Advertisement

Confirmatory factor analyses of the ORTO 15-, 11- and 9-item scales and recommendations for suggested cut-off scores

  • Stephan Moller
  • Pragalathan Apputhurai
  • Simon R. KnowlesEmail author
Original Article
Part of the following topical collections:
  1. Orthorexia Nervosa

Abstract

Aims

To explore the validity and recommend cut-off scores in an English-speaking sample for 9, 11, and 15-item versions of the ORTO measure for orthorexia, a proposed eating disorder characterised by a pathological obsession with consuming only ‘healthy’ foods.

Materials and methods

The sample comprised of 585 participants (82.4% female) who completed an online questionnaire containing the ORTO-15, Eating Attitudes test, Obsessive Compulsive Inventory Revised. A series of Confirmatory Factor Analyses were conducted to test model fit. Binary logistic linear regression and receiver-operating-characteristics (ROC) analyses were used to obtain cut-offs.

Results and conclusion

Results showed that none of the three published versions (9, 11, and 15-item) of the ORTO produced an acceptable model. Subsequent exploratory and confirmatory factor analyses yielded a seven-item version of the ORTO (ORTO-7) with a strong and stable factor structure. Analysis of cut-offs revealed that a cut-off score of equal or greater than 19 on the ORTO-7 represents probable orthorexia.

Level of evidence

Level V, descriptive study.

Keywords

Orthorexia Scale validation Confirmatory factor analysis Disordered eating 

Notes

Author contributions

All authors identified on this manuscript have contributed equally to the study and provide approval for the final version of this manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that this research was conducted in the absence of any 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.

