This descriptive cross-sectional study was conducted with the general population between October and November 2019. As there is no similar study in the literature, a prior sample size calculation would not be possible in advance. Therefore, we conducted a pilot study (n=16). The sample size was calculated with the G-Power analysis method and the Power test using the PS 3.0 software package . The power of the study was calculated based on the correlation between the ORTO-15 score and the total MEQ score. The corresponding score ranges from 0.3 to 0.47. Following the calculation based on these scores, a sample size of 109 was found to provide 90% power with a two-sided type I error (α)=0.05 and a medium effect size of 0.3 (Cohen’s r). Taking into account that there might be some patients who would refuse to participate in the study, the initial sample size was increased, and the study included 197 adults (92 males and 105 females).
The inclusion criteria were set as follows: being between the ages of 18 and 64 years and responding to all four scales. At the beginning of the study, 200 adults were reached and three participants were excluded because they did not respond to all four scales. After informing the participants about the objective of the study as well as the questionnaires used in the study, informed consent forms were obtained from them. The approval for the study was obtained from the Non-Interventional Clinical Research Ethics Committee of Karabuk University (Decision No: 2019/8).
The researchers conducted face-to-face interviews using a questionnaire questioning demographic characteristics. Five results of five scales along with demographic data were analyzed. The sociodemographic form included age, gender, smoking/alcohol use, and marital status. Participants were also asked to indicate whether they have ever suffered from, or been diagnosed with, an eating disorder. Bodyweight (kg) and height (m) were based on self-reported measurements by the participants. Body Mass Index (BMI) values were calculated by the researcher according to the following formula: body weight (kg)/height (m)2.
The Orthorexia Nervosa Questionnaire-15 (ORTO-15)
The ORTO-15 scale was developed to assess ON. It was first prepared by Bratman and Knight . Donini later revised it in 2004 and developed the ORTO-15 scale consisting of 15 questions . It is the most frequently used tool for the assessment of ON, even though it is not a diagnostic tool [19, 20]. Even though it is not a diagnostic tool, it is the most frequently used scale for the assessment of ON. Distinguishing responses to the questionnaire items are evaluated as ’1’, while responses indicating normal eating behavior are evaluated as ‘4’. The minimum and maximum scores that can be obtained from the questionnaire are 15 and 60 points, respectively. Validation studies have used different threshold values (<35 and <40). Based on the review of other studies in the literature, it was decided to use 40 points as the cut-off point in the present study. Individuals with a score of 40 or below were considered to have ON. As the test score increases, the eating behavior of the individual approaches normality .
The Eating Attitudes Test (EAT-26)
The Eating Attitudes Test (EAT) was developed by Garner and Garfinkel in 1979 to measure symptoms of Anorexia Nervosa . After the completion of the test, individuals can get a minimum score of 0 points and a maximum score of 53 points. A score of 20 points has been determined as the cut-off point, and individuals with a score of ‘20 points and above’ are classified as individuals with abnormal eating behavior .
The SCOFF Test
The scale was created by Morgan et al in 2000 . The name of the questionnaire was created using the letters chosen from the items of the scale. The questionnaire aims to determine the risk of eating disorders. It consists of a total of 5 items. One point is assigned for every ‘yes’ response, with a total score of ‘5’ points. A score of ‘2’ points has been determined as the cut-off point and those with a score of ‘2 points or higher’ are considered to be at risk of eating disorders .
The Mindful Eating Questionnaire (MEQ)
This questionnaire was developed by Framson et al. in 2009 to obtain information about eating behavior, awareness, and emotional eating . The sub-factors of the questionnaire are thoughtless eating, emotional eating, eating control, awareness, eating discipline, conscious eating, and interference. A higher the score obtained from the questionnaire, the higher the awareness of eating .
Statistical Package for Social Sciences (SPSS, version 23) was used for data analysis, with a significance level of 0.05 and a confidence interval of 95 percent. When evaluating the study data, the normality distribution of parameters was evaluated by the Kolmogorov-Smirnov test. Data were analyzed by descriptive statistical methods (mean, standard deviation, number, and percentage). The Student's t-test was used for the two-group comparison of quantitative data. Spearman's correlation coefficient (.05 level for significance) was computed between all continuous variables and the main dependent variable (the ORTO-15 score). Multiple linear regression was used to identify predictors of the ORTO-15 score.