A consensus document on definition and diagnostic criteria for orthorexia nervosa

Purpose: Since the term orthorexia nervosa (ON) was coined from the Greek (ὀρθός, right and ὄρεξις, appetite) in 1997 to describe an obsession with “correct” eating, it has been used worldwide without a consistent definition. Although multiple authors have proposed diagnostic criteria, and many theoretical papers have been published, no consensus definition of ON exists, empirical primary evidence is limited, and ON is not a standardized diagnosis. These gaps prevent research to identify risk and protective factors, pathophysiology, functional consequences, and evidence-based therapeutic treatments. The aims of the current study are to categorize the common observations and presentations of ON pathology among experts in the eating disorder field, propose tentative diagnostic criteria, and consider which DSM chapter and category would be most appropriate for ON should it be included. Methods: 47 eating disorder researchers and multidisciplinary treatment specialists from 14 different countries across four continents completed a three-phase modified Delphi process, with 75% agreement determined as the threshold for a statement to be included in the final consensus document. In phase I, participants were asked via online survey to agree or disagree with 67 statements about ON in four categories: A–Definition, Clinical Aspects, Duration; B–Consequences; C–Onset; D–Exclusion Criteria, and comment on their rationale. Responses were used to modify the statements which were then provided to the same participants for phase II, a second round of feedback, again in online survey form. Responses to phase II were used to modify and improve the statements for phase III, in which statements that met the predetermined 75% of agreement threshold were provided for review and commentary by all participants. Results: 27 statements met or exceeded the consensus threshold and were compiled into proposed diagnostic criteria for ON. Conclusions: This is the first time a standardized definition of ON has been developed from a worldwide, multidisciplinary cohort of experts. It represents a summary of observations, clinical expertise, and research findings from a wide base of knowledge. It may be used as a base for diagnosis, treatment protocols, and further research to answer the open questions that remain, particularly the functional consequences of ON and how it might be prevented or identified and intervened upon in its early stages. Although the participants encompass many countries and disciplines, further research will be needed to determine if these diagnostic criteria are applicable to the experience of ON in geographic areas not represented in the current expert panel. Level of evidence_ Level V: opinions of expert committee

A survey of Registered Dietitian Nutritionists who provide care to clients with eating disorders: Implications for education, training and clinical practice

Successful management of eating disorder (ED) symptoms includes Registered Dietitian Nutritionists (RDNs) with specialized expertise, nutrition counseling skills, and advanced training. We conducted an anonymous on-line survey of self-identified ED-specialized RDNs about their previous education and training, workload, job duties, and job satisfaction. Respondents were 182 RDNs who were U.S. members of the International Federation of Eating Disorder Dietitians. Qualitative methods identified salient themes from narrative responses to augment survey data. Most respondents expressed confidence in their ED-related competence, however these skills were gained from post-professional, self-funded activities, not from ED-specific education or training in either school or work settings. While two-thirds of RDNs surveyed held an advanced degree and more than half held specialty certification, an inverse relationship between provider expertise and patient acuity was observed. RDNs working at the highest levels of ED care with the most medically complex patients were less likely to hold graduate degrees or have prior clinical experience. Obstacles to job satisfaction included high patient caseloads, low compensation, lack of employer support, and high burnout. Facilitators of job satisfaction included professional and client communities, and the private practice setting. Considering the essential nature of nutrition rehabilitation in ED treatment and the high prevalence of dysfunctional eating behaviors in society at-large, these observations identify gaps in RDN preparedness and facility staffing practices that may affect treatment outcomes for individuals with known and undiagnosed ED’s. Enhancements in dietetics education and heightened attention to supervision for entry-level clinicians in ED-specific treatment programs are prime targets for actioSuccessful management of eating disorder (ED) symptoms includes Registered Dietitian Nutritionists (RDNs) with specialized expertise, nutrition counseling skills, and advanced training. We conducted an anonymous on-line survey of self-identified ED-specialized RDNs about their previous education and training, workload, job duties, and job satisfaction. Respondents were 182 RDNs who were U.S. members of the International Federation of Eating Disorder Dietitians. Qualitative methods identified salient themes from narrative responses to augment survey data. Most respondents expressed confidence in their ED-related competence, however these skills were gained from post-professional, self-funded activities, not from ED-specific education or training in either school or work settings. While two-thirds of RDNs surveyed