Orthorexia nervosa is a concern in gastroenterology: A scoping review

Abstract

There is concern that use of restrictive therapeutic diets, such as those used in disorders of the gut-brain interaction (DGBI), may increase disordered eating. In this issue of Neurogastroenterology and Motility, Burton Murray et al. and Peters et al. both demonstrate a high prevalence of disordered eating in patients with gastrointestinal conditions, particularly those with DGBI. Given these findings, it is likely that orthorexia is common in this patient group, although this was not directly examined in these studies. Orthorexia nervosa is described as an obsessive and unsafe focus on eating foods perceived as healthy. This mini-review therefore focuses on orthorexia by conducting a scoping review, as per the PRISMA extension for scoping reviews, aimed to assess the prevalence of orthorexia, and associations between orthorexia and restrictive eating practices. While a wide range of orthorexia prevalence has been reported (0%-97%) across the 57 studies included, no studies assessed prevalence specifically in gastrointestinal conditions. Four of eight studies describing diseases associated with specific dietary patterns suggested that participants who followed a diet for "digestive issues" or "food intolerances" were at higher orthorexia risk. These results suggest that dietary modifications may be a factor contributing to orthorexia. Additionally, we provide a commentary on the clinical implications of the findings for gastrointestinal conditions including a clinical flow chart. Clinicians should consider if a restrictive diet is appropriate for individuals with DGBI and include screening for disordered eating prior to implementation of dietary modifications. Future prospective studies should evaluate orthorexia within this patient group.

Keywords: coeliac disease; dietary management; disordered eating; disorders of gut-brain interaction; irritable bowel syndrome.

FIGURE 1

Study selection flow chart

FIGURE 2

Clinical flowchart for use of diet therapies in gastroenterology. *Until there is a DGBI validated tool, recommendations for screening in clinical practice include using the SCOFF questionnaire to screen for risk of disordered eating and the Food Avoidance questionnaire to screen for potential diagnosis of avoidance/restricting food intake disorder. ^If access to a psychologist is not possible, the patient should have regular follow‐up and monitoring with their general practitioner. Additionally, they should work with another healthcare professional where available such as a dietitian, gastroenterologist, nurse, or counsellor who has experience with implementing dietary management or seek alternative telehealth or group‐based therapies”