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

PURPOSE OF REVIEW: This review synthesizes research on orthorexia nervosa published in 2025 and early 2026. RECENT FINDINGS: 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. SUMMARY: Orthorexia nervosa is an eating disorder that also reflects broader nutritional, sociocultural, and moral trends. Longitudinal research is needed on its course and management.