Abstract: Purpose The association between binge eating and obesity is increasing. Treatments for disorders of recurrent binge eating comorbid with obesity reduce eating disorder (ED) symptoms, but not weight. This study investigated the efficacy and safety of introducing a weight loss intervention to the treatment of people with disorders of recurrent binge eating and a high body mass index (BMI). Methods A single-blind randomized controlled trial selected adults with binge eating disorder or bulimia nervosa and BMI ≥ 27 to < 40 kg/m2. The primary outcome was sustained weight loss at 12-month follow-up. Secondary outcomes included ED symptoms. Mixed effects models analyses were conducted using multiple imputed datasets in the presence of missing data. Results Ninety-eight participants were randomized to the Health Approach to Weight Management and Food in Eating Disorders (HAPIFED) or to the Cognitive Behavioural Therapy-Enhanced (CBT-E). No between-group differences were found for percentage of participants achieving weight loss or secondary outcomes, except for reduction of purging behaviour, which was greater with HAPIFED (p = 0.016). Binge remission rates specifically at 12-month follow-up favoured HAPIFED (34.0% vs 16.7%; p = 0.049). Overall, significant improvements in the reduction of ED symptoms were seen in both groups and these were sustained at the 12-month follow-up. Conclusion HAPIFED was not superior to CBT-E in promoting clinically significant weight loss and was not significantly different in reducing most ED symptoms. No harm was observed with HAPIFED, in that no worsening of ED symptoms was observed. Further studies should test approaches that target both the management of ED symptoms and the high BMI. Level of evidence Level I, randomized controlled trial Trial registration US National Institutes of Health clinical trial registration number NCT02464345, date of registration 1 June 2015. PubDate: 2020-01-25
Abstract: Purpose Even though many studies have investigated the relationship between body dissatisfaction and eating disorder symptoms, the relationship is still far from being clear, especially about what factors that could potentially mediate such relationship. This study aimed to examine the direct pathway in the relationship between body dissatisfaction and eating disorder symptoms, and possible mediation pathways between the two via regulatory emotional self-efficacy and depression symptoms. Methods A sample of 654 adolescents from central China completed questionnaires for a set of study variables. Modeling analysis was conducted that examined the direct pathway between body dissatisfaction and eating disorder symptoms, and the mediating roles of regulatory emotional self-efficacy and depression symptoms between these two constructs. Multi-group modeling analysis was conducted to assess model invariance across gender and age groups. Results The results showed that, in addition to the direct pathway between body dissatisfaction and eating disturbances, regulatory emotional self-efficacy and depression symptoms partially mediated the relationship between these two constructs. Results of multi-group invariance analysis showed that the mediation model was consistent across gender and age groups. Discussion These results indicated that management of regulatory emotional self-efficacy and appropriate intervention for depression could potentially buffer against the negative impact of body dissatisfaction on eating disorder symptoms. Finally, some potential clinical implications are discussed, and possible preventions for eating disorder symptoms are suggested. Level of evidence V, Cross-sectional descriptive study PubDate: 2020-01-20
Abstract: Purpose Weight/shape concerns and disordered eating are common among young adults. Minimal research has examined these variables longitudinally by gender and in connection to self-control. The present study examined the level of weight/shape concerns and disordered eating at the end of the first and fourth year of college separately by gender and explored differences in self-control. Methods Participants included 394 female and 157 male undergraduates (N = 551; 40% non-white) who were categorized into three groups using a cluster analysis by gender: low weight/shape concerns and low disordered eating (LowWS–LowDE group), high weight/shape concerns and low disordered eating (HighWS–LowDE group), and high weight/shape concerns and high disordered eating (HighWS–HighDE group). Results Approximately, 62% of women and 54% of men reported having weight/shape concerns and/or disordered eating at the end of the first year of college, and around 51% of women and 44% of men reported having weight/shape concerns and/or disordered eating at the end of the fourth year. Results indicated that those in the HighWS–HighDE group had lower self-control compared to those in the LowWS–LowDE group at the end of the first and fourth year in both women and men. Women, but not men, who worsened in weight/shape concerns and/or disordered eating over time also reported significantly decreased self-control from their first to their fourth year. Conclusion Findings support the role of self-control in the maintenance of weight/shape concerns and disordered eating for both women and men. Level III Evidence obtained from well-designed cohort or case–control analytic studies PubDate: 2020-01-20
