Limited health literacy increases the risk of orthorexia nervosa among urban schoolteachers
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Abstract
Orthorexia nervosa (ON) describes a pathological obsession with proper nutrition that is characterized by a restrictive diet, ritualized patterns of eating, and rigid avoidance of foods believed to be unhealthy or impure. Limited health literacy may play a role in the onset and progression of orthorexia. The aim of this study was to determine the relationship between health literacy and ON among urban schoolteachers.
Methods
This cross-sectional study was conducted in central Black Sea region of Turkey with 420 primary and secondary schoolteachers aged between 18 and 51 years. A questionnaire form including socio-demographic characteristics was used. The Orthorexia Nervosa Questionnaire (ORTO-15) was used to assess orthorexia nervosa behavior and the Turkey Health Literacy Scale (TSOY-32) to assess health literacy. Simple binary and multiple binary logistic regression analyses were carried out to verify the associations between the variables.
Results
Of the study group 46.4% were in the 40-49 year age group, 53.8% were male, 78.6% had ON and 93.6% had limited health literacy. Nearly all of the orthorexics (96.4%) had limited health literacy. Female gender, Instagram use and limited health literacy was significantly associated with ON. Limited health literacy increases the risk of ON 4.85 times among teachers (aOR=4.85;95% C.I. : 2.15-10.94;p=0.000).
Conclusion
The current findings suggest that limited health literacy is the strongest risk factor for ON among urban schoolteachers. School health literacy and social media literacy programs can open a new window into revealing ON.
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References
World Health Organization. Noncommunicable diseases country profiles 2018. Geneva: World Health Organization;2018.
Hawkes C. Promoting healthy diets through nutrition education and changes in the food environment: an international review of actions and their effectiveness. Rome: Nutrition Division Food and Agriculture Organization of the United Nations;2013.
World Health Organization. Guideline 2012: sodium intake for adults and children. Geneva: World Health Organization, 2012 (Reprinted, 2014).
World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva: World Health Organization;2013.
Chaki B, Pal S, Bandyopadhyay A. Exploring scientific legitimacy of orthorexia nervosa: a newly emerging eating disorder. J Hum Sport Exerc 2013;8:1045-53. doi:10.4100/jhse.2013.84.14.
American Psychiatric Associaton. Diagnostic and statistical manual of mental disorders DSM-5. Arlington, VA, USA: American Psychiatric Publishing; 2013.
Plichta M, Jezewska-Zychowicz M, Gębski J. Orthorexic tendency in Polish students: exploring association with dietary patterns, body satisfaction and weight. Nutrients 2019;11:100. doi:10.3390/nu11010100.
Koven NS, Abry AW. The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatr Dis Treat 2015;11:385–94. doi:10.2147/NDT. S61665.
Luck-Sikorski C, Jung F, Schlosser K, Riedel-Heller SG. Is orthorexic behavior common in the general public? A large representative study in Germany. Eat Weight Disord 2019;24:267-73. doi: 10.1007/s40519-018-0502-5.
Farchakh Y, Hallit S, Soufia M. Association between orthorexia nervosa, eating attitudes and anxiety among medical students in Lebanese universities: results of a cross-sectional study. Eat Weight Disord 2019;24:683-91. doi: 10.1007/s40519-019-00724-6.
Ozkan A, Ulkucu A, Kanter T, Tapan M, Turgutlugil B, Çaylan A. Evaluating orthorexia tendency among Trakya University medical school students. Turkish Med Student J 2015;2:1-4.
Arslantaş H, Adana F, Öğüt S, Ayakdaş D, Korkmaz A. Relationship between eating behaviors of nursing students and orthorexia nervosa (obsession with healthy eating): a cross-sectional study. Journal of Psychiatric Nursing 2017;8:137-44. doi: 10.14744/phd.2016.36854.
Hyrnik J , Janas-Kozik M, Stochel M, Jelonek I, Siwiec A, Rybakowski JF. The assessment of orthorexia nervosa among 1899 Polish adolescents using the ORTO-15 questionnaire. Int J Psychiatry Clin Pract 2016;20:199-203. doi: 10.1080/13651501.2016.1197271.
