A Cross-Sectional Study: Orthorexia Nervosa In Regular Exercising Individuals For Healthy Life

Main Article Content

Ozge Yesildemir
Nilufer Acar Tek


Orthorexia nervosa, exercise, healthy eating obsessions, nutrition, body composition


This study was conducted to determine the prevalence of orthorexia nervosa (ON) among individuals who exercise regularly and to define the factors associated with ON. A total of 206 individuals, (102 males and 104 females) who exercise regularly at least twice a week were included in the study. Anthropometric measurements were taken and body composition was measured by BIA in addition to energy. Also, nutrient intake was done through a 24-hour diet recall and the ORTO-15 test was applied to the participants. Orhtorexia was more prevalent among participants who exercise regularly (81.6%). There was no statistically significant relationship between orthorexic tendency or gender, marital status, education, and income. The mean exercise frequency was significantly higher in individuals with ON than in non-ON individuals. Total dietary energy intake and the percentage of energy from carbohydrates were higher in males with ON than in non-ON males. The percentage of energy from protein was higher in females with ON. Body weight, percentage of body fat, and BMI were higher in orthorexic females than in non-orthorexic females, while there was no difference in anthropometric measurements and body composition in relation to ON in males. As a result, it was determined that individuals who exercise regularly were a risk group in terms of ON.


