of all mental illnesses but are associated with low rates of screening and early intervention. In addition, there remains considerable uncertainty regarding the use of current standardised screening tools in measuring eating pathology in vegetarians and vegans. With these groups presenting as potential at-risk groups for disordered eating development, the present study aimed to develop and preliminary validate a novel eating disorder screening tool, the Vegetarian Vegan Eating Disorder Screener (V-EDS). METHODS We utilised a mixed-methods approach, comprising four phases. RESULTS A conceptual framework was developed from 25 community, clinician, and lived experience interviews and used to derive a preliminary set of 163 items (Phase 1). Phase 2 piloted the items to establish face and content validity through cognitive debriefing interviews of 18 additional community, clinician, and lived experience participants, resulting in a reduced, revised questionnaire of 53 items. Phase 3 involved scale purification using Item Response Theory in analysis of 230 vegetarians and 230 vegans resulting in a further reduced 18-item questionnaire. Phase 4 validated the screening tool in a large community sample of 245 vegetarians and 405 vegans using traditional psychometric analysis, finding the V-EDS supports a unidimensional factor structure with excellent internal consistency (α = 0.95-0.96) and convergent validity (0.87-0.88), and moderate discriminate validity (0.45-0.55). CONCLUSIONS This study provided strong initial support for the psychometric validity and theoretical assumptions of the novel V-EDS screening tool. The V-EDS has the potential to increase early intervention rates for vegetarians and vegans experiencing eating disorder symptoms, further supporting advocacy and treatment approaches for these expanding dietary groups.
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Affiliation(s)
- Courtney P McLean
- Department of Neuroscience, Monash University, 99 Commercial Rd, Melbourne, VIC, Australia.
| | - Zhibin Chen
- Department of Neuroscience, Monash University, 99 Commercial Rd, Melbourne, VIC, Australia
| | - Richard Song
- University of Melbourne, Grattan Street, Parkville, VIC, Australia
- Alfred Hospital, 55 Commercial Rd, Melbourne, VIC, Australia
| | - Jessica Le
- Alfred Hospital, 55 Commercial Rd, Melbourne, VIC, Australia
| | - Joanne Fielding
- Department of Neuroscience, Monash University, 99 Commercial Rd, Melbourne, VIC, Australia
| | - Gemma Sharp
- Department of Neuroscience, Monash University, 99 Commercial Rd, Melbourne, VIC, Australia
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Reynolds R, McGowan A, Smith S, Rawstorne P. Vegan and vegetarian males and females have higher orthorexic traits than omnivores, and are motivated in their food choice by factors including ethics and weight control. Nutr Health 2023:2601060231187924. [PMID: 37464872 DOI: 10.1177/02601060231187924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Evidence associating plant-based diets with the proposed 'obsessively healthy eating' eating disorder, orthorexia nervosa, has mostly focused on females. Diet motivations have seldom been assessed. AIM To compare orthorexic tendencies between vegans/vegetarians and omnivores of both sexes, and reasons behind food choice with an English-validated Food Choice Questionnaire. METHODS A cross-sectional survey of 444 males and females were recruited via social media, email, and Amazon MTurk; to investigate eating patterns, orthorexic tendencies using the ORTO-15 questionnaire, and eating motivations using the Food Choice Questionnaire. RESULTS Over half of the participants were male (53.4%), younger adults (mean ± SD 37.2 ± 11.2 years), and mostly from the United States (89%). Vegan and vegetarian eating habits were reported by 15.8% of people. Vegans/vegetarians had significantly higher orthorexic tendencies than omnivores, and chose food significantly more often for Weight Control, Ethical Concern, Natural Content, and Mood reasons. People with greater orthorexic tendencies (ORTO-15 score<35) chose food significantly more often for Weight Control and Ethical Concern reasons than those with less orthorexic tendencies (ORTO-15 score 35+). CONCLUSION This study's results are in line with the majority of the evidence that shows an association between vegan/vegetarian diets and orthorexic tendencies, but strengthens the evidence base by including more male participants. Additionally, this is the first study to use an English-validated motivation-based questionnaire that explored diet motivators in vegans/vegetarians compared to omnivories, and in those with orthorexic tendencies vs. those without orthorexic tendencies.