held an advanced degree and more than half held specialty certification, an inverse relationship between provider expertise and patient acuity was observed. RDNs working at the highest levels of ED care with the most medically complex patients were less likely to hold graduate degrees or have prior clinical experience. Obstacles to job satisfaction included high patient caseloads, low compensation, lack of employer support, and high burnout. Facilitators of job satisfaction included professional and client communities, and the private practice setting. Considering the essential nature of nutrition rehabilitation in ED treatment and the high prevalence of dysfunctional eating behaviors in society at-large, these observations identify gaps in RDN preparedness and facility staffing practices that may affect treatment outcomes for individuals with known and undiagnosed ED’s. Enhancements in dietetics education and heightened attention to supervision for entry-level clinicians in ED-specific treatment programs are prime targets for actioSuccessful management of eating disorder (ED) symptoms includes Registered Dietitian Nutritionists (RDNs) with specialized expertise, nutrition counseling skills, and advanced training. We conducted an anonymous on-line survey of self-identified ED-specialized RDNs about their previous education and training, workload, job duties, and job satisfaction. Respondents were 182 RDNs who were U.S. members of the International Federation of Eating Disorder Dietitians. Qualitative methods identified salient themes from narrative responses to augment survey data. Most respondents expressed confidence in their ED-related competence, however these skills were gained from post-professional, self-funded activities, not from ED-specific education or training in either school or work settings. While two-thirds of RDNs surveyed held an advanced degree and more than half held specialty certification, an inverse relationship between provider expertise and patient acuity was observed. RDNs working at the highest levels of ED care with the most medically complex patients were less likely to hold graduate degrees or have prior clinical experience. Obstacles to job satisfaction included high patient caseloads, low compensation, lack of employer support, and high burnout. Facilitators of job satisfaction included professional and client communities, and the private practice setting. Considering the essential nature of nutrition rehabilitation in ED treatment and the high prevalence of dysfunctional eating behaviors in society at-large, these observations identify gaps in RDN preparedness and facility staffing practices that may affect treatment outcomes for individuals with known and undiagnosed ED’s. Enhancements in dietetics education and heightened attention to supervision for entry-level clinicians in ED-specific treatment programs are prime targets for actioSuccessful management of eating disorder (ED) symptoms includes Registered Dietitian Nutritionists (RDNs) with specialized expertise, nutrition counseling skills, and advanced training. We conducted an anonymous on-line survey of self-identified ED-specialized RDNs about their previous education and training, workload, job duties, and job satisfaction. Respondents were 182 RDNs who were U.S. members of the International Federation of Eating Disorder Dietitians. Qualitative methods identified salient themes from narrative responses to augment survey data. Most respondents expressed confidence in their ED-related competence, however these skills were gained from post-professional, self-funded activities, not from ED-specific education or training in either school or work settings. While two-thirds of RDNs surveyed held an advanced degree and more than half held specialty certification, an inverse relationship between provider expertise and patient acuity was observed. RDNs working at the highest levels of ED care with the most medically complex patients were less likely to hold graduate degrees or have prior clinical experience. Obstacles to job satisfaction included high patient caseloads, low compensation, lack of employer support, and high burnout. Facilitators of job satisfaction included professional and client communities, and the private practice setting. Considering the essential nature of nutrition rehabilitation in ED treatment and the high prevalence of dysfunctional eating behaviors in society at-large, these observations identify gaps in RDN preparedness and facility staffing practices that may affect treatment outcomes for individuals with known and undiagnosed ED’s. Enhancements in dietetics education and heightened attention to supervision for entry-level clinicians in ED-specific treatment programs are prime targets for actioSuccessful management of eating disorder (ED) symptoms includes Registered Dietitian Nutritionists (RDNs) with specialized expertise, nutrition counseling skills, and advanced training. We conducted an anonymous on-line survey of self-identified ED-specialized RDNs about their previous education and training, workload, job duties, and job satisfaction. Respondents were 182 RDNs who were U.S. members of the International Federation of Eating Disorder Dietitians. Qualitative methods identified salient themes from narrative responses to augment survey data. Most respondents expressed confidence in their ED-related competence, however these skills were gained from post-professional, self-funded activities, not from ED-specific education or training in either school or work settings. While two-thirds of RDNs surveyed held an advanced degree and more than half held specialty certification, an inverse