Article

Food Neophobia and Two Facets of Orthorexia Among Women:

Cross-Sectional Study
Tuba Yalçın 1, * , Seda Çiftçi 2 and Elif Esra Ozturk 3

1 Department of Nutrition and Dietetics, Faculty of Health Sciences, Izmir Katip Çelebi University, 35620 Izmir,
Türkiye
2 Department of Nutrition and Dietetics, Faculty of Health Sciences, Izmir Democracy University, 35140 Izmir,
Türkiye; seda.ciftci@idu.edu.tr
3 Department of Gastronomy and Culinary Arts, Faculty of Fine Arts and Architecture, Gaziantep Islam
Science and Technology University, 27260 Gaziantep, Türkiye; elifesra.ozturk@gibtu.edu.tr
* Correspondence: tuba.yalcin@ikcu.edu.tr; Tel.: +90-533-354-62-06

Abstract: The purpose of this study was to investigate the link between food neophobia
and two dimensions of orthorexia in women. This cross-sectional study of 985 women
aged 18 years and over was conducted using face-to-face questionnaires. Women who
had a disability, had a chronic disease, or were pregnant or breastfeeding were excluded.
Participants provided information on their sociodemographic details (age and educational
level) and frequency of physical activity. Orthorexic tendencies were assessed using the
Teruel Orthorexia Scale. The women’s attitude towards trying new foods was assessed
using the Food Neophobia Scale. A total of 337 participants (34.2%) were neophilic,
322 participants (32.7%) were neutral, and 326 participants (33.1%) were neophobic. There
was no correlation between food neophobia scores and either age or body mass index.
However, food neophobia was positively correlated with healthy orthorexia and orthorexia
nervosa (p < 0.05). The mean individual scores for orthorexia nervosa and healthy orthorexia
according to the Teruel Orthorexia Scale were 11.45 ± 3.91 and 20.04 ± 4.31, respectively.
The results indicate that individuals with orthorexia nervosa have higher food neophobia
scores, reflecting a greater reluctance to try unfamiliar foods, whereas individuals with
healthy orthorexia do not show significant differences in food neophobia tendencies. This
distinction highlights the importance of distinguishing between pathological and non-
pathological eating behaviors when addressing dietary concerns.
Academic Editor: Paul E Rapp

Received: 18 October 2024 Keywords: orthorexia nervosa; healthy orthorexia; food neophobia; women
Revised: 17 December 2024
Accepted: 9 January 2025
Published: 15 January 2025

Citation: Yalçın, T., Çiftçi, S., & Ozturk, 1. Introduction

E. E. (2025). Food Neophobia and Two
Food neophobia (FN) is characterized by a reluctance or refusal to eat novel or un-
Facets of Orthorexia Among Women:
familiar foods (Białek-Dratwa et al., 2022). Evidence suggests that FN may be negatively
Cross-Sectional Study. Behavioral
Sciences, 15(1), 70. https://doi.org/ associated with the acceptance of not only novel/foreign foods but also familiar foods
10.3390/bs15010070 (Karaağaç & Bellikci-Koyu, 2023). Although it is not formally classified as a disorder in
the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) (Association, 2023),
Copyright: © 2025 by the authors.
Licensee MDPI, Basel, Switzerland. it is recognized as an important psychological and behavioral phenomenon (Barrena &
This article is an open access article Sánchez, 2013). FN is typically measured using the Food Neophobia Scale (FNS), which
distributed under the terms and assesses an individual’s tendency to avoid novel foods (Pliner & Hobden, 1992). A study
conditions of the Creative Commons conducted in Türkiye found a prevalence of FN of14.6%, while 15.9% of university students
Attribution (CC BY) license
were found to be neophilic (Basaran & Ozbek, 2023). Another study found that 22.8% of
(https://creativecommons.org/
participants were neophilic and 24.2% were neophobic among Turkish adults (Çakır et al.,
licenses/by/4.0/).

