Food categorization strategies in adults living with obesity: the role of orthorexia nervosa and food addiction

OBJECTIVE: Obesity is associated with societal pressure to eat "healthy", potentially increasing the risk of orthorexia nervosa (ON), an obsession with healthy eating characterized by food hyperselectivity. This observational study explored ON traits in obesity, focusing on food hyperselectivity and categorization strategies. METHODS: A total of 114 participants with obesity (91 women, 20 men, 3 gender-diverse; Age = 44.6 ± 10.5; BMI = 39.6 ± 7.4) were assessed through an online food categorization task and questionnaires, including the Eating Habits Questionnaire, Eating Disorders Examination Questionnaire, Yale Food Addiction Scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorders-7. Quantitative data were analyzed using correlations and regression models. RESULTS: Participants scored high on eating disorders, addictive-like eating behaviors, anxiety, and depression, but not ON traits. However, those with higher ON traits displayed distinct food categorization strategies compared to those with lower ON traits, avoiding categorizing unhealthy foods as healthy. Participants with addictive-like eating behaviors exhibited similar categorization patterns alongside heightened scores for eating disorders, anxiety, and depression. CONCLUSION: ON traits correlated with risk-averse food evaluation strategies in obesity, emphasizing caution towards "unhealthy" foods, potentially exacerbating restrictive eating behaviors. Integrating these insights into psychological or nutritional interventions could improve support by addressing maladaptive food evaluation.