Orthorexia nervosa and disordered eating attitudes among Lebanese adults: Assessing psychometric proprieties of the ORTO-R in a population-based sample

Abstract

Background Previous research demonstrated a relationship between ON and disordered eating symptoms (eating concern, restraint, cognitive preoccupations about body shape and weight) and disordered eating attitudes (DEA). Since screening for orthorexia nervosa is now part of clinical practice, the measurement instruments to be used must be clinically significant, reliable, valid and sensitive to our target population. The main objective of the present study was to confirm the factor structure of the Arabic version of the ORTO-R using a first sample of Lebanese adults and confirm those results on another sample. The secondary objective was to assess sex differences in terms of ON and DEA, as well as to examine whether symptoms of ON were related to DEA in Lebanese adults. Methods A total of 783 Lebanese adults was selected to participate in this cross-sectional study (January-May 2018) using a proportionate random sample from all Lebanese governorates. Results The mean age of the total sample was 27.78 ± 11.60 years (Min. 18 –Max. 84) (33.5% females) and their mean BMI was 24.36 ± 5.31 kg/m2. All items of the ORTO-R were extracted during the factor analysis and yielded a two-factor solution with Eigenvalues > 1 (variance explained = 50.07%; KMO = 0.570; Bartlett’s sphericity test p<0.001; αCronbach = 0.755). This factor structure was confirmed by a confirmatory factor analysis; the Maximum Likelihood Chi-Square = 26.894 and Degrees of Freedom = 8, which gave a χ2/df = 3.36. The Tucker Lewis Index (TLI) value was 0.914, whereas the standardized root mean square residual (SRMR) value was 0.032. The root mean square error of approximation (RMSEA) value was 0.077 [95% CI 0.046–0.111] (pclose = 0.07) and comparative fit index (CFI) value was 0.967 respectively, indicating a good fit of the model. There was also no measurement invariance between genders. Female gender was significantly associated with lower ORTO-R scores (more orthorexia nervosa) compared to males (B = -0.65; p = 0.026, 95% CI -1.22- -0.08; ɳ2 = 0.006). However, no significant difference was found between genders in terms of EAT-26 scores (B = 0.23; p = 0.813, 95% CI -1.66–2.12; ɳ2 = 0.0001). Higher ORTO-R scores (lower/ less pathological ON tendencies and behaviors) were significantly related to higher EAT-26 total scores (higher levels of DEA) as well as higher dieting, bulimia and oral control scores in both females (from a weak to a moderate positive correlation) and males (a weak positive correlation). Conclusion This cross-sectional population-based study confirmed the factor structure of the Arabic version of the ORTO-R, demonstrated an association between ON and DEA and revealed more ON among females compared to males.

Investigating Orthorexia Nervosa With the ORTO-R in a Sample of University Students With or Without Subthreshold Autism Spectrum: Focus on Dietary Habits and Gender Differences

“…Our data support the reliability of the ORTO-R as a measure for ON symptoms, reporting for the instrument a good internal consistency as measured by Cronbach's alpha coefficient. The value of 0.740 reported in our sample is in line with those reported for the ORTO-R in other languages ( 46 – 48 ) and with the measures of reliability reported in the original validation study ( 19 ).…”

“…As in the case of the ORTO-15, the ORTO-R has been developed in Italian and English, while its Italian version has been used for the validation study, performed in an Italian population ( 18 , 19 ). The questionnaire has also been validated in Arabic ( 46 , 47 ) and Greek ( 48 ), confirming good psychometric properties. A Turkish version has been developed on the basis of the Turkish ORTO-11 ( 49 ).…”

Validation of the Arabic version of the ORTO-R among a sample of Lebanese young adults

“…Although the content of items in ORTO-R was modified [ 23 ], the factor validity of this modified measure has never been actually assessed. Furthermore, existing studies, including the one conducted in the Lebanese population, used items in their original, unmodified meaning [ 27 ]; thus, they are re-assessment of the best working items of the ORTO-15 rather than an adaptation and validation of the ORTO-R items. Second, we aim to assess its validity in regards to disordered eating attitudes, perfectionism, and other relevant variables such as self-esteem, depression, anxiety, and body dissatisfaction.…”

Validation of the Arabic version of the Dusseldorf Orthorexia Scale (DOS) among Lebanese adolescents

“…Additionally, only a small correlation with the ORTO was observed [ 55 , 56 ]. While we used the items included in a revised version of this scale, we used the original wording of the items and not the revised, which might have influenced the obtained results [ 48 , 49 ]. Summing up, results obtained in the current study supports the validity of the DOS.…”

“…The ORTO questionnaire [ 16 ], which has been previously validated in Lebanon [ 47 ], is composed of 15 items, to which respondents answer using a four-point Likert scale 4-point Likert-scale ranging from 1 = always and 4 = never. Within the current study, we used the six items of the original scale (ORTO-R scale), which demonstrated best psychometric qualities [ 18 , 19 ] and is validated in Lebanon [ 48 ]. In this study, the internal consistency of the measure was acceptable (α = 0.72).…”