Behav. Sci. 2025, 15, 70 https://doi.org/10.3390/bs15010070

Behav. Sci. 2025, 15, 70 2 of 11

2023). The prevalence of FN in adults varies, with estimates suggesting that a significant
minority retain neophobic tendencies, which may affect their dietary diversity and nutrient
intake (Roehr, 2013).
Orthorexia nervosa (OrNe) was first conceptualized in 1997 by family physician Steven
Bratman (Bratman, 1997). The term is derived from the Greek words orthos, meaning
‘correct’, and orexis, meaning ‘appetite’, and was introduced to describe an obsessive
preoccupation with ‘correct’ eating that he observed in his patients. In 2016, Bratman
and Dunn further refined the definition of OrNe, distinguishing it from a general desire
to live a healthy life by highlighting its association with negative outcomes, including
malnutrition and impaired social functioning (Dunn & Bratman, 2016). Some people
may pathologize their ideas and interest in healthy food preferences. This can lead to an
obsession with consuming only what they think is healthy (WHO, 2020). Studies have
reported that individuals with high orthorexic tendencies often exhibit strict dietary rules
and obsessive food-related behaviors, which can lead to significant disruptions in their daily
lives, including social and psychological difficulties (Oberle et al., 2017; Varga et al., 2014).
According to the literature, orthorexic behavior can be characterized either as a reasonable
concern in proper nutrition or as a compulsive fixation on healthy eating. Studies indicate
that it is difficult to distinguish between OrNe and non-pathological attitudes towards
healthy eating (Barrada & Roncero, 2018; Şentürk et al., 2022). For this purpose, a new
term, “healthy orthorexia (HeOr)”, has recently emerged in the literature (Barthels et al.,
2019; Şentürk et al., 2022). The ORTO-15, the most widely used self-report measure for the
assessment of OrNe, has shown an unstable factorial structure in diverse populations. It
has been criticized for its inadequate psychometric properties and inability to effectively
discriminate between healthy and pathological eating behaviors (Cena et al., 2019; Valente
et al., 2019). A relatively recent development in this area is the Teruel Orthorexia Scale (TOS),
which was designed to assess both HeOr and OrNe (Barrada & Roncero, 2018). Therefore,
orthorexia can be divided into two distinct dimensions. HeOr refers to a constructive
interest in dieting and self-assessed healthy behaviors related to eating patterns (Barrada &
Roncero, 2018). Conversely, OrNe is characterized by an intense fixation on eating healthy
foods, which may lead to contradictory concerns when trying to adhere to this goal, as well
as distress when deviating from prescribed eating behaviors (Depa et al., 2019). However,
HeOr scores are not necessarily indicative of actual healthy eating patterns and should not
be equated with them. Individuals who score high on the HeOr may place great importance
on a healthy diet and make serious efforts to adhere to it. Healthy eating patterns may not
correspond to a precise definition. Therefore, it is important to avoid using the two terms
interchangeably, and a high score on the HeOr does not indicate that an individual has a
truly healthy diet (Roncero et al., 2021).
Understanding FN is crucial in contexts such as orthorexia, a behavior characterized
by an obsession with healthy eating to the point of restrictive dietary patterns (Roehr, 2013).
Individuals with orthorexia are considered a high-risk group for nutrient deficiencies due to
their adoption of restrictive diets that significantly reduce the diversity of essential nutrients
(Horovitz & Argyrides, 2023). A study suggests an association between FN and OrNe,
as individuals with higher FNS scores may be more prone to restrictive eating behaviors
associated with OrNe (Uçar et al., 2021). Exploring this relationship helps to elucidate
the psychological underpinnings of eating behaviors and provides insights into how food-
related anxiety contributes to the development and maintenance of disordered eating
patterns. The existing literature has mainly focused on the pathological manifestation of
OrNe in research studies (Barthels et al., 2019). Only a few studies have investigated the
two-dimensional aspect of orthorexia, which distinguishes between a healthy interest in
Behav. Sci. 2025, 15, 70 3 of 11

eating (HeOr) and a pathological fixation on eating healthy foods (OrNe) (Awad et al., 2022;
Barthels et al., 2019).
Research suggests that physical activity can be both positively and negatively asso-
ciated with orthorexic tendencies. For instance, while moderate physical activity is often
associated with general health awareness and constructive dietary practices, excessive
exercise has been linked to increased orthorexic behaviors, as individuals may seek to
supplement restrictive eating habits with compulsive exercise to achieve perceived health
ideals (Oberle et al., 2018; Strahler et al., 2021). Similarly, physical activity may influence FN
by either by promoting dietary diversity through exposure to diverse nutritional require-
ments or by reinforcing neophobic tendencies when paired with rigid dietary regimens
(Guzek et al., 2018). Including physical activity as a variable in the context of OrNe and FN
provides valuable insights into their interplay with lifestyle behaviors.
Furthermore, the relationship between OrNe and gender remains inconclusive in the
existing literature. While some studies report that orthorexia nervosa may affect women
more often than men (Elias et al., 2022; Parra-Fernández et al., 2018; Sanlier et al., 2016),
other studies show that there is no gender difference in orthorexia nervosa (Luck-Sikorski
et al., 2019; Oberle et al., 2017). Women may influence the food choices and diet quality of
family members within the household (Fulkerson et al., 2008). The relationship between
OrNe and FN, among women, remains poorly understood. Therefore, further research
is needed to understand the link between orthorexia and FN in relation to both sub-
dimensions of orthorexia in women. Therefore, investigating the association between ON
and FN in women is of great societal importance. Therefore, the purpose of this cross-
sectional study is to determine the relationship between FN and two sub-dimensions of
orthorexia in women.

2. Materials and Methods

2.1. Participants and Procedure
This cross-sectional study was conducted in Izmir, Türkiye, between January and June
2023. The researchers reached a total of 985 women living in the central districts of Izmir
using the random sampling method. They were randomly selected in various public places
such as universities, parks, and shopping malls to complete a face-to-face questionnaire, no
monetary or any other benefit was offered to them, and their participation was completely
voluntary. Participants were given a clear explanation of the purpose of the study, and
those who wished to participate were included. The inclusion criteria were women aged
18 years or older, living in the İzmir region, who agreed to participate in the survey and
who were able to read, understand, and write in Turkish. Women who had any disability,
were suffering from any chronic disease, or were pregnant or breastfeeding were excluded.
We enrolled women in our study for several reasons. First, there is evidence suggesting
that OrNe may be more common in women than in men. Women may also influence
the food choices and diet quality of family members in the household. However, the
relationship between orthorexia and FN specifically in women remains unclear. Therefore,
the identification of orthorexia and FN, especially in women, is very important for society.
Additionally, Freco et al. highlighted the intricate differences in dietary patterns between
men and women, which are shaped not only by biological factors such as genetics and
hormonal responses but also by societal norms and cultural environments (Feraco et al.,
2024). The unique dietary behaviors and attitudes of this population make them an
important focus for understanding nutrition-related issues.
The first section of the questionnaire collected general characteristics and sociodemo-
graphic information, including details about participants’ frequency of physical activity.
The second section used the TOS to evaluate tendencies related to orthorexic behaviors.
Behav. Sci. 2025, 15, 70 4 of 11

The third section used the FNS to measure individuals’ attitudes towards trying new foods.
Anthropometric measurements were recorded based on the declarations of the individuals
in the study regarding their current body weight and height. The researchers calculated the
body mass index (BMI) values using the ‘kg/m2 ’ formula.

