The aims for this study were to perform a Portuguese language cross-cultural adaptation of the Teruel Orthorexia Scale (TOS) and to evaluate the scale’s psychometric properties, including verifying the frequency of behaviors characteristic of orthorexia nervosa and healthy orthorexia, among a group of Brazilian gym users. First, we adapted the Spanish version of the TOS to the Brazilian Portuguese language following international protocols to guarantee idiomatic, semantic, conceptual, and cultural equivalence. Then participants completed both the new Portuguese version of the TOS and a socioeconomic questionnaire. Among our sample of 226 young Brazilian adults (63.7% men; Mage = 28.8, SD = 5.1 years), we assessed the bi-factorial model of the TOS through factorial, convergent, and discriminant validity, reliability, and factorial invariance. We calculated the mean scores of the TOS factors and the frequency of behaviors of both orthorexia nervosa and healthy orthorexia. The new Portuguese version was well understood by participants, and the TOS bi-factorial model presented adequate psychometric properties and showed invariance in independent subsamples and in men and women. The mean scores were different between sexes only for orthorexia nervosa, with women obtaining higher values. The frequency of orthorexia nervosa behaviors was 5.3% and of healthy orthorexia was 41.2%. Based on these findings, the Brazilian Portuguese version of the TOS can be a useful tool for investigating orthorexia-like behaviors in future research.
ABEP. (2020). Associação Brasileira de Empresas de Pesquisa. Critério de Classificação Econômica Brasil [Brazilian Economic Classification Criteria]. http://www.abep.org/criterio-brasil
2.
AgopyanA.KengerE. B.KermenS.UlkerM. T.UzsoyM. A.YetginM. K. (2019).
The relationship between orthorexia nervosa and body composition in female students of the nutrition and dietetics department. Eating and Weight Disorders,
24(2), 257–266. https://doi.org/10.1007/s40519-018-0565-3
3.
AlmeidaC.Vieira BorbaV.SantosL. (2018).
Orthorexia nervosa in a sample of Portuguese fitness participants. Eating and Weight Disorders,
23(4), 443–451. https://doi.org/10.1007/s40519-018-0517-y
4.
AlvarengaM. S.MartinsM. C.SatoK. S.VargasS. V.PhilippiS. T.ScagliusiF. B. (2012).
Orthorexia nervosa behavior in a sample of Brazilian dietitians assessed by the Portuguese version of ORTO-15. Eating and Weight Disorders,
17(1), e29–e35. https://doi.org/10.1007/BF03325325
5.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Author.
BarradaJ. R.RonceroM. (2018).
Bidimensional structure of the orthorexia: Development and initial validation of a new instrument. Anales de Psicología,
34(2), 283–291. https://doi.org/10.6018/analesps.34.2.299671
BarthelsF.KisserJ.PietrowskyR. (2020).
Orthorexic eating behavior and body dissatisfaction in a sample of young females. Eating and Weight Disorders. https://doi.org/10.1007/s40519-020-00986-5
10.
BarthelsF.MeyerF.PietrowskyR. (2015).
Duesseldorf orthorexia scale—Construction and evaluation of a questionnaire measuring orthorexic eating behavior [die düsseldorfer orthorexie skala—Construktion und evaluation eines fragebogens zur erfassung orthorektischen ernährungsverhaltens. Zeitschrift Für Klinische Psychologie Und Psychotherapie,
44(2), 97–105. https://doi.org/10.1026/1616-3443/a000310
11.
BauerS. M.FusteA.AndresA.SaldanaC. (2019).
The Barcelona Orthorexia Scale (BOS): Development process using the Delphi method. Eating and Weight Disorders,
24(2), 247–255. https://doi.org/10.1007/s40519-018-0556-4
12.
BeatonD. E.BombardierC.GuilleminF.FerrazM. B. (2000).
Guidelines for the process of cross-cultural adaptation of self-report measures. Spine,
25(24), 3186–3191. https://doi.org/10.1097/00007632-200012150-00014
13.
BertF.GualanoM. R.VoglinoG.RosselloP.PerretJ. P.SiliquiniR. (2019).
Orthorexia nervosa: A cross-sectional study among athletes competing in endurance sports in Northern Italy. PloS One,
14(8), e0221399. https://doi.org/10.1371/journal.pone.0221399
14.
BónaE.SzelZ.KissD.GyarmathyV. A. (2019).
An unhealthy health behavior: Analysis of orthorexic tendencies among Hungarian gym attendees. Eating and Weight Disorders,
24(1), 13–20. https://doi.org/10.1007/s40519-018-0592-0
BratmanS.KnightD. (2000). Health food junkies: Orthorexia nervosa: Overcoming the obsession with healthful eating (1st ed.).
Broadway.
18.
BrownT. A. (2015). Confirmatory factor analysis for applied research (2nd ed.).
Guilford Press.
19.
