‘Disturbing’ rate of disordered eating among young people

Around one in five boys and one in three girls are experiencing disordered eating across the world, according to a systematic review and meta-analysis of 32 studies recently published in JAMA.
 
The research tracked 63,181 participants from 16 countries, comprising children and adolescents aged 6–18 years, finding that 22.36% had disordered eating.
 
Disordered eating, defined by the Australian Butterfly Foundation as a ‘disturbed and unhealthy eating pattern’ can include restrictive dieting, compulsive eating or skipping meals.
 
While the condition is considered separate to eating disorders such as anorexia nervosa, bulimia nervosa and binge eating disorder, it can often include some behaviours of these, in particular dieting, and is the most common indicator of the development of an eating disorder.
 
For the JAMA international study, participants were assessed using the ‘Sick, Control, One, Fat, Food’ (SCOFF) questionnaire – a five-question screening tool designed to clarify any notions that an eating disorder might exist, rather than make a diagnosis. While the authors note the SCOFF questionnaire is the most widely used screening measure for eating disorders, theirs is the first systematic review and meta-analysis to determine the proportion of disordered eating among children and adolescents.
 
They found disordered eating was significantly higher among girls (30.03%) compared to boys (16.98%), and that rates increased with age and body mass index (BMI).
 
Clinical psychologist Dr Gemma Sharp, who leads the Body Image and Eating Disorders Research Group in the Department of Neuroscience at Monash University, emphasised the importance of research such as 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,’ she said.
 
‘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.
 
‘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.’
 
Rates of disordered eating and eating disorders in Australia increased over the COVID-19 pandemic, with a large number of people being impacted by extended lockdowns and experiencing mental health issues, body image concerns, food restrictions and binge eating.
 
While these conditions have been exacerbated by the impacts of the pandemic, Dr Sharp notes that the majority of the studies included in the JAMA review were published prior to the start of the pandemic, so the 22% ‘may potentially be an underestimate of the current situation in 2023’.
 
Speaking to the ABC, Dr Sharp said the JAMA review is the ‘tip of the iceberg’ of a ‘disturbing’ trend.
 
‘Aside from the pandemic contributing to increasing rates, we have noticed a difference in sociocultural differences, particularly the media – things like diet culture [and] influencer culture are having an impact on how young people are seeing their bodies and pursuing unhealthy dietary behaviours,’ she said.
 
‘Disordered eating is associated with poorer mental and physical health … and can lead to eating disorders.
 
‘We all have a part to play, from parents to educators, the media, healthcare professionals. We shouldn’t be encouraging young people to diet, and we need to stop weight shaming.’
 
The JAMA authors conclude that their results confirm the need for stronger public health messaging and implementation of targeted prevention strategies.
 
GPs have been recognised for their important role in this area, as well as enabling appropriate referral pathways.
 
Dr Kanita Kunaratnam, a dietitian at the School of Medical and Health Sciences at Edith Cowan University, not involved in the JAMA research, agrees that early intervention and ongoing education is key.
 
‘Upskilling the primary healthcare workforce to help pick up eating disorders/disordered eating practices is a good suggestion,’ she said.
 
‘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.’
 
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children and young people dietary behaviours disordered eating eating disorders