2.2. Measurements
2.2.1. Teruel Orthorexia Scale
The Teruel Orthorexia Scale (TOS) (Barrada & Roncero, 2018) was used to evaluate the
participants’ tendencies towards orthorexia. This scale consists of two dimensions: OrNe
and HeOr. The OrNe subscale assesses the pathological fixation on healthy eating and
its consequences, while the HeOr subscale evaluates the non-pathological tendency that
also focuses on maintaining a diet consisting of healthy foods. On the Likert scale, each
item was rated from zero to three. The scores of the sub-dimensions were calculated by
summing the responses of the participants. The version of the TOS used was confirmed to
be valid and reliable (Asarkaya & Arcan, 2021). Cronbach’s alpha coefficient of internal
consistency was used to estimate the reliability of the questionnaire. The validity of the TOS
was tested and was found to have a Cronbach’s alpha value of 0.883, which was considered
acceptable for the TOS in the present study. In this study, the Cronbach’s alpha was 0.859
for the TOS OrNe and 0.839 for the TOS HeOr.

2.2.2. The Food Neophobia Scale

The FNS was used to assess individuals’ attitudes towards novel foods (Pliner &
Hobden, 1992). We used a validated and established version in Turkish that is known for
its reliability (Uçar et al., 2021). The FNS is a ten-item Likert-type scale that includes items
with seven response categories. Higher scores indicate a greater tendency towards FN
or a reluctance to try new foods. In our study, the participants were divided into three
groups according to percentiles, specifically, the 33rd and 66th percentiles (Falciglia et al.,
2000; Vaarno et al., 2015). Neophilic participants scored between 10 and 34, indicating a
higher willingness to accept new foods. Participants were classified into three categories
based on their scores: neophilic, neutral, and neophobic. Those who scored between 35
and 41 were considered neutral in their approach to new foods. Neophobic individuals,
who scored between 42 and 61, showed a marked reluctance to try new foods. The validity
of the FNS was tested and was found to have a Cronbach’s alpha of 0.691, which was
considered acceptable for the present study. In this study, the Cronbach’s alpha of the FNS
was 0.705. This value is similar to the reliability coefficients reported in previous studies.
This indicates consistency in the application of the scale across different populations.

2.2.3. International Physical Activity Questionnaire

The International Physical Activity Questionnaire—Short Form (IPAQ-SF) was used
in conjunction with a questionnaire item asking about the individual’s weekly amount of
physical activity, with the aim of achieving at least 150 min per week. The IPAQ-SF (Craig
et al., 2003) was validated in our language (Saglam et al., 2010). The responses obtained
from this form classify individuals as inactive, minimally active, or highly active based
on their weekly MET (metabolic equivalent of task) values. The results are interpreted
according to their level of activity.

2.2.4. Anthropometric Measurements

Participants’ height (m) and body weight (kg) were recorded by the researchers, and
the BMI was then calculated and assessed according to the World Health Organization
criteria (WHO, 2010).
Behav. Sci. 2025, 15, 70 5 of 11

2.3. Statistical Analysis

Statistical Package for the Social Sciences (SPSS) version 25.0 was used for data analysis.
Data were expressed as means and standard deviations or frequencies and percentages.
The chi-squared test for independence was used for categorical variables. The study
compared numerical variables across three independent groups (neophilic, neutral, and
neophobic) using the Kruskal–Wallis test, followed by the Tukey post hoc test for pairwise
comparisons (Cohen, 2013). Correlations were calculated using Kendall’s tau correlation.
The significance level was set at p < 0.05.

3. Results
General characteristics are shown in Table 1. The mean age of the participants was
27.77 ± 10 years. The vast majority of participants (94%) had at least a high school education.
Based on the BMI classifications, the majority of participants (64.6%) were classified as
having a normal weight. The study also evaluated the level of physical activity among
women with IPAQ. It was found that 12.2% of the participants were inactive, 63.2% were
moderately active, and 24.6% were active. In terms of FNS score classification, a significant
proportion (34.2%) of participants were classified as neophilic, indicating a high willingness
to try new foods. Another group (32.7%) fell into the neutral category, while a substantial
proportion (33.1%) were classified as neophobic, indicating a reluctance to experiment with
new foods. The mean score for OrNe was 11.45 ± 3.91, and for HeOr, it was 20.04 ± 4.31.

Table 1. Characteristics of women (n: 985).

