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Abstract 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

Therapeutic ultrasound (TUS) is the most commonly used physiotherapy treatment for inflammatory conditions of the lactating breast (ICLB) which can affect up to 33% of post-partum women. There is no literature on whether the thermal effect of TUS alters breastmilk composition. The aim of this quasi-experimental study was to determine the effect of therapeutic ultrasound (TUS) on the pre–post-session protein, fat and lactose concentration of breastmilk. During a single session conducted in an enclosed room within the community in Perth, Western Australia, TUS was applied for 10 min to the right breast. Pre- and post-TUS 5 mL expressed breastmilk samples were collected. The main outcome measured was concentration of breastmilk protein (g/L), fat (%) and lactose (g/L) before and after application of TUS. There was a significant increase in breastmilk fat concentration between measures taken pre- and post-TUS (mean difference, 1.36%; 95% CI [0.97, 1.75], p < 0.001). There was no significant difference in breastmilk protein (mean difference, −0.64; 95% CI [−1.93, 0.64], p = 0.328) or lactose concentration (mean difference, −4.77; 95% CI [−11.57, 2.03], p = 0.169) between measures taken pre- and post-TUS. In conclusion, TUS applied to the healthy lactating breast does not adversely affect the protein, fat or lactose concentrations of breastmilk. The results of this study support the use of TUS as a safe treatment option for mothers suffering from ICLB.