relationship between provider expertise and patient acuity was observed. RDNs working at the highest levels of ED care with the most medically complex patients were less likely to hold graduate degrees or have prior clinical experience. Obstacles to job satisfaction included high patient caseloads, low compensation, lack of employer support, and high burnout. Facilitators of job satisfaction included professional and client communities, and the private practice setting. Considering the essential nature of nutrition rehabilitation in ED treatment and the high prevalence of dysfunctional eating behaviors in society at-large, these observations identify gaps in RDN preparedness and facility staffing practices that may affect treatment outcomes for individuals with known and undiagnosed ED’s. Enhancements in dietetics education and heightened attention to supervision for entry-level clinicians in ED-specific treatment programs are prime targets for actioSuccessful management of eating disorder (ED) symptoms includes Registered Dietitian Nutritionists (RDNs) with specialized expertise, nutrition counseling skills, and advanced training. We conducted an anonymous on-line survey of self-identified ED-specialized RDNs about their previous education and training, workload, job duties, and job satisfaction. Respondents were 182 RDNs who were U.S. members of the International Federation of Eating Disorder Dietitians. Qualitative methods identified salient themes from narrative responses to augment survey data. Most respondents expressed confidence in their ED-related competence, however these skills were gained from post-professional, self-funded activities, not from ED-specific education or training in either school or work settings. While two-thirds of RDNs surveyed held an advanced degree and more than half held specialty certification, an inverse relationship between provider expertise and patient acuity was observed. RDNs working at the highest levels of ED care with the most medically complex patients were less likely to hold graduate degrees or have prior clinical experience. Obstacles to job satisfaction included high patient caseloads, low compensation, lack of employer support, and high burnout. Facilitators of job satisfaction included professional and client communities, and the private practice setting. Considering the essential nature of nutrition rehabilitation in ED treatment and the high prevalence of dysfunctional eating behaviors in society at-large, these observations identify gaps in RDN preparedness and facility staffing practices that may affect treatment outcomes for individuals with known and undiagnosed ED’s. Enhancements in dietetics education and heightened attention to supervision for entry-level clinicians in ED-specific treatment programs are prime targets for action.</jats:p

A survey of registered dietitian nutritionists who provide care to clients with eating disorders: implications for education, training and clinical practice

Successful management of eating disorder (ED) symptoms includes Registered Dietitian Nutritionists (RDNs) with specialized expertise, nutrition counseling skills, and advanced training. We conducted an anonymous on-line survey of self-identified ED-specialized RDNs about their previous education and training, workload, job duties, and job satisfaction. Respondents were 182 RDNs who were U.S. members of the International Federation of Eating Disorder Dietitians. Qualitative methods identified salient themes from narrative responses to augment survey data. Most respondents expressed confidence in their ED-related competence, however these skills were gained from post-professional, self-funded activities, not from ED-specific education or training in either school or work settings. While two-thirds of RDNs surveyed held an advanced degree and more than half held specialty certification, an inverse relationship between provider expertise and patient acuity was observed. RDNs working at the highest levels of ED care with the most medically complex patients were less likely to hold graduate degrees or have prior clinical experience. Obstacles to job satisfaction included high patient caseloads, low compensation, lack of employer support, and high burnout. Facilitators of job satisfaction included professional and client communities, and the private practice setting. Considering the essential nature of nutrition rehabilitation in ED treatment and the high prevalence of dysfunctional eating behaviors in society at-large, these observations identify gaps in RDN preparedness and facility staffing practices that may affect treatment outcomes for individuals with known and undiagnosed ED’s. Enhancements in dietetics education and heightened attention to supervision for entry-level clinicians in ED-specific treatment programs are prime targets for actioSuccessful management of eating disorder (ED) symptoms includes Registered Dietitian Nutritionists (RDNs) with specialized expertise, nutrition counseling skills, and advanced training. We conducted an anonymous on-line survey of self-identified ED-specialized RDNs about their previous education and training, workload, job duties, and job satisfaction. Respondents were 182 RDNs who were U.S. members of the International Federation of Eating Disorder Dietitians. Qualitative methods identified salient themes from narrative responses to augment survey data. Most respondents expressed confidence in their ED-related competence, however these skills were gained from post-professional, self-funded activities, not from ED-specific education or training in either school or work settings. While two-thirds of RDNs