Editor’s Note: Dr. Ella Perrin (she/her/hers) is a resident physician in pediatrics at Naval Medical Center San Diego. Her interests include disordered eating, obesity, decreasing weight stigma and bias, and the field of hospital medicine. The views expressed in this blog are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government. Dr. Perrin declares no conflicts of interest. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
Disordered eating behavior (DEB) is increasing in prevalence, and adolescents and young adults are particularly vulnerable to disordered eating (DE). Patients with obesity have a high rate of DE, likely due to many factors including poor self-esteem, body shaming, and an overemphasis by clinicians on dieting and weight loss.
There is little research evaluating DE longitudinally in a population. Similarly, while the relationship between obesity and DEB has been well established, the relationship between metabolic syndrome and DEB is unknown.
In an article and accompanying video abstract being early released this week in Pediatrics entitled, “Disordered Eating Profiles in Adolescence to Early Adulthood and Future Cardiometabolic Health,” Rita Pereira and colleagues from the University of Porto in Portugal analyzed DEB trajectories for adolescents into young adulthood and studied the association of different DEB profiles with BMI and cardiometabolic features (10.1542/peds.2024-066076).
Data came from the EPITeen Study, a population-based cohort study of adolescents in Porto, Portugal, who were enrolled in public and private schools in 2003/2004 and were 13 years old at the time of the initial assessment. Participants were followed at age 17, 21, 24, and 27. Data collected included vital signs, height, weight, metabolic labs, and various medical and social history questions. Patients also completed the Eating Disorder Inventory (EDI) questionnaire.
Based on the EDI responses, authors found 4 categories of eating disorder profiles for adolescents: high DE, moderate but elevated DE, low but elevated DE, and low to absent DE. They looked at the associations by gender between the different DE categories and BMI and other cardiometabolic markers (waist circumference, blood pressure, different lipid studies, fasting glucose) at each visit.
Their findings are compelling:
- Males were more likely to be in the two lower DE categories, whereas females were most likely to be in the two moderate DE categories.
- Males and females with high or moderately elevated DE had an increasing BMI at all follow-up visits.
- High and moderately elevated DE was associated with increased risk of metabolic syndrome features at all follow-up visits for males and multiple follow-ups for females (as early as 21 years old for both groups).
- Males with high and moderately elevated DE had a higher risk of elevated BMI and metabolic syndrome features compared to females in these groups.
I think this study is fantastic—while it makes sense that (due to its association with obesity) DE would be associated with increased risk of metabolic syndrome, this is the first study to my knowledge that has analyzed this relationship over time. The young age at which patients with DE developed metabolic abnormalities, and the increased risk of metabolic abnormalities in males with DE (a population which does not fit traditional eating disorder stereotypes), are great reminders to clinicians: it is important to screen all adolescents and young adults (including males and persons with obesity) for DE, and to provide early, non-stigmatizing interventions to patients with DE and obesity.
