Recently, improper eating habits have become the subject of research by scientists around the world. Nutrition and dietary habits are now recognized as some of the most important factors influencing our health, for example, Lalonde’s health field concept, where increasing the consumption of healthy foods and limiting the consumption of unhealthy, highly processed foods is considered an element of healthy eating habits. The purposes of healthy practicing eating habits are numerous, such as reducing the risk of chronic non-communicable diseases (NCD's) like cardiovascular disease, diabetes, and cancer.1 However, clinical practice indicates that behind an apparently healthy lifestyle, there might be underlying eating disorder (ED). One such concern within the field of eating disorders research and practice is Orthorexia Nervosa (ON), which mainly consists of a pathological obsession with eating foods and food products that are considered healthy that leads to following a restrictive diet and a harmful focus on the quality of these products and their origin.2 While not an officially recognized ED diagnosis within the Diagnostic and Statistical Manual (DSM), the term orthorexia nervosa was first coined in 1998 as a means of specifically identifying obsessive and ritualistic eating behaviours related to the concept of eating healthfully. Whether or not ON should be considered a unique form of ED, or whether it is a kind of presentation of behaviours and practices within other forms of ED, such as anorexia nervosa, is still a subject of debate. Within the academic and clinical discussions surrounding ON, the concern stems from what may seem like actions and habits being undertaken to improve one’s dietary habits and achieve best possible health condition, can instead lead a person with ON to serious health complications such as malnutrition, loss or disturbance of relationships with loved ones, and deterioration of quality of life.3 While it is traditionally assumed that EDs typically only affect women and adolescents, there is growing scientific evidence indicating a higher frequency of EDs among men and sexual minorities. 4–7
It is a well-known phenomenon that people who consider themselves as part of the LGBTQ community (hereinafter also referred to as: LGBT) (lesbian, gay, bisexual, transgender, queer) experience disproportionate burdens of physical and mental health issues when compared to the heterosexual population.8–9 Additionally, many studies indicate that EDs are more frequent among the LGBT people as compared to the heterosexual or cisgender population. Despite of the fact that signalling data is emerging on the subject, EDs are not well studied in males and among sexual minority populations. In research exploring prevalence of eating disorders within community samples, men are estimated to represent approximately 25% of those with both lifetime and past or current year prevalence of eating ED, and about 10% of clinical samples.10 Despite the presence of eating disorders in male populations, ED in men continues to be underdiagnosed and misunderstood by clinicians, and is often under researched by scholars.11 Much of this appears to be due to stigma that persists among the notion of men experiencing eating disorders like anorexia nervosa and bulimia nervosa, as well as body dysmorphia pertaining to a desire to be both lean and muscular, which is sometimes referred to as “bigorexia” by some.12 Sexual trauma and abuse are also less likely to be reported among male survivors, again often due to the additional burdens of shame and stigma that are placed upon male survivors, which can be a significant factor in assessing risk for developing eating disorders.11
Sexuality and sexual orientation/identity has also been shown to have a relationship with eating disorder risk. The studies that have been conducted indicate that gay men have a higher rate of eating disorders than their heterosexual counterparts.13 Specifically, gay men have been shown to have significant differences in rates of bulimia nervosa, body dysmorphia, and more concerning attitudes towards eating practices.14 Gay men have been found to have higher rates of body dissatisfaction in general when compared to heterosexual men, with dissatisfaction related to body fatness and muscularity being particularly prominent.15 From a psychological point of view, there is no doubt that the LGBT community experiences unique stressors, often unknown to other groups, such as fear of being rejected by loved ones or by the social environment, experiencing such rejection by their friends, family or co-workers; experience related to physical, economic, mental violence and post-traumatic stress disorder (PTSD); incompatibility between biological sex and gender identity (the so-called gender dysphoria); being a victim of harassment on the basis of sexual orientation and / or gender identity, or simply discrimination and lack of acceptance.16− 17 These experiences can lead to a deterioration in physical and mental health, including the development of EDs.18− 19 It should also be added that LGBT patients tend to remain silent about important health problems more often, as they are afraid that disclosing them may lead to stigmatization or even hatred.20 A factor that can also lead to EDs among this group of people is the pursuit of an ideal appearance, which may be influenced by, among other factors, social media and dating sites used by the LGBT community.21 An ideal appearance being promoted by the media, the need for attractiveness in the environment, as well as frequent linking of sexual activity with an ideal appearance, are some of the reasons why ideal appearance is important for the representatives of the LGBT community. However, in spite of the knowledge of these increased intrapersonal and interpersonal risk factors, diagnosing EDs among this population may be difficult. Based on the available literature on the subject, it is known that up to 40% of LGBT patients who have informed their doctor about their sexual orientation experience discrimination afterwards in the form of offensive comments or refusal to provide health services.22 Discussions around the usage of dating and hook-up apps like Grindr ®, as well as discussions around the usage of pre-exposure prophylaxis medications (PrEP), continue to be influenced by fear that stigma and judgement will be exhibited by the healthcare provider to their LGBT patient, which can lead to less open and honest discussions during healthcare interactions. Given this reticence to have conversations and discussions about the usage of dating apps and PrEP, it is currently unknown whether utilization of either has any other correlational relationship with health beliefs and habits, including dietary behaviours that may fall under the category of orthorexia nervosa.
Therefore, the aim of this exploratory study was: 1) to identifying demographic factors associated with ON behaviour (measured with the ORTO-15 test) among a sample group of Spanish and Polish identifying gay men; 2) to identifying unique predictors of orthorexia nervosa e.g. the use of pre-exposure prophylaxis (PrEP - a medication used to help prevent HIV), the use of social media and the Grindr ® dating application.