Introduction and objective:
Orthorexia nervosa (OrNe) is poorly understood in older adults, in whom dietary control may reflect either adaptive disease management or anxiety-driven restriction. The aim of the study is to examine somatic profiles, psychological predictors, and psychosocial consequences of OrNe in adults aged 60 years or older.

Material and methods:
A cross-sectional study included 360 adults aged 60–89 years, classified into four disease profiles: no diet-related disease, metabolic/cardiovascular, strict dietary control, and weight loss/cachexia. Orthorexia, body mass anxiety, health anxiety, nutritional status, depression, well-being, dietary restraint, and psychosocial consequences were assessed. Group comparisons, Spearman correlations, and hierarchical linear regressions were performed.

Results:
The metabolic/cardiovascular profile showed the highest negative orthorexia, dietary restraint, and fear of weight gain, whereas the weight-loss/cachexia profile showed the lowest nutritional status and the greatest fear of weight loss. In the final TOS-Ne model, self-imposed diet, number of supplements, fear of weight gain, health anxiety, dietary restraint, and lower well-being were independent predictors; medically recommended diet, BMI, and depressive symptoms were not. The final psychosocial-consequence model explained 42.8% of variance, with negative orthorexia, health anxiety, and fear of weight loss as independent predictors.

Conclusions:
In older adults, pathological orthorexia appears more closely related to health and weight-change anxiety than to objective BMI or depression. Screening should distinguish medically indicated dietary adherence from self-imposed restriction and should consider supplement use, nutritional risk, and psychosocial functioning.