The questionnaires typically used to assess "orthorexia risk" don't necessarily work for vegans


Last year, I was fortunate enough to have a letter to the editor on the topic of orthorexia nervosa published in the journal Eating and Weight Disorders (also see here). In my letter I wanted to explain that vegans may answer the questionnaires - which are used to assess "restrictive eating behaviour" and in turn "orthorexia risk" - differently from non-vegans. And this might lead to wrong conclusions about vegans being at a "higher risk" - when really it doesn't seem like they (we) are.

There are a number of different "questionnaires" being used by psychology researchers to assess this "orthorexia risk". The one I addressed in my letter to the editor is called the "Düsseldorf Orthorexia Scale" (from Germany).

Now, a really amazing review article (titled "Disordered eating and the meat-avoidance spectrum: a systematic review and clinical implications") has just been published in the same journal (Eating and Weight Disorders) ... and amazingly ... the authors created a table with similar issues addressing a number of other (frequently used) "questionnaires".

I have copied and pasted the table from the article here (which should be permissible as this is an open access article). I have also added some comments in square brackets.


Quote starts here:

"

Table 1 Examples of potentially confusing items in eating disorder scales for veg*ans

From: Disordered eating and the meat-avoidance spectrum: a systematic review and clinical implications

EAT-40 [18]Item 2. Prepare foods for others but do not eat what I cook
-Veg*ans may frequently prepare foods with animal products for others
[Unfortunately, especially vegan caregivers (often mothers/wives) and
vegans who work in non-vegan restaurants etc.]

Item 19. Enjoy eating meat
-Veg*ns do not eat meat and may be biased in their response
[I think, "biased" is not the right word. The questionnaire is "biased"
against vegans maybe.]

Item 30. Eat diet foods
-Veg*n foods are often considered to be “diet” foods [Good point.
Might or might not be relevant.]

Item 32. Display self-control around food
-Veg*ans must display self-control around foods containing animal products
[Vegans do not HAVE TO but CHOOSE TO "display self-control in regard to
animal products.]

Item 33. Feel that others pressure me to eat
-Veg*ans may feel pressure to eat animal products by family and friends
[Definitely true. All the time. Vegans even get pressured to eat vegan foods.
"Here, eat this. It's vegan." "Eat some fruit."]
EDE-Q [19]Item 3 (Restraint Subscale). Have you tried to exclude from your diet foods
that you like in order to influence your shape or weight?
-Veg*ans routinely exclude animal products as part of their diet. This item
also relies on the respondent being aware and honest about their motivations
for these exclusions
Item 4 (Restraint Subscale). Have you tried to follow definite rules regarding
your eating in order to influence your shape or weight?
-Veg*ans routinely follow definite rules around the exclusion of animal products
as part of their diet. This item also relies on the respondent being aware and honest
about their motivations for following rules
ORTO-15 [20]Item 2. When you go to a food shop do you feel confused?
-Veg*ans may often feel confused when reading ingredients lists to assess
whether they contain animal products [Do vegans often feel confused? Could be
true for new vegans.]

Item 8. Do you allow yourself any eating transgressions?
-Veg*ans do not allow eating transgressions within the realm of animal products
[Very important point!]
TFEQ [21]Item 1 (Cognitive Restraint Subscale). When I smell a sizzling steak or see a juicy
piece of meat, I find it very difficult to keep from eating, even if I have just
finished a meal
-Veg*ans do not eat meat and may be biased in their response. We encourage
the use of Forestell, Spaeth and Kane [22]’s modified item (“When I smell a
chocolate cake baking or see a delicious cookie, I find it very difficult to keep
from eating, even if I have just finished a meal”) when administering the TFEQ
to veg*ans [To be honest, I don't find this scenario makes too much sense.
Wouldn't it make more sense to say "When I'M EATING A CAKE, I can hardly
stop eating"??]
YFAS [23]Item 11 (Important social, occupational, or recreational activities given up or
reduced Subscale). There have been times when I avoided professional or
social situations because I was not able to consume certain foods there
-Veg*ans may avoid professional or social situations where there is limited
veg*an options [Yes, or where there are too many agressive anti-vegans ...
or just people with drastically different political views.]

Item 23. I have tried to cut down to stop eating certain kinds of food
-Veg*ans regularly restrict their diet to ensure they do not consume animal
products [Vegans do not restrict their diet TO ENSURE they do not consume
animal products. The non-eating of animal products IS the "restriction."
Anyone who does not eat certain things by definition "restricts" their diet.]

Item 24 (Persistent desire or repeated unsuccessful attempts to quit Subscale).
I have been successful at cutting down or not eating these kinds of foods
-Veg*ans regularly restrict their diet to ensure they do not consume animal
products [See the previous comment.]
  1. EAT  eating attitudes test, EDE-Q  eating disorder examination-questionnaire, TFEQ three-factor eating questionnaire, YFAS  Yale food addiction scale
"