What are the key features of Orthorexia Nervosa and influences on its development? A qualitative investigation?

Orthorexia nervosa (ON) – a pathological obsession with healthy eating - is an emerging eating disorder. The precise nature of ON and its causes remain unclear, yet few published research studies speak directly to those with ON tendencies or professionals working with them. Our study redresses this gap in the literature by uncovering the defining ON features and the factors influencing its development. The exploratory qualitative research design included semi-structured interviews with those self-identifying as orthorexic or obsessively preoccupied with healthy eating (n=9); professionals working with ON and eating disorders - psychologists, dieticians and a family therapist (n=7). Data were analysed thematically. ON emerged as multifactorial, with a variety of interrelated influences needing to coalesce for ‘healthy eating’ to become pathological. Key features included rigidity and control (around food choices, routines and preparation) and moral judgements around food, along with a range of negative psychosocial and physical impacts. Influences on the development of ON were organised according to their occurrence at the individual (micro) level, external/relational (meso) level and societal (macro) level. Influences on the individual included health concerns, belief in food as medicine, past trauma, personality (e.g. obsessive, perfectionist), exposure to extreme views and behaviours while growing up and moral concerns. External influences included parents, partners and relational groups (e.g. fitness or clean eating groups). Societal influences included aestheticism, moral citizenship and social media. We conclude that ON is more than an individual pathology, it is symptomatic of our ‘orthorexic society’: where hyper-reflexivity around food choices, conflicting information what is the correct diet, preoccupation with appearance, and emphasis on individual (not collective) responsibility for health combine with individual susceptibilities and ecological/moral concerns, to predispose toward pathological ‘healthy’ eating

The psychometric properties of Orthorexia Nervosa assessment scales:A systematic review and reliability generalization

The main objective of this systematic review was to provide a comprehensive overview of the psychometric properties of all available Orthorexia Nervosa (ON) assessment tools, in order to evaluate their scope of application for research and practice. Ten databases were searched for studies quantitatively assessing ON. The psychometric properties were evaluated according to specified quality criteria, focusing on the reliability, structural validity and construct validity of the scales. A meta-analytic approach was used to summarize eligible Cronbach's alpha coefficients between studies. Sixty-eight unique studies fulfilled the inclusion criteria for this systematic review. Ten discrete ON scales were identified. Half of the included studies exclusively utilized a version of the ORTO-15. The evaluation of all available ON measures raise issues regarding ON's dimensionality and conceptualization. Most of the identified scales require further validation. Based on the reported psychometric properties it is advised to re-evaluate existing tools and to focus on establishing consensus regarding the conceptualization of ON to establish a measure with sound psychometric properties

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

The Orthorexia Nervosa Task Force (ON-TF): Objectives and Key Strategies.

For the first time Orthorexia Nervosa (ON) was described in the late ‘90 s as a pathological obsession with healthful eating often associated with obtrusive thoughts on being healthy, lack of flexibility in diet, life threatening medical conditions related to malnutrition, affective instability, social isolation and negative impact of food choices on quality of life. Despite the existing theoretical, case studies and empirical research, ON is still not well understood. The Orthorexia Nervosa Task Force (ON-TF) includes researchers investigating ON. At present, the working group consists of researchers from different countries (Austria, Germany, Hungary, Italy, United States, and Poland)