Orthorexia nervosa in a sample of Portuguese fitness participants

  • Carolina AlmeidaEmail author
  • Vânia Vieira Borba
  • Lèlita Santos
Original Article
Part of the following topical collections:
  1. Orthorexia Nervosa



Orthorexia Nervosa (ON) is described as an obsessive behaviour motivated by great concern for following a healthy diet. Although it was first described in 1997, ON remains inconspicuous and poorly characterized in the literature. The aims of this study were to evaluate the prevalence of ON in a sample of ambulatory individuals and to investigate their common characteristics, attempting to better characterize this entity.


A non-random sample of 193 adult gym members answered a questionnaire based on a Portuguese version of ORTO-15, supplemented with additional questions. Possible associations between the different variables and pathological scores on ORTO-15 were analysed using logistic regression models.


ON behaviour was documented in 51.8% of the sample, mean age 30.96 years (± 1.03 years), and this condition tended to be correlated with younger ages. Physical appearance and frequent exercising were also associated with ON, while no correlation between orthorexic tendencies and both gender and educational field was found. Furthermore, consumption of special food, dissatisfaction with physical appearance and frequent exercising could predict the presence of ON in the sample.


Despite the use of a convenience sample, results place us in a different perspective, considering the idea that orthorexic individuals are exclusively concerned about pursuing a pure diet. The presence of ON was associated with other non-dietary behaviours allied to a healthy lifestyle and aesthetic concerns.

Level of evidence

Level V: Descriptive study.


Orthorexia nervosa ORTO-15 Eating disorders Lifestyle Physical appearance Exercise 