Abstract: Purpose Compelling evidence indicates that an addictive process might contribute to overeating/obesity. We hypothesize that this process consists of two components: (a) a sensory addiction to the taste, texture, and temperature of food, and (b) a motor addiction to the actions of eating (e.g., biting, chewing, crunching, sucking, swallowing). Previously, we reported a mobile health application (mHealth app) obesity intervention addressing the sensory addiction component, based on staged food withdrawal. We propose that the motor addiction component can be treated using cognitive behavioral therapy (CBT)-based strategies for body-focused repetitive behaviors (BRFB), e.g., nail biting, skin picking, and hair pulling. Methods The present study tested the effectiveness of CBT-based, BFRB therapies added to the staged withdrawal app. Thirty-five participants, ages 8–20, 51.4% females, mean zBMI 2.17, participated in a 4-month study using the app, followed by a 5-month extension without the app. Using staged withdrawal, participants withdrew from specific, self-identified, “problem” foods until cravings resolved; then from non-specific snacking; and lastly from excessive mealtime amounts. BFRB therapies utilized concurrently included: distractions, competing behaviors, triggers avoidance, relaxation methods, aversion techniques, and distress tolerance. Results Latent growth curve analysis determined that mean body weight and zBMI decreased significantly more than in a previous study that used only staged withdrawal (p < 0.01). In the 5-month follow-up, participants maintained overall weight loss. Conclusions This study provides further preliminary evidence for the acceptability of an addiction model treatment of obesity in youth, and that the addition of CBT-based, BFRB therapies increased the effectiveness of staged food withdrawal. Level of evidence Level IV, Evidence obtained from multiple time series analysis with the intervention. PubDate: 2020-01-14
Abstract: Purpose Personality traits such as perfectionism and asceticism, and combinations of these traits (i.e., overcontrol) have been related to eating disorder (ED) diagnosis, symptoms, and chronicity in adult patients with EDs. However, as limited evidence exists in adolescents, the aim of the present study was to examine these links in a clinical sample of adolescents with EDs. Method A retrospective chart review was conducted on 178 adolescents (91% females; Mage = 15.73 years, SD = 1.31) receiving services at a tertiary care pediatric ED program. An examination of variability in mean levels of perfectionism, asceticism, and overcontrol across ED symptom groups (restrictive and binge/purge ED subtypes) was conducted to learn of diagnostic differences, while correlations were used to explore the association of these personality traits with comorbid anxiety and depressive symptoms. Hierarchical linear regression was used to assess whether overcontrol was related to length of stay (LOS) in an inpatient program. Results Results indicated that adolescents with binge–purge symptoms had higher levels of perfectionism, asceticism and overcontrol compared to those with restrictive symptoms, and that greater levels of perfectionism, asceticism and overcontrol were associated with elevated depression and anxiety symptoms. Additionally, overcontrol predicted greater LOS in the inpatient ED program. Conclusion Results suggest the importance of assessing, monitoring and targeting overcontrol in treatment for adolescents with EDs given its impact on comorbid symptoms and LOS. Level of evidence Level III, evidence obtained from case–control analytic studies. PubDate: 2020-01-08
Abstract: Purpose Wasting is a main indicator of Child’s undernutrition that is associated with several non-communicable diseases and child mortality. This is the first population-based study which evaluated the association of serum zinc and vitamin D levels with wasting in a Middle East region. We also reported the prevalence of vitamin D and zinc deficiencies among Iranian pre-school children aged 6 years. Methods This was a multicenter cross-sectional study that included 425 children aged between 5 and 7 years (on average 6 years) with BMI-for-age Z-scores of < − 1 SD resident in urban and rural areas of Iran in the spring of 2012 as part of the National Integrated Micronutrient Survey 2 (NIMS-2). Anthropometric measurements and blood sampling were obtained. The prevalence of vitamin D and zinc deficiencies together with the correlations of these variables with the increase of BMI-for-age Z-scores were evaluated. Results The prevalence of vitamin D and zinc deficiencies was 18.8% and 12.7%, respectively. In addition, 31.1% of children were wasted. Children in the second tertile of 25(OH)D levels were less likely to have wasting compared with those in the first tertile in both crude and adjusted models (OR 0.47, 95% CI 0.27–0.83). A significant inverse association was found between serum levels of zinc and wasting (OR 0.57, 95% CI 0.34–0.96); such that after adjusting for confounders, children in the highest tertile of serum zinc had 47% less odds of wasting compared with those in the first tertile (OR 0.53, 95% CI 0.31–0.91). Conclusion The prevalence of vitamin D and zinc deficiencies among Iranian pre-school children aged 6 years was 18.8 and 12.7%, respectively. Serum levels of vitamin D and zinc were inversely associated with wasting either before or after controlling for confounders. Level of evidence Level III, case–control analytic studies. PubDate: 2020-01-03
