Exploring Disordered Eating During Early Adolescence

A large study underscores the importance of early identification and prevention.

Early adolescence is a time of major changes and transitions. The Avon Longitudinal Study of Parents and Children (ALSPAC) is a population-based study that follows 14,541 women and their children, beginning at the child’s birth. This study recently provided helpful information on the frequency and patterns of eating disorder symptoms in 13-year-old girls and boys. The results underscore the importance of identifying disordered eating early, to help prevent obesity and eating disorders.

Drs. Nadia Micali, Janet Treasure, and colleagues at University College, the London School of Hygiene and Tropical Medicine, and King’s College, London, mailed questionnaires to the parents of 10,135 ALSPAC participants with children who were then 13 years of age and 479 children who were enrolled in a second phase of the study (J Adolesc Health. 2014; 54:574). The researchers sought information on disordered eating behavior and cognitions, such as fear of gaining weight and evidence of distress about weight and shape. They also looked for patterns of avoidance of fattening foods, food restriction, excess exercising for weight loss, binge eating and purging.

Parents provided data on binge eating by their children, and the teens were asked how eating patterns and concerns about weight and shape had interfered with getting along with other family members, making and keeping friends, and learning at school. Parents also filled out a separate questionnaire for all other mental health disorders. All children still enrolled in the study were re-evaluated when they reached 15 years of age.

Differences by gender emerged at age 13

The sample was comprised of 49.0% boys and 50.1% girls, and the participants were similar on all sociodemographic and childhood characteristics, with the exception of slightly higher birth weights for boys, which was expected. DSM-IV/ICD-10 emotional disorders at age 13 were similar between the sexes (2.0% vs. 1.9%) but DSM-IV/ICD behavioral disorders were more common among boys than among girls (4.0% vs 2.9%, respectively).

In the case of eating disorder behavior and cognitions, however, things were quite different. By 13 years of age, 63.2% of the girls were afraid of gaining weight or “getting fat” and 11.5% were extremely afraid or terrified of gaining weight or becoming fat. Fewer than 5% of the boys expressed such concerns. A significant difference was also seen in food restriction, where girls were more than twice as likely as boys to restrict their food intake. More boys than girls were using more intensive exercise to lose weight. Purging and binge eating were rare in both girls and boys.

At age 15, binge eating or overeating were associated with impairment at school and home for the girls. Among boys, binge eating or overeating was similarly associated with impairment but also with burden on their parents. At age 15, binge eating/overeating among the girls was strongly associated with a higher body mass index (BMI, or kg/m²), and contributed to an expected .24 increase in BMI z-scores A similarly strong association with bingeing/overeating and increased BMI z-