Missbach B, Dunn TM, König JS. 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 2017;108:521-4. doi:10.1016/j.appet.2016.07.010.
Dunn TM, Gibbs J, Whitney N, Starosta A. Prevalence of orthorexia nervosa is less than 1%: data from a US sample. Eat Weight Disord 2017;22:185-92. doi: 10.1007/s40519-016-0258-8.
Costa CB, Hardan-Khalil K, Gibbs K. Orthorexia nervosa: a review of the literature. Issues Ment Health Nurs 2017;38:980-8. doi:10.1080/01612840.2017.1371816.
Clifford T, Blyth C. A pilot study comparing the prevalence of orthorexia nervosa in regular students and those in University sports teams. Eat Weight Disord 2019;24:473-80. doi:10.1007/s40519-018-0584-0.
Segura-García C, Papaianni MC, Caglioti F, et al. Orthorexia nervosa: a frequent eating disordered behavior in athletes. Eat Weight Disord 2012;17:e226-33. doi:10.3275/8272.
Stochel M, Janas-Kozik M, Zejda J, Hyrnik J, Jelonek I, Siwiec A. Validation of ORTO-15 questionnaire in the group of urban youth aged 15-21. Psychiatr Pol 2015;49:119-34. doi:10.12740/PP/25962.
Ramacciotti CE, Perrone P, Coli E, et al. Orthorexia nervosa in the general population: a preliminary screening using a self-administered questionnaire (ORTO-15). Eat Weight Disord 2011;16:e127-30.doi:10.1007/BF03325318.
Holland G, Tiggemann M. A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. Body Image 2016;17:100-10. doi: 10.1016/j.bodyim.2016.02.008.
Qutteina Y, Nasrallah C, Kimmel L, Khaled SM. Relationship between social media use and disordered eating behavior among female university students in Qatar. J Health Soc Sci 2019;4:59-72. doi: 10.19204/2019/rltn7.
Lin LY, Sidani JE, Shensa A, et al. Association between social media use and depression among US young adults. Depress Anxiety 2016;33:323–31. doi: 10.1002/da.22466.
Carrotte ER, Vella AM, Lim MS. Predictors of “liking” three types of health and fitness-related content on social media: a cross-sectional study. J Med Internet Res 2015;17:e205. doi: 10.2196/jmir.4803.
Speirs KE, Messina LA, Munger AL, Grutzmacher SK. Health literacy and nutrition behaviors among low-income adults. J Health Care Poor Underserved 2012;23:1082–91. doi: 10.1353/hpu.2012.0113.
Zoellner J, You W, Connell C, et al. Health literacy is associated with healthy eating index scores and sugar-sweetened beverage intake: findings from the rural Lower Mississippi Delta. J Am Diet Assoc 2011;111:1012–20. doi:10.1016/ j.jada.2011.04.010.
Sørensen K, Van den Broucke S, Fullam J, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health 2012;12:80 doi:10.1186/1471-2458-12-80.
Yang SJ, Chee YK. Development and psychometric testing of the Health Literacy Index for Female Marriage Immigrants (HLI-FMI) in Korea. Women Health 2017;57:1007-30. doi:10.1080/03630242. 2016.1222328.
van der Vaart R, Drossaert C J. Development of the digital health literacy instrument: measuring a broad spectrum of Health 1.0 and Health 2.0 skills. Med Internet Res 2017; 19:e27. doi:10.2196/jmir.6709.
Peralta L, Rowling L, Samdal O, Hipkins R, Dudley D. Conceptualising a new approach to adolescent health literacy. Health Educ J 2017;76:787–801. doi: 10.1177/0017896917714812.
Mounsey A, Sexton B. Health literacy tools in the outpatient setting. Am Fam Physician 2017;96:252.
Mafutha NG, Mogotlane S, De Swardt H. Development of a hypertension health literacy assessment tool for use in primary healthcare clinics in South Africa, Gauteng. Afr J Prim Health Care Fam Med 2017;98. doi: 10.4102/phcfm.v9i1.1305.
Sørensen K, Pelikan JM, Röthlin F, et al. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). Eur J Public Health 2015;25:1053-8. doi:10.1093/eurpub/ckv043.
