Abstract

Background: Orthorexia nervosa (ON), a term coined in the late 1990s by Steven Bratman, MD, is characterized by an obsessive preoccupation with practicing a “healthy diet”. There is scant reliable literature on the topic and it remains unrecognized as a diagnosis in the Diagnostic and Statistical Manual for Mental Disorders 5. Thus, debate surrounding its legitimacy as a diagnosis continues. However, eating disorders (EDs) in the category Other Specified Feeding and Eating Disorder (OSFED), including ON, account for the highest percentage of ED diagnoses in the U.S. Although primary care physicians are often the first to encounter patients suffering from EDs, they receive little training in nutrition. As a result, a significant number of ON cases may go undetected. Purpose: The goal of this study is to determine the current state of knowledge on ON among health care professionals and gaps in current ON education, research, and diagnostic efforts. The objective is to provide the scientific community with a multidisciplinary summary of gaps in ON literature to facilitate further, translational research into the condition. Methods: A mixed methods study design was used. Professionals working in family medicine, nutrition, and psychology were recruited using purposive and snowball sampling. Data collection occurred in three phases (pre-interview survey, interview, and post-interview debriefing); surveys were administered via Qualtrics and the interview via Zoom. The pre-interview survey included questions about demographic information, eating competence and orthorexic behavior levels. The interview was used to gather knowledge of EDs and ON and personal and professional experiences with EDs and ON. The post-interview debriefing served to determine how the participant’s thoughts on the topic changed as a result of participation. Data analysis was conducted using SPSS v27.0 and Dedoose software version 8.3.47. Results: Seventeen of 22 professionals completed all three phases of the study; 5 working in family medicine/primary care, 10 in nutrition/dietetics, and 2 in psychology. Quantitative analysis showed the sample was eating competent and not orthorexic; orthorexic behavior significantly differed by professional domain (p = 0.014). Of professionals in family medicine/primary care who had not heard of ON (n=4), 75% had worked with patients that presented with similar behaviors to the condition. Ninety-four percent of professionals felt there were gaps in the way ON is medically/clinically addressed and that awareness of ON in healthcare is important. Qualitative analysis indicated that professionals in nutrition/dietetics had more intimate experiences working with patients with EDs and more detailed knowledge of ON. Common descriptions of patients with ON included having a general obsession around one’s physical health, conducting extensive online research on health and nutrition, and hyper-focusing on the ingredients/additives in food. Perceived gaps in the way ON is medically/clinically addressed included lack of reliable research and diagnostic tools and treatment methods for ON, unawareness of the condition among healthcare professionals, and encouragement of ON related behaviors by providers. Discussion: Little remains known about ON; although many providers remain ignorant to the condition, it is not uncommon for patients to display ON related behaviors. Future research efforts should be aimed at developing accurate diagnostic tools, testing efficacy of new and existing treatment regimes, and identifying the most efficient and effective method of delivering ON education to medical providers.

Library of Congress Subject Headings

Eating disorders--Public opinion; Natural foods--Psychological aspects--Public opinion; Nutrition--Psychological aspects--Public opinion; Nutritionists--Attitudes; Physicians (General practice)--Attitudes; Psychologists--Attitudes

Publication Date

8-3-2021

Document Type

Thesis

Student Type

Graduate

Degree Name

Health and Well-being Management (MS)

Advisor

Barbara Lohse

Advisor/Committee Member

Brenda Abu

Advisor/Committee Member

Jessamy Comer

Campus

RIT – Main Campus

Plan Codes

HLTH-MS

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