Individuals with cancer face daily challenges regarding diet and healthy lifestyle behaviors that may lead them to better health. This quest for improved health can be exaggerated in unhealthy ways if it is not approached with moderation as occurs with a condition called orthorexia nervosa (ON). Our aim in this study was to determine the prevalence of ON tendencies and their behavioral correlates among Lebanese adults with cancer. This was a monocentric cross-sectional study, conducted between December 2021 and February 2022, involving 366 patients. We collected data via telephone and recorded answers online on a Google form. We used the Düsseldorf Orthorexia Scale (DOS) to assess orthorexic behaviors, and we checked for behavioral correlates of orthorexia through a linear regression model using the DOS score as the dependent variable. On the DOS scale, we found that 9% of these participants showed possible ON tendencies, whereas 22.2% had definite ON tendencies. Factors associated with having more ON tendencies were (a) receipt of hormonotherapy, (b) being female and (c) having breast cancer. Having prostate cancer was significantly associated with fewer ON tendencies. Our results should help improve the management of patients with cancer through programs to increase patient awareness and education.
AlizadehS.KhanahmadiS.VedadhirA.BarjastehS. (2018). The relationship between resilience with self- compassion, social support and sense of belonging in women with breast cancer. Asian Pacific Journal of Cancer Prevention: APJCP, 19(9), 2469–2474. https://doi.org/10.22034/APJCP.2018.19.9.2469
2.
AltunH. K.OzyildirimC.SeymaK.AksoyH. N.SagirB.BozkurtM. S.KarasuH. (2022). Evaluation of the presence of orthorexia nervosa in individuals with type 2 diabetes and its relationship with diabetes self-management.
AslanH.AkturkU. (2020). Demographic characteristics, nutritional behaviors, and orthorexic tendencies of women with breast cancer: A case-control study. Eating and Weight Disorders: EWD, 25(5), 1365–1375. https://doi.org/10.1007/s40519-019-00772-y
5.
AstudilloR. B. (2021). Ortorexia nervosa : A lifestyle or the emergence of a new eating disorder?Revista chilena de nutrición, 48(2), 255–265. https://doi.org/10.4067/s0717-75182021000200255
6.
AtchisonA. E.ZickgrafH. F. (2022). Orthorexia nervosa and eating disorder behaviors: A systematic review of the literature. Appetite, 177, 106134. https://doi.org/10.1016/j.appet.2022.106134
7.
AwadE.SalamehP.SacreH.MalaebD.HallitS.ObeidS. (2021). Association between impulsivity and orthorexia nervosa/healthy orthorexia: Any mediating effect of depression, anxiety, and stress?BMC Psychiatry, 21, 604. https://doi.org/10.1186/s12888-021-03594-4
8.
BarthelsF.BarradaJ. R.RonceroM. (2019). Orthorexia nervosa and healthy orthorexia as new eating styles. PLoS One, 14(7), Article e0219609. https://doi.org/10.1371/journal.pone.0219609
9.
BarthelsF.MeyerF.PietrowskyR. (2015). Orthorexic eating behavior. A new type of disordered eating. Ernahrungs Umschau, 62(10), 156–161.
10.
Bobonis BabiloniaM.DonovanK. A.Lubrano di CicconeB. B.RajasekharaS. (2020). When orthorexia nervosa meets cancer-A case review. Psycho-oncology, 29(10), 1507–1509. https://doi.org/10.1002/pon.5419
11.
Brytek-MateraA.SacreH.StaniszewskaA.HallitS. (2020). The prevalence of orthorexia nervosa in polish and Lebanese adults and its relationship with sociodemographic variables and BMI ranges: A cross-cultural perspective. Nutrients, 12(12), 3865. https://doi.org/10.3390/nu12123865
12.
BulutA.YigitbasC. (2022). Prevalence of orthorexia nervosa in academicians and the influencing factors. Clinical and Experimental Health Sciences, 12(2), 346–351. https://doi.org/10.33808/clinexphealthsci.819884
13.
DoniniL. M.BarradaJ. R.BarthelsF.DunnT. M.BabeauC.Brytek-MateraA.CenaH.CeroliniS.ChoH. H.CoimbraM.CuzzolaroM.FerreiraC.GalfanoV.GrammatikopoulouM. G.HallitS.HamanL.HayP.JimboM.LassonC.LombardoC. (2022). A consensus document on definition and diagnostic criteria for orthorexia nervosa. Eating and Weight Disorders: EWD, 27(8), 3695–3711. https://doi.org/10.1007/s40519-022-01512-5
14.
DoumaE. R.ValenteM.SyurinaE. V. (2021). Developmental pathway of orthorexia nervosa: Factors contributing to progression from healthy eating to excessive preoccupation with healthy eating. Experiences of Dutch health professionals. Appetite, 158, 105008. https://doi.org/10.1016/j.appet.2020.105008
15.
FaulF.ErdfelderE.LangA. G.BuchnerA. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191. https://doi.org/10.3758/bf03193146
16.
