Prevalence of orthorexia nervosa is less than 1 %: data from a US sample

  • Thomas M. DunnEmail author
  • Josh Gibbs
  • Noelle Whitney
  • Amy Starosta
Original Article



Orthorexia nervosa, or pathological dieting based on being “healthy,” has been of growing interest. Clinical data are limited to less than a half-dozen case studies reporting instances of medical problems due to healthful eating. However, more than a dozen studies using a measure to identify orthorexia, the ORTO-15, report very high prevalence rates in non-clinical samples. Point prevalence rates are reported from 6 % to nearly 90 %. Such variability could be due to cultural issues or psychometric problems with the instrument. This study examines prevalence rate of orthorexia in a US sample.


The ORTO-15 was administered to 275 US college students along with other questions regarding diet, exercise, and health.


While the ORTO-15 indicated a prevalence rate of 71 %, only 20 % of the sample endorsed a dietary practice of removing a particular food type (e.g. meat) from their diet. Those who endorsed following a vegan diet had the highest (less pathological) mean ORTO-15 score. Further, when classifying participants based on their seriousness about healthy eating and whether their diet had led to impairment in everyday activities and medical problems, less than 1 % of the sample fell into such a category.


As in other countries, a large proportion of a non-clinical US sample scored in the orthorexia range on the ORTO-15. However, this instrument is likely unable to distinguish between healthy eating and pathologically healthful eating. Our estimate is that orthorexia nervosa like anorexia nervosa and bulimia nervosa, is not a common condition.


Orthorexia nervosa ORTO-15 Eating disorders Pathological healthful eating 



The authors wish to acknowledge Peter Ray Concepcion for his assistance in data collection.

Compliance with ethical standards

Conflict of interest

The authors disclose that we have no conflicts of interest with this research and are not receiving any consideration with this work.

Ethical approval

Prior to data collection, this study was approved by our university’s institutional review board for the ethical treatment of human participants in research. The project was given “exempt” status.

Informed consent

All participants read informed consent statements. As our study consisted solely of anonymous questionnaires, and a signed consent statement would be the sole way to identify participants, they provided consent by taking the anonymous questionnaire.