Abstract: Purpose As a 12-item Short Form of the Eating Disorder Examination Questionnaire (EDE-QS), the EDE-QS was developed based on Rasch modeling to address certain weaknesses of the EDE-Q, and it has been demonstrated to be a psychometrically sound measure. Thus, the current study aimed to obtain a Chinese version of the EDE-QS and validate its psychometric properties in the Chinese context. Methods According to standard procedures, the Chinese version of the EDE-QS (C-EDE-QS) was obtained. A total of 1068 Chinese college students finished the survey. The psychometric properties of the C-EDE-QS were examined under the frameworks of both classic test theory and Rasch modeling. Results The one-factor structure of the C-EDE-QS was confirmed in confirmatory factor analysis; the C-EDE-QS showed good reliability with a Cronbach’s α of 0.89; and the total scores of the C-EDE-QS were significantly correlated with eating disturbances and psychological distress in expected magnitudes and directions. Rasch analysis supported the unidimensional construct of the C-EDE-QS and the four-point rating scale structure. However, results revealed differential item functioning (DIF) across gender groups. Conclusions The findings suggest that the C-EDE-QS could be a useful tool to assess key attitudes and behavioral features of eating disorder psychopathologies in the Chinese context. Level of evidence V, descriptive (cross-sectional) study. PubDate: 2020-01-02
Abstract: Background Weight regain (WR) after bariatric surgery (BS) is frequent. Objective The aim of this study was to evaluate whether the occurrence of psychiatric disorders would be associated with short- and long-term WR after BS. Methods Ninety-six patients (77.6% female, age 40.2 ± 10.1 years, BMI of 50 ± 8.2 kg/m2) from the Obesity and Bariatric Surgery Outpatient Clinic of the Universidade Federal São Paulo completed the Questionnaire on Eating and Weight Patterns-Revised, the Beck Depression Inventory and an anxiety inventory to assess the occurrence of binge eating, depressive symptoms (DS) and anxious symptoms (AS) before and after short-term and long-term BS. Results Twenty-four months after BS, the prevalence of binge eating, depression and anxiety decreased from 100 to 13%, 100 to 15% and 43 to 4%, respectively. The mean WR of 35.2 ± 17.3% of weight loss occurred in nine patients after 24 months and was associated with binge eating (p = 0.002) but not with DS or AS. At long-term follow-up (12 ± 1.5 years), 67% had a mean WR of 50.3 ± 24.9%. The prevalence of binge eating, DS and AS were 48%, 46% and 63%, respectively, in this group, and significant associations were observed between WR and binge eating (p = 0.001), DS (p = 0.029) and AS (p = 0.001). Furthermore, the number of psychiatric disorders was inversely associated with the percentage of weight loss (p < 0.05) and positively associated with WR (p < 0.05). Conclusion Weight regain was associated with the occurrence of binge eating in the short and long term after BS, whereas the occurrence of depressive and anxious symptoms was associated with WR only in the long term. Level III Evidence obtained from well-designed cohort or case–control analytic studies. PubDate: 2020-01-02
Abstract: Purpose Cognitive rumination is a transdiagnostic construct that has been increasingly studied in the context of eating disorders (EDs). While this literature has consistently linked trait-level general and ED-specific forms of rumination to ED psychopathology, it is not clear whether trait-level measures are independently related to symptoms in daily life. Therefore, the present study used ecological momentary assessment (EMA) to assess the ecological validity of trait measures of general rumination and ED-specific rumination, and assess the degree to which ruminative brooding and reflection were differentially related to relevant momentary affective, cognitive, and behavioral processes. Methods Forty women completed baseline measures (Ruminative Response Scale [RRS] and Ruminative Response Scale for Eating Disorders [RRSED]) followed by a 10-day EMA protocol. Results Generalized estimating equations indicated trait-level ED-specific rumination was related to momentary general and ED-specific rumination, and trait-level general and ED-specific rumination were related to momentary affect and concentration difficulties. Trait-level general rumination was related to momentary self-discrepancy, while higher trait-level ED-specific rumination was related to greater loss of control eating, overeating, and body dissatisfaction. Lastly, trait levels of ruminative brooding, compared to reflection, were more consistently related to maladaptive momentary symptoms (i.e., general rumination, negative affect, concentration problems, body dissatisfaction). Conclusion Together these findings support the ecological validity of the RRSED and identify shared and unique momentary correlates of the RRS and RRSED. Results also highlight the importance of measuring and addressing trait- and state-level ruminative processes that are both general and specific to ED psychopathology in research and clinical work. Level of evidence Level V, observational descriptive study. PubDate: 2020-01-01