Fekih-RomdhaneF.FawazM.HallitR.SawmaT.ObeidS.HallitS. (2023). Psychometric properties of an Arabic translation of the multidimensional social support scale (MSPSS) in a community sample of Lebanese adults. BMC Psychiatry. https://doi.org/10.1186/s12888-023-04937-z
17.
FisherB.CostantinoJ. P.WickerhamD. L., et al. (1998). Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst, 90(18), 1371–1388. https://doi.org/10.1093/jnci/90.18.1371
18.
GeorgeD. (2011). SPSS for windows step by step: a simple study guide and reference, 17.0 update (10/e). Pearson Education India.
19.
Greville-HarrisM.TalbotC. V.MoseleyR. L.VuillierL. (2022). Conceptualisations of health in orthorexia nervosa: A mixed-methods study. Eating and weight disorders, 27(8), 3135–3143. https://doi.org/10.1007/s40519-022-01443-1
20.
HaddadC.ObeidS.AkelM.HoneinK.AkikiM.AzarJ.HallitS. (2019). Correlates of orthorexia nervosa among a representative sample of the Lebanese population. Eating and Weight Disorders: EWD, 24(3), 481–493. https://doi.org/10.1007/s40519-018-0631-x
21.
HallitS.BarradaJ. R.SalamehP.SacreH.RonceroM.ObeidS. (2021a). The relation of orthorexia with lifestyle habits: Arabic versions of the eating habits questionnaire and the dusseldorf orthorexia scale. Journal of Eating Disorders, 9(1), 102. https://doi.org/10.1186/s40337-021-00455-z
22.
HallitS.Brytek-MateraA.ObeidS. (2021b). Orthorexia nervosa and disordered eating attitudes among Lebanese adults: Assessing psychometric proprieties of the ORTO-R in a population-based sample. PLoS One, 16(8), Article e0254948. https://doi.org/10.1371/journal.pone.0254948
23.
HallitS.ObeidS.HaddadC.HallitR.AkelM.HaddadG.SoufiaM.KhansaW.KhouryR.KheirN.Abi Elias HallitC.SacreH.SalamehP. (2020). Construction of the Lebanese anxiety scale (LAS-10): A new scale to assess anxiety in adult patients. International Journal of Psychiatry in Clinical Practice, 24(3), 270–277. https://doi.org/10.1080/13651501.2020.1744662
24.
HoskinP. J.AshleyS.YarnoldJ. R. (1992). Weight gain after primary surgery for breast cancer--effect of tamoxifen. Breast Cancer Res Treat, 22(2), 129–132. https://doi.org/10.1007/BF01833342
25.
HuangZ.HankinsonS. E.ColditzG. A.StampferM. J.HunterD. J.MansonJ. E.HennekensC. H.RosnerB.SpeizerF. E.WillettW. C.WillettW. C. (1997). Dual effects of weight and weight gain on breast cancer risk. JAMA: The Journal of the American Medical Association, 278(17), 1407–1411. https://doi.org/10.1001/jama.278.17.1407
26.
KeaverL.CallaghanH.WalshL.HoulihanC. (2020). Nutrition guidance for cancer patients and survivors—a review of the websites of Irish healthcare and charitable organisations and cancer centres. European Journal of Cancer Care, 29(2), Article e13216. https://doi.org/10.1111/ecc.13216
27.
Koçan, S., Gürsoy, A. (2016). Body image of women with breast cancer after mastectomy: A qualitative research. J Breast Health, 12(4), 145–150. https://doi.org/10.5152/tjbh.2016.2913
28.
KujawowiczK.Mirończuk-ChodakowskaI.WitkowskaA. M. (2022). Dietary behavior and risk of Orthorexia in women with celiac disease. Nutrients, 14(4), 904. https://doi.org/10.3390/nu14040904
29.
LipositsG.OrrevallY.KaasaS.OsterlundP.CederholmT. (2021). Nutrition in cancer care: A brief, practical guide with a focus on clinical practice. JCO Oncology Practice, 17(7), Article e992–e998. https://doi.org/10.1200/op.20.00704
30.
Makari-JudsonG.BraunB.JerryD. J.MertensW. C. (2014). Weight gain following breast cancer diagnosis: Implication and proposed mechanisms. World J Clin Oncol, 5(3), 272–282. https://doi.org/10.5306/wjco.v5.i3.272
31.
MelkiI. S.BeydounH. A.KhogaliM.TamimH.YunisK. A.National Collaborative Perinatal Neonatal Network NCPNN (2004). Household crowding index: A correlate of socioeconomic status and inter-pregnancy spacing in an urban setting. Journal of Epidemiology and Community Health, 58(6), 476–480. https://doi.org/10.1136/jech.2003.012690
32.
MerhyG.AzziV.SalamehP.ObeidS.HallitS. (2021). Anxiety among Lebanese adolescents: Scale validation and correlates. BMC Pediatrics, 21(1), 288. https://doi.org/10.1186/s12887-021-02763-4
33.