General Characteristics All (n: 985)

n (%)
Age (years) (M ± SD) 27.77 ± 10
Educational level
Primary school 39 4.0
Secondary school 20 2.0
High school 475 48.2
University 400 40.6
Master’s and Ph.D. 51 5.2
Body weight (kg) (M ± SD) 62.55 ± 12.14
BMI (kg/m2 ) (M ± SD) 23.24 ± 4.57
BMI classification
Underweight 84 8.5
Normal 636 64.6
People with overweight 175 17.8
People with obesity 90 9.1
MET (M ± SD) 2796.62 ± 4336.11
Inactive 120 12.2
Moderate 623 63.2
Active 242 24.6
FNS (M ± SD) 38.6 ± 10.22
Neophilic 337 34.2
Neutral 322 32.7
Neophobic 326 33.1
TOS (M ± SD)
TOS—Healthy orthorexia 20.04 ± 4.31
TOS—Orthorexia nervosa 11.45 ± 3.91
n, number of women; %, percentage of women; M, mean; SD, standard deviation; BMI, body mass index; FNS,
Food Neophobia Scale; TOS, Teruel Orthorexia Scale; inactive, <300 MET; moderate, 600 MET and over; active,
3000 MET and over.
Behav. Sci. 2025, 15, 70 6 of 11

Table 2 presents a detailed summary of the distribution of age, anthropometric mea-

surements, physical activity, and TOS based on the FN groups of the participants. There
were no differences in age and BMI between the groups (p > 0.05). However, there was a
difference in the distribution of BMI classifications between the three groups (p < 0.05). The
neophobic proportion of obese participants (45.6%) was statistically significantly higher
than that of neophilic participants (24.4%) (p < 0.05). Additionally, a significant differ-
ence was observed in the total MET scores between the neophobic and neophilic groups
(p = 0.036). There was no difference in HeOr scores between the neutral (20.22 ± 4.24),
neophobic (20.28 ± 4.57), and neophilic (19.61 ± 4.09) groups. However, the neophobic
group had a higher OrNe score compared to the neophilic groups. In addition, the OrNe
score of the FN groups was found to be 0.019 in the ANOVA test and partial eta squared.
A significant difference with a small effect size was found in the OrNe score according to
FN groups.

Table 2. Distribution of age, anthropometric measurements, physical activity, and TOS by food
neophobia groups.

Neophilic Group Neutral Group Neophobic Group

K-W Statistics
(n = 337) (n = 322) (n = 326)
M ± SD M ± SD M ± SD
27.75± 5.33 a b 48.70± 6.06 c <0.001 §
FNS 38.69± 2.25 875.429
Age (year) 26.46 ± 9.18 27.36 ± 9.75 28.48 ± 11.00 1.761 0.414 §
BMI (kg/m2 ) 22.85 ± 4.03 23.21± 4.33 23.67 ± 5.23 0.976 0.614 §
MET 2528.80 ± 3396.32 a 2837.62 ± 4147.67 a,b 3032.96 ± 5279.88 b 6.654 0.036 §
HeOr 19.61 ± 4.09 20.22 ± 4.24 20.28 ± 4.57 5.664 0.059 §
OrNe 10.76 ± 3.55 a 11.52 ± 3.75 b 12.07 ± 4.28 b 15.788 <0.001 §
n (%) n (%) n (%)
BMI Classification
Underweight 23 (27.4) a 27 (32.1) a 34 (40.5) a
Normal 242 (38.1) a 206 (32.3) a,b 188 (29.6) b χ2 : 14.799; #
People with overweight 50 (28.6) a 62 (35.4) a 63 (36.0) a 0.009
df: 6
People with obesity 22 (24.4) a 27 (30.0) a,b 41 (45.6) b
MET Classification
Inactive 44 (36.7) 40 (33.3) 36 (30.0)
χ2 : 8.660;
Moderate 228 (36.6) 200 (32.1) 195 (31.3) 0.061 #
Active 65 (26.9) 82 (33.9) 95 (39.2) df: 4

FNS, Food Neophobia Scale; BMI, body mass index; MET, metabolic equivalent of task; HeOr, healthy orthorexia;
OrNe, orthorexia nervosa; § the Kruskal–Wallis test was used for the test of differences and Tukey’s post hoc
test and values in the same row with different superscript letters are significantly different. Inactive, <300 MET;
moderate, 600–3000 MET; active, 3000 MET and over. # The Pearson chi-squared test was used, and for row
proportion comparison, the Bonferroni method was used. Bold values denote p < 0.05.

Table 3 shows the correlation coefficients between various variables, including age,
BMI, MET, FNS, and the two subscales of the TOS related to HeOr and OrNe. Notably, FNS
showed no correlation with age (r = −0.029, p = 0.188) or BMI (r = 0.031, p = 0.147). However,
FNS scores were significantly correlated with physical activity (r = 0.050, p = 0.020), HeOr
(r = 0.046, p = 0.038), and OrNe (r = 0.088, p < 0.001). The results indicate that age is positively
correlated with BMI (r = 0.245, p < 0.001) and negatively correlated with physical activity
(r = −0.100, p < 0.001). In addition, age is positively correlated with both HeOr (r = 0.138,
p < 0.001) and OrNe (r = 0.087, p < 0.001), whereas BMI only shows a positive correlation
with OrNe (r = 0.135, p < 0.001). Furthermore, HeOr indicated a positive correlation with
OrNe (r = 0.368, p < 0.001), showing a link between HeOr and OrNe inclinations.
Behav. Sci. 2025, 15, 70 7 of 11

Table 3. Correlation coefficients between age, BMI, physical level activity, FNS, and TOS subscales.