surveyed held an advanced degree and more than half held specialty certification, an inverse relationship between provider expertise and patient acuity was observed. RDNs working at the highest levels of ED care with the most medically complex patients were less likely to hold graduate degrees or have prior clinical experience. Obstacles to job satisfaction included high patient caseloads, low compensation, lack of employer support, and high burnout. Facilitators of job satisfaction included professional and client communities, and the private practice setting. Considering the essential nature of nutrition rehabilitation in ED treatment and the high prevalence of dysfunctional eating behaviors in society at-large, these observations identify gaps in RDN preparedness and facility staffing practices that may affect treatment outcomes for individuals with known and undiagnosed ED’s. Enhancements in dietetics education and heightened attention to supervision for entry-level clinicians in ED-specific treatment programs are prime targets for actioSuccessful management of eating disorder (ED) symptoms includes Registered Dietitian Nutritionists (RDNs) with specialized expertise, nutrition counseling skills, and advanced training. We conducted an anonymous on-line survey of self-identified ED-specialized RDNs about their previous education and training, workload, job duties, and job satisfaction. Respondents were 182 RDNs who were U.S. members of the International Federation of Eating Disorder Dietitians. Qualitative methods identified salient themes from narrative responses to augment survey data. Most respondents expressed confidence in their ED-related competence, however these skills were gained from post-professional, self-funded activities, not from ED-specific education or training in either school or work settings. While two-thirds of RDNs surveyed held an advanced degree and more than half held specialty certification, an inverse relationship between provider expertise and patient acuity was observed. RDNs working at the highest levels of ED care with the most medically complex patients were less likely to hold graduate degrees or have prior clinical experience. Obstacles to job satisfaction included high patient caseloads, low compensation, lack of employer support, and high burnout. Facilitators of job satisfaction included professional and client communities, and the private practice setting. Considering the essential nature of nutrition rehabilitation in ED treatment and the high prevalence of dysfunctional eating behaviors in society at-large, these observations identify gaps in RDN preparedness and facility staffing practices that may affect treatment outcomes for individuals with known and undiagnosed ED’s. Enhancements in dietetics education and heightened attention to supervision for entry-level clinicians in ED-specific treatment programs are prime targets for actioSuccessful management of eating disorder (ED) symptoms includes Registered Dietitian Nutritionists (RDNs) with specialized expertise, nutrition counseling skills, and advanced training. We conducted an anonymous on-line survey of self-identified ED-specialized RDNs about their previous education and training, workload, job duties, and job satisfaction. Respondents were 182 RDNs who were U.S. members of the International Federation of Eating Disorder Dietitians. Qualitative methods identified salient themes from narrative responses to augment survey data. Most respondents expressed confidence in their ED-related competence, however these skills were gained from post-professional, self-funded activities, not from ED-specific education or training in either school or work settings. While two-thirds of RDNs surveyed held an advanced degree and more than half held specialty certification, an inverse relationship between provider expertise and patient acuity was observed. RDNs working at the highest levels of ED care with the most medically complex patients were less likely to hold graduate degrees or have prior clinical experience. Obstacles to job satisfaction included high patient caseloads, low compensation, lack of employer support, and high burnout. Facilitators of job satisfaction included professional and client communities, and the private practice setting. Considering the essential nature of nutrition rehabilitation in ED treatment and the high prevalence of dysfunctional eating behaviors in society at-large, these observations identify gaps in RDN preparedness and facility staffing practices that may affect treatment outcomes for individuals with known and undiagnosed ED’s. Enhancements in dietetics education and heightened attention to supervision for entry-level clinicians in ED-specific treatment programs are prime targets for actioSuccessful management of eating disorder (ED) symptoms includes Registered Dietitian Nutritionists (RDNs) with specialized expertise, nutrition counseling skills, and advanced training. We conducted an anonymous on-line survey of self-identified ED-specialized RDNs about their previous education and training, workload, job duties, and job satisfaction. Respondents were 182 RDNs who were U.S. members of the International Federation of Eating Disorder Dietitians. Qualitative methods identified salient themes from narrative responses to augment survey data. Most respondents expressed confidence in their ED-related competence, however these skills were gained from post-professional, self-funded activities, not from ED-specific education or training in either school or work settings. While two-thirds of RDNs surveyed held an advanced degree and more than half held specialty certification, an