Informed consent

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

References

  1. 1.
    Bratman S (1997) The health food eating disorder. Yoga J.  https://doi.org/10.1016/j.psym.2014.03.003 Google Scholar
  2. 2.
    Kaplan S (2015) Psychiatry doesn’t recognize “orthorexia”—an obsession with healthy eating. But the Internet does. [online] Washington Post. https://www.washingtonpost.com/news/morningmix/wp/2015/11/05/psychiatry-doesnt-recognize-orthorexia-an-obsession-with-healthy-eating-but-theinternet-does/?noredirect=on&utm_term=.9e9d22a59701. Accessed 15 Jan 2016
  3. 3.
    Oksman O (2015) Orthorexia: when healthy eating turns against you. [online] The Guardian. https://www.theguardian.com/lifeandstyle/2015/sep/26/orthorexia-eating-disorder-clean-eating-dsmmiracle-foods. Accessed 3 Mar 2016
  4. 4.
    Jones R (2016) Orthorexia: the dangerous trend behind #cleaneating. [online] Triple J Hack. http://www.abc.net.au/triplej/programs/hack/orthorexia-the-dangerous-trend-behind-clean-eating/7251952. Accessed 1 Apr 2016
  5. 5.
    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn.  https://doi.org/10.1176/appi.books.9780890425596.744053
  6. 6.
    Barthels F, Meyer F, Pietrowsky R (2015) Orthorexic eating behavior. Ernahrungs Umschau 62:156–161.  https://doi.org/10.4455/eu.2015.029 Google Scholar
  7. 7.
    Bratman S, Knight D (2000) Health food junkies: orthorexia nervosa: overcoming the obsession with healthful eating. J Am Med Assoc.  https://doi.org/10.1007/BF02221369 Google Scholar
  8. 8.
    Dunn TM, Bratman S (2016) On orthorexia nervosa: a review of the literature and proposed diagnostic criteria. Eat Behav 21:11–17.  https://doi.org/10.1016/j.eatbeh.2015.12.006 CrossRefGoogle Scholar
  9. 9.
    Moroze RM, Dunn TM, Craig Holland J et al (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.  https://doi.org/10.1016/j.psym.2014.03.003 CrossRefGoogle Scholar
  10. 10.
    Donini LM, Marsili D, Graziani MP et al (2005) Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord 10:28–32.  https://doi.org/10.1007/BF03327537 CrossRefGoogle Scholar
  11. 11.
    Mosticoni R, Chiari G (1985) Una descrizione obiettiva della personalità. Il Minnesota Multiphasic Personalità Inventory. Organizzazioni Speciali, FirenzeGoogle Scholar
  12. 12.
    Missbach B, Hinterbuchinger B, Dreiseitl V et al (2015) When eating right, is measured wrong! A validation and critical examination of the ORTO-15 questionnaire in German. PLoS One 10:1–16.  https://doi.org/10.1371/journal.pone.0135772 CrossRefGoogle Scholar
  13. 13.
    Varga M, Thege B, Dukay-Szabó S et al (2014) When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry 14:59.  https://doi.org/10.1186/1471-244X-14-59 CrossRefGoogle Scholar
  14. 14.
    Alvarenga MS, Martins MCT, Sato KSCJ. et al (2012) Orthorexia nervosa behavior in a sample of Brazilian dietitians assessed by the Portuguese version of ORTO-15. Eat Weight Disord Stud Anorex Bulim Obes 17:29–35.  https://doi.org/10.1007/BF03325325 CrossRefGoogle Scholar
  15. 15.
    Pontes JB, Montagner MI, Montagner M (2014) Ortorexia nervosa: adaptação cultural do ORTO-15. Demetra Aliment Nutr Saúde 9:533–548.  https://doi.org/10.12957/demetra.2014.8576 Google Scholar
  16. 16.
    Gubiec E, Lewandowicz A, Rasmus P, Sobów T (2015) Orthorexia in a group of dietetics students. Med Ogólna i Nauk o Zdrowiu 21:95–100.  https://doi.org/10.5604/20834543.1142367 CrossRefGoogle Scholar
  17. 17.
    Stochel M, Janas-Kozik M, Zejda J et al (2015) Validation of ORTO-15 Questionnaire in the group of urban youth aged 15–21. Psychiatr Pol 49:119–134.  https://doi.org/10.12740/PP/25962 CrossRefGoogle Scholar
  18. 18.
    Brytek-Matera A, Krupa M, Poggiogalle E, Donini LM (2014) Adaptation of the ORTHO-15 test to Polish women and men. Eat Weight Disord 19:69–76.  https://doi.org/10.1007/s40519-014-0100-0 CrossRefGoogle Scholar
  19. 19.
    Jerez T, Lagos R, Valdés-Badilla P et al (2015) Prevalencia de conducta ortoréxica en estudiantes de educación media de Temuco. Rev Chil Nutr 42:41–44.  https://doi.org/10.4067/S0717-75182015000100005 CrossRefGoogle Scholar
  20. 20.
    Valera JH, Ruiz PA, Valdespino BR, Visioli F (2014) Prevalence of orthorexia nervosa among ashtanga yoga practitioners: a pilot study. Eat Weight Disord 19:469–472.  https://doi.org/10.1007/s40519-014-0131-6 CrossRefGoogle Scholar
  21. 21.
    Asil E, Sürücüoğlu MS (2015) Orthorexia nervosa in Turkish dietitians. Ecol Food Nutr 244:1–11.  https://doi.org/10.1080/03670244.2014.987920 Google Scholar
  22. 22.
