Orthorexia nervosa: An integrative literature review of a lifestyle syndrome

Abstract

Bratman first proposed orthorexia nervosa in the late 1990s, defining it an obsession with eating healthy food to achieve, for instance, improved health. Today, in the Swedish media, excessive exercising plays a central role in relation to orthorexia. A few review articles on orthorexia have been conducted; however, these have not focused on aspects of food and eating, sport, exercise, or a societal perspective. The overall aim of this study was to provide an overview and synthesis of what philosophies of science approaches form the current academic framework of orthorexia. Key questions were: What aspects of food and eating are related to orthorexia? What role do exercise and sports play in relation to orthorexia? In what ways are orthorexia contextualized? Consequently, the concept of healthism was used to discuss and contextualize orthorexia. The method used was an integrative literature review; the material covered 19 empirical and theoretical articles published in peer-reviewed journals. This review demonstrates a multifaceted nature of orthorexia research; this field has been examined from four different philosophies of science approaches (i.e., empirical-atomistic, empirical-atomistic with elements of empirical-holistic, empirical-holistic, and rational-holistic) on individual, social, and societal levels. The majority of the articles followed an empirical-atomistic approach that focused on orthorexia as an individual issue, which was discussed using healthism. Our analysis indicates a need for (a) more empirical-holistic research that applies interpretive qualitative methods and uses a social perspective of health, e.g., healthism and (b) examining the role of sports and exercise in relation to orthorexia that takes the problematizing of “orthorexic behaviours” within the sports context into account.

On a correct diet: exploration of the orthorexia construct from the essential nuclei of experimental discourse

“…The results represented in the present study with respect to the correct appetite are in tune with some studies in which the characteristics of people with orthorexia or with a pathological inclination are indicated for the food considered healthy; 23,27 that is, their ideology (what and how they think) is in line with the themes expressed in this paper "The World of Healthy Eating", "Why I Choose to Eat It" and "Absence of Infirmity as an Object of Ideal Consciousness". The set of strategies and constitutive mechanisms of experience (what do they do), are related with the theme "A recreated optimism", as an exercise of feedback of the condition between knowledge, manipulation and consumption of natural and organic food.…”

“…27 Consequently, due to insufficient research (ambiguity and variability in results) and because it is a multifaceted reality, a qualitative study approach is necessary in orthorexia; in fact, there are studies that rely on the requirement of an empirical-holistic approach and an interpretative analysis. 23 The increase in literature and other documents, relevant clinical experience and research studies in recent years circumscribe the relevance of the topic:…”

“If it’s not Iron it’s Iron f*cking biggest Ironman”: personal trainers’ views on health norms, orthorexia and deviant behaviours

“…On one hand, ON is understood as exhibiting excessive behaviour regarding exercise and eating and, on the other hand, as being in total control. Moreover, ON is conceptualized in terms of unhealthy exercise rather than unhealthy eating behaviours, which differs from previous descriptions (Bratman & Knight, 2000; Bratman, 1997), proposed criteria (Dunn & Bratman, 2016) and the scientific literature (Håman et al, 2015). Thus, it seems that PTs reproduce the general perception of ON in Sweden that, for instance, has been identified in the way Swedish daily newspapers frame ON (Håman et al, 2016).…”

“…In addition, the emphasis on exercise can also be regarded as natural since PTs practice in a gym context in which exercise is the main focus. However, a clear definition of ON does not yet exist since the scientific body of knowledge regarding ON is still limited (Håman et al, 2015, 2016) and diagnostic criteria have just recently been proposed (Dunn & Bratman, 2016). …”

“…What is perceived as healthy among individuals who are considered to have ON is based on subjective criteria (Bratman & Knight, 2000). However, research covering ON is still limited (e.g., Håman, Barker-Ruchti, Patriksson, & Lindgren, 2015) and diagnostic criteria have only recently been proposed (Dunn & Bratman, 2016). Today, ON is not an accepted diagnostic category, that is, it is not included in the diagnostic manuals DSM-5 or ICD-10 (Varga, Dukay-Szabó, Túry, & Van Furth, 2013).…”