NucciD.SantangeloO. E.ProvenzanoS.NardiM.FirenzeA.GianfrediV. (2022). Altered food behavior and cancer: A systematic review of the literature. International Journal of Environmental Research and Public Health, 19(16), 10299. https://doi.org/10.3390/ijerph191610299
34.
ObeidS.AwadE.WachtenH.HallitS.StrahlerJ. (2022). Temperaments and orthorexia nervosa: A cross-cultural study between Germany and Lebanon. Current Psychology, 1–14. https://doi.org/10.1007/s12144-022-03467-3
35.
OersH.SchlebuschL. (2020). Indicators of psychological distress and body image disorders infemale patients with breast cancer. 7(2).
36.
OlejniczakD.BugajecD.PanczykM.Brytek-MateraA.ReligioniU.CzerwA.GrąbczewskaA.JuszczykG.Jabłkowska-GóreckaK.StaniszewskaA. (2017). Analysis concerning nutritional behaviors in the context of the risk of orthorexia. Neuropsychiatric Disease and Treatment, 13, 543–550. https://doi.org/10.2147/NDT.S129660
37.
PlaydonM. C.BrackenM. B.SanftT. B.LigibelJ. A.HarriganM.IrwinM. L. (2015). Weight gain after breast cancer diagnosis and all-cause mortality: Systematic review and meta-analysis. J Natl Cancer Inst, 107(12). https://doi.org/10.1093/jnci/djv275
38.
Puigpinos-RieraR.Graells-SansA.SerralG.ContinenteX.BargalloX.DomenechM.Espinosa-BravoM.GrauJ.MaciaF.ManzaneraR.PlaM.QuintanaM. J.SalaM.VidalE. (2018). Anxiety and depression in women with breast cancer: Social and clinical determinants and influence of the social network and social support (DAMA cohort). Cancer Epidemiology, 55, 123–129. https://doi.org/10.1016/j.canep.2018.06.002
39.
RaghavendraA.SinhaA. K.ValleJ.ShenY.TripathyD.BarcenasC. H. (2018). Determinants of weight gain during adjuvant endocrine therapy and association of such weight gain with recurrence in long-term breast cancer survivors. Clin Breast Cancer, 18(1), e7–e13. https://doi.org/10.1016/j.clbc.2017.11.006
RogozaR.HallitS.SoufiaM.BarthelsF.ObeidS. (2021). Validation of the Arabic version of the dusseldorf orthorexia scale (DOS) among Lebanese adolescents. Journal of Eating Disorders, 9(1), 130. https://doi.org/10.1186/s40337-021-00488-4
42.
SawayaH.AtouiM.HamadehA.ZeinounP.NahasZ. (2016). Adaptation and initial validation of the patient health questionnaire - 9 (PHQ-9) and the generalized anxiety disorder - 7 questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample. Psychiatry Research, 239, 245–252. https://doi.org/10.1016/j.psychres.2016.03.030
43.
SestakI.HarvieM.HowellA.ForbesJ. F.DowsettM.CuzickJ. (2012). Weight change associated with anastrozole and tamoxifen treatment in postmenopausal women with or at high risk of developing breast cancer. Breast Cancer Res Treat, 134(2), 727–734. https://doi.org/10.1007/s10549-012-2085-6
44.
SfeirE.HaddadC.SalamehP.et al. (2021). Binge eating, orthorexia nervosa, restrained eating, and quality of life: A population study in Lebanon. Eat Weight Disord, 26, 145–158. https://doi.org/10.1007/s40519-019-00831-4
45.
StrahlerJ. (2019). Sex differences in orthorexic eating behaviors: A systematic review and meta-analytical integration. Nutrition, 67–68, 110534. https://doi.org/10.1016/j.nut.2019.06.015
46.
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
47.
StuttsL. A. (2020). It’s complicated: The relationship between orthorexia and weight/shape concerns, eating behaviors, and mood. Eating Behaviors, 39, 101444. https://doi.org/10.1016/j.eatbeh.2020.101444
48.
UstaY. Y. (2012). Importance of social support in cancer patients. Asian Pacific Journal of Cancer Prevention: APJCP, 13(8), 3569–3572. https://doi.org/10.7314/apjcp.2012.13.8.3569
49.
WatermanM.LeeR. M.CarterJ. C.GarlandS. N. (2022). Orthorexia symptoms and disordered eating behaviors in young women with cancer. Eating Behaviors, 47, 101672. https://doi.org/10.1016/j.eatbeh.2022.101672
50.
YakınE.ObeidS.Fekih-RomdhaneF.SoufiaM.SawmaT.SamahaS.MhannaM.AzziR.MinaA.HallitS. (2022). “In-between orthorexia” profile: The co-occurrence of pathological and healthy orthorexia among male and female non-clinical adolescents. Journal of Eating Disorders, 10(1), 155. https://doi.org/10.1186/s40337-022-00673-z
51.
ZimetG. D.DahlemN. W.ZimetS. G.FarleyG. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52(1), 30–41. https://doi.org/10.1207/s15327752jpa5201_2