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Affiliation(s)
- Rebecca Reynolds
- School of Population Health, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Andrea McGowan
- School of Population Health, Faculty of Medicine, UNSW, Sydney, NSW, Australia
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sophie Smith
- School of Population Health, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Patrick Rawstorne
- School of Population Health, Faculty of Medicine, UNSW, Sydney, NSW, Australia
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McLean CP, Kulkarni J, Sharp G. The 26-Item Eating Attitudes Test (EAT-26): Psychometric Properties and Factor Structure in Vegetarians and Vegans. Nutrients 2023; 15:nu15020297. [PMID: 36678167 PMCID: PMC9864971 DOI: 10.3390/nu15020297] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
The eating disorder screener, Eating Attitudes Test (EAT), has been used widely; however, its usability in specific dietary groups such as vegetarians and vegans remain unknown. Considering the rising popularity of vegetarianism and veganism, the current study aimed to assess the psychometric properties and theoretical assumptions of the 26-item EAT in separate groups of vegetarians (n = 278), vegans (n = 580), and omnivores (n = 413). Confirmatory factor analysis of four models from previous literature revealed inadequate fit of the data, with the exception of a 16-item four-factor model in vegetarians and vegans. Further assessment of the original three-factor model and 16-item four-factor model demonstrated poor psychometric properties. The primarily inadequate test-retest reliability discovered in this study, independent of whether a shortened version was used, raises concerns around the utility and stability of the EAT-26 in vegetarians and vegans. Future research should potentially investigate novel ways of measuring eating disorder pathology in these groups.
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Affiliation(s)
- Courtney P. McLean
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3800, Australia
| | - Jayashri Kulkarni
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, VIC 3800, Australia
| | - Gemma Sharp
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3800, Australia
- Correspondence:
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Schultz A, Maurer L, Alexandrowicz RW. Strengths and weaknesses of the German translation of the Inflexible Eating Questionnaire and of eating disorder assessment in general. Front Psychol 2022; 13:1002463. [PMID: 36600707 PMCID: PMC9806356 DOI: 10.3389/fpsyg.2022.1002463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Objective The present article introduces the German translation of the Inflexible Eating Questionnaire (IEQ-G), performs a psychometric evaluation, and explores the relationship of Inflexible Eating to the subscales of the Eating Disorder Examination-Questionnaire (EDE-Q) and Obsessive-Compulsive (OC) symptoms. Methods The cross-sectional study was carried out in the German-speaking area. A paper and pencil survey was completed by 612 females and 442 males of the general population. Results SEM analyses showed that the IEQ-G allows for calculating a total score and invariance tests were mostly promising. As a side result, the original 4-factorial structure of the EDE-Q could not be replicated, but a 3 dimensional solution proved convincing. From a psychometric point of view, the IEQ-G outperformed the EDE-Q. On a latent level, Inflexible Eating was remarkably strong related to OC-symptoms and the EDE-Q subscales. Discussion The detail analyses revealed that Eating Disorder assessment in general lacks subgroup-specific aspects, for instance, regarding gender or dietary preferences, important for early diagnosis and screening of ED. The IEQ-G proved applicable in a German speaking adult population and recommends itself for cross-cultural studies.