Okyay P, Abacıgil F. Türkiye Sağlık Okuryazarlığı Ölçekleri Güvenilirlik ve Geçerlilik Çalışması. 1. Baskı. Ankara: Anıl Matbaa; 2016. pp. 43-60.
Durusu-Tanrıöver M, Yıldırım HH, Demiray-Ready FN, Çakır B, Akalın HE. Turkey health literacy research. Ankara: Sağlık-SenYayınları; 2014.
Ermumcu MŞK, Nilüfer AT. Healthy eating concern in health professionals: orthorexia nervosa (ON). J Gazi Health Sci 2016;1:59-71.
Reynolds R, McMahon S. Views of health professionals on the clinical recognition of orthorexia nervosa: a pilot study. Eat Weight Disord 2020;25:1117–1124. doi:10.1007/s40519-019-00701-z.
Kiss-Leizer M, Rigó A. People behind unhealthy obsession to healthy food: the personality profile of tendency to orthorexia nervosa. Eat Weight Disord 2019;24:29-35. doi:10.1007/s40519-018-0527-9.
Asil E, Sürücüoğlu MS. Orthorexia nervosa in Turkish dietitians. Ecol Food Nutr 2015;54:303-13. doi: 10.1080/03670244.2014.987920.
Dunn TM, Bratman S. On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eat Behav 2016;21:11-7. doi: 10.1016/j.eatbeh.2015.12.006.
Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C. Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eat Weight Disord 2004;9:151-7. doi: 10.1007/bf03325060.
Brytek-Matera A, Rogoza R, Gramaglia C, Zeppegno P. Predictors of orthorexic behaviours in patients with eating disorders: a preliminary study. BMC Psychiatry 2015; 15:252. doi: 10.1186/s12888-015-0628-1.
Cinosi E, Matarazzo I, Marini S, et al. Prevalence of orthorexia nervosa in a population of young Italian adults. European Psychiatry 2015;30:1330. doi.org/10.1016/S0924-9338(15)31038-5.
Varga M, Thege BK, Dukay-Szabó S, Túry F, Van Furth EF. When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry 2014;14:59. doi:10.1186/ 1471-244X-14-59.
Pehlivan E, Mete B, Fırıncı B, Doğan E. Prevalence of orthorexia nervosa and its relations with health literacy in university students. ESTUDAM Public Health J 2019;4:166-75. doi:10.35232/estudamhsd. 500538
Denuwara HMBH, Gunawardena NS. Level of health literacy and factors associated with it among school teachers in an education zone in Colombo, Sri Lanka. BMC Public Health 2017;17:631. doi: 10.1186/s12889-017-4543-x
Yilmazel G, Çetinkaya F. Health literacy among schoolteachers in Çorum, Turkey. East Mediterr Health J 2015;21:598-605. doi:10.26719/ 2015.21.8.598.
Asadian A, Sotoudeh A, Zarei Venovel M, Moosai R. Investigating health literacy of teachers in Asaluyeh. Soc Behav Res Health 2018;2:234-28. doi: 10.18502/sbrh.v2i2.284.
Parra-Fernández ML, Rodríguez-Cano T, Onieva-Zafra MD, et al. Prevalence of orthorexia nervosa in university students and its relationship with psychopathological aspects of eating behaviour disorders. BMC Psychiatry 2018;18:364. doi: 10.1186/s12888-018-1943-0.
Yeşil E, Turhan B, Tatan D, Şarahman C, Saka M. The effect of gender to orthorexia nervosa tendency in adults. J Ankara Health Sci 2018;7:1-9.
Brytek-Matera A, Donini LM, Krupa M, Poggiogalle E, Hay P. Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students. J Eat Disord 2016;16:16. doi:10.1186/s40337-015-0038-2.
Turner PG, Lefevre CE. Instagram use is linked to increased symptoms of orthorexia nervosa. Eat Weight Disord 2017;22:277–84. doi: 10.1007/s40519-017-0364-2.
Robert M, Callahan L, O'Leary C. Social media: A path to health literacy. Stud Health Technol Inform 2017;37:177-87. doi:10.3233/ISU-170836.