The prevalence of orthorexia in exercising populations: a systematic review and meta-analysis

Abstract

Aim

Orthorexia Nervosa (ON) describes a pathological obsession with proper and high-quality nutrition that is necessary to research further in order to elucidate its prevalence and correlates which may bear implications for prevention and treatment. The aim of this study was to review studies that report the prevalence of ON in people who exercise, calculate an overall prevalence through a random-effects meta-analysis approach and investigate the association of ON prevalence using a random-effects meta-regression. In addition, a sub-group-analysis based on ON-instruments and a sensitivity analysis excluding students samples, were conducted.

Method

Systematic searches were conducted in the following online databases: PubMed, Embase, Web of Science, PsychInfo, CINAHL, Google Scholar and OpenNet. The following search terms were used: Orthore* AND (prevalenc* OR incidenc* OR frequen* OR cut-off OR epidem*). A total of 613 unique hits were reviewed by two blinded authors, and 24 studies were coded and assessed for risk of bias (Holy et.al). The meta-regression included three independent variables (sex, type of sport, and sample size).

Results

The overall prevalence of ON in the exercising population was 55.3% (95% CI 43.2–66.8). Cochran’s Q was 11,436.38 ( df = 23, p < 0.0000), and the I ² was 98.4%, indicating high heterogeneity across studies. The sensitivity showed an overall prevalence of 51.3% (95% CI 51.3–70.0). There was a significant difference in prevalence estimates based on the instruments used (Q _bet = 33.6, df = 2, p < 0.01).

Discussion

The overall prevalence of ON in exercising populations was very high. The between-study disparity was large and was partly explained by the ON-instrument administered. One fourth of the studies had a moderate risk of bias. The majority of the studies did not specify relevant demographic information about the sample, and information about the type of sport was frequently missing.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40337-023-00739-6.

Plain English summary

Orthorexia Nervosa (ON) describes a pathological obsession with proper and high quality nutrition that is characterized by a restrictive diet, ritualized patterns of eating, and rigid avoidance of foods believed to be unhealthy or impure. This obsession is found among sports athletes in some studies, and there is an assumed link between ON and exercise in general. In this study, the term exercise is defined as any activity requiring physical effort, carried out to sustain or improve health and fitness. In this systematic review and meta-analysis, we examined the overall prevalence of ON in the exercising population. Searching in scientific databases resulted in 613 articles, of which 24 met the rigorous inclusion criteria. The overall prevalence of ON in the general exercising population was 55.3%. The prevalence was thought to be predictable by sex, type of sport, and sample size, but no significant associations were found. This may be due to poor study quality and a lack of demographic information on the participants in some of the included studies. Other predictors worth investigating might be age, student status, status as vegetarian/vegan, psychiatric comorbidity, and intensity/frequency of exercise. This knowledge may bear implications for the prevention and right treatment for people at risk of developing ON.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40337-023-00739-6.