Orthorexia nervosa: assessment, prevalence, high-risk groups, co-occurring features and management

This review synthesizes research on orthorexia nervosa published in 2025 and early 2026.

Orthorexia nervosa is characterized by an excessive focus on healthy eating. Widely used measures, particularly the ORTO-15, have been criticized for poor reliability, prompting the development of new assessment instruments. Recent prevalence estimates of orthorexia nervosa vary widely. Meta-analyses based on ORTO-15 assessment in highly heterogeneous settings suggest an overall prevalence of 27.5%, with men and women equally at risk. However, more recent studies indicate a substantially lower prevalence, 0.5-1.5% for orthorexia nervosa and 7.5-15% for elevated orthorexic tendencies. High-risk groups include dietitians, nutrition and sport science students, athletes, and individuals required to monitor their diet. Dietary patterns involving plant-based eating are associated with orthorexia. Other factors associated with increased risk include societal stressors, such as pandemics and climate concerns, social media use, particularly image-based platforms, and psychological traits, such as perfectionism, emotion regulation difficulties, obsessive-compulsive features, alexithymia, and autistic traits. Evidence on long-term outcomes and treatment remains limited, although psychoeducation appears promising.

Orthorexia nervosa is an eating disorder that also reflects broader nutritional, sociocultural, and moral trends. Longitudinal research is needed on its course and management.