Determinants of healthy orthorexia and orthorexia nervosa: the roles of food security, dietary behaviors, and obesogenic environment

Orthorexia has recently gained attention as a two-dimensional construct centered on a shared health orientation. Recent conceptual developments distinguish healthy orthorexia (HeOr), defined as a non-pathological interest in healthy eating, from orthorexia nervosa (OrNe), characterized by rigid and compulsive food control accompanied by psychological and social impairment. This cross-sectional study investigated the associations of HeOr and OrNe with sociodemographic variables, dietary behaviors, and obesogenic environmental factors, and aimed to identify shared and distinct determinants of these tendencies with 1,015 adults aged 18-65 years. Orthorexia tendencies were assessed using the Teruel Orthorexia Scale. Additional measures included the Sustainable and Healthy Eating Behaviors Scale, Short Screening Questionnaire of Highly Processed Food Consumption, Adult Food Security Survey Module, Food Label Reading Attitude Scale, Food Choice Questionnaire, and the Obesogenic Environment Assessment Scale. In the adjusted regression models, HeOr was positively associated with sustainable and healthy eating behaviors (beta = 0.26), AFSS food-insecurity severity score (beta = 0.11), food label reading attitudes (beta = 0.07), health-related food choice motives (beta = 0.09), natural-ingredient preference (beta = 0.14), weight-control motives (beta = 0.15), ethical food choice motives (beta = 0.10), and obesogenic social determinants and effects (beta = 0.09). Conversely, affordability-related motives (beta = -0.08), emotional appeal (beta = -0.15), familiarity (beta = -0.10), and obesogenic cultural determinants/access to experts (beta = -0.12) were negatively associated with HeOr. For OrNe, positive associations were observed with sustainable and healthy eating behaviors (beta = 0.13), AFSS food-insecurity severity score (beta = 0.17), mood-related food choice motives (beta = 0.13), weight-control motives (beta = 0.26), familiarity (beta = 0.09), ethical food choice motives (beta = 0.18), and obesogenic social determinants and effects (beta = 0.30), whereas health-related food choice motives (beta = -0.12), affordability-related motives (beta = -0.08), and emotional appeal (beta = -0.24) showed negative associations. These findings suggest that orthorectic tendencies are associated with individual health motivations as well as broader behavioral and environmental contexts; however, because of the cross-sectional design, these associations should be interpreted as correlational and hypothesis-generating rather than causal.