CenaH.BarthelsF.CuzzolaroM.BratmanS.Brytek-MateraA.DunnT.VargaM.MissbachB.DoniniL. M. (2019).
Definition and diagnostic criteria for orthorexia nervosa: A narrative review of the literature. Eating and Weight Disorders,
24(2), 209–246. https://doi.org/10.1007/s40519-018-0606-y
20.
CicchettiD. V. (1994).
Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological Assessment,
6(4), 284–290. https://doi.org/10.1037/1040-3590.6.4.284
21.
ColuciM. Z. O.AlexandreN. M. C. (2009).
Development of a questionnaire to evaluate the usability of assessment instruments. Revista de Enfermagem,
17(3), 378–382.
22.
da SilvaW. R.MarocoJ.CamposJ. (2021).
Examination of the factorial model of a scale developed to assess body satisfaction in the Brazilian context: A study with people 18 to 40 years old. Eating and Weight Disorders. https://doi.org/10.1007/s40519-020-01102-3
23.
De OnisM.OnyangoA. W.BorghiE.SiyamA.NishidaC.SiekmannJ. (2007).
Development of a WHO growth reference for school-aged children and adolescents. Bulletin of the World Health Organization,
85(9), 660–667. https://doi.org/10.1590/S0042-96862007000900010
24.
Dell'OssoL.CarpitaB.MutiD.CremoneI. M.MassimettiG.DiademaE.GesiC.CarmassiC. (2018).
Prevalence and characteristics of orthorexia nervosa in a sample of university students in Italy. Eating and Weight Disorders,
23(1), 55–65. https://doi.org/10.1007/s40519-017-0460-3
25.
DepaJ.BarradaJ. R.RonceroM. (2019).
Are the motives for food choices different in orthorexia nervosa and healthy orthorexia?Nutrients,
11(3), 697–614. https://doi.org/10.3390/nu11030697
26.
DepaJ.SchweizerJ.BekersS. K.HilzendegenC.Stroebele-BenschopN. (2017).
Prevalence and predictors of orthorexia nervosa among German students using the 21-item-DOS. Eating and Weight Disorders,
22(1), 193–199. https://doi.org/10.1007/s40519-016-0334-0
27.
DominguesR. B.CarmoC. (2021).
Orthorexia nervosa in yoga practitioners: Relationship with personality, attitudes about appearance, and yoga engagement. Eating and Weight Disorders,
26(3), 789–795. https://doi.org/10.1007/s40519-020-00911-w
28.
DoniniL. M.MarsiliD.GrazianiM. P.ImbrialeM.CannellaC. (2005).
Orthorexia nervosa: Validation of a diagnosis questionnaire. Eating and Weight Disorders,
10(2), e28–e32. https://doi.org/10.1007/BF03327537
29.
DunnT. M.BratmanS. (2016).
On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eating Behaviors,
21(2), 11–17. https://doi.org/10.1016/j.eatbeh.2015.12.006
GadermannA. M.GuhnM.ZumboB. D. (2012).
Estimating ordinal reliability for Likert-type and ordinal item response data: A conceptual, empirical, and practical guide. Practical Assessment, Research & Evaluation,
17(3), 1–13. https://doi.org/10.7275/n560-j767
GleavesD. H.GrahamE. C.AmbwaniS. (2013).
Measuring “orthorexia”: development of the eating habits questionnaire. The International Journal of Educational and Psychological Assessment,
12(2), 1–18.
34.
GroganS. (2017). Body image: Understanding body dissatisfaction in men, women and children (3rd. ed.).
Routledge.
35.
Hair Jr.J. F.BlackW. C.BabinB.AndersonR. E. (2019). Multivariate data analysis (8th ed.).
Cengage Learning EMEA.
36.
HartT. A.FloraD. B.PalyoS. A.FrescoD. M.HolleC.HeimbergR. G. (2008).
Development and examination of the social appearance anxiety scale. Assessment,
15(1), 48–59. https://doi.org/10.1177/1073191107306673
37.
HuL.BentlerP. M. (1999).
Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling,
6(1), 1–55. https://doi.org/10.1080/10705519909540118
KimS.LuZ.CohenA. S. (2020).
Reliability for tests with items having different numbers of ordered categories. Applied Psychological Measurement,
44(2), 137–149. https://doi.org/10.1177/0146621619835498
40.
LorenzonL. F. L.MinossiP. B. P.PegoloG. E. (2020).
Ortorexia nervosa e imagem corporal em adolescentes e adultos [Orthorexia nervosa and body image in adolescents and adults]. Jornal Brasileiro de Psiquiatria,
69(2), 117–119. https://doi.org/10.1590/0047-2085000000266
MissbachB.DunnT. M.KonigJ. S. (2017).
We need new tools to assess orthorexia nervosa. A commentary on “prevalence of orthorexia nervosa among college students based on Bratman's test and associated tendencies. Appetite,
108, 521–524. https://doi.org/10.1016/j.appet.2016.07.010
44.
