The Barcelona Orthorexia Scale (BOS): development process using the Delphi method

Abstract

64 items were obtained, with two versions in Spanish and English. The future BOS aims to provide a possible solution to the shortage of valid instruments to evaluate psychological features of orthorexia and to promote research on this field. Further analysis regarding validity and reliability is necessary to prove the BOS' value on this matter.

Orthorexic tendencies are linked with difficulties with emotion identification and regulation

“…More recently, other questionnaires such as the Eating Habits Questionnaire (EHQ) [31], the Düsseldorf Orthorexie Scale, DOS, [32], or the Teruel Orthorexia Scale, TOS, [23,33] have been developed but they lack generalizability and also suffer from psychometric limitations [23,34]. Importantly, while some studies have offered some diagnosis criteria [5,32,35] an official set of criteria does not yet exist [22].…”

“…Indeed, although two of the seven scale items of the ORTO-7CS focus upon the preoccupation with healthy eating (items 4 and 11), the remaining items focus upon worries and guilt around food, and one item asks about attention to caloriesa symptom arguably more relevant to AN [20]. The limitations of the ORTO measures have been acknowledged in the ON literature [23,34,66], however a good quality validated alternative is not yet available. Although the ORTO-15 [21], and its translated and abbreviated versions [28,30], are the most widely used measures of ON tendencies to date, these measures were developed based on items of the Bratman Orthorexia Test (a non-validated screening tool), without reference to any proposed diagnostic criteria for ON [5,29].…”

“…The Eating Habits Questionnaire, EHQ [31] is perhaps the most established alternative to the ORTO scale, measuring feelings, behaviours and cognitions related to extreme healthy eating [34]. However, whilst it is proposed to have satisfactory psychometric properties in terms of internal consistency and test-retest reliability [34], this scale has been criticised for failing to include items which capture the clinical impairment of ON [23] as well as for potential limitations with its construct validity [34]. One scale which looks promising in addressing some of the limitations of other psychometrics in this area is the Barcelona Orthorexia Scale, BOS [34].…”

“…However, whilst it is proposed to have satisfactory psychometric properties in terms of internal consistency and test-retest reliability [34], this scale has been criticised for failing to include items which capture the clinical impairment of ON [23] as well as for potential limitations with its construct validity [34]. One scale which looks promising in addressing some of the limitations of other psychometrics in this area is the Barcelona Orthorexia Scale, BOS [34]. The BOS has been developed using a three round Delphi study with input from 58 international experts in disordered eating.…”

The Social Construction of a Concept—Orthorexia Nervosa: Morality Narratives and Psycho-Politics

“…; DSM-5; American Psychiatric Association, 2013 ) criteria, ON is likely to be clinically categorized as avoidant/restrictive food intake disorder (ARFID; APA, 2013 , p.334); however, there have been calls for its recognition as a distinct psychiatric diagnosis ( Chaki et al, 2013 ; McGregor, 2017 ). Multiple orthorexia scales have been developed including the Bratman Orthorexia Test ( Bundros et al, 2016 ), the ORTO-15 ( Dunn & Bratman, 2016 ), and the Barcelona Orthorexia Scale ( Bauer, Fusté, Andrés, & Saldaña, 2019 ), each attempting to define, predict, and assess risk factors for ON in different population groups.…”