Variables FNS Age BMI MET HeOr OrNe

FNS r 1 −0.03 0.03 0.05 * 0.05 * 0.09 **
Age r 1 0.25 ** −0.10 ** 0.14 ** 0.09 **
BMI r 1 −0.01 0.03 0.14 **
MET r 1 0.01 0.03
HeOr r 1 0.37 **
OrNe r 1
FNS, Food Neophobia Scale; BMI, body mass index; MET, metabolic equivalent of task; HeOr, healthy orthorexia;
OrNe, orthorexia nervosa. Kendall’s Tau: * p < 0.05, ** p < 0.001.

4. Discussion
The aim of this study was to investigate the relationship between FN and orthorexia
in women. To our knowledge, this is the first study to examine the relationship between
FN and two facets of orthorexia in women. Participants with OrNe scored higher on the
FNS, suggesting a greater tendency towards neophobic tendencies in individuals with
symptoms of OrNe. In contrast, participants with healthy orthorexic tendencies show no
difference in FN.
The link between FN and orthorexia indicates that people who are more neophobic
about food, meaning that they have a greater fear or reluctance to try new foods, also tend
to exhibit more symptoms of OrNe. Orthorexia nervosa is characterized by an obsessive
focus on healthy eating, which can lead to restrictive eating patterns. We found higher
FNS scores in individuals with OrNe, suggesting that their rigid eating habits may be
partly driven by a fear of unfamiliar foods. Uçar et al. (2018) showed that participants with
OrNe had higher scores, indicating a stronger tendency towards neophobic tendencies.
Furthermore, Hazley et al. (Hazley et al., 2022) examined the relationship between FN
and dietary patterns, suggesting that FN may be associated with reduced dietary variety
and quality. Our study, in line with the literature, provides evidence for the potential link
between OrNe and FN, suggesting that individuals with symptoms of OrNe may be more
likely to be reluctant to try new foods (Hazley et al., 2022; Uçar et al., 2018). On the other
hand, participants with healthy orthorexic tendencies showed no difference in FNS scores,
suggesting that the pathological aspects of OrNe are more closely related to FN than the
non-pathological, health-orientated behaviors.
The prevalence of FN, or reluctance to try new foods, appears to vary between different
age groups. Some studies have suggested an increase in FN among older age groups (Yo-
dogawa et al., 2022), while others have reported a decrease in FN with increasing age (van
den Heuvel et al., 2019). Although our findings did not reach statistical significance, they
suggest a negative relationship between age and FN. There is a tendency for individuals to
become more receptive to new foods as they age.
Many studies have investigated the relationship between age and orthorexia. Although
the results are not entirely consistent, some research suggests that younger individuals may
be more susceptible to orthorexic tendencies (Skella et al., 2022; Yılmaz & Dundar, 2022).
However, conflicting results have been reported in the literature, and the influence of age
on orthorexia, as a research topic, still lacks a clear consensus (Gkiouleka et al., 2022; Yılmaz
& Dundar, 2022). We found a positive correlation between age and both HeOr and OrNe.
In line with prior research suggesting a positive association between orthorexic ten-
dencies and higher BMI (Agopyan et al., 2019; Novara et al., 2022), we found a positive
correlation between BMI and OrNe. People with higher levels of body fat, such as those
who are overweight or obese, and wish to improve their physical well-being, may follow
strict diets to reduce their body weight, which could increase their risk of developing
orthorexic tendencies (Novara et al., 2022).
Behav. Sci. 2025, 15, 70 8 of 11

Furthermore, our results showed a positive correlation between HeOr and OrNe,
suggesting a link between tendencies towards HeOr and OrNe. ‘Healthy orthorexia’ is not
a medical term, but rather denotes a milder form of orthorexic tendencies, characterized by
an increased focus on consuming only ‘clean’ or ‘pure’ foods. Although initially perceived
as a positive mission to achieve better health, orthorexic tendencies can potentially lead to
nutritional deficiencies, social isolation, and other health problems. Research has suggested
that a preoccupation with healthy eating may be associated with emotional difficulties,
as orthorexic tendencies have been linked to challenges in emotional well-being (Vuillier
et al., 2020). It is therefore important to maintain a balanced approach to healthy eating.
In summary, although the medical literature does not provide a clear definition of HeOr,
we acknowledge the potential risks linked with an excessive preoccupation with healthy
eating. This behavior can lead to OrNe and other health problems.
The relationship between FN and physical activity is complex and multifaceted. Some
studies have suggested that there is a possible link between FN and physical activity
and that regular physical activity and exercise can influence food choices and dietary
behaviors (Beckford, 2018; Bellisle, 1999). However, further studies are needed to identify
this relationship and the underlying mechanisms. Previous studies have shown that
exercise is a factor that influences eating behavior traits associated with susceptibility to
neophobia and the types of food that individuals potentially choose to consume (Guzek
et al., 2018). In this study, the neophilic group had the lowest mean MET score, while
the neophobic group had the highest. The study suggests a positive association between
physical activity and FN, suggesting that more physically active individuals may be more
wary of unfamiliar foods.

