Ortorexia nervoasă la adolescenți – implicații pentru sănătatea fizică și mintală

Eating behavior disorders represent a global issue, and Romanian adolescents are no exception, facing intense social pressures regarding body image and healthy eating. Adolescence is a critical stage in the development of individual personality, marked by multiple physical, psychological, and social transformations that significantly influence both eating behavior and self-esteem, which are mutually interdependent during this life phase.

In this context, concerns related to food are not merely a public health issue, but also a growing challenge for adolescent mental health. Eating disorders such as orthorexia nervosa, bulimia nervosa and binge eating disorder are well-documented in the scientific literature⁽¹⁾.

However, an emerging disorder like orthorexia nervosa has increasingly drawn researchers’ attention due to its complex connection with self-esteem, body image perception and contemporary social norms⁽²⁾, particularly during adolescence, when biological and psychological maturation progress in parallel.

Studies suggest that self-esteem, body ideals and the values attributed to physical appearance play a crucial role in the development and maintenance of eating disorders⁽⁵⁾. Eating behavior disorders encompass a wide spectrum of psychological disturbances characterized by excessive concerns related to diet, body weight and body image.

Anorexia nervosa is defined by severe food restriction, intense fear of gaining weight and a distorted perception of body weight and shape⁽¹⁾. Bulimia nervosa, on the other hand, involves recurrent episodes of binge eating followed by inappropriate compensatory behaviors such as self-induced vomiting or excessive use of laxatives.

Binge eating disorder is characterized by episodes of compulsive overeating without subsequent compensatory behaviors⁽³⁾. Orthorexia nervosa represents an obsessive preoccupation with the consumption of foods perceived as “pure” and health-promoting, stemming from an extreme concern for healthy eating⁽²⁾.

Viewed as an unhealthy, pathological eating behavior, orthorexia nervosa in its dynamic form is shaped by sociocultural influences and by mass media. This condition, which falls within the obsessive-compulsive spectrum, can lead to severe dietary restrictions, malnutrition and impairment in both social and occupational functioning, even though the initial intention is to preserve health.

Research indicates that orthorexia nervosa is strongly associated with certain personality traits, such as meticulousness, perfectionism and cognitive and attitudinal rigidity factors that may contribute to both the development and persistence of this disorder⁽⁴⁾.

Orthorexia nervosa is a relatively recently defined disorder, characterized by an unhealthy preoccupation with healthy eating. Although it is not officially recognized in the DSM-5, it has attracted significant research interest due to its implications for both physical and psychological health^(1,4).

Individuals with orthorexia nervosa tend to follow extremely restrictive diets, avoiding entire food groups and focusing exclusively on consuming products considered “clean” or “healthy”.

This attitudinal rigidity may result in nutritional deficiencies, malnutrition and social isolation, significantly impacting overall quality of life⁽²⁾.

Orthorexia nervosa can be triggered by a variety of factors, including social pressures and role models, as well as elevated levels of conscientiousness and perfectionism⁽⁶⁾. Adolescents are particularly vulnerable to developing this disorder due to the pressure to conform to body ideals promoted in the media and on social platforms – pressures that stem from the fragile self-image and low self-esteem characteristic of this developmental stage⁽⁷⁾.

Self-esteem plays a fundamental role in the development of eating behaviors and in the susceptibility to eating disorders.

Adolescents with low self-esteem and a fragile self-image are more likely to adopt unhealthy eating behaviors – such as excessive dietary restriction or compulsive eating – as compensatory strategies to gain social validation and acceptance⁽⁵⁾. Social pressure to maintain a specific body ideal can intensify these behaviors, further contributing to the development of eating disorders⁽⁶⁾.

In this context, self-esteem influences how adolescents perceive their bodies and their relationship with food.

Low self-esteem may lead to a distorted body image and to excessive concerns about weight and body shape, thereby promoting the development of pathological eating behaviors⁽³⁾.

In what follows, we present a questionnaire administered to a group of adolescent participants.

The sample consisted of 216 adolescents, aged between 14 and 18 years old, of whom 60% were girls and 40% were boys. All participants were high school students from various schools in Târgu-Mureș and active users of social media platforms.

The questionnaire was distributed via social media (Facebook and Instagram) and through partnerships with several high schools in Târgu-Mureș, where school counselors supported its promotion among students.