Abstract: Background Exercise addiction is associated with multiple adverse outcomes and can be classified as co-occurring with an eating disorder, or a primary condition with no indication of eating disorders. We conducted a meta-analysis exploring the prevalence of exercise addiction in adults with and without indicated eating disorders. Methods A systematic review of major databases and grey literature was undertaken from inception to 30/04/2019. Studies reporting prevalence of exercise addiction with and without indicated eating disorders in adults were identified. A random effect meta-analysis was undertaken, calculating odds ratios for exercise addiction with versus without indicated eating disorders. Results Nine studies with a total sample of 2140 participants (mean age = 25.06; 70.6% female) were included. Within these, 1732 participants did not show indicated eating disorders (mean age = 26.4; 63.0% female) and 408 had indicated eating disorders (mean age = 23.46; 79.2% female). The odds ratio for exercise addiction in populations with versus without indicated eating disorders was 3.71 (95% CI 2.00–6.89; I2 = 81; p ≤ 0.001). Exercise addiction prevalence in both populations differed according to the measurement instrument used. Discussion Exercise addiction occurs more than three and a half times as often as a comorbidity to an eating disorder than in people without an indicated eating disorder. The creation of a measurement tool able to identify exercise addiction risk in both populations would benefit researchers and practitioners by easily classifying samples. PubDate: 2020-01-01
Abstract: Purpose Approximately 70% of adults in Mexico are overweight or obese. Unhealthy lifestyle behaviors are also prevalent. We examined the association of three lifestyle behaviors with body mass index (BMI) categories in adults from Mexico. Methods We used publicly available data from the ENSANUT 2016 survey (n = 6419). BMI was used to categorize participants. Differences in sleep duration, suffering from symptoms of insomnia, TV watching time, time in front of any screen, vigorous physical activity (yes vs no), moderate physical activity (> 30 min/day—yes vs. no) and walking (> 60 min/day—yes vs. no) were compared across BMI groups using adjusted linear and logistic regression analyses. Results Thirty-nine percent of participants were overweight and 37% obese. Time in front of TV, in front of any screen, sleep duration and physical activity were significantly associated with overweight and obesity. Compared to normal weight participants, participants in the obese II category spend on average 0.60 h/day (95% CI 0.36–0.84, p = 0.001) and participants in the obese III category 0.54 h/day (95% CI 0.19–0.89, p < 0.001) more in front of any screen; participants in the obese II category reported 0.55 h/day less sleep (95% CI − 0.67 to − 0.43, p < 0.001); participants in the obese III category were less likely to engage in vigorous activity (OR = 0.60, 95% CI 0.43–0.84, p ≤ 0.003), or walking (OR = 0.65, 95% CI 0.49–0.88, p = 0.005). Conclusion Screen time, sleeping hours, and physical activity were associated with overweight and obesity. However, these associations were not consistent across all BMI categories. Assuming established causal connections, overweight individuals and individuals with obesity would benefit from reduced screen time and engaging in moderate/vigorous physical activity. Level of evidence Level III: observational case-control analytic study. PubDate: 2019-12-31
Abstract: The article “Nutrition behaviour and compliance with the Mediterranean diet pyramid recommendations: an Italian survey‑based study”, written by “Renata Bracale, Concetta M. Vaccaro, Vittoria Coletta, Claudio Cricelli, Francesco Carlo Gamaleri, Fabio Parazzini and Michele Carruba” was originally published electronically on the publisher’s internet portal on 8th November 2019 without open access. PubDate: 2019-12-21
