Deconstructing Orthorexia in an Age of Healthism and Social Media

Orthorexia, a pathological fixation with healthy eating, has recently emerged as a construct of interest in the field of clinical psychology. Despite its growing recognition, the origin of this construct remains unclear. This dissertation aims to contribute to the understanding of orthorexia by examining its emergence and contextual factors through a constructivist lens. The study found that the cultural, economic, and moralistic landscape of healthism and social medially have played a role in the development of orthorexia. The dominant clinical perspective of orthorexia was also deconstructed, revealing potential biases that may lead to pathologizing the experiences of those who demonstrate orthorexic behaviors. The study highlights the need for careful consideration of the risks and vulnerabilities associated with the integration of orthorexia into diagnostic and clinical models. However, it also acknowledges the reality of individuals expressing suffering in the form of orthorexic behavior and provides treatment considerations to honor their experiences and desire for relief in a clinical setting. This dissertation is available in open access at AURA (https://aura.antioch.edu) and OhioLINK ETD Center (https://etd.ohiolink.edu)

When Healthy Turns Harmful: Increasing Understanding of Potential Risk Factors and Approaches to Decreasing Orthorexic Behaviors

Orthorexia Nervosa (ON) is a relatively new term used to describe individuals who place an excessive value on consuming a “pure” or healthful diet, so much so that their psychological, and potentially physical, health is negatively affected. ON is driven by a focus of consuming high-quality foods rather than limiting the quantity of food. This has sometimes been referred to as “clean eating”, or only consuming “clean” foods. A commonality between ON and other eating disorders (EDs) is that the behaviors are rooted in restriction, where an individual with ON would focus on restricting specific foods, or even entire food groups. The overall objective of the research studies included in this dissertation was to investigate the behaviors associated with ON in young adults and adolescents, and to implement and evaluate the effectiveness of a program for adolescents designed to decrease these behaviors. The first study investigated the relationship between high or low amounts of nutrition knowledge, how interested an individual was in the subject of nutrition, and ON behaviors. Results of this study show that those who indicate they are more interested in the subject of nutrition may be at a higher risk for practicing behaviors associated with ON, while those who have greater amounts of nutrition knowledge tend to be at a lower risk. Next, given the scarcity of research of this disorder in adolescent populations, the second study evaluated a test originally designed to measure ON behaviors in adults to determine if it was appropriate for use in adolescents. A secondary aim of this study was to explore gender differences in how adolescents think and talk about food and nutrition. Results showed that with minor modifications to several words used in the tool, this tool would be appropriate for use within adolescents. Further, interesting differences between genders were found, with girls mentioning dieting and body image, and boys mentioning their eating decisions were based on participation in sports. The final study in this dissertation investigated the effectiveness of an Intuitive Eating (IE) program on decreasing risky eating behaviors among ninth grade high school students, specifically ON behaviors. We tested two versions of the program (single session and multisession) and looked for differences in students’ scores between each program compared to a control group who did not receive either program. Our results showed neither program had a significant impact on decreasing either behaviors associated with ON or ED symptoms, or on increasing IE. However, our results showed interesting gender differences, where boys showed fewer ON behaviors and ED symptoms than girls at the follow up test, and greater IE behaviors than girls at the pretest and posttest. Results also showed those who were more interested in the subject of nutrition tended to demonstrate more ON behaviors. This study showed nutrition education may be beneficial in decreasing risky eating behaviors, though more research is needed to determine if IE is an effective approach

Mining Social Media to Understand Consumers' Health Concerns and the Public's Opinion on Controversial Health Topics.

Social media websites are increasingly used by the general public as a venue to express health concerns and discuss controversial medical and public health issues. This information could be utilized for the purposes of public health surveillance as well as solicitation of public opinions. In this thesis, I developed methods to extract health-related information from multiple sources of social media data, and conducted studies to generate insights from the extracted information using text-mining techniques. To understand the availability and characteristics of health-related information in social media, I first identified the users who seek health information online and participate in online health community, and analyzed their motivations and behavior by two case studies of user-created groups on MedHelp and a diabetes online community on Twitter. Through a review of tweets mentioning eye-related medical concepts identified by MetaMap, I diagnosed the common reasons of tweets mislabeled by natural language processing tools tuned for biomedical texts, and trained a classifier to exclude non medically-relevant tweets to increase the precision of the extracted data. Furthermore, I conducted two studies to evaluate the effectiveness of understanding public opinions on controversial medical and public health issues from social media information using text-mining techniques. The first study applied topic modeling and text summarization to automatically distill users' key concerns about the purported link between autism and vaccines. The outputs of two methods cover most of the public concerns of MMR vaccines reported in previous survey studies. In the second study, I estimated the public's view on the ac{ACA} by applying sentiment analysis to four years of Twitter data, and demonstrated that the the rates of positive/negative responses measured by tweet sentiment are in general agreement with the results of Kaiser Family Foundation Poll. Finally, I designed and implemented a system which can automatically collect and analyze online news comments to help researchers, public health workers, and policy makers to better monitor and understand the public's opinion on issues such as controversial health-related topics.PhDInformationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/120714/1/owenliu_1.pd