Strengths and Limitations

The strength of this study lies in its comprehensive approach to evaluating the relation-
ship between two dimensions of orthorexic tendencies and FN in women. The investigation
of factors influencing these two eating behaviors was conducted with a substantial sample
size of 985 participants. Notably, this study is the first to examine the relationship between
FN and orthorexia, including its two sub-dimensions, in a large sample of women. Ex-
ploring the interplay between orthorexia, FN, physical activity, and demographic factors
provides a nuanced understanding of these relationships. Our findings are expected to
make a significant contribution to the current literature. The study’s commitment to ad-
vancing scientific understanding is demonstrated by the acknowledgement of complexity
and the call for further research to explore underlying mechanisms and interventions.
However, it is important to consider some limitations. While a substantial sample size
is crucial, the generalizability of the findings may be limited due to the homogeneity of
the sample, particularly as it includes only women and primarily those with at least a high
school education. Consequently, the results cannot be generalized to the male population
or to women with lower levels of education. Future researchers should consider including
men and diverse educational and socio-economic groups to improve the external validity
of the findings. Moreover, this study did not fully account for other potential confounding
variables, such as social class, cultural background, or socio-economic status, which may
influence FN and orthorexic tendencies. These factors may play an essential role in shaping
eating behaviors and warrant further investigation in future research. Additionally, while
this study acknowledges the influence of various factors on the relationships examined,
it could not comprehensively control for all possible confounders. Finally, as this is a
cross-sectional study, causal relationships cannot be inferred, and longitudinal or experi-
mental designs are recommended to explore the mechanisms underlying these associations.
Behav. Sci. 2025, 15, 70 9 of 11

Nevertheless, the strengths of our study allowed it to provide valuable insights that can
guide future research in understanding complex aspects of orthorexia and related traits.

5. Conclusions
This study offers insights into the relationships between factors and characteristics
that may influence orthorexia and FN. Our findings provide a better understanding of the
relationships between age, BMI, physical activity, FN, and different aspects of orthorexia.
Notably, the findings suggest that individuals with OrNe have higher FN scores, reflect-
ing a reluctance to try unfamiliar foods, while those with HeOr do not differ in their FN
tendencies. This distinction emphasizes the importance of distinguishing between non-
pathological and pathological eating behaviors when addressing dietary concerns. The
study highlights several psychological factors that may influence eating behavior, including
restrictive tendencies driven by a fear of unfamiliar foods, an increased focus on healthy
eating, and the potential impact of body image concerns, as suggested by the positive
correlation between OrNe and BMI. These findings highlight the need for targeted interven-
tions that address restrictive eating behaviors and food anxiety. For instance, therapeutic
approaches could focus on improving dietary flexibility, reducing rigid eating patterns,
and addressing underlying psychological stressors such as perfectionism or anxiety. In-
terventions should also include educational strategies to promote a balanced approach to
healthy eating. The findings highlight the importance of including diverse perspectives in
future research, particularly studies that include male participants, broader age ranges, and
individuals from different socio-economic and cultural backgrounds. Such studies would
provide a more comprehensive understanding of these eating behaviors and inform the
development of tailored interventions.

Author Contributions: Conceptualization, T.Y., S.Ç. and E.E.O.; Methodology, T.Y., S.Ç. and E.E.O.;
Data curation, S.Ç. and E.E.O.; Writing—original draft preparation, T.Y. and S.Ç.; Writing—review
and editing, Supervision, T.Y., S.Ç. and E.E.O. All authors have read and agreed to the published
version of the manuscript.

Funding: This research received no external funding.

Institutional Review Board Statement: The study was conducted in accordance with the Declaration
of Helsinki, and approved by the İzmir Katip Çelebi University Non-Interventional Clinical Research
Ethics Committee (protocol code 22.12.2022/0609 and date of approval 22 December 2022).

Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.

Data Availability Statement: All data are available from the corresponding author upon reason-
able request.

Acknowledgments: We thank all participants for their support.

Conflicts of Interest: The authors declare no competing interests.

References
Agopyan, A., Kenger, E. B., Kermen, S., Ulker, M. T., Uzsoy, M. A., & Yetgin, M. K. (2019). The relationship between orthorexia
nervosa and body composition in female students of the nutrition and dietetics department. Eating and Weight Disorders-Studies
on Anorexia, Bulimia and Obesity, 24, 257–266. [CrossRef]
Asarkaya, B., & Arcan, K. (2021). Teruel Ortoreksiya Ölçeği’nin (TOÖ) uyarlama, geçerlik ve güvenirlik çalışması. Klinik Psikoloji
Dergisi, 5(2), 113–127.
Association, A. P. (2023). Understanding mental disorders: Your guide to DSM-5-TR® . American Psychiatric Pub.
Awad, E., Obeid, S., Sacre, H., Salameh, P., Strahler, J., & Hallit, S. (2022). Association between impulsivity and orthorexia nervosa: Any
moderating role of maladaptive personality traits? Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity, 27(2),
483–493.
Behav. Sci. 2025, 15, 70 10 of 11

