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Abstract an Investigation of Orthorexia Nervosa In ABSTRACT AN INVESTIGATION OF ORTHOREXIA NERVOSA IN NUTRITION STUDENTS VS. STUDENTS IN ALTERNATIVE DISCIPLINES by Madeline Jane McDonough Students who choose to pursue degrees in nutrition have been noted as having an elevated risk for developing disordered eating practices (Houston, 2008). Perhaps this is due to having a hyper-awareness of “correct” eating behaviors and thus attempting to meet the standards of their future profession. Orthorexia Nervosa is a particularly troubling pattern of behavior characterized by a fixation on eating healthy food, or an obsession with proper nutrition (Bratman, 2000). The purpose of this study was to determine if students at a university majoring in nutrition differed from students with health and non-health majors, with respect to disordered eating behaviors and Orthorexia. The hypothesis was that nutrition students would report more disordered eating and Orthorexic practices than health and non-health students. In a cross-sectional design, 49 nutrition students, 85 health students and 45 non-health students completed the ORTO-15, Eating Pathology Symptoms Inventory (EPSI) and Eating Habits Questionnaire (EHQ). Results showed there were no significant differences between nutrition students and other students on measures used to evaluate Orthorexia (EHQ and ORTO-15). Nutrition students did, however, indicate significantly higher levels of binge eating, cognitive restraint, excessive exercise, negative attitudes toward obesity and muscle building. Nutrition students, also exhibit disordered eating behaviors more than other students. Future research is warranted to identify stronger measures and additional constructs for Orthorexia Nervosa. AN INVESTIGATION OF ORTHOREXIA NERVOSA IN NUTRITION STUDENTS VS. STUDENTS IN ALTERNATIVE DISCIPLINES A Thesis Submitted to the Faculty of Miami University in partial fulfillment of the requirements for the degree of Master of Science in Kinesiology and Health by Madeline McDonough Miami University Oxford, Ohio 2018 Advisor: Rose Marie Ward Reader: Paul Branscum Reader: Jay Kimiecik ©2018 Madeline Jane McDonough This Thesis titled AN INVESTIGATION OF ORTHOREXIA NERVOSA IN NUTRITION STUDENTS VS. STUDENTS OF ALTERNATIVE DISCIPLINES by Madeline Jane McDonough has been approved for publication by The College of Education, Health, and Society and Department of Kinesiology and Health ____________________________________________________ Rose Marie Ward: Thesis Chair ______________________________________________________ Paul Branscum: Reader _______________________________________________________ Jay Kimiecik: Reader Table of Contents Page List of Tables ............................................................................................................. iv Acknowledgments ....................................................................................................... v Chapter 1: Introduction ............................................................................................. 1 Chapter 2: Review of the Literature .......................................................................... 4 Chapter 3: Rationale for, and Overview of, Study ................................................... 13 Chapter 4: Methods .................................................................................................. 15 Chapter 5: Results .................................................................................................... 18 Chapter 6: Discussion ............................................................................................... 22 References ................................................................................................................. 25 iii List of Tables Page Table 1. Self-Reported Demographic Characteristics of Study Participants…………….18 Table 2. Means, Standard Deviations and ANOVAs for Self-Reported Measures……...19 Table 3. Cronbach’s α for Scales Used…………………………………………………..20 iv Acknowledgments I would like to express my unending gratitude to Dr. Ward who turned my dream into a reality when I came to her office in 2015. She described my passion for this field as something that “set me on fire” – her unrelenting belief in me has been fueling the fire ever since. v Chapter 1: Introduction Disordered eating appears to be common among those who have training in nutrition. Although those students who enter the field of dietetics have an interest in nutrition, oftentimes they find themselves with an additional risk for developing unhealthy eating patterns and even disordered eating behaviors (Korinth, 2008). Disordered eating can be described as a range of eating-related issues which include, but are not limited to: food restriction; bingeing; eating for reasons other than hunger and labeling of foods (i.e. “good,” “bad,” “unhealthy,” or “fattening,”) which can lead to feelings of anxiety and guilt if these foods are consumed or consumed in excess (Houston, 2008). It is essential that this issue be addressed in nutrition departments to open a dialogue and implement intervention strategies to engage in preventative efforts and protective behaviors as well as help students suffering from disordered eating behaviors and patterns. According to the National Institute of Mental Health, the most common eating disorders include Anorexia Nervosa (0.6%), Bulimia Nervosa (0.6%) and Binge Eating Disorder (2.8%) (Hudson, 2007). There is, however, far less attention devoted to a newer and concerning disordered eating pattern, Orthorexia Nervosa. Orthorexia Nervosa is characterized by having a fixation on eating healthy food, or an obsession with proper nutrition (Bratman, 2000). Like other eating disorders, Orthorexia Nervosa is a psychological ailment accompanied by physical consequences. Despite a lack of research on Orthorexia, this disorder contains a series of co-occurring behaviors including: (a) spending an excessive amount of time on thinking about looking for and preparing healthy food; (b) feeling superior to those with different eating habits; (c) following a particular health-food diet rigidly and engaging in compensatory restriction to make up for any dietary indiscretions; (d) associating self-esteem with adherence to the diet (e) turning eating “properly” into the central focus of life, at the expense of other personal values, relationships, previously enjoyed activities, and sometimes physical health (Bratman, 2000). Whereas these behaviors have not been identified as having empirical significance, they seem to be consistent with those reportedly suffering from Orthorexia. 1 Most commonly, Orthorexia is categorized as an Eating Disorder Not Otherwise Specified (EDNOS) according to the Diagnostic and Statistical Manual - V (DSM-V). It does not have a standard criterion for diagnosis like Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. However, the most commonly used validated questionnaire in the field, ORTO-15, seeks to investigate eating behaviors as it pertains to “healthy foods,” pre-occupation with food choices and other such psychological consequences. There is significant research in the way of eating disorders such as Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder on college campuses; however, little research is conducted specifically with students who choose ‘nutrition’ as a major. Furthermore, there is even less research with nutrition students on Orthorexic behaviors. Whereas the students’ developing knowledge of nutrition may certainly contribute to positive eating behaviors, it may conversely create an unhealthy fixation on food thus reinforcing eating disorder tendencies. For example, the nutrition student population has been found to have greater incidences of restrained eating in order to lose weight or prevent weight gain (Korinth, 2009). This behavior may be driven by the individual’s desire to fulfill the thin ideal or comply with the “correct” eating standards that their chosen profession values. Current literature also displays a paradox in that nutrition students have higher rates of disordered eating behaviors, such as restrained eating, as well as more positive eating behaviors, such as adequate consumption of fruits and vegetables (Crockett, 1985). This inconsistency is both reminiscent of Orthorexia Nervosa behaviors and concerning in that such behaviors may be perpetuated a result of their nutrition coursework. This paper describes a thesis project that was conducted to examine whether nutrition students have higher incidences of Orthorexia Nervosa compared to peers that are non-nutrition majors. To provide a context for this study, a review of some relevant research studies on this topic is provided in the next section. These studies are organized into four different categories. In the first section, the studies comprehensively review the relevant literature as it pertains to Orthorexia Nervosa. In the following section, the studies have examined the differences in disordered eating behaviors and disordered eating patterns among nutrition and dietetic students when compared to other academic disciplines. In the third section, the studies address motivation and influences on nutrition 2 students that result in engaging in disordered eating behaviors. The final section addresses the literature that has been devoted to examining Orthorexia specifically among those students in the health sciences. 3 Chapter 2: Review of the Literature Defining Orthorexia Orthorexia Nervosa is a pathological fixation on healthy food (Bratman, 2000). Orthorexia
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