Published online Oct 19, 2022. doi: 10.5498/wjp.v12.i10.1298
Peer-review started: March 19, 2022
First decision: May 30, 2022
Revised: June 15, 2022
Accepted: September 2, 2022
Article in press: September 2, 2022
Published online: October 19, 2022
Orthorexia nervosa (ON) is the persistent concern of maintaining the self-imposed diet to improve one's health. Many factors have been associated to ON in univ-ersity students.
To assess the prevalence of ON in Italian and Spanish university students in relation to eating attitude and psychological distress, and the possible overlaps between ON (evaluated with different scored questionnaires from the originally proposed ORTO-15), distress and risk of eating disorders.
This study was carried out on 160 students recruited at La Sapienza University of Rome and at the Catholic University of Murcia. Questionnaires were administered to evaluate ON (ORTO-15 and sub-scores), body concerns (Multidimensional Body-Self Relations Questionnaire, MBSRQ, and Body Uneasiness test, BUT), psychological distress (Kessler Psychological Distress Scale, K10), physical activity (International Physical Activity Questionnaire, IPAQ), eating attitude (Eating Attitudes Test, EAT-26) and malnutrition (Starvation Symptom Inventory, SSI). Sex differences, within the same country, and differences between Italian and Spanish students, within the same sex, were evaluated.
The ORTO-15 positive subjects, assessed with the originally proposed cut-off, were above 70% in both Italian and Spanish students, with a higher prevalence in the Spanish sample (Italian females 76.3%, Italian males 70.7%; Spanish females 97.0%, Spanish males 96.3%). According to ORTO-7, about 30% of Italian and 48% of Spanish students were positive to ON with no significant sex differences. When excluding students underweight (UW), overweight (OW) or obese (OB), as well as those potentially at risk of eating disorders or presenting mild, moderate and severe distress, in the resultant normal weight (NW)-K10neg-EAT-26neg subgroup, we did not find many correlations observed in the whole sample, including those between ORTO scores and BUT, SSI, Total MBSRQ and some of its components. Moreover, ORTO-7 resulted in the only ON score unrelated with Body Mass Index, MBSRQ components and IPAQ-assessed intense activity, in the NW-K10neg-EAT-26neg subgroup. After this sort of “exclusion diagnosis”, the prevalence of ON of these students on the overall sample resulted in 16.9%, 12.2%, 15.2% and 25.9% for Italian females, Italian males, Spanish females and Spanish males, respectively.
In some university students ON could be a symptom of other conditions related to body image concerns and distress, as well as to high physical activity and appearance, fitness, health or illness orientation (from MBSRQ). However, ORTO-7 became independent from these confounding variables, after the exclusion of UW, OW, OB and students positive to EAT-26 and K10, suggesting the possibility of identifying orthorexic subjects with this specific questionnaire.
Core Tip: This study explores the overlap of orthorexia nervosa with eating attitude and psychological distress in Italian and Spanish university students. After excluding, among normal weight students, those with high score on the Kessler Distress Scale and Eating Attitudes Test, we did not find correlations among orthorexia and Starvation Symptoms Inventory, Body Uneasiness Test, and Multidimensional Body Self-Relations Questionnaire (MBSRQ), observed in the whole sample. After this kind of “exclusion diagnosis”, sub-scores of MBSRQ indicating body concerns correlated with ORTO-12 and ORTO-9, whereas ORTO-7 resulted the only score unrelated with all outcomes, including fitness and health orientations (MBSRQ), and intense physical activity.