This is an important study highlighting the widespread prevalence of disordered eating in children and adolescents across the globe. With nearly a quarter of the included participants presenting disordered eating, these findings turn a spotlight onto an area that has long been underfunded and overlooked. Disordered eating during childhood and adolescence frequently evolves into eating disorders, which can entail serious health consequences. Implementing strategies for early intervention could reduce this risk.

Combating stigmatisation surrounding disordered eating and weight is one of the keys to individuals asking for help. Likewise, allocating greater resources to actions aimed at preventing, detecting, and better understanding the mechanisms underlying disordered eating would greatly benefit vulnerable youths. These results make it apparent that the magnitude of disordered eating can no longer be ignored. Future research examining binge eating behaviours is needed, as binge eating disorder has the highest prevalence of any eating disorder and was not thoroughly examined in this study.

It is so important to see research like this being conducted. For those of us working in the field of adolescent eating disorders and mental health in Australia, the 22% proportion of children and adolescents with disordered eating is highly concerning, but sadly not surprising. We have been seeing an increase in presentations of younger and younger children with eating disorders at clinical services and this has been exacerbated by the impacts of the COVID-19 pandemic.

The majority of the studies included in this review were published prior to the start of the pandemic and so the 22% may potentially be an underestimate of the current situation in 2023. The finding that girls were more likely to be impacted than boys is also not unexpected, however, the ~17% proportion in boys should not be ignored. Anyone of any gender can experience disordered eating. The study showed that children with a higher BMI were seemingly more at risk of developing disordered eating. It is possible that these young people faced discrimination or stigma based on their weight from important people in their lives, and so were engaging in disordered eating to try to lose weight. Weight stigma needs to stop being perpetuated at every level!

We know that children and adolescents are at risk of body image/eating disorder-related issues. This well-written paper highlights just how pervasive and widespread this issue can be. Although disordered eating in childhood/adolescence won’t necessarily lead to a diagnosed eating disorder, it still puts individuals at high risk.

Further, as the results showed that girls were more likely to report disordered eating compared to boys, and increasing age and BMI (body mass index) led to greater disordered eating, it is important to target interventions aimed at reducing the instances of disordered eating. It is especially critical for early intervention around this area, as we know that eating disorders are some of the most deadly psychiatric diagnoses. Early prevention can save lives.

I would have expected that the proportion would actually be a lot higher. This study adds to the existing body of literature but I also think there are several limitations to the studies included, namely the age group for children and adolescents, was defined from 6yrs – 18yrs. A lot of studies have shown that children as young as 3 years already show body image preference, with the 'thin ideal' desire being driven from preschool age. This study also focused purely on the prevalence of eating disorders without linking to the 'whys'. In younger children, many studies have pin-pointed the use of body-shaming language from health professionals, parents, siblings, media or peers, as precursors for body image issues, and in adolescence, peer influence was particularly high with media (in particular social media) influence growing across all age groups. 

Upskilling the primary healthcare workforce to help pick up eating disorders/disordered eating practices is a good suggestion, however, beyond healthcare providers, early childhood educators, schools and parents all form an integral part of a child’s support network and are all equally influential in improving child/youth health outcomes.