We thank Emília Nogueira, Ph.D and Esmeralda Gonçalves, Ph.D for the statistical component of this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Bratman S (1997) Original essay on orthorexia. Retrieved January 2017 from
  2. 2.
    Brytek-Matera A, Rogoza R, Gramaglia C, Zeppegno P (2015) Predictors of orthorexic behaviours in patients with eating disorders: a preliminary study. BMC Psychiatry 15:1–8. CrossRefGoogle Scholar
  3. 3.
    Vandereycken W (2011) Media hype, diagnostic fad or genuine disorder? Professionals’ opinions about night eating syndrome, orthorexia, muscle dysmorphia and emetophobia. Eat Disord 19:145–155. PubMedCrossRefGoogle Scholar
  4. 4.
    Lovelady CA, Hunter CP, Geigerman C (2003) Effect of exercise on immunologic factors in breast milk. Pediatrics 111(2):148–152. CrossRefGoogle Scholar
  5. 5.
    Koven NS, Abry AW (2015) The clinical basis of orthorexia nervosa: emerging perspectives. Dovepress 11:385–394. CrossRefGoogle Scholar
  6. 6.
    Michalska A, Szejko N, Jakubczyk A, Wojnar M (2016) Nonspecific eating disorders—a subjective review. Psychiatr Pol 50(3):497–507. PubMedCrossRefGoogle Scholar
  7. 7.
    Setnick J (2013) The eating disorders clinical pocket guide, 2nd edn. TX Snack Time Press, Dallas.Google Scholar
  8. 8.
    Dunn TM, Bratman S (2016) Eating behaviors on orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eat Behav 21:11–17. PubMedCrossRefGoogle Scholar
  9. 9.
    Barthels F, Meyer F, Huber T, Pietrowsky R (2017) Orthorexic eating behaviour as a coping strategy in patients with anorexia nervosa. Eat Weight Disord Stud Anorexia Bulim Obes 22(2):269–276. CrossRefGoogle Scholar
  10. 10.
    Barnes MA, Caltabiano ML (2016) The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eat Weight Disord. PubMedCrossRefGoogle Scholar
  11. 11.
    Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C (2005) Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord 10:28–32. CrossRefGoogle Scholar
  12. 12.
    de Souza QJOV, Rodrigues AM (2014) Risk behavior for orthorexia nervosa in nutrition students. Rev Chil Nutr 63(3):200–204. CrossRefGoogle Scholar
  13. 13.
    Behar R, Molinari D (2010) Dismorfia muscular, imagen corporal y conductas alimentarias en dos poblaciones masculinas. Rev Med Chile 138:1386–1394. PubMedCrossRefGoogle Scholar
  14. 14.
    Danielsen M, Bjørnelv S, Rø Ø (2015) Validation of the exercise and eating disorders questionnaire. Int J Eat Disord 48(7):983–993. PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    McKinley NM, Hyde JS (1996) The objectified body consciousness scale: development and validation. Psychol Women Q 20(2):181–215. CrossRefGoogle Scholar
  16. 16.
    Stice E, Agras WS (1998) Predicting the onset and remission of bulimic behaviours in adolescence: a longitudinal grouping analysis. Behav Ther 29:257–276CrossRefGoogle Scholar
  17. 17.
    Pope H, Phillips K, Olivardia R (2002) The adonis complex. Touchstone, New YorkGoogle Scholar
  18. 18.
    Varga M, Thege BK, Dukay-Szabó S, Túry F, Furth EF, Van (2014) When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry 14:1–11. CrossRefGoogle Scholar
  19. 19.
    Stochel M, Janas-Kozik M, Zejd JE, Hyrnik J, Jelo I, Siw A (2015) Validation of ORTO-15 Questionnaire in the group of urban youth aged 15–21. Psychiatr Pol 49:119–134. PubMedCrossRefGoogle Scholar
  20. 20.
    Herranz Valera J, Acuña Ruiz P, Romero Valdespino B, Visioli F (2014) Prevalence of orthorexia nervosa among ashtanga yoga practitioners: a pilot study. Eat Weight Disord 19:469–472. PubMedCrossRefGoogle Scholar
  21. 21.
    Bo S, Zoccali R, Ponzo V, Soldati L, De Carli L, Benso A et al. (2014) University courses, eating problems and muscle dysmorphia: are there any associations? J Transl Med. PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    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. PubMedCrossRefGoogle Scholar
  23. 23.
    Aksoydan E, Camci N (2009) Prevalence of orthorexia nervosa among Turkish performance artists. Eat Weight Disord 14:33–37. PubMedCrossRefGoogle Scholar
  24. 24.
    Fidan T, Ertekin V, Sedat I, Ismet K (2010) Prevalence of orthorexia among medical students in Erzurum, Turkey. Compr Psychiatry 51:49–54. PubMedCrossRefGoogle Scholar
  25. 25.
    Missbach B, Hinterbuchinger B, Dreiseitl V, Zellhofer S. When eating right, is measured wrong! A validation and critical examination of the ORTO-15 Questionnaire in German. PLoS One. 2015;1–15.
  26. 26.
    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 3:2. 1–8.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Bosi A, Derya C, Çagatay G (2007) Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey). Appetite 49:661–666. CrossRefGoogle Scholar
  28. 28.
    Brytek-Matera A, Fonte ML, Poggiogalle E, Donini L, Cena H (2017) Orthorexia nervosa: relationship with obsessive-compulsive symptoms, disordered eating patterns and body uneasiness among Italian university students. Eat Weight Disord 22(4):609–617. PubMedCrossRefGoogle Scholar
  29. 29.
    Malmborg J, Bremander A, Olsson MC, Bergman S (2016) Health status, physical activity, and orthorexia nervosa: A comparison between exercise science students and business students. Appetite. PubMedCrossRefGoogle Scholar
  30. 30.
    Mathieu J (2005) What is orthorexia? J Am Diet Assoc 105:1510–1512. PubMedCrossRefGoogle Scholar
  31. 31.
    Moroze RM, Dunn TM, Holland JC, Yager J, Weintraub P (2014) Microthinking about Micronutrients: a case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria. Psychosomatics. PubMedCrossRefGoogle Scholar
  32. 32.
    Oberle CD, Watkins RS, Burkot AJ (2018) Orthorexic eating behaviors related to exercise addiction and internal motivations in a sample of university students. Eat Weight Disord 23(1):67–74. CrossRefGoogle Scholar
  33. 33.
    Rudolph S (2017) The connection between exercise addiction and orthorexia nervosa in German fitness sports. Eat Weight Disord. PubMedCrossRefGoogle Scholar
  34. 34.
    Brierley M, Brooks KR, Mond J, Stevenson RJ (2016) The Body and the Beautiful: Health, Attractiveness and Body Composition in Men’s and Women’s Bodies. PLoS One. PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Gómez-Ambrosi J, Silva C, Galofre JC, Escalada J, Santos S, Milla D et al (2012) Body mass index classification misses subjects with increased cardiometabolic risk factors related to elevated adiposity. Int J Obes 36:286–294. CrossRefGoogle Scholar
  36. 36.
    Dell’Osso L, Abelli M, Carpita B, Massimetti G, Pini S, Rivetti L et al (2016) Orthorexia nervosa in a sample of Italian university population. Riv Psichiatr 51(5):190–196. PubMedCrossRefGoogle Scholar
  37. 37.
    Ramacciotti CE, Perrone P, Coli E, Burgalassi A, Conversano C, Massimetti G (2011) Orthorexia nervosa in the general population: a preliminary screening using a self-administered questionnaire (ORTO-15). Eat Weight Disord 16:127–130. CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Faculty of MedicineUniversity of CoimbraCoimbraPortugal
  2. 2.Internal Medicine A DepartmentCentro Hospitalar e Universitário de CoimbraCoimbraPortugal

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