Adolescents and young adults are in a sensitive transitional phase in which important developmental tasks must be mastered. Successful mastery of these challenges is crucial not only for long-term physical and mental health, but also for economic success and interpersonal relationships throughout the lifespan. Failure to successfully overcome these challenges is a major cause of mental illness 1. Adolescents and young adults, especially young women, are particularly at-risk of developing eating disorders. In Austria, 31% of all females aged 10 to 18 might be affected. A study based on nationally representative US survey data found the highest annual prevalence at age 21, with initial onset mostly before the age of 25 2. In the "growing up" phase, independence and personal responsibility also develop with regard to important health-related behavior patterns 3. A positive relationship with one's own body and associated healthy dietary and behavioral patterns are essential building blocks for healthy adolescence and adult life. Healthy nutritional habits are not only associated with better physical well-being but also with increased mental health and well-being 4. However, an obsession towards healthy foods may cause negative outcomes in physical and mental health as well as overall quality of life. The concept of Orthorexia Nervosa (ON) describes this phenomenon of the obsession towards the quality rather than the quantity of food. It includes very particular rules about the origin, processing, and/or preparation of foods 5. Consuming foods that do not comply with these rules can cause feelings of guilt, fear and worries. ON leads to avoidance of certain foods or categories of foods and therefore can cause malnutrition and unintentional weight loss. ON is not recognized as a distinct eating disorder but ON may also impair the overall quality of life (QoL), social relations and psychological well-being 6. The prevalence of ON may be correlated with the educational status, knowledge about nutrition, and health consciousness. Some studies found an increased prevalence among university students 67, but prevalence estimates for Austria are not available to date.

Therefore, the aims of this study are to investigate the prevalence of ON and its relationship with different aspects of quality of life and lifestyle factors (sport and nutritional habits) in a sample of young adults in Austria.

We investigated the prevalence of ON and its relationship with different aspects of quality of life and lifestyle factors (sport and nutritional habits) in a sample of young adults in Austria.

We found no significant difference in the DOS-scores of male and female participants, and no significant difference between students and non-students. High DOS-scores significantly impair all three domains of QoL. We did not find a significant relationship between high DOS-scores and taking nutritional supplements or being vegan, vegetarian or omnivore. Participants with high DOS-scores spent significantly more hours per week with sport/exercising.

In several studies, the prevalence of ON is reported between 3% and 6.9% in the general population 910. ON was reported to show a higher prevalence in people with higher BMI 11. Findings on gender differences in the prevalence of ON are contradictory, in contrast to many other eating disorders that show a distinctly higher prevalence in women 12. Strahler et al. report a higher tendency towards pathologically healthy eating in women 6. Another group suspected to be at risk for developing ON are university students with a prevalence 8% and up to 12.4% being at risk of developing ON 13. Differences in prevalence according to age could not be clearly established 12.

In our study we did not find significant differences in DOS-scores neither between female and male participants nor between the students and non-students’ group. More than 80% of our sample are highly educated, therefore it could be considered that high education has a higher predictive value for ON than being a university student 14. DOS-scores did not significantly correlate with BMI and age, but it must be taken into account that about 80% of our sample had a BMI of 25 or lower and that our age range was only between 18 and 30 years. Therefore, we have a relatively young sample with overall low BMI scores. The overall prevalence of ON estimated with the DOS was 3% and therefore in line with the results of other studies 910. 16.3% of our sample may be at risk of developing orthorectic eating behavior. With 22.6% of male and 13.8% of female participants, more men seem to be at risk. Ab Hamid et al explain a similar finding in their study with a particular eagerness of men to maintain body shape 15.

ON can have a negative impact on physical and mental health and it can lead to social problems. ON can lead to malnutrition caused by a narrowed food pallet resulting in vitamin deficiencies or thyroid and gonadal dysfunction, amenorrhea, and menstrual disturbances 161718. Furthermore, ON poses a risk for developing obsessive compulsive disorders (OSD) and other eating disorders. Studies also found tendencies towards excessively high demands on themselves and harsh criticism themselves 192021. ON can cause disturbances in social interactions by avoiding social events that include eating or through the narrowed interest and activities related to food and eating 2223. Our data shows that high values in the DOS-questionnaire are negatively correlated with all three domains of quality of life; physical, psychological, and social. Other studies found similar negative relations between ON and quality of life 1524. Vegan and vegetarian diets are associated with ON in different studies 510. In our sample, we could not find a connection between high values in the DOS-questionnaire and vegan or vegetarian diet. ON may also be associated with other health related aspects of life like exercising 25 and health knowledge and health consciousness 1426. We tested if DOS-scores are associated with the hours exercising and the tendency to take nutritional supplements as a particular form of health-conscious behavior. In line with the results of a review and meta-analysis of Strahler et al 25, we found a significant correlation between the hours of exercise per week but no difference in taking supplements.

Careful and conscious selection of foods and viewing nutrition as part of a healthy lifestyle is not a pathological behavior. But thinking too much about food and nutrition, executing extreme dietary restrictions, harsh self-criticism, and an impaired social life due to strict dietary rules can be a sign of possible ON. Even if ON is not an official diagnosis according to DSM or ICD, it impairs health and quality of life in those affected. There is a need for research regarding ON and its differences and similarities with other eating disorders as well as regarding risk and protective factors. More knowledge about ON could lead to improved diagnostic and screening tools. This might be an important preventive measure to detect and treat ON in early stages.

We have no conflict of interest to declare.