inverse relationship between provider expertise and patient acuity was observed. RDNs working at the highest levels of ED care with the most medically complex patients were less likely to hold graduate degrees or have prior clinical experience. Obstacles to job satisfaction included high patient caseloads, low compensation, lack of employer support, and high burnout. Facilitators of job satisfaction included professional and client communities, and the private practice setting. Considering the essential nature of nutrition rehabilitation in ED treatment and the high prevalence of dysfunctional eating behaviors in society at-large, these observations identify gaps in RDN preparedness and facility staffing practices that may affect treatment outcomes for individuals with known and undiagnosed ED’s. Enhancements in dietetics education and heightened attention to supervision for entry-level clinicians in ED-specific treatment programs are prime targets for actioSuccessful management of eating disorder (ED) symptoms includes Registered Dietitian Nutritionists (RDNs) with specialized expertise, nutrition counseling skills, and advanced training. We conducted an anonymous on-line survey of self-identified ED-specialized RDNs about their previous education and training, workload, job duties, and job satisfaction. Respondents were 182 RDNs who were U.S. members of the International Federation of Eating Disorder Dietitians. Qualitative methods identified salient themes from narrative responses to augment survey data. Most respondents expressed confidence in their ED-related competence, however these skills were gained from post-professional, self-funded activities, not from ED-specific education or training in either school or work settings. While two-thirds of RDNs surveyed held an advanced degree and more than half held specialty certification, an inverse relationship between provider expertise and patient acuity was observed. RDNs working at the highest levels of ED care with the most medically complex patients were less likely to hold graduate degrees or have prior clinical experience. Obstacles to job satisfaction included high patient caseloads, low compensation, lack of employer support, and high burnout. Facilitators of job satisfaction included professional and client communities, and the private practice setting. Considering the essential nature of nutrition rehabilitation in ED treatment and the high prevalence of dysfunctional eating behaviors in society at-large, these observations identify gaps in RDN preparedness and facility staffing practices that may affect treatment outcomes for individuals with known and undiagnosed ED’s. Enhancements in dietetics education and heightened attention to supervision for entry-level clinicians in ED-specific treatment programs are prime targets for action.Published versio

A consensus document on definition and diagnostic criteria for orthorexia nervosa

Purpose Since the term orthorexia nervosa (ON) was coined from the Greek (omicron rho theta omicron sigma, right and omicron rho epsilon xi iota sigma, appetite) in 1997 to describe an obsession with "correct" eating, it has been used worldwide without a consistent definition. Although multiple authors have proposed diagnostic criteria, and many theoretical papers have been published, no consensus definition of ON exists, empirical primary evidence is limited, and ON is not a standardized diagnosis. These gaps prevent research to identify risk and protective factors, pathophysiology, functional consequences, and evidence-based therapeutic treatments. The aims of the current study are to categorize the common observations and presentations of ON pathology among experts in the eating disorder field, propose tentative diagnostic criteria, and consider which DSM chapter and category would be most appropriate for ON should it be included.Methods 47 eating disorder researchers and multidisciplinary treatment specialists from 14 different countries across four continents completed a three-phase modified Delphi process, with 75% agreement determined as the threshold for a statement to be included in the final consensus document. In phase I, participants were asked via online survey to agree or disagree with 67 statements about ON in four categories: A-Definition, Clinical Aspects, Duration; B-Consequences; C-Onset; D-Exclusion Criteria, and comment on their rationale. Responses were used to modify the statements which were then provided to the same participants for phase II, a second round of feedback, again in online survey form. Responses to phase II were used to modify and improve the statements for phase III, in which statements that met the predetermined 75% of agreement threshold were provided for review and commentary by all participants.Results 27 statements met or exceeded the consensus threshold and were compiled into proposed diagnostic criteria for ON.Conclusions This is the first time a standardized definition of ON has been developed from a worldwide, multidisciplinary cohort of experts. It represents a summary of observations, clinical expertise, and research findings from a wide base of knowledge. It may be used as a base for diagnosis, treatment protocols, and further research to answer the open questions that remain, particularly the functional consequences of ON and how it might be prevented or identified and intervened upon in its early stages. Although the participants encompass many countries and disciplines, further research will be needed to determine if these diagnostic criteria are applicable to the experience of ON in geographic areas not represented in the current expert panel