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This study aimed to evaluate adherence to the Mediterranean diet, a recognized healthy eating pattern, and the tendency toward orthorexia nervosa in professional athletes, and to examine their relationship with physical activity levels. The study was conducted with athletes (n=134) at the Turkish Olympic Preparation Center (TOHM). Data were collected using a questionnaire covering: socio-demographic information, dietary habits, anthropometric measurements, the Mediterranean Diet Quality Index (KIDMED), the International Physical Activity Questionnaire-Short Form (IPAQ-SF), and the ORTO-11 scale assessing orthorexic tendencies. Of the participants, 17.2% had poor dietary quality, 60.4% moderate, and 22.4% good dietary quality. According to the ORTO-11 (cutoff ≤25 points), 30.6% of athletes exhibited orthorexic tendencies. Athletes adhering to a diet had significantly higher orthorexia tendencies compared to non-dieters (p<0.05). A significant association was found between athletic experience and orthorexic tendencies, particularly among those with 4-8 years and ≥8 years of experience (p<0.05). Moreover, athletes consuming three main meals had significantly higher KIDMED and ORTO-11 scores than those consuming two meals (p<0.05). No statistically significant correlation was found between the KIDMED score, ORTO-11 score, and physical activity level (p>0.05). Professional athletes showed moderate adherence to the Mediterranean diet, while certain groups displayed higher orthorexia tendencies. Diet quality and orthorexic tendencies differed significantly with eating habits such as athletic experience and meal patterns, whereas physical activity level had no effect. These findings highlight the importance of multidisciplinary nutrition strategies focusing on both performance and sustainable healthy eating behaviors.