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Does ORTO-15 produce valid data for 'Orthorexia Nervosa'? A mixed-method examination of participants' interpretations of the fifteen test items.
Eat Weight Disord. 2021 Apr; 26(3):897-909.EW

Abstract

PURPOSE

Orthorexia Nervosa (ON) is defined as a pathological eating behaviour stemming from being "healthy" or "pure". Survey-based studies typically rely on the ORTO-15 questionnaire or its variations to detect orthorexia. However, frequent post-hoc adjustments to the ORTO-15 suggest psychometric problems. In this study, we explored people's cognitions about the ORTO-15 items to (1) identify problems specific to ORTO-15 items and (2) explore participants' understanding of ON symptoms.

METHODS

Fifty adult participants (40% male, mean age = 34.0 ± 14.4 years) completed the ORTO-15, the Eating Attitudes Test (EAT-26) and the Obsessive-Compulsive Inventory-Revised edition (OCI-R). Qualitative data were collected using the modified "think aloud" protocol, which asked participants to 'verbalise' their responses to the ORTO-15 items. These qualitative responses were first analysed conjunctively with the quantitative responses; then subjected to thematic analysis.

RESULTS

ORTO-15 identified 64% of the participants for orthorexic tendencies. In most cases (76%), participants reported no issues completing the ORTO-15. However, in some cases, qualitative responses differed from quantitative ones. When people encountered problems, it was because of poor psychometric construction: lack of clarity, ambiguous wording and multiple statements in a single item. Elaborations around the ORTO-15 items formed four major themes: "preoccupation with physical appearance", "control", "food is fuel" and "alone, not isolated".

CONCLUSION

Even though in the majority of cases there were no issues with completing ORTO-15, thematic analysis revealed several discrepancies between our participants' perceptions of the ORTO-15 items and the previously proposed diagnostic criteria for ON. The results suggest that ORTO-15 is, at best, a mediocre screening tool for ON, which is sensitive to diet but fails to have sufficient level of specificity to detect the pathological stage. More accurate instruments are needed to further research on ON.

LEVEL OF EVIDENCE

V (cross-sectional descriptive study with qualitative analysis).

Authors+Show Affiliations

School of Life Sciences, Pharmacy and Chemistry, Kingston University, Penrhyn Road, Kingston upon Thames, KT1 2EE, Surrey, UK. elina.mitrofanova@gmail.com.School of Life Sciences, Pharmacy and Chemistry, Kingston University, Penrhyn Road, Kingston upon Thames, KT1 2EE, Surrey, UK.School of Life Sciences, Pharmacy and Chemistry, Kingston University, Penrhyn Road, Kingston upon Thames, KT1 2EE, Surrey, UK. Peter Symonds College, Winchester, SO22 6RX, Hampshire, UK.School of Life Sciences, Pharmacy and Chemistry, Kingston University, Penrhyn Road, Kingston upon Thames, KT1 2EE, Surrey, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32445114

Citation

Mitrofanova, Elina, et al. "Does ORTO-15 Produce Valid Data for 'Orthorexia Nervosa'? a Mixed-method Examination of Participants' Interpretations of the Fifteen Test Items." Eating and Weight Disorders : EWD, vol. 26, no. 3, 2021, pp. 897-909.
Mitrofanova E, Pummell E, Martinelli L, et al. Does ORTO-15 produce valid data for 'Orthorexia Nervosa'? A mixed-method examination of participants' interpretations of the fifteen test items. Eat Weight Disord. 2021;26(3):897-909.
Mitrofanova, E., Pummell, E., Martinelli, L., & Petróczi, A. (2021). Does ORTO-15 produce valid data for 'Orthorexia Nervosa'? A mixed-method examination of participants' interpretations of the fifteen test items. Eating and Weight Disorders : EWD, 26(3), 897-909. https://doi.org/10.1007/s40519-020-00919-2
Mitrofanova E, et al. Does ORTO-15 Produce Valid Data for 'Orthorexia Nervosa'? a Mixed-method Examination of Participants' Interpretations of the Fifteen Test Items. Eat Weight Disord. 2021;26(3):897-909. PubMed PMID: 32445114.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does ORTO-15 produce valid data for 'Orthorexia Nervosa'? A mixed-method examination of participants' interpretations of the fifteen test items. AU - Mitrofanova,Elina, AU - Pummell,Elizabeth, AU - Martinelli,Laura, AU - Petróczi,Andrea, Y1 - 2020/05/22/ PY - 2019/09/01/received PY - 2020/05/05/accepted PY - 2020/5/24/pubmed PY - 2021/6/24/medline PY - 2020/5/24/entrez KW - Clean eating KW - Eating disorder KW - ORTO-15 KW - Orthorexia KW - Pathological eating KW - Psychometrics SP - 897 EP - 909 JF - Eating and weight disorders : EWD JO - Eat Weight Disord VL - 26 IS - 3 N2 - PURPOSE: Orthorexia Nervosa (ON) is defined as a pathological eating behaviour stemming from being "healthy" or "pure". Survey-based studies typically rely on the ORTO-15 questionnaire or its variations to detect orthorexia. However, frequent post-hoc adjustments to the ORTO-15 suggest psychometric problems. In this study, we explored people's cognitions about the ORTO-15 items to (1) identify problems specific to ORTO-15 items and (2) explore participants' understanding of ON symptoms. METHODS: Fifty adult participants (40% male, mean age = 34.0 ± 14.4 years) completed the ORTO-15, the Eating Attitudes Test (EAT-26) and the Obsessive-Compulsive Inventory-Revised edition (OCI-R). Qualitative data were collected using the modified "think aloud" protocol, which asked participants to 'verbalise' their responses to the ORTO-15 items. These qualitative responses were first analysed conjunctively with the quantitative responses; then subjected to thematic analysis. RESULTS: ORTO-15 identified 64% of the participants for orthorexic tendencies. In most cases (76%), participants reported no issues completing the ORTO-15. However, in some cases, qualitative responses differed from quantitative ones. When people encountered problems, it was because of poor psychometric construction: lack of clarity, ambiguous wording and multiple statements in a single item. Elaborations around the ORTO-15 items formed four major themes: "preoccupation with physical appearance", "control", "food is fuel" and "alone, not isolated". CONCLUSION: Even though in the majority of cases there were no issues with completing ORTO-15, thematic analysis revealed several discrepancies between our participants' perceptions of the ORTO-15 items and the previously proposed diagnostic criteria for ON. The results suggest that ORTO-15 is, at best, a mediocre screening tool for ON, which is sensitive to diet but fails to have sufficient level of specificity to detect the pathological stage. More accurate instruments are needed to further research on ON. LEVEL OF EVIDENCE: V (cross-sectional descriptive study with qualitative analysis). SN - 1590-1262 UR - https://www.unboundmedicine.com/medline/citation/32445114/Does_ORTO_15_produce_valid_data_for_'Orthorexia_Nervosa'_A_mixed_method_examination_of_participants'_interpretations_of_the_fifteen_test_items_ L2 - https://dx.doi.org/10.1007/s40519-020-00919-2 DB - PRIME DP - Unbound Medicine ER -