Abstract: Background In association with the rapid lengthening of life expectancy and the ever-rising prevalence of obesity, many studies explored in the elderly the phenomenon usually defined as the obesity paradox. Objective and methods This article is a narrative overview of seventy-two papers (1999–2019) that investigated the obesity paradox during the aging process. Twenty-nine documents are examined more in detail. Results The majority of studies suggesting the existence of an obesity paradox have evaluated just BMI as an index of obesity. Some aspects are often not assessed or are underestimated, in particular body composition and visceral adiposity, sarcopenic obesity, and cardio fitness. Many studies support that central fat and relative loss of fat-free mass may become relatively more important than BMI in determining the health risk associated with obesity in older ages. Conclusion Inaccurate assessments may lead to a systematic underestimation of the impact of obesity on morbidity and premature mortality and, consequently, to clinical behaviors that are not respectful of the health of elderly patients. Knowledge of the changes in body composition and fat distribution will help to better understand the relationship between obesity, morbidity, and mortality in the elderly. Level of evidence Level V, narrative overview. PubDate: 2019-12-21
Abstract: Purpose To the best of our knowledge, no scientific publications on orthorexia nervosa have been based on a French population. The goal of our study was to confirm the factor structure of the French version of the ORTO-15 questionnaire. Methods An online survey (N = 768) was conducted asking participants (84.77% were women) to answer several questions about their dietary habits and to assess orthorexia nervosa using the ORTO-15 scale. Confirmatory factor analysis (CFA) was used for the validation. Results Given our results, we deemed it necessary to adapt the French version of the ORTO-15 questionnaire by omitting three items. The CFA supported the ORTO-12-FR (composed of 12 items and addressing three domains: rational, emotional, and behavioral) as the better-fitting model, with an internal consistency of 0.73. The Comparative Fit Index value was 0.93, the Tucker–Lewis Index was 0.90, and the Root Mean-Square Error of Approximation was 0.05. Conclusions Our results provide evidence for the reliability of ORTO-12-FR with a French population. Level of evidence V, descriptive cross-sectional study. PubDate: 2019-12-20
Abstract: Objective Determine whether gender differences exist in associations among central barriers to and facilitators of eating disorder (ED) help-seeking—ED stigma, negative affect, perceived ED treatment need—as a function of individuals’ probability of classification within empirically derived groups characterized by different dietary restraint patterns. Method As part of the cross-sectional, multi-institute Healthy Bodies Study, women (n = 2215) and men (n = 986) attending three colleges and universities in 2015 completed measures of ED symptoms, affect, and ED help-seeking in an online survey. Structural equation mixture modeling was used to (1) classify women and men, separately, into distinct classes characterized by unique dietary restraint patterns and (2) test associations among the three ED help-seeking barriers and facilitators within each class. Results Five dietary restraint symptoms (food amount limiting attempts, fasting, food avoidance, following food/diet rules, desiring an empty stomach) clustered within four classes among women and three classes among men, which were characterized by qualitative and quantitative similarities and differences. Further, opposite patterns were generally found in associations among the ED help-seeking barriers and facilitators for women versus men as a function of the way dietary restraint symptoms clustered within each class. For example, bivariate associations between worse ED stigma and negative affect relative to greater perceived ED treatment need were both significant only among women in their lowest restraint severity class, whereas these associations were both significant among men in their highest severity class. Discussion These findings can help to increase the reach of ED intervention efforts, including increasing ED help-seeking rates. Level of evidence Level V, cross-sectional descriptive study. PubDate: 2019-12-18
Abstract: Objectives To assess the implication of disordered eating behaviors (DEBs) on the quality of life (QOL) of a sample of the Lebanese population, after adjustment over sociodemographic characteristics of those participants. Secondary objective aimed to assess the role of body dissatisfaction (BD) in the association of DEBs and QOL. Methods This cross-sectional study was done between January and May 2018 and enrolled 811 participants from the community. A proportionate random sample technique was used to select the sample from all Lebanese Mohafazat. The World Health Organization Quality-of-life (WHOQOL)-BREF was used to assess the QOL and it includes four domains: physical health, psychological health, social relations, and environment. Results Body dissatisfaction was found to be a major confounding factor contributing to psychological and environmental HQOL impairments in patient with restrained eating. Nevertheless, orthorexia nervosa was associated with QOL impairments in its physical and environmental domains, regardless of body dissatisfaction that was shown to be a major contributor for QOL impairments. Similarly, ON was directly correlated with QOL of life impairment in its physical and environmental domains, independently of all other risk factors. Conclusion When adding body dissatisfaction as a confounding variable, restrained eating and orthorexia nervosa remained significantly associated with quality-of-life impairments. Level of evidence Level V, cross-sectional descriptive study. PubDate: 2019-12-17
