In the first global analysis of its kind, involving 63 000 participants in 32 studies from 16 countries, researchers have found that more than one in five children and teens have disordered eating patterns, and have called for urgent action to tackle the issue.
The results showed that the problem is common among girls, older adolescents and those with a higher body mass, and were worrying for various reasons.
“These high figures are concerning from a public health perspective and highlight the need to implement strategies for preventing eating disorders,” said the corresponding authors, Dr Jose Francisco Lopez-Gil of Universidad de Castilla-La Mancha, Spain, and Dr Hector Gutierrez-Espinoza, of Universidad de las Americas, Ecuador.
The researchers report that in 2019, 14m people experienced eating disorders, including nearly 3m children and adolescents, and that more than 17 000 years of life were lost from 1990 to 2019 because of this.
Weight loss dieting, binge eating, self-induced vomiting, excessive exercise and the use of laxatives or diuretics, can predict eating disorders and obesity later in life, they said.
“Eating disorders are among the most life-threatening psychiatric problems, people with these conditions dying 10 to 20 years younger than the general population,” the researchers warned in their paper published in JAMA Paediatrics.
Disordered eating behaviours among boys, “such as intensely engaging in muscle mass and weight gain with the goal of improving body image satisfaction”, are not detected, based on diagnostic criteria.
TimesLIVE reports that South African studies have demonstrated that teenage girls have “weight and shape concerns with body image issues and related dieting behaviour”, according to psychiatrist Professor Chris Szabo, who previously ran the eating disorders unit at Tara Hospital in Johannesburg.
Szabo, author of the book Eating Disorders, said: “Dieting is a major risk factor, influenced to some extent by societal values. (There is) an emphasis on physical appearance as a determinant of self-worth. Hence self-esteem issues also contribute to risk.”
Roughly one in six South African girls expressed attitudes and behaviours that “could indicate an eating disorder or risk for developing an eating disorder”, he said.
However, there are no studies in this country measuring how common “diagnosable eating disorders, specifically anorexia nervosa and bulimia nervosa” are among adolescents, Szabo reported.
Twelve-years-old is the median age for the onset of eating disorders like anorexia nervosa, bulimia nervosa, and binge eating disorder, according to a US nationally representative sample of more than 10 000 adolescents.
Szabo said the finding in the latest review that 22% of children and adolescents have disordered eating was a cause of concern but must be “interpreted carefully” since selected symptoms did not amount to a full-blown condition of an eating disorder.
“Treating eating disorders is complex,” he said. “As much as the sufferer needs treatment, family issues also need to be addressed within that treatment.”
Other studies have revealed that social media use has aggravated the threat of eating disorders among adolescents and young adults, with the Covid-19 pandemic worsening the problem.
Study details
Global Proportion of Disordered Eating in Children and Adolescents
A Systematic Review and Meta-analysis
José Francisco López-Gil, Antonio García-Hermoso, Lee Smith, et al
Published in JAMA Pediatrics on 20 February 2023
Key Points
Question What is the global proportion of disordered eating in children and adolescents?
Findings In this systematic review and meta-analysis of 32 studies including 63 181 participants from 16 countries, 22% reported that children and adolescents showed disordered eating. The proportion was further elevated among girls, older adolescents, and those with higher body mass index.
Meaning Identifying the magnitude of disordered eating and its distribution in at-risk populations is crucial for planning and executing actions aimed at preventing, detecting, and dealing with them.
Abstract
Importance
The 5-item Sick, Control, One, Fat, Food (SCOFF) questionnaire is the most widely used screening measure for eating disorders. However, no previous systematic review and meta-analysis determined the proportion of disordered eating among children and adolescents.
Objective
To establish the proportion among children and adolescents of disordered eating as assessed with the SCOFF tool.
Data Sources
Four databases were systematically searched (PubMed, Scopus, Web of Science, and the Cochrane Library) with date limits from January 1999 to November 2022.
Study Selection
Studies were required to meet the following criteria: (1) participants: studies of community samples of children and adolescents aged 6 to 18 years and (2) outcome: disordered eating assessed by the SCOFF questionnaire. The exclusion criteria included (1) studies conducted with young people who had a diagnosis of physical or mental disorders; (2) studies that were published before 1999 because the SCOFF questionnaire was designed in that year; (3) studies in which data were collected during COVID-19 because they could introduce selection bias; (4) studies based on data from the same surveys/studies to avoid duplication; and (5) systematic reviews and/or meta-analyses and qualitative and case studies.
Data Extraction and Synthesis
A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.
Main Outcomes and Measures
Proportion of disordered eating among children and adolescents assessed with the SCOFF tool.
Results
Thirty-two studies, including 63 181 participants from 16 countries, were included in this systematic review and meta-analysis. The overall proportion of children and adolescents with disordered eating was 22.36% (95% CI, 18.84%-26.09%; P < .001; n = 63 181) (I2 = 98.58%). Girls were significantly more likely to report disordered eating (30.03%; 95% CI, 25.61%-34.65%; n = 27 548) than boys (16.98%; 95% CI, 13.46%-20.81%; n = 26 170) (P < .001). Disordered eating became more elevated with increasing age (B, 0.03; 95% CI, 0-0.06; P = .049) and body mass index (B, 0.03; 95% CI, 0.01-0.05; P < .001).
Conclusions and Relevance
In this systematic review and meta-analysis, the available evidence showed that 22% of children and adolescents showed disordered eating according to the SCOFF tool. Proportion of disordered eating 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.
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