MissbachB.HinterbuchingerB.DreiseitlV.ZellhoferS.KurzC.KonigJ. (2015).
When eating right, is measured wrong! a validation and critical examination of the ORTO-15 questionnaire in German. PloS One,
10(8), e0135772. https://doi.org/10.1371/journal.pone.0135772
45.
MitrofanovaE.PummellE.MartinelliL.PetrocziA. (2021).
Does ORTO-15 produce valid data for ‘orthorexia nervosa'? A mixed-method examination of participants' interpretations of the fifteen test items. Eating and Weight Disorders,
26(3), 897–909. https://doi.org/10.1007/s40519-020-00919-2
46.
MuthénL. K.MuthénB. O. (2017). MPlus: Statistical analysis with latent variables user’s guide. https://www.StatModel.com
47.
NovaraC.PardiniS.MaggioE.MattioliS.PiasentinS. (2021).
Orthorexia nervosa: Over concern or obsession about healthy food?Eating and Weight Disorders. https://doi.org/10.1007/s40519-021-01110-x
48.
OberleC. D.De NadaiA. S.MadridA. L. (2021).
Orthorexia nervosa inventory (ONI): Development and validation of a new measure of orthorexic symptomatology. Eating and Weight Disorders,
26(2), 609–622. https://doi.org/10.1007/s40519-020-00896-6
49.
Parra-FernandezM. L.Rodriguez-CanoT.Onieva-ZafraM. D.Perez-HaroM. J.Casero-AlonsoV.Fernandez-MartinezE.Notario-PachecoB. (2018).
Prevalence of orthorexia nervosa in university students and its relationship with psychopathological aspects of eating behaviour disorders. BMC Psychiatry,
18(1), 364–368. https://doi.org/10.1186/s12888-018-1943-0
50.
ReichenheimM. E.MoraesC. L. (2007).
Operationalizing the cross-cultural adaptation of epidemological measurement instruments. Revista de Saúde Pública,
41(4), 665–673. https://doi.org/10.1590/S0034-89102006005000035
RosselY. (2012).
Lavaan: An R package for structural equation modeling. Journal of Statistical Software,
48(2), 1–36. https://doi.org/10.18637/jss.v048.i02
53.
RudolphS. (2018).
The connection between exercise addiction and orthorexia nervosa in German fitness sports. Eating and Weight Disorders,
23(5), 581–586. https://doi.org/10.1007/s40519-017-0437-2
54.
Segura-GarciaC.PapaianniM. C.CagliotiF.ProcopioL.NisticoC. G.BombardiereL.AmmendoliaA.RizzaP.De FazioP.CapranicaL. (2012).
Orthorexia nervosa: A frequent eating disordered behavior in athletes. Eating and Weight Disorders,
17(4), e7560–e7560. https://doi.org/10.3275/8272
55.
StrahlerJ. (2020).
The dark side of healthy eating: Links between orthorexic eating and mental health. Nutrients,
12(12), 3662–3612. https://doi.org/10.3390/nu12123662
56.
StrahlerJ. (2021).
Trait mindfulness differentiates the interest in healthy diet from orthorexia nervosa. Eating and Weight Disorders,
26(3), 993–998. https://doi.org/10.1007/s40519-020-00927-2
57.
StrahlerJ.HaddadC.SalamehP.SacreH.ObeidS.HallitS. (2020).
Cross-cultural differences in orthorexic eating behaviors: Associations with personality traits. Nutrition,
77(1), 110811–110811. https://doi.org/10.1016/j.nut.2020.110811
58.
StrahlerJ.HermannA.WalterB.StarkR. (2018).
Orthorexia nervosa: A behavioral complex or a psychological condition?Journal of Behavioral Addictions,
7(4), 1143–1156. https://doi.org/10.1556/2006.7.2018.129
59.
TurnerP. G.LefevreC. E. (2017).
Instagram use is linked to increased symptoms of orthorexia nervosa. Eating and Weight Disorders,
22(2), 277–284. https://doi.org/10.1007/s40519-017-0364-2
60.
ValenteM.SyurinaE. V.DoniniL. M. (2019).
Shedding light upon various tools to assess orthorexia nervosa: A critical literature review with a systematic search. Eating and Weight Disorders,
24(4), 671–682. https://doi.org/10.1007/s40519-019-00735-3
World Health Organization. (2018). International classification of diseases for mortality and morbidity statistics (11th Revision). https://icd.who.int/browse11/l-m/en
63.
YangY.GreenS. B. (2015).
Evaluation of structural equation modeling estimates of reliability for scales with ordered categorical items. Methodology,
11(1), 23–34. https://doi.org/10.1027/1614-2241/a000087
64.
ZumboB. D.GadermannA. M.ZeisserC. (2007).
Ordinal versions of coefficients alpha and theta for Likert rating scales. Journal of Modern Applied Statistical Methods,
6(1), 21–29. https://doi.org/10.22237/jmasm/1177992180
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