Abstract: Background Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of mortality and morbidity. VTE may occur asymptomatic or subclinical. Fluid retention during intensive re-nutrition or rapid weight changes are well-known phenomena in anorexia nervosa (AN) and may represent a significant risk factor for VTE. Objective The incidence of VTE in patients with AN is unknown, and the conditions may be overlooked in a complex clinical picture. Method This study report four cases of VTE in women with severe AN (age range 19–41 years, BMI range 10.6–13.1) admitted to a specialized unit for medical stabilization. Results DVT or PE was diagnosed in all four patients. The patients were admitted for intensive re-nutrition according to conventional conservative guidelines with slow increase in energy supply (start low and advance slow). Due to suspected VTE, thromboprophylaxis was given during hospitalization, three of whom were undergoing re-nutrition. Conclusion The four presented cases suggest that VTE during re-nutrition in AN may be an overlooked risk which may not be sufficiently addressed in the literature. General recommendations should not be issued on the basis of case reports; however, we want to raise awareness and call for studies to identify the VTE risk and appropriate thromboprophylaxis in AN patients. PubDate: 2019-12-17
Abstract: Purpose Impaired oral health is a well-known complication in individuals with eating disorders, although this is difficult to identify by mental health professionals. The aim of this study was to evaluate the relationship between routine blood parameters and two oral health outcomes (dental erosion, reduced periodontium) in women with eating disorders. Methods A face-to-face interview and a clinical oral examination were carried out in a cohort of 70 women from an addiction and psychiatry hospital unit. Biochemical and hematological parameters were collected in medical records at admission. Biological factors associated with a generalized reduced periodontium (≥ 30% of sites with clinical attachment loss ≥ 3 mm) and dental erosion [a basic erosive wear examination (BEWE) score ≥ 3] were determined by logistic regression models. Results Forty-five women with either anorexia nervosa (n = 27) or bulimia nervosa (n = 18) were included in the study. None of the women had active periodontitis or other inflammatory comorbidity. Women with ≥ 30% of sites with clinical attachment loss ≥ 3 mm and those with a BEWE score ≥ 3 were older than women that did not exhibit a generalized reduced periodontium or dental erosion (37.1 ± 10.4 versus 28.8 ± 7.4, p < 0.01 and 35.2 ± 9.7 versus 28.1 ± 7.8, p = 0.01), respectively. After adjustments for age and duration of eating disorder, high serum ferritin levels were associated with a generalized reduced periodontium [OR (95%CI) = 1.04 (1.01; 1.07)]. No association was found between biological factors and dental erosion. Conclusion Serum ferritin levels together with age may be helpful to mental health professionals in screening patients with eating disorders for adequate referral to a dentist. Level III Evidence obtained from a case–control analytic study. PubDate: 2019-12-16
Abstract: Purpose Although anecdotal reports suggest a relation between orthorexic eating behavior and symptoms of somatoform disorders, this issue has not yet been investigated. The aim of this study was to compare orthorexic eating behavior and other characteristics of disordered eating behavior in patients with somatoform disorders to a sample of healthy controls. Methods 31 patients with somatoform disorders and 30 matched controls completed eight questionnaires, i.a., the Düsseldorf Orthorexia Scale, three scales of the Eating Disorder Inventory-2, Eating Attitudes Test-26, Multidimensional Inventory of Hypochondriacal Traits, Attitudes Towards Body and Health Questionnaire, and Screening for Somatoform Disorders. Results The patients displayed higher levels of orthorexic eating behavior, drive for thinness, body dissatisfaction, bulimia, and dieting than the control group. In both groups, orthorexic eating behavior was associated with higher levels of somatization in eating and health habits. The control group showed an association of orthorexic eating behavior with catastrophizing cognitions and the perceptual component of health anxiety. Conclusion The results support the hypothesis of a connection between orthorexic eating behavior and somatoform disorders. However, patients with somatoform disorders do not seem to be at particular risk for orthorexia. Future studies should investigate causes for the relationship between orthorexic eating behavior and characteristics of somatoform disorders in samples of healthy individuals. Level of evidence Level V, descriptive study with matched control group. PubDate: 2019-12-12
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