Photo by Elena Leya on Unsplash
Photo by Elena Leya on Unsplash

EXPERT REACTION: One in five kids and teens struggle with disordered eating

Embargoed until: Publicly released:
Peer-reviewed: This work was reviewed and scrutinised by relevant independent experts.

Meta-analysis: This type of study involves using statistics to combine the data from multiple previous studies to give an overall result. The reliability of a meta-analysis depends on both the quality and similarity of the individual studies being grouped together.

Systematic review: This type of study is a structured approach to reviewing all the evidence to answer a specific question. It can include a meta-analysis which is a statistical method of combining the data from multiple studies to get an overall result.

People: This is a study based on research using people.

22% of children and teens show signs of disordered eating, according to international researchers who looked at assessments using the same diagnosis tool across 16 countries. They compiled studies that used the SCOFF questionnaire to assess rates of disordered eating in samples of children aged 6-18 in countries across Europe, Asia, the Americas and one in Africa. They say girls were more likely to show signs of disordered eating at 30%, and kids who were older or had a higher BMI were at greater risk of disordered eating.

Journal/conference: JAMA Pediatrics

Link to research (DOI): 10.1001/jamapediatrics.2022.5848

Organisation/s: Universidad de Castilla-La Mancha, Spain

Funder: Dr López-Gil is a Margarita Salas Fellow (Universidad de Castilla-La Mancha; 2021-MS-20563). Dr García-Hermoso is a Miguel Servet Fellow (Instituto de Salud Carlos III; CP18/0150). No other disclosures were reported.

Media release

From: JAMA

About The Study: This systematic review and meta-analysis of 32 studies including 63,000 participants from 16 countries found that the overall proportion of children and adolescents with disordered eating was 22%. The proportion was further elevated among girls, as well as with increasing age and body mass index. These high figures are concerning from a public health perspective and highlight the need to implement strategies for preventing eating disorders. 

Authors: Jose Francisco Lopez-Gil, Ph.D., of Universidad de Castilla-La Mancha in Cuenca, Spain, and Hector Gutierrez-Espinoza, Ph.D., of Universidad de las Americas in Quito, Ecuador, are the corresponding authors.

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Expert Reaction

These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.

Dr Trevor Steward is Senior Research Fellow in the School of Psychological Sciences at the University of Melbourne

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.

Last updated: 28 Jun 2023 1:37pm
Declared conflicts of interest:
Trevor has declared that he has no conflicts of interest.
Associate Professor Gemma Sharp is the leader of the Body Image & Eating Disorders Research Group at Monash University and a Senior Clinical Psychologist at Alfred Health

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!

Last updated: 28 Jun 2023 1:39pm
Declared conflicts of interest:
Gemma has declared that she has no conflicts of interest.
Sophie Dahlenburg is a lecturer from the School of Psychology at the University of Adelaide

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.

Last updated: 28 Jun 2023 1:40pm
Declared conflicts of interest:
Sophie has declared that she has no conflicts of interest.
Dr Kanita Kunaratnam is a Lecturer and Dietitian in the School of Medical and Health Sciences at Edith Cowan University

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.

Last updated: 20 Feb 2023 12:01pm
Declared conflicts of interest:
Kanita has declared that she has no conflicts of interest.

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