Earlier this year, Dr López-Gil and other researchers published a pioneering systematic review and meta-analysis of disordered eating behaviours among children and adolescents across the globe. The results were deeply concerning: they found that as many as one in five young people showed signs of disordered eating, with even higher rates among girls, older adolescents, and young people with higher BMIs.
These findings show the urgent need for public health strategies aimed at preventing eating disorders, which constitute some of the most severe mental health conditions experienced by young people. While eating disorders are dangerous illnesses, it is possible to both prevent and treat the conditions with effective support and care. Widespread and accessible screening for disordered eating behaviours may help medics to spot the early signs of eating disorders, offer interventions to stop harmful behaviours in their tracks, and guide young people to a healthy future.
How Common Are Eating Disorders in Young People?
Eating disorder diagnoses are common among young people. Around 5.7% of girls and 1.2% of boys between the ages of 11 and 19 are estimated to have an eating disorder. Moreover, researchers and medics predict the actual number of cases – including unidentified and undiagnosed cases – may be much higher, particularly among boys. Many young people try to hide the symptoms of their disorder and avoid seeking support because of social stigmas and feelings of embarrassment. Unfortunately, these social pressures can prevent adolescents from receiving the expert care they need.
What Is the Difference Between Eating Disorders and Disordered Eating?
Eating disorders are medical diagnoses that correspond to sets of criteria or symptoms set out by scientists and mental health professionals. There are multiple diagnostic tools and systems available, including the Diagnostic and Statistical Manual for Mental Disorders (DSM-5), one of the most established psychiatric resources today.
The DSM-5 lays out several types of eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, and unspecified eating disorder. For a young person to receive a diagnosis, they must display a certain number of the corresponding system for a length of time, and to an extent that significantly affects their daily life.
Disordered eating, on the other hand, is not a medical diagnosis but describes unhealthy, problematic, or harmful behaviours that relate to food, weight, and body image. Disordered eating behaviours may include using food as a coping mechanism, engaging in cycles of binging and purging, or following strict dietary restrictions. Disordered eating behaviours often look different in boys than girls, with boys more concerned about muscle mass and a muscular body shape.
While every young person with an eating disorder diagnosis engages in disordered eating behaviours, not all young people with disordered eating may fit a diagnosis of an eating disorder. However, this doesn’t mean that their problems are not serious.
Any young person with eating problems requires and deserves attention, care, and effective support. Moreover, children and adolescents with disordered eating may be more likely to develop eating disorders in early adulthood, adding to the importance of early identification and intervention.
Disordered Eating and Gender, Age, and BMI
In their systematic review, López-Gil and others analysed data from 32 large-sample studies across 16 countries. They found while 22% of children and adolescents displayed signs of disordered eating, these statistics varied considerably according to gender, age, and BMI.
The study found that girls were significantly more likely to report disordered eating than boys (30.03% compared to 16.78%). Much of this difference may be explained by the tendency of boys to underreport eating problems and conceptualisations that are directed towards the behaviours of girls. Diagnostic criteria and discourse surrounding disordered eating often overlook the specific ways that eating problems present in boys, such as a focus on building muscle mass and following ‘bulking and cutting’ cycles.
In line with other research, the study found that the presence of disordered eating in young people increased with age. Most people who have a serious eating disorder are diagnosed during adolescence, often at the start of their teenage years. Adolescents may be particularly vulnerable to the disorders due to exposure to media pressures, hormonal changes, and other life changes, such as starting a new school.
In its analysis of disordered eating and BMI, the study found that young people with higher BMIs are more likely to report disordered eating behaviours. They posit that people with higher BMIs may follow disordered eating behaviours to lose weight. Dietary restrictions, particularly when unsupervised, may develop into disordered eating behaviours – especially when young people are exposed to social stigma, media pressures, and overly restrictive, unhealthy ‘diet plans’.
While the study offers an important insight into disordered eating among young people – and a stark but essential reminder of the urgency of response worldwide – it has certain limitations. In particular, it only analyses studies using a specific questionnaire to assess disordered behaviours (the SCOFF questionnaire).
The authors note that there is not yet enough evidence to support the use of SCOFF for screening certain eating disorders, including binge eating and unspecified eating disorders. That said, SCOFF is a widespread, established questionnaire that has been translated into several languages and has shown to be a simple and effective tool for identifying both anorexia nervosa and bulimia nervosa.
What Causes Disordered Eating in Young People?
The causes of disordered eating are complex and vary from one young person to another. Many young people’s eating problems are rooted in a combination of factors, including biological factors, things they experienced in their surroundings, or things that they experienced growing up.
Some of the causes of eating disorders may include:
- Distressing Life Experiences – Some young people may develop eating disorders because of a difficult life event or trauma, such as the death of someone close to them or surviving abuse.
- Media and Social Pressures – Media and social pressures that cause young people to value themselves on their weight or body image can contribute to and exacerbate eating problems. Young people may feel like their body is not good enough and/or devalue themselves as a whole.
- Family Issues – For some young people, family issues may play a role in the development of disordered eating. While research addressing specific family dynamics is lacking, some studies suggest that an unsafe or unstable family home may make eating problems more likely.
- Low Self-Esteem – Many young people with eating problems also have low self-worth. For some teenagers, low self-esteem may be linked to one of the aforementioned factors, or it may be rooted in other causes.
Moving Forward – Implementing A Strategy for Change
The multicenter study alerts us to the magnitude of the problem of disordered eating, a public health issue that has serious consequences for young people’s mental and physical health across the world. It points to the importance of implementing widespread screening mechanisms in accessible settings (such as GP clinics) to identify and support as many people as possible.
It also highlights the essential need for professionals, parents, guardians, and other community members who care for young people to know and understand the symptoms of disordered eating, to prevent teenagers and adolescents with eating problems from going unnoticed.
Overcoming eating disorders isn’t easy, but with the dedication of health institutions, scientists, medics, family members, and communities, we can work together to prevent and treat the conditions – and improve the lives of young people worldwide.
The Wave Clinic – Opening Doors for Young People
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Our centre combines a gap year experience with education, social responsibility, and exceptional medical and psychological support. Our team includes experts in adolescent mental health from around the world, providing young people with the incredible care they deserve.