The questionnaire included 10 items: seven were Likert-scale questions (ranging from 1 – “not at all” to 5 – “very much”), and three were open-ended questions designed to capture adolescents’ perceptions of body image, social influences and their level of awareness regarding orthorexia nervosa.

The participants were informed about the voluntary and anonymous nature of the study, and the informed consent was obtained prior to questionnaire completion, in accordance with ethical standards for confidentiality.

The responses were analyzed using descriptive statistical methods to calculate percentages and means.

Questionnaire

• How do you perceive your current body image?
• How often do you feel pressured to look a certain way due to social influences (friends, family, media)?
• How important is healthy eating to you?
• Have you ever avoided eating certain foods because you considered them unhealthy?
• How often do you think about the quality of the foods you consume?
• Have you ever experienced anxiety or guilt after eating a food you considered unhealthy?
• Do you believe there is a connection between self-esteem and the food choices you make?
• How often do you use social media, and how does it influence your perception of body image?
• Have you heard of orthorexia nervosa? If yes, to what extent do you identify with the description of this disorder?

Results and discussion

1. How do you perceive your current body image?

A total of 34.2% of adolescents reported being satisfied with their body image. Approximately one-third of respondents expressed a positive self-perception, suggesting that a portion of the adolescent population maintains a healthy body image. However, the remaining two-thirds were either neutral or dissatisfied, which may reflect vulnerability to external influences and potentially lower self-esteem. These findings highlight the need for educational interventions that promote self-awareness and self-acceptance as a means of reducing the negative effects of social appearance standards.

2. How often do you feel pressured to look a certain way due to social influences (friends, family, media)?

About one-third of adolescents reported occasionally feeling pressure from social influences. This proportion indicates a moderate degree of external influence on self-perception and eating behaviors, which, although not dominant, can still contribute indirectly to unhealthy eating patterns, such as restricting certain food types or following rigid diets in an attempt to meet societal expectations.

3. How important is healthy eating to you?

A significant percentage of adolescents assign high importance to healthy eating, which is an encouraging finding. However, when this concern becomes excessive, it may evolve into obsessive behavior and contribute to the development of rigid dietary patterns. The data emphasize the need to promote a balanced, nonrestrictive approach to nutrition as a preventive strategy against orthorexic tendencies.

4. Have you ever avoided eating certain foods because you considered them unhealthy?

Nearly 37.5% of adolescents reported occasionally avoiding foods they perceived as unhealthy, which reflects a heightened awareness of dietary quality. However, when this behavior is influenced by low self-esteem or social pressure, it may evolve into compulsive avoidance, thereby fostering rigid and potentially disordered eating patterns.

5. How often do you think about the quality of the foods you consume?

Approximately one-third of respondents frequently think about the quality of their food. While this can reflect a conscientious attitude toward health, in some cases, it may indicate the onset of obsessive behavior, which can be associated with orthorexic tendencies. Such heightened attention, if not managed properly, may become pathological, requiring interventions focused on promoting flexibility and psychological balance.

6. Have you ever experienced anxiety or guilt after eating a food you considered unhealthy?

A total of 44.2% reported never feeling guilt or anxiety after eating unhealthy foods, yet the remaining 55.8% experienced such emotions at least occasionally. This emotional response indicates a sensitivity that may lead to restrictive or compensatory behaviors, underscoring the need for nutritional education that promotes acceptance and reduces food-related guilt.

7. Do you believe there is a connection between self-esteem and the food choices you make?

Only 7.9% of adolescents strongly acknowledged a connection between self-esteem and food choices, while the majority demonstrated a moderate level of awareness. This suggests a need for psychological support programs that integrate nutrition education with strategies to enhance body image and self-worth.

8. How often do you use social media, and how does it influence your perception of body image?

Social media usage is high among respondents, with over 35% using it often or always, and many acknowledging its impact on their body image. This underscores the need for media literacy initiatives aimed at helping adolescents critically assess the influence of online content and idealized body representations.

9. Have you heard of orthorexia nervosa? If so, to what extent do you identify with the description of this disorder?

In terms of body image perception, 34.2% of respondents reported being satisfied with their own appearance.

Approximately one-third of the adolescents express satisfaction with their body image, indicating that a portion of the young population maintains a positive self-perception. However, the remaining two-thirds either hold a neutral stance or are dissatisfied, which may reflect a vulnerability to external influences and a potential negative impact on self-esteem.