Utilizing Consumer Health Posts for Pharmacovigilance: Identifying Underlying Factors Associated with Patients’ Attitudes Towards Antidepressants

Non-adherence to antidepressants is a major obstacle to antidepressants therapeutic benefits, resulting in increased risk of relapse, emergency visits, and significant burden on individuals and the healthcare system. Several studies showed that non-adherence is weakly associated with personal and clinical variables, but strongly associated with patients’ beliefs and attitudes towards medications. The traditional methods for identifying the key dimensions of patients’ attitudes towards antidepressants are associated with some methodological limitations, such as concern about confidentiality of personal information. In this study, attempts have been made to address the limitations by utilizing patients’ self report experiences in online healthcare forums to identify underlying factors affecting patients attitudes towards antidepressants. The data source of the study was a healthcare forum called “askapatients.com”. 892 patients’ reviews were randomly collected from the forum for the four most commonly prescribed antidepressants including Sertraline (Zoloft) and Escitalopram (Lexapro) from SSRI class, and Venlafaxine (Effexor) and duloxetine (Cymbalta) from SNRI class. Methodology of this study is composed of two main phases: I) generating structured data from unstructured patients’ drug reviews and testing hypotheses concerning attitude, II) identification and normalization of Adverse Drug Reactions (ADRs), Withdrawal Symptoms (WDs) and Drug Indications (DIs) from the posts, and mapping them to both The UMLS and SNOMED CT concepts. Phase II also includes testing the association between ADRs and attitude. The result of the first phase of this study showed that “experience of adverse drug reactions”, “perceived distress received from ADRs”, “lack of knowledge about medication’s mechanism”, “withdrawal experience”, “duration of usage”, and “drug effectiveness” are strongly associated with patients attitudes. However, demographic variables including “age” and “gender” are not associated with attitude. Analysis of the data in second phase of the study showed that from 6,534 identified entities, 73% are ADRs, 12% are WDs, and 15 % are drug indications. In addition, psychological and cognitive expressions have higher variability than physiological expressions. All three types of entities were mapped to 811 UMLS and SNOMED CT concepts. Testing the association between ADRs and attitude showed that from twenty-one physiological ADRs specified in the ASEC questionnaire, “dry mouth”, “increased appetite”, “disorientation”, “yawning”, “weight gain”, and “problem with sexual dysfunction” are associated with attitude. A set of psychological and cognitive ADRs, such as “emotional indifference” and “memory problem were also tested that showed significance association between these types of ADRs and attitude. The findings of this study have important implications for designing clinical interventions aiming to improve patients\u27 adherence towards antidepressants. In addition, the dataset generated in this study has significant implications for improving performance of text-mining algorithms aiming to identify health related information from consumer health posts. Moreover, the dataset can be used for generating and testing hypotheses related to ADRs associated with psychiatric mediations, and identifying factors associated with discontinuation of antidepressants. The dataset and guidelines of this study are available at https://sites.google.com/view/pharmacovigilanceinpsychiatry/hom

