Orthorexia Nervosa and Eating Disorder Symptoms in Registered Dietitian Nutritionists in the United States

J Acad Nutr Diet. 2017 Oct;117(10):1612-1617. doi: 10.1016/j.jand.2017.05.001. Epub 2017 Jun 15.


Background: Registered dietitian nutritionists are trained to identify optimal food choices for clients based on medical state and lifestyle. Orthorexia nervosa (ON) is a proposed disorder related to obsessions about eating healthfully. Eating disorders (EDs) are serious mental illnesses with symptoms related to eating, body image, and self-esteem. Both ON and EDs are more common among RDNs than the general population.

Objective: This study examined the prevalence of ON and EDs in RDNs in the United States and, among this sample, assessed whether the presence of ON symptoms related to symptoms of EDs, including weight, shape, eating, and restraint.

Design: A cross-sectional design compared responses for participants after dividing into three groups: those scoring at-risk for ON, those with a current or past ED, and a comparison group.

Participants: A sample of 2,500 RDNs were invited to complete surveys electronically; 636 responses were received.

Main outcome measures: Scores on the Orthorexia Nervosa Questionnaire (ORTO-15) and Eating Disorder Examination Questionnaire (EDE-Q) determined prevalence of ON and EDs. Differences in these measures, and body mass index were compared among the three groups.

Statistical analyses: Analysis of variance and χ2 analyses were used to compare the groups.

Results: For the entire sample, scores on the ORTO-15 suggested 49.5% were at risk for ON, and scores on the EDE-Q suggested 12.9% were at risk for an ED, with 8.2% of RDNs self-disclosing treatment for an ED. Both the group disclosing ED treatment and the group at risk for ON had a lower mean body mass index, lower scores on the ORTO-15, and higher scores on the EDE-Q and all its subscales than the comparison group.

Conclusions: Clarifying the relationship between ON and EDs is warranted because ON symptoms appear to be associated not only with disturbances in eating, but also with elevated shape and weight concerns.

Keywords: Clinicians; Dietitians; Eating disorders; Orthorexia nervosa; Prevalence.

MeSH terms

  • Adult
  • Analysis of Variance
  • Body Image / psychology
  • Chi-Square Distribution
  • Cross-Sectional Studies
  • Diet, Healthy / psychology*
  • Eating / psychology
  • Feeding and Eating Disorders / epidemiology*
  • Feeding and Eating Disorders / psychology
  • Female
  • Humans
  • Male
  • Nutritionists / psychology*
  • Nutritionists / statistics & numerical data*
  • Prevalence
  • Risk Factors
  • Surveys and Questionnaires
  • United States / epidemiology