This finding highlights the importance of education aimed at fostering self-awareness and self-acceptance in order to mitigate the effects of social standards on vulnerable adolescents.

Likewise, about one-third of the adolescents reported occasionally feeling pressure from social influences. This proportion suggests a moderate level of influence on dietary choices and self-perception, without reaching a critical threshold for most participants.

Indirectly, this influence may lead to unhealthy eating behaviors, such as restricting the consumption of “unhealthy” foods or adopting strict diets in an effort to conform to an idealized body image.

The fact that a significant percentage of adolescents place high importance on healthy eating is a positive and encouraging finding, reflecting a conscious concern for personal health. However, when this concern becomes excessive, it can reach obsessive intensity and contribute to the development of rigid and restrictive eating behaviors.

This observation underscores the need to promote a balanced and harmonious approach to nutrition in order to prevent orthorexic manifestations.

Nearly 37.5% of adolescents occasionally avoid foods they perceive as unhealthy, indicating a strong awareness of their potential health impact. However, when combined with other influences – such as social pressure or low self-esteem – this attitude may become compulsive, fostering rigid eating behaviors.

Nutritional education should not only provide information about healthy eating, but also emphasize the importance of flexibility and moderation in order to prevent restrictive patterns and dietary excesses.

Approximately one-third of adolescents frequently think about the quality of the foods they consume, which may reflect an excessive preoccupation with food that can evolve into obsessive behavior. This heightened attention may be associated with symptoms of orthorexia.

The results suggest that increased attention to healthy eating, if not properly managed, can become pathological, thus requiring interventions that emphasize the importance of dietary balance.

A total of 44.2% of adolescents reported experiencing anxiety or guilt after consuming foods perceived as unhealthy. This response reflects a high sensitivity to such foods and may contribute to the development of orthorexic tendencies.

This percentage serves as a warning signal, highlighting the need for nutritional education programs that promote dietary flexibility and self-acceptance to reduce stress and guilt related to food choices.

Only 28% of adolescents believe that self-esteem influences their food choices. This indicates a moderate level of awareness regarding the relationship between self-image and eating habits. Adolescents who are vulnerable to social influences may adopt unhealthy eating behaviors in an attempt to protect their subjective well-being and self-esteem.

The findings underscore the importance of psychological support programs and nutritional counseling focused on self-acceptance and the development of a healthy body image. Food choices should be informed, personalized, and aligned with the individual’s maturation process.

Approximately 30.4% of respondents reported that their body image is influenced by social media. Exposure to idealized online representations can lead to unrealistic comparisons and may encourage the adoption of strict eating habits in an attempt to conform to promoted beauty standards.

This result highlights the need for educational programs addressing the impact of social media on body image, aimed at helping adolescents navigate the online environment with greater discernment.

The fact that 50.8% of adolescents do not identify with orthorexic behaviors is encouraging. However, some adolescents show an increased interest in healthy eating and report anxiety related to food choices, revealing a significant vulnerability in this area.

Education on orthorexia and its early warning signs may help adolescents recognize and avoid the development of such behavior, while also promoting a more balanced approach to food and health.

Only 9.1% of adolescents believe there is a clear need for a balance between healthy eating and dietary flexibility, indicating a limited understanding of the concept of nutritional flexibility. This attitudinal rigidity may contribute to the emergence of disordered eating behaviors.

Promoting a balance between healthy eating and dietary flexibility is essential in preventing orthorexic tendencies and fostering a well-rounded, adaptive eating behavior.

In conclusion, the results of the questionnaire suggest that a substantial proportion of the adolescents are preoccupied with food and body image – concerns clearly influenced by social pressure and the digital environment. Although interest in healthy eating is generally a positive sign, the risk remains that such interest may become rigid and maladaptive. These findings indicate a clear need for targeted educational and psychological interventions that address both the relationship between self-esteem and body image and encourage self-acceptance and balanced eating behaviors.

Autor corespondent: Bianca-Maria Moldovan E-mail: bianca.moldovan11@yahoo.com

CONFLICT OF INTEREST: none declared.

FINANCIAL SUPPORT: none declared.

This work is permanently accessible online free of charge and published under the CC-BY.