Nutrition knowledge and skills among young endurance athletes

Nutrition plays an important role in athletic performance. Its full potential is rarely realized due to limited nutrition knowledge among athletes and their coaches. Misunderstandings and gaps in knowledge can lead to food choices that do not support athletic development. This thesis study was undertaken to gain further insight into the nutrition knowledge of young Finnish endurance athletes. Another aim was to evaluate how athletes’ knowledge and nutritional skills can be improved. Study I created and validated a questionnaire measuring knowledge in different areas of sports nutrition. This questionnaire was then used in Study II, which aimed to measure the nutrition knowledge of young Finnish endurance athletes and their coaches. The results of Study II were used to develop an education intervention, aiming to improve athletes’ nutrition knowledge and dietary intake, in Study III. The intervention compared the effects of participatory nutrition sessions alone to those enhanced by a mobile app. In Study II, a total of 312 athletes and 94 coaches completed the questionnaire. The athletes were 17.9±1.2 and the coaches 44.3±12.3 years old. Half of the athletes were women and half men; of the coaches 27% were women. Of the athletes 36% were cross country skiers, 35% orienteers and the rest other endurance athletes. Seventy-nine athletes took part in the intervention in Study III. Their mean age was 18.0±1.4 years, 56% of them were men and 44% were women, and 42% were cross-country skiers. The education in the intervention was based on the Self-Determination Theory and the concept of meaningful learning processes. The education sessions included discussions, tasks and goal setting, which were all intended to increase the athletes’ intrinsic motivation. This motivation in turn is a prerequisite for effective learning. The three sessions lasted 90 minutes each and were held fortnightly. The athletes filled in the questionnaire at baseline and a week and three months after the last session. The athletes in the mobile app group used the app for four days after each session and took photos of everything they ate or drank. Both groups completed a three-day food diary at baseline and three months after the last session and received personal feedback on it. On average, the athletes in Study II answered 73% and the coaches 81% of the items correctly. However, over a half of the athletes and 44% of the coaches scored below the mean knowledge score, at worst answering only 47% of the items correctly. The coaches scored better in all sections of the questionnaire. The questions in the ‘Dietary supplements’ section proved to be the most difficult for the athletes, and those in the ‘Nutrition recommendations for endurance athletes’ section for the coaches. The older the athletes were, the higher was their mean nutrition knowledge score. Among the coaches, the situation was the opposite. On average, the female athletes and coaches scored better than the men. The athletes who were part of a national team had higher knowledge scores than those who were not. The athletes’ nutrition knowledge improved significantly during the intervention. At baseline, their knowledge score was 78%. A week after the education sessions, the athletes in the mobile app group answered on average 87% of the questions correctly and three months later, 86%. In the group without the mobile app, the scores were 85% and 84%, respectively. There was no significant difference between the groups in any sections of the questionnaire. The mean energy intake of the athletes was below the estimated energy expenditure during Study III. The intake of protein and fat met the recommendations for endurance athletes, but the intake of carbohydrates was below them (6–10 g·kg-1·day-1) throughout the study, even though it slightly improved. At the end of the intervention, the athletes in the mobile app group consumed 5.4 g·kg-1·day-1 of carbohydrates and the athletes in the other group 5.0 g·kg-1·day-1. Many psychological, social and economic factors affect what we eat. Improved knowledge does not automatically lead to better food choices if the intention to perform the behavioural change is lacking. The duration of the intervention may also have been too short for notable behavioural changes. In addition, already at the beginning of the study the diet of the athletes was better than that of the general Finnish population, thus leaving less room for dietary improvements. Nutrition knowledge improved after only three education sessions and food diary feedback, but the mobile app did not further improve this learning. Thus, if sport clubs and other sport organizations dedicated even a relatively small amount of time and other resources to structured, targeted, motivational and science-based nutrition education, it may promote positive changes in nutrition knowledge. As athletes make use of the skills they learn during their sports careers in their everyday lives as well as when training other athletes, receiving influential nutrition education could also benefit their performance and health in the future.Hyvä ravitsemustila vaikuttaa urheilijan terveyteen, kehittymiseen, suorituskykyyn ja palautumiseen. Sen tärkeys voi kuitenkin jäädä huomioimatta urheilijoilta ja valmentajilta, sillä heidän ravitsemustiedoissaan on usein puutteita. Harhaluulot ja väärinymmärrykset voivat johtaa ruokavalintoihin, jotka eivät tue urheilemista. Tämän tutkimuksen perusteella nuorten urheilijoiden ravitsemustietoja voidaan parantaa ravitsemusohjauksella. Jo suhteellisen pienellä ajan- ja muiden resurssien käytöllä voidaan saada aikaan merkittäviä muutoksia ravitsemusosaamisessa. Tässä tutkimuksessa selvitettiin, millaista 16–20-vuotiaiden suomalaisten kestävyysurheilijoiden ravitsemusosaaminen on ja miten siihen voidaan vaikuttaa. Tutkimuksen alussa luotiin ja validoitiin kyselylomake mittaamaan osaamista urheiluravitsemuksen eri osa-alueilla. Kyselytutkimukseen osallistui 312 urheilijaa ja 94 valmentajaa. Sen tuloksiin pohjautuen suunniteltiin luentomallista ravitsemusohjausta sekä mobiilisovellusta hyödyntävä ravitsemusinterventio, jolla urheilijoiden ravitsemustietoihin ja ruokavalintoihin pyrittiin vaikuttamaan. Kyselytutkimukseen osallistuneista urheilijoista puolet oli naisia ja puolet miehiä. Osallistuneista valmentajista 27 % oli naisia. Interventioon osallistui 79 urheilijaa, joista 56 % oli miehiä ja 44 % naisia. Vuorovaikutteista ravitsemusohjausta annettiin kolmesti kahden viikon välein. Toinen ryhmä käytti jokaisen luennon jälkeen mobiilisovellusta, jolla kuvattiin kaikki syömiset neljän päivän ajan ja tehtiin näihin liittyviä tehtäviä. He saivat sovelluksen kautta palautetta ruokavaliostaan. Molemmat ryhmät täyttivät kolme vuorokautta ruokapäiväkirjaa tutkimuksen alussa ja lopussa ja saivat tästä palautetta. Kyselytutkimuksessa urheilijat vastasivat keskimäärin 73 % ja valmentajat 81 % kysymyksistä oikein, mutta vaihtelu oli suurta. Heikoimmillaan urheilijat vastasivat alle puoliin kysymyksistä oikein. Valmentajien ravitsemusosaaminen oli parempaa kaikilla kyselyn osa-alueilla. Haasteellisimmiksi osoittautuivat ravintolisiin ja urheilijoiden ravitsemussuosituksiin liittyvät väittämät. Nuoremmilla urheilijoilla oli tiedoissaan enemmän puutteita kuin vanhemmilla; valmentajilla tilanne oli päinvastainen. Naisurheilijat ja -valmentajat saivat keskimäärin miehiä parempia tuloksia. Urheilijoiden ravitsemustiedot paranivat merkittävästi intervention aikana. Tutkimuksen alussa urheilijat vastasivat 78 % kysymyksistä oikein. Viikko luentojen jälkeen oikeita vastauksia oli mobiilisovellusryhmässä keskimäärin 87 % ja kolmen kuukauden päästä 86 %; toisessa ryhmässä vastaavasti 85 ja 84 %. Urheilijoiden keskimääräinen energiansaanti jäi alle arvioidun kokonais-energiankulutuksen, vaikka se tutkimuksen aikana kasvoikin. Proteiineja ja rasvoja saatiin kestävyysurheilijoiden ravitsemussuositusten mukaisesti, mutta hiilihydraatinsaanti jäi suosituksista. Ruokavalintoihin vaikuttavat monet psykologiset, sosiaaliset ja taloudelliset tekijät. Parantuneet tiedot eivät suoraan johda parempiin ruokavalintoihin, jos riittävää motivaatiota käyttäytymisen muutokseen ei ole. Muutokset voivat myös vaatia aikaa, miksi intervention lyhyehkö kesto voi selittää sen, ettei ruokavalioissa tapahtunut tilastollisesti merkitseviä muutoksia. Lisäksi urheilijat söivät jo lähtötilanteessa paremmin kuin suomalaiset keskimäärin. Nuorten urheilijoiden ravitsemustietoja voidaan parantaa merkittävästi huolellisesti suunnitellulla, vuorovaikutteisella, ryhmämuotoisella ravitsemusohjauksella. Urheilijat voivat hyödyntää oppimiaan tietoja uransa aikana sekä sen jälkeen, mikä voi näkyä heidän suorituskyvyssään ja terveydessään. Heidän on lisäksi mahdollista toimia esimerkkeinä muille sekä auttaa ravitsemukseen liittyvien harhaluulojen torjumisessa