  1. 1.
    Bratman S (1997) The health food eating disorder. Yoga J 42–50Google Scholar
  2. 2.
    Bratman S, Knight D (2000) Health food junkies. Orthorexia nervosa: overcoming the obsession with healthful eating. Broadway Books, New YorkGoogle Scholar
  3. 3.
    Fugh-Berman A (2001) Health food: health food junkies: orthorexia nervosa: overcoming the obsession with healthful eating. JAMA 285:2255–2256. doi: 10.1001/jama.285.17.2255-JBK0502-2-1 CrossRefGoogle Scholar
  4. 4.
    Dunn TM, Bratman S (2016) On orthorexia nervosa: a review of the literature and proposed diagnostic criteria. Eat Behav 21:11–17. doi: 10.1016/j.eatbeh.2015.12.006 CrossRefPubMedGoogle Scholar
  5. 5.
    Donini L, Marsili D, Graziani M, Imbriale M, Cannella C (2004) Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eat Weight Disord ST 9:151–157. doi: 10.1007/bf03325060 CrossRefGoogle Scholar
  6. 6.
    Moroze RM, Dunn TM, Holland JC, Yager J, Weintraub P (2015) Microthinking about micronutrients: a case of transition from obsessions about healthy eating to near-fatal “Orthorexia Nervosa” and proposed diagnostic criteria. Psychosomatics 56:397–403. doi: 10.1016/j.psym.2014.03.003 CrossRefPubMedGoogle Scholar
  7. 7.
    Zamora MLC, Bonaechea BB, Sánchez FG, Rial BR (2005) Orthorexia nervosa. A new eating behavior disorder? Actas Esp Psiquiatr 33:66–68Google Scholar
  8. 8.
    Park SW, Kim JY, Go GJ, Jeon ES, Pyo HJ, Kwon YJ (2011) Orthorexia nervosa with hyponatremia, subcutaneous emphysema, pneumomediastimum, pneumothorax, and pancytopenia. Electrolyte Blood Press 9:32–37. doi: 10.5049/EBP.2011.9.1.32 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Saddichha S, Babu GN, Chandra P (2012) Orthorexia nervosa presenting as prodrome of schizophrenia. Schizophr Res 134:110. doi: 10.1016/j.schres.2011.10.017 CrossRefPubMedGoogle Scholar
  10. 10.
    Donini L, Marsili D, Graziani M, Imbriale M, Cannella C (2005) Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord ST 10:e28–e32. doi: 10.1007/bf03327537 CrossRefGoogle Scholar
  11. 11.
    Ramacciotti C, Perrone P, Coli E, Burgalassi A, Conversano C, Massimetti G et al (2011) Orthorexia nervosa in the general population: a preliminary screening using a self-administered questionnaire (ORTO-15). Eat Weight Disord ST 16:e127–e130. doi: 10.1007/bf03325318 CrossRefGoogle Scholar
  12. 12.
    Segura-García C, Papaianni MC, Caglioti F, Procopio L, Nisticò CG, Bombardiere L et al (2012) Orthorexia nervosa: a frequent eating disordered behavior in athletes. Eat Weight Disord ST 17:226–233. doi: 10.3275/8272 CrossRefGoogle Scholar
  13. 13.
    Bosi BAT, Çamur D, Güler Ç (2007) Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey). Appetite 49:661–666. doi: 10.1016/j.appet.2007.04.007 CrossRefGoogle Scholar
  14. 14.
    Alvarenga M, Martins M, Sato K, Vargas S, Philippi S, Scagliusi F (2012) Orthorexia nervosa behavior in a sample of Brazilian dietitians assessed by the Portuguese version of ORTO-15. Eat Weight Disord ST 17:e29–e35CrossRefGoogle Scholar
  15. 15.
    Brytek-Matera A, Krupa M, Poggiogalle E, Donini LM (2014) Adaptation of the ORTHO-15 test to Polish women and men. Eat Weight Disord ST 19:69–76. doi: 10.1007/s40519-014-0100-0 CrossRefGoogle Scholar
  16. 16.
    Brytek-Matera A, Donini LM, Krupa M, Poggiogalle E, Hay P (2015) Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students. J Eat Disord 3:1–8. doi: 10.1186/s40337-015-0038-2 CrossRefGoogle Scholar
  17. 17.
    Arusoğlu G, Kabakci E, Köksal G, Merdol TK (2008) Orthorexia nervosa and adaptation of ORTO-11 into Turkish. Turk Psikiyatri Derg 19:283–291. doi: 10.1007/bf03327792 CrossRefPubMedGoogle Scholar
  18. 18.
    Fidan T, Ertekin V, Işikay S, Kırpınar I (2010) Prevalence of orthorexia among medical students in Erzurum, Turkey. Compr Psychiatry 51:49–54. doi: 10.1016/j.comppsych.2009.03.001 CrossRefPubMedGoogle Scholar
  19. 19.
    Varga M, Thege BK, Dukay-Szabó S, Túry F, van Furth EF (2014) When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry 14:59–70. doi: 10.1186/1471-244X-14-59 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Missbach B, Hinterbuchinger B, Dreiseitl V, Zellhofer S, Kurz C, König J (2015) When eating right, is measured wrong! A validation and critical examination of the ORTO-15 Questionnaire in German. PLoS One 10:1–15. doi: 10.1371/journal.pone.0135772 CrossRefGoogle Scholar
  21. 21.
    Smink FR, van Hoeken D, Hoek HW (2012) Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 14:406–414CrossRefGoogle Scholar
  22. 22.
    Jerez T, Lagos R, Valdés-Badilla P, Pacheco E, Pérez C (2015) Prevalencia de conducta ortoréxica en estudiantes de educación media de Temuco [Prevalence of orthorexic behaviour in high school students of Temuco]. Rev Chil Nutr 42:41–44. doi: 10.4067/S0717-75182015000100005 CrossRefGoogle Scholar
  23. 23.
    Spitzer RL, Wakefield JC (1999) DSM-IV diagnostic criterion for clinical significance: does it help solve the false positives problem? Am J Psychiatry 156:1856–1864PubMedGoogle Scholar
  24. 24.
    Dunn TM, Bratman S (2016) On orthorexia nervosa: a review of the literature and proposed diagnoistic criteria. Eat Behav 21:11–17CrossRefGoogle Scholar
  25. 25.
    Lopes MR, Kirsten VR (2009) Comortamentos de ortorexia nervosa em mulheres jovens [Orthorexia nervosa behaviors in young women]. Disciplinarum Scientia 10:97–105Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Thomas M. Dunn
    • 1
    • 2
    Email author
  • Josh Gibbs
    • 1
  • Noelle Whitney
    • 1
  • Amy Starosta
    • 2
  1. 1.School of Psychological SciencesUniversity of Northern ColoradoGreeleyUSA
  2. 2.Behavioral Health Service, Denver Health Medical CenterDenverUSA

Personalised recommendations