Barrada, J. R., & Roncero, M. (2018). Bidimensional structure of the orthorexia: Development and initial validation of a new instrument.
Anales De Psicología/Annals of Psychology, 34(2), 283–291. [CrossRef]
Barrena, R., & Sánchez, M. (2013). Neophobia, personal consumer values and novel food acceptance. Food Quality and Preference, 27(1),
72–84. [CrossRef]
Barthels, F., Barrada, J. R., & Roncero, M. (2019). Orthorexia nervosa and healthy orthorexia as new eating styles. PLoS ONE, 14(7),
e0219609. [CrossRef] [PubMed]
Basaran, A. G., & Ozbek, Y. D. (2023). A study of the relationship between university students’ food neophobia and their tendencies
towards orthorexia nervosa. Behavioral Sciences, 13(12), 958. [CrossRef] [PubMed]
Beckford, S. E. (2018). The relationship between habitual physical activity and food choices [Master’s thesis, University of Nebraska].
Bellisle, F. (1999). Food choice, appetite and physical activity. Public Health Nutrition, 2(3a), 357–361. [CrossRef]
Białek-Dratwa, A., Szczepańska, E., Szymańska, D., Grajek, M., Krupa-Kotara, K., & Kowalski, O. (2022). Neophobia—A natural
developmental stage or feeding difficulties for children? Nutrients, 14(7), 1521. [CrossRef] [PubMed]
Bratman, S. (1997). The health food eating disorder. Yoga Journal, 42, 50.
Cena, H., Barthels, F., Cuzzolaro, M., Bratman, S., Brytek-Matera, A., Dunn, T., Varga, M., Missbach, B., & Donini, L. M. (2019).
Definition and diagnostic criteria for orthorexia nervosa: A narrative review of the literature. Eating and Weight Disorders-Studies
on Anorexia, Bulimia and Obesity, 24, 209–246. [CrossRef]
Cohen, J. (2013). Statistical power analysis for the behavioral sciences. Routledge.
Craig, C. L., Marshall, A. L., Sjöström, M., Bauman, A. E., Booth, M. L., Ainsworth, B. E., Pratt, M., Ekelund, U., Yngve, A., Sallis, J. F., &
Oja, P. (2003). International physical activity questionnaire: 12-country reliability and validity. Medicine & Science in Sports &
Exercise, 35(8), 1381–1395.
Çakır, B., Durmaz, S. E., Kılınç, F. N., Özenir, Ç., & Gümüş, A. B. (2023). Relationship Between food neophobia and dietary habits in
turkish adults: A cross-sectional study. Artuklu International Journal of Health Sciences, 3(1), 10–17. [CrossRef]
Depa, J., Barrada, J. R., & Roncero, M. (2019). Are the motives for food choices different in orthorexia nervosa and healthy orthorexia?
Nutrients, 11(3), 697. [CrossRef] [PubMed]
Dunn, T. M., & Bratman, S. (2016). On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eating Behaviors,
21, 11–17. [CrossRef] [PubMed]
Elias, M. C., Gomes, D. L., & Paracampo, C. C. P. (2022). Associations between orthorexia nervosa, body self-image, nutritional beliefs,
and behavioral rigidity. Nutrients, 14(21), 4578. [CrossRef] [PubMed]
Falciglia, G. A., Couch, S. C., Gribble, L. S., Pabst, S. M., & Frank, R. (2000). Food neophobia in childhood affects dietary variety. Journal
of the American Dietetic Association, 100(12), 1474–1481. [CrossRef] [PubMed]
Feraco, A., Armani, A., Amoah, I., Guseva, E., Camajani, E., Gorini, S., Strollo, R., Padua, E., Caprio, M., & Lombardo, M. (2024).
Assessing gender differences in food preferences and physical activity: A population-based survey. Frontiers in Nutrition, 11,
1348456. [CrossRef]
Fulkerson, J. A., Story, M., Neumark-Sztainer, D., & Rydell, S. (2008). Family meals: Perceptions of benefits and challenges among
parents of 8-to 10-year-old children. Journal of the American Dietetic Association, 108(4), 706–709. [CrossRef]
Gkiouleka, M., Stavraki, C., Sergentanis, T. N., & Vassilakou, T. (2022). Orthorexia nervosa in adolescents and young adults: A literature
review. Children, 9(3), 365. [CrossRef]
Guzek, D., Głabska,
˛ D., Mellová, B., Zadka, K., Żywczyk, K., & Gutkowska, K. (2018). Influence of food neophobia level on fruit and
vegetable intake and its association with urban area of residence and physical activity in a nationwide case-control study of
polish adolescents. Nutrients, 10(7), 897. [CrossRef]
Hazley, D., McCarthy, S. N., Stack, M., Walton, J., McNulty, B. A., Flynn, A., & Kearney, J. M. (2022). Food neophobia and its relationship
with dietary variety and quality in Irish adults: Findings from a national cross-sectional study. Appetite, 169, 105859. [CrossRef]
[PubMed]
Horovitz, O., & Argyrides, M. (2023). Orthorexia and orthorexia nervosa: A comprehensive examination of prevalence, risk factors,
diagnosis, and treatment. Nutrients, 15(17), 3851. [CrossRef]
Karaağaç, Y., & Bellikci-Koyu, E. (2023). A narrative review on food neophobia throughout the lifespan: Relationships with dietary
behaviours and interventions to reduce it. British Journal of Nutrition, 130(5), 793–826. [CrossRef]
Luck-Sikorski, C., Jung, F., Schlosser, K., & Riedel-Heller, S. G. (2019). Is orthorexic behavior common in the general public? A large
representative study in Germany. Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity, 24, 267–273. [CrossRef]
Novara, C., Pardini, S., Visioli, F., & Meda, N. (2022). Orthorexia nervosa and dieting in a non-clinical sample: A prospective study.
Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity, 27(6), 2081–2093. [CrossRef]
Oberle, C. D., Samaghabadi, R. O., & Hughes, E. M. (2017). Orthorexia nervosa: Assessment and correlates with gender, BMI, and
personality. Appetite, 108, 303–310. [CrossRef]
Behav. Sci. 2025, 15, 70 11 of 11