Download data is not yet available.
Abstract 9 |


1. Rudolph S. The connection between exercise addiction and orthorexia nervosa in German fitness sports. Eat Weight Disord 2018;23(5):581-6.
2. Tek NA, Ermumcu MŞK. Healthy eating concern (Orthorexia Nervosa) and related factors in women. J Nurs Healthc Manag 2018;2(5):1-5.
3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifth ed. 2013.
4. Oberle CD, Lipschuetz SL. Orthorexia symptoms correlate with perceived muscularity and body fat, not BMI. Eat Weight Disord 2018;23(3):363-8.
5. Kiss-Leizer M, Tóth-Király I, Rigó A. How the obsession to eat healthy food meets with the willingness to do sports: the motivational background of orthorexia nervosa. Eat Weight Disord 2019:1-8.
6. Oberle CD, Watkins RS, Burkot AJ. Orthorexic eating behaviors related to exercise addiction and internal motivations in a sample of university students. Eat Weight Disord 2018;23(1):67-74.
7. Bartrina J. Orthorexia or when a healthy diet becomes an obsession. Arch Latinoam Nutr 2007;57(4):313-5.
8. Dunn TM, Bratman S. On orthorexia nervosa: a review of the literature and proposed diagnostic criteria. Eat Behav 2016;21:11-7.
9. Donini L, Marsili D, Graziani M, Imbriale M, Cannella C. Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord 2005;10(2):e28-e32.
10. Martins MCT, Alvarenga MdS, Vargas SVA, Sato KSCdJ, Scagliusi FB. Orthorexia nervosa: reflections about a new concept. Rev de Nutr 2011;24(2):345-57.
11. Hagger M. Current issues and new directions in psychology and health: Physical activity research showcasing theory into practice. Psychol Health 2010;25(1):1-5.
12. Republic of Turkey Ministry of Health. Physical Activity Guidelines for Turkey. 2 ed. Ankara, Kuban Publishing: 2014. [cited 2021 June 20]. Available from: https://hsgm.saglik.gov.tr/depo/birimler/saglikli-beslenme-hareketli-hayat db/Fiziksel_Aktivite_Rehberi/Turkiye_Fiziksel_Aktivite_Rehberi.pdf
13. Bóna E, Szél Z, Kiss D, Gyarmathy VA. An unhealthy health behavior: analysis of orthorexic tendencies among Hungarian gym attendees. Eat Weight Disord 2019;24(1):13-20.
14. Segura-García C, Papaianni MC, Caglioti F, Procopio L, Nisticò CG, Bombardiere L, et al. Orthorexia nervosa: a frequent eating disordered behavior in athletes. Eat Weight Disord 2012;17(4):226-33.
15. Varga M, Thege BK, Dukay-Szabó S, Túry F, van Furth EF. When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry 2014;14(1):59.
16. Eriksson L, Baigi A, Marklund B, Lindgren E-C. Social physique anxiety and sociocultural attitudes toward appearance impact on orthorexia test in fitness participants. Scand J Med Sci Spor 2008;18(3):389-94.
17. Rakıcıoğlu N, Tek NA, Ayaz A, Pekcan G. Photograph Catalog of Food and Dishes: Portion Sizes and Amounts. 7 ed. Ankara, Merdiven Offset Publication: 2017.
18. BeBiS. Computer Aided Nutrition Program, Nutrition Information System (version 7.2). 2010.
19. Arusoğlu G, Kabakçi E, Köksal G, Merdol TK. Orthorexia Nervosa and Adaptation of ORTO-11 into Turkish [Ortoreksiya Nervoza ve Orto-11’in Türkçeye Uyarlama Çalışması]. Turk Psikiyatri Derg 2008;19(3).
20. Pekcan G. Determination of nutritional status [Beslenme durumunun belirlenmesi]. 2 ed. Tüfekçi EA, editor. Ankara, Hatiboğlu Publications: 2014.
21. Pekcan G. Diet Handbook [Diyet El Kitabı]. Ankara, Hatipoğlu Publications: 2008
22. Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. Human kinetics books. Champaign, IL: 1988
23. Word Health Organization. Waist circumference and waist-hip ratio. 2008. [cited 2021 June 20] Available from: https://www.webcitation.org/query?url=http%3A%2F%2Fapps.who.int%2Firis%2Fbitstream%2F10665%2F44583%2F1%2F9789241501491_eng.pdf&date=2018-01-20
24. Statistical Package for the Social Sciences (SPSS Inc.). 2001.
25. Dalmaz M, Tekdemir-Yurtdaş G. Prevalence of orthorexia nervosa symptoms among people who exercise in gyms [Spor salonunda spor yapanlarda ortoreksiya nervoza belirtilerinin incelenmesi]. OTSHD 2015;4(4):23-39.
26. Bosi ATB, Çamur D, Güler Ç. Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey). Appetite. 2007;49(3):661-6.
27. Korinth A, Schiess S, Westenhoefer J. Eating behaviour and eating disorders in students of nutrition sciences. Public Health Nutr 2010;13(1):32-7.
28. Fidan T, Ertekin V, Işikay S, Kırpınar I. Prevalence of orthorexia among medical students in Erzurum, Turkey. Compr Psychiatry 2010;51(1):49-54.
29. Brytek-Matera A, Donini LM, Krupa M, Poggiogalle E, Hay P. Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students. J Eat Disord 2015;3(1):2.
30. Donini L, Marsili D, Graziani M, Imbriale M, Cannella C. Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eat Weight Disord 2004;9(2):151-7.
31. Ramacciotti C, Perrone P, Coli E, Burgalassi A, Conversano C, Massimetti G, et al. Orthorexia nervosa in the general population: a preliminary screening using a self-administered questionnaire (ORTO-15). Eat Weight Disord 2011;16(2):127-30.
32. Dell’Osso L, Abelli M, Carpita B, Massimetti G, Pini S, Rivetti L, et al. Orthorexia nervosa in a sample of Italian university population. Riv Psichiatr 2016;51(5):190-6.
33. Aksoydan E, Camci N. Prevalence of orthorexia nervosa among Turkish performance artists. Eat Weight Disord 2009;14(1):33-7.
34. Bo S, Zoccali R, Ponzo V, Soldati L, De Carli L, Benso A, et al. University courses, eating problems and muscle dysmorphia: are there any associations? J Transl Med 2014;12(1):221.
35. Malmborg J, Bremander A, Olsson MC, Bergman S. Health status, physical activity, and orthorexia nervosa: A comparison between exercise science students and business students. Appetite 2017;109:137-43.
36. Varga M, Dukay-Szabo S, Tury F. Orthorexia nervosa and it's background factors. Ideggyogy Sz 2013;66(7-8):220-7.
37. Asil E, Sürücüoğlu MS. Orthorexia nervosa in Turkish dietitians. Ecol Food Nutr 2015;54(4):303-13.
38. Haskell WL, Lee I-M, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 2007;116(9):1081.
39. Word Health Organization. Active ageing: A policy framework. 2002. [cited 2021 June 20] Available from: https://apps.who.int/iris/bitstream/handle/10665/67215/WHO_NMH_NPH_02.8.pdf?sequence=1&isAllowed=y
40. Turkey Dietary Guidelines. Ankara, Ministry of Turkey Health Publication: 2016.
41. Griffiths M. Exercise addiction: A case study. Addiction Research 1997;5(2):161-8.
42. Prichard I, Tiggemann M. Relations among exercise type, self-objectification, and body image in the fitness centre environment: The role of reasons for exercise. Psychol Sport Exerc 2008;9(6):855-66.
43. Kilpatrick M, Hebert E, Bartholomew J. College students' motivation for physical activity: differentiating men's and women's motives for sport participation and exercise. J Am Coll Health 2005;54(2):87-94.
44. Maltby J, Day L. The relationship between exercise motives and psychological weil-being. J Psychol 2001;135(6):651-60.
45. Byrne S, McLean N. Eating disorders in athletes: a review of the literature. J Sports Sci Med 2001;4(2):145-59.
46. Baum A. Eating disorders in the male athlete. Sports Med 2006;36(1):1-6.
47. Hausenblas HA, Carron AV. Eating disorder indices and athletes: An integration. J Sport Exercise Psy 1999;21(3):230-58.
48. Smolak L, Murnen SK, Ruble AE. Female athletes and eating problems: A meta‐analysis. Int J Eat Disord 2000;27(4):371-80.
49. Adkins EC, Keel PK. Does “excessive” or “compulsive” best describe exercise as a symptom of bulimia nervosa? Int J Eat Disord 2005;38(1):24-9.
50. Cook BJ, Hausenblas HA. The role of exercise dependence for the relationship between exercise behavior and eating pathology: mediator or moderator? J Health Psychol 2008;13(4):495-502.
51. Gezer C, Kabaran S. The risk of orthorexia nervosa for female students studying nutrition and dietetics [Beslenme ve diyetetik bölümü kız öğrencileri arasında görülen ortoreksiya nervosa riski]. SDÜ Sağlık Bilimleri Dergisi 2013;4(1):14-22.
52. Karadag MG, Elibol E, Yildiran H, Akbulut G, Celik MG, Degirmenci M, et al. Evaluation of the Relationship Between Obesity with Eating Attitudes and Orthorexic Behavior in Healthy Adults. Gazi Medical J 2016;27(3):107-14.
53. Varga M, Dukay-Szabó S, Túry F, van Furth Eric F. Evidence and gaps in the literature on orthorexia nervosa. Eat Weight Disord 2013;18(2):103-11.