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Gerontidis A, Grammatikopoulou MG, Tzimos C, Gkiouras K, Taousani E, Athanasiadis L, Goulis DG. Effectors of Pregorexia and Emesis among Pregnant Women: A Pilot Study. Nutrients 2022; 14:nu14245275. [PMID: 36558433 PMCID: PMC9785442 DOI: 10.3390/nu14245275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
During pregnancy, women tend to improve their lifestyle habits and refine their dietary intake. Quite often, however, these dietary improvements take an unhealthy turn, with orthorexia nervosa (ON) practices being apparent. The aim of the present pilot cross-sectional study was to assess the prevalence of ON tendencies and the incidence of pica and record diet practices in a sample of pregnant women. A total of 157 pregnant women were recruited through private practice gynecologists during the first months of 2021. Nutrition-related practices were recorded, orthorexic tendencies were assessed using the translated and culturally adapted Greek version of the ORTO-15 questionnaire, pica practices were evaluated with a binary question and nausea and emesis during pregnancy (NVP) was evaluated using the translated modified Pregnancy-Unique Quantification of Emesis and Nausea (mPUQE). Only two women reported pica tendencies, with ice and snow being the consumed items. The majority (61.1%) of women reported improving their diet since conception was achieved. Folic acid and iron oral nutrient supplements (ONS) were reportedly consumed by the majority of participants (87.9% and 72.6%, respectively) and 9.6% reported using herbal medicine products. The ORTO-15 score was reduced with tertiary education attainment, ART conception, being in the third trimester of pregnancy, consumption of folic acid and MV supplements and was only increased among women who were at their first pregnancy. The majority of participants experienced severe NVP and the remaining experienced moderate NVP. NVP was associated with lower hemoglobin levels, lack of supplementary iron intake, avoidance of gluten-containing foods, as well as with increased gestational weight gain. The results highlight the need to screen pregnant women for disturbed eating behaviors and nutrition-related problems, in order to ensure a healthy pregnancy outcome.
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Affiliation(s)
- Alexandros Gerontidis
- Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-56429 Thessaloniki, Greece
| | - Maria G. Grammatikopoulou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
- Correspondence: (M.G.G.); (D.G.G.)
| | - Christos Tzimos
- Northern Greece Statistics Directorate, Hellenic Statistical Authority, 218 Delfon Str., GR-54646 Thessaloniki, Greece
| | - Konstantinos Gkiouras
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Eleftheria Taousani
- Department of Midwifery, Faculty of Health Sciences, International Hellenic University, Alexander Campus, GR-57400 Thessaloniki, Greece
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, 76 Agiou Pavlou Street, GR-54629 Thessaloniki, Greece
| | - Loukas Athanasiadis
- 3rd Department of Psychiatry, Medical School, Aristotle University of Thessaloniki, 76 Agiou Pavlou Street, GR-54629 Thessaloniki, Greece
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, 76 Agiou Pavlou Street, GR-54629 Thessaloniki, Greece
- Correspondence: (M.G.G.); (D.G.G.)
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Psychometric properties and factor structure of the Eating Disorder Examination-Questionnaire in omnivores, vegetarians, and vegans. Body Image 2022; 43:374-384. [PMID: 36283293 DOI: 10.1016/j.bodyim.2022.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
The psychometric properties of the Eating Disorder Examination-Questionnaire (EDE-Q) have been widely reported, but there remains considerable uncertainty regarding the factor structure of the tool, with vegetarians and vegans remaining no exception. Due to the utility of the EDE-Q as a screening and outcome measure, we assessed the theoretical assumptions and psychometric properties of the EDE-Q in vegetarians (n = 278), vegans (n = 580), and omnivores (n = 413) separately, owing to the expectation of different structures within each dietary population given their varying degrees of restraint. We undertook confirmatory factor analysis of five models previously described demonstrating inadequate fit. Exploratory factor analysis supported unique three-factor models across dietary groups incorporating Weight and Shape Concern subscales, potentially suggesting that community samples of varying of dietary restraint consistently interpret weight/shape to be related to general body image concerns. These novel findings also suggest a shorter version of the EDE-Q may be more suitable in community samples to reduce the time burden of the tool. The predominately poor test-retest reliability raises doubt around the overall utility and stability of the EDE-Q in all dietary populations, regardless of whether a shortened version is employed. Future research is needed to validate of other eating disorder tools across dietary populations.
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