    Baǧci Bosi AT, Çamur D, Güler Ç (2007) Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey). Appetite 49:661–666.  https://doi.org/10.1016/j.appet.2007.04.007 CrossRefGoogle Scholar
  23. 23.
    Arusoǧlu G, Kabakçi E, Köksal G, Kutluay Merdol T (2008) Orhorexia nervosa and adaptation of ORTO-11 into Turkish. Turk Psikiyatr Derg 19:283–291Google Scholar
  24. 24.
    Aksoydan E, Camci N (2009) Prevalence of orthorexia nervosa among Turkish performance artists. Eat Weight Disord 14:33–37.  https://doi.org/10.1007/BF03327792 CrossRefGoogle Scholar
  25. 25.
    Fidan T, Ertekin V, Isikay S, Kirpinar I (2010) Prevalence of orthorexia among medical students in Erzurum, Turkey. Compr Psychiatry 51:49–54.  https://doi.org/10.1016/j.comppsych.2009.03.001 CrossRefGoogle Scholar
  26. 26.
    Ramacciotti CE, Perrone P, Coli E et al (2011) Orthorexia nervosa in the general population: a preliminary screening using a self-administered questionnaire (ORTO-15). Eat Weight Disord 16:e127–e130.  https://doi.org/10.1007/BF03325318 CrossRefGoogle Scholar
  27. 27.
    Segura-Garcia C, Ramacciotti C, Rania M et al (2015) The prevalence of orthorexia nervosa among eating disorder patients after treatment. Eat Weight Disord 20:161–166.  https://doi.org/10.1007/s40519-014-0171-y CrossRefGoogle Scholar
  28. 28.
    Segura-García C, Papaianni MC, Caglioti F et al (2012) Orthorexia nervosa: a frequent eating disordered behavior in athletes. Eat Weight Disord 17:226–233.  https://doi.org/10.3275/8272 Google Scholar
  29. 29.
    Brytek-Matera A, Rogoza R, Gramaglia C, Zeppegno P (2015) Predictors of orthorexic behaviours in patients with eating disorders: a preliminary study. BMC Psychiatry 15:252.  https://doi.org/10.1186/s12888-015-0628-1 CrossRefGoogle Scholar
  30. 30.
    McInerney-Ernst EM (2011) Orthorexia nervosa: real construct or newest social trend? Faculty of the University of Missouri-Kansas City, Kansas CityGoogle Scholar
  31. 31.
    Forester DS (2014) Examining the relationship between orthorexia nervosa and personality traits. California State University, StanislausGoogle Scholar
  32. 32.
    Koven NS, Senbonmatsu R (2013) A neuropsychological evaluation of orthorexia nervosa. Open J Psychiatry 214–222.  https://doi.org/10.4236/ojpsych.2013.32019
  33. 33.
    Barnes MA, Caltabiano ML (2017) The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eat Weight Disord 22:177–184.  https://doi.org/10.1007/s40519-016-0280-x CrossRefGoogle Scholar
  34. 34.
    Dunn TM, Gibbs J, Whitney N, Starosta A (2017) Prevalence of orthorexia nervosa is less than 1%: data from a US sample. Eat Weight Disord 22:185–192.  https://doi.org/10.1007/s40519-016-0258-8 CrossRefGoogle Scholar
  35. 35.
    Sanlier N, Yassibas E, Bilici S et al (2016) Does the rise in eating disorders lead to increasing risk of orthorexia nervosa? Correlations with gender, education, and body mass index. Ecol Food Nutr 55:266–278.  https://doi.org/10.1080/03670244.2016.1150276 CrossRefGoogle Scholar
  36. 36.
    Garner DM, Olmsted MP, Bohr Y, Garfinkel PE (1982) The Eating Attitudes test: psychometric features and clinical correlates. Psychol Med 12:871–878.  https://doi.org/10.1017/S0033291700049163 CrossRefGoogle Scholar
  37. 37.
    Foa EB, Huppert JD, Leiberg S et al (2002) The obsessive–compulsive inventory: development and validation of a short version. Psychol Assess 14:485–496.  https://doi.org/10.1037//1040-3590.14.4.485 CrossRefGoogle Scholar
  38. 38.
    Byrne BM (2009) Structural equation modeling with AMOS: basic concepts, applications, and programming, 2nd edn. Routledge, LondonGoogle Scholar
  39. 39.
    Westin LK (2001) Receiver operating characteristic (ROC) analysis: evaluating discriminance effects among decision support systems. https://www.semanticscholar.org/paper/Receiver-operating-characteristic-(ROC)-analysis-Westin/dfc1e148b1d08500954f5c78f0a1001affbfc041. Accessed 27 Apr 2018
  40. 40.
    Kaufman JD, Dunlap WP (2000) Determining the number of factors to retain: a windows-based FORTRAN-IMSL program for parallel analysis. Behav Res Methods Instrum Comput 32:389–395.  https://doi.org/10.3758/BF03200806 CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Stephan Moller
    • 1
  • Pragalathan Apputhurai
    • 1
  • Simon R. Knowles
    • 1
    • 2
    • 3
    • 4
    • 5
    Email author
  1. 1.Faculty of Health Arts, and DesignSwinburne University of TechnologyMelbourneAustralia
  2. 2.Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia
  3. 3.Department of GastroenterologyThe Alfred HospitalMelbourneAustralia
  4. 4.Department of Mental HealthSt Vincent’s HospitalMelbourneAustralia
  5. 5.University of MelbourneMelbourneAustralia

Personalised recommendations