Comparing Questionnaires for Assessing Orthorexic Thoughts and Behaviors in College Students

Mindful eating (ME) is becoming increasingly popular as a method of changing problematic eating behaviors, including orthorexic (ON) thoughts and behaviors. Simultaneously, the psychometric flaws of commonly used questionnaires for assessing ON thoughts and behaviors limit the potential of exploring their association with ME and diet quality. The study aimed to (a) assess the intensity of ON thoughts and behaviors; (b) evaluate the associations between ON thoughts and behaviors, ME, and diet quality; and (c) compare ORTO-R with ORTO-15 and its shortened versions and PL-DOS. Data were collected from a sample of 478 college students through a cross-sectional study conducted in 2021 across eighteen universities in Poland. Students completed the ORTO-R, ORTO-15, Düsseldorf Orthorexia Scale (PL-DOS), Mindful Eating Scale (MES), and Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN). ORTO-15 and its shortened versions correlated at least highly positively with each other for both sexes, as did ORTO-R and PL-DOS. Positive correlations were found between ORTO-15 and its shortened versions and such mindful eating behaviors as act with awareness as well as awareness for females and/or males. Meanwhile, ORTO-R correlated negatively with act with awareness and acceptance for females and/or males. In addition, PL-DOS correlated negatively with awareness and acceptance for females and/or males. An increase in the intensity of ON thoughts and behaviors measured by almost all questionnaires was associated with an increase in the intensity of beneficial dietary characteristics for health (higher the "Pro-Healthy Diet Index"-pHDI, and the "Diet Quality Index"-DQI) and a decrease in the intensity of harmful dietary characteristics for health (lower the "Non-Healthy Diet Index"-nHDI). Overall, ORTO-R and PL-DOS proved to be the most effective questionnaires for distinguishing eating behaviors in the context of orthorexic thoughts and behaviors, but only for ME. The results may suggest that ME practices may be associated with reduced ON thoughts and behaviors. However, limitations of the study, for example, a sample of college students, a non-randomly selected of sample, a cross-sectional design of the study, and an imbalanced biological sex ratio, make it much more difficult to generalize the results.