Purpose: Since the term orthorexia nervosa (ON) was coined from the Greek (ὀρθός, right and ὄρεξις, appetite) in 1997 to describe an obsession with “correct” eating, it has been used worldwide without a consistent definition. Although multiple authors have proposed diagnostic criteria, and many theoretical papers have been published, no consensus definition of ON exists, empirical primary evidence is limited, and ON is not a standardized diagnosis. These gaps prevent research to identify risk and protective factors, pathophysiology, functional consequences, and evidence-based therapeutic treatments. The aims of the current study are to categorize the common observations and presentations of ON pathology among experts in the eating disorder field, propose tentative diagnostic criteria, and consider which DSM chapter and category would be most appropriate for ON should it be included. Methods: 47 eating disorder researchers and multidisciplinary treatment specialists from 14 different countries across four continents completed a three-phase modified Delphi process, with 75% agreement determined as the threshold for a statement to be included in the final consensus document. In phase I, participants were asked via online survey to agree or disagree with 67 statements about ON in four categories: A–Definition, Clinical Aspects, Duration; B–Consequences; C–Onset; D–Exclusion Criteria, and comment on their rationale. Responses were used to modify the statements which were then provided to the same participants for phase II, a second round of feedback, again in online survey form. Responses to phase II were used to modify and improve the statements for phase III, in which statements that met the predetermined 75% of agreement threshold were provided for review and commentary by all participants. Results: 27 statements met or exceeded the consensus threshold and were compiled into proposed diagnostic criteria for ON. Conclusions: This is the first time a standardized definition of ON has been developed from a worldwide, multidisciplinary cohort of experts. It represents a summary of observations, clinical expertise, and research findings from a wide base of knowledge. It may be used as a base for diagnosis, treatment protocols, and further research to answer the open questions that remain, particularly the functional consequences of ON and how it might be prevented or identified and intervened upon in its early stages. Although the participants encompass many countries and disciplines, further research will be needed to determine if these diagnostic criteria are applicable to the experience of ON in geographic areas not represented in the current expert panel. Level of evidence: Level V: opinions of expert committees

Orthorexia nervosa: An integrative literature review of a lifestyle syndrome

Coaches in elite sport must ensure a balance between performance, high pressure and well-being. A caring approach, based on a coach’s commitment to caring for athletes, has the potential to create such a balance and sustainability. The aim of this study was to identify coaches’ caring and problematise their ethics of care in relation to sustainability. We draw on and integrate the theoretical concept of caring into a conception of (un-) sustainable sport. Semi-structured interviews were conducted with seven Swedish elite athletics coaches. Results show that coaches’ ethics of care is important for creating sustainable elite athletics practices, but that caring also conflicts with sustainability thinking if coaches do not base their actions on practical wisdom and moral and ethical dilemmas.

Migration over recent years has meant that issues of integration are high on the agenda. Sports clubs are considered important settings for promoting integration. This notion is reflected in national and international policy documents. This study focuses on how leaders in a non-profit sports club, operating in a community where a majority have a migrant background, work with the stated goal of promoting integration. The aim of this study is to explore how leaders interpret and negotiate their explicit assignment to promote integration and counteract segregation and how they try to implement strategies to reach these goals and also to explore how participants experience the sports club’s activities related to aspects of integration. The study takes an ethnographic approach with participant observations and interviews. The results indicate that the leaders' work in terms of integration was related to negotiating diversity, norms, rules and language. Both leaders and participants highlight how the activities enhance feelings of trust despite racism in society and how the leaders worked to create relationships and to make the activities into safe spaces. Whether this work contributes to integration is, however, debatable and the leaders emphasised inclusion as their main strategy and goal.

Elite sport is a precarious context and as athletes are pushing their physical and mental boundaries to enhance performance, consequences can be devastating. In contrast to arguments that elite sport cannot be sustainable, some scholars have argued that with certain considerations and precautions, elite sport can have fewer unsustainable consequences. However, the current literature has missed to capture athletes’ voices regarding sustainability in elite sport. Therefore, this article aims to give voice to athletes and their needs and concerns regarding sustainable elite sport and through this, to extend the existing elite sport sustainability conceptualisation with knowledge from the athlete perspective. Focus-group interviews were conducted with 15 high performance athletes. The findings suggest that athletes need athlete-centred coaching, focus on holistic perspectives, and co-creation of their overall development. However, athletes also seem to adapt and accept commodity structures, as their focus on results overrules most aspects regarding long-term health and well-being.