Oberle, C. D., Watkins, R. S., & Burkot, A. J. (2018). Orthorexic eating behaviors related to exercise addiction and internal motivations
in a sample of university students. Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity, 23, 67–74. [CrossRef]
[PubMed]
Parra-Fernández, M.-L., Rodríguez-Cano, T., Onieva-Zafra, M.-D., Perez-Haro, M. J., Casero-Alonso, V., Fernández-Martinez, E., &
Notario-Pacheco, B. (2018). Prevalence of orthorexia nervosa in university students and its relationship with psychopathological
aspects of eating behaviour disorders. BMC Psychiatry, 18(1), 364. [CrossRef] [PubMed]
Pliner, P., & Hobden, K. (1992). Development of a scale to measure the trait of food neophobia in humans. Appetite, 19(2), 105–120.
[CrossRef]
Roehr, B. (2013). American psychiatric association explains DSM-5. BMJ, 346, f3591. [CrossRef] [PubMed]
Roncero, M., Barrada, J. R., García-Soriano, G., & Guillén, V. (2021). Personality profile in orthorexia nervosa and healthy orthorexia.
Frontiers in Psychology, 12, 710604. [CrossRef]
Saglam, M., Arikan, H., Savci, S., Inal-Ince, D., Bosnak-Guclu, M., Karabulut, E., & Tokgozoglu, L. (2010). International physical activity
questionnaire: Reliability and validity of the Turkish version. Perceptual and Motor Skills, 111(1), 278–284. [CrossRef] [PubMed]
Sanlier, N., Yassibas, E., Bilici, S., Sahin, G., & Celik, B. (2016). Does the rise in eating disorders lead to increasing risk of orthorexia
nervosa? Correlations with gender, education, and body mass index. Ecology of Food and Nutrition, 55(3), 266–278. [CrossRef]
Skella, P., Chelmi, M. E., Panagouli, E., Garoufi, A., Psaltopoulou, T., Mastorakos, G., Sergentanis, T. N., & Tsitsika, A. (2022). Orthorexia
and eating disorders in adolescents and young adults: A systematic review. Children, 9(4), 514. [CrossRef] [PubMed]
Strahler, J., Wachten, H., & Mueller-Alcazar, A. (2021). Obsessive healthy eating and orthorexic eating tendencies in sport and exercise
contexts: A systematic review and meta-analysis. Journal of Behavioral Addictions, 10(3), 456–470. [CrossRef]
Şentürk, E., Güler Şentürk, B., Erus, S., Geniş, B., & Coşar, B. (2022). Dietary patterns and eating behaviors on the border between
healthy and pathological orthorexia. Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity, 27(8), 3279–3288.
[CrossRef]
Uçar, E. M., Gümüş, D., Karabulut, E., & Kızıl, M. (2021). Adaptation of the food neophobia scale to turkish and determination of
appropriate factor structure. Turkiye Klinikleri Journal of Health Sciences, 6(3), 393–400. [CrossRef]
Uçar, M. E., Sevim, S., & Kizil, M. (2018). Is there a link to food neophobia and orthorexia nervosa? Clinical Nutrition, 37, S120.
[CrossRef]
Vaarno, J., Niinikoski, H., Kaljonen, A., Aromaa, M., & Lagström, H. (2015). Mothers’ restrictive eating and food neophobia and fathers’
dietary quality are associated with breast-feeding duration and introduction of solid foods: The STEPS study. Public Health
Nutrition, 18(11), 1991–2000. [CrossRef]
Valente, M., Syurina, E. V., & Donini, L. M. (2019). Shedding light upon various tools to assess orthorexia nervosa: A critical literature
review with a systematic search. Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity, 24, 671–682. [CrossRef]
[PubMed]
van den Heuvel, E., Newbury, A., & Appleton, K. M. (2019). The psychology of nutrition with advancing age: Focus on food neophobia.
Nutrients, 11(1), 151. [CrossRef]
Varga, M., Thege, B. K., Dukay-Szabó, S., Túry, F., & van Furth, E. F. (2014). When eating healthy is not healthy: Orthorexia nervosa and
its measurement with the ORTO-15 in Hungary. BMC Psychiatry, 14, 59. [CrossRef] [PubMed]
Vuillier, L., Robertson, S., & Greville-Harris, M. (2020). Orthorexic tendencies are linked with difficulties with emotion identification
and regulation. Journal of Eating Disorders, 8(1), 15. [CrossRef] [PubMed]
WHO. (2010). A healthy lifestyle—WHO recommendations. Available online: https://www.who.int/europe/news-room/fact-sheets/
item/a-healthy-lifestyle---who-recommendations#:~:text=It%20is%20defined%20as%20a,have%20a%20BMI%20of%2022.9 (ac-
cessed on 21 December 2023).
WHO. (2020). Hearts: Technical package for cardiovascular disease management in primary health care. WHO.
Yodogawa, T., Nerome, Y., Tokunaga, J., Hatano, H., & Marutani, M. (2022). Effects of food neophobia and oral health on the nutritional
status of community-dwelling older adults. BMC Geriatrics, 22(1), 334.
Yılmaz, M. N., & Dundar, C. (2022). The relationship between orthorexia nervosa, anxiety, and self-esteem: A cross-sectional study in
Turkish faculty members. BMC Psychology, 10(1), 82. [CrossRef] [PubMed]

Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual
author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to
people or property resulting from any ideas, methods, instructions or products referred to in the content.