Overlap of orthorexia, eating attitude and psychological distress in some Italian and Spanish university students

Abstract

Background: 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.

Aim: 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.

Methods: 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.

Results: 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)-K10^neg-EAT-26^neg 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-K10^neg-EAT-26^neg 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.

Conclusion: 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.

Keywords: Diet; Exercise; Food avoidance; Lifestyle; Other Specified Feeding and Eating Disorder.

Figure 1

Prevalence of orthorexia nervosa. A and B: Prevalence of orthorexia nervosa among students who presented an eating disorder (ED) risk [Eating Attitudes Test (EAT)-26] or psychological distress [Kessler Psychological Distress Scale (K10)] (A) and overlap of EAT-26 and K10 (B), in the whole sample. ORTO: Scores for orthorexia nervosa; K10: Kessler Psychological Distress Scale; EAT-26: Eating Attitudes Test; F: Italian and Spanish females; M: Italian and Spanish males; ED: Eating disorder.

Figure 2

Prevalence of orthorexia nervosa among different body mass index classes and lifestyle factors. A: Body mass index; B: Physical activity; C: Lifestyle factors. ORTO: Scores for orthorexia nervosa; OB: Obese; OW: Overweight; NW: Normal weight; UW: Underweight; PA: Physical activity.

Figure 3

Decision tree for the exclusion diagnosis of orthorexia nervosa (ON) in healthy normal weight university students. ORTO-7: Score for orthorexia nervosa; K10: Kessler Psychological Distress Scale; EAT-26: Eating Attitudes Test; MBSRQ: Multidimensional Body-Self Relations Questionnaire; BUT: Body Uneasiness Test; SSI: Starvation Symptom Inventory; NW: Normal weight.