Sorting the Healthy Diet Signal from the Social Media Expert Noise: Preliminary Evidence from the Healthy Diet Discourse on Twitter

: Over 2.8 million people die each year from being overweight or obese, a largely preventable disease. Social media has fundamentally changed the way we communicate, collaborate, consume, and create content. The ease with which content can be shared has resulted in a rapid increase in the number of individuals or organisations that seek to influence opinion and the volume of content that they generate. The nutrition and diet domain is not immune to this phenomenon. Unfortunately, from a public health perspective, many of these ‘influencers’ may be poorly qualified in order to provide nutritional or dietary guidance, and advice given may be without accepted scientific evidence and contrary to public health policy. In this preliminary study, we analyse the ‘healthy diet’ discourse on Twitter. While using a multi-component analytical approach, we analyse more than 1.2 million English language tweets over a 16-month period in order to identify and characterise the influential actors and discover topics of interest in the discourse. Our analysis suggests that the discourse is dominated by non-health professionals. There is widespread use of bots that pollute the discourse and seek to create a false equivalence on the efficacy of a particular nutritional strategy or diet. Topic modelling suggests a significant focus on diet, nutrition, exercise, weight, disease, and quality of life. Public health policy makers and professional nutritionists need to consider what interventions can be taken in order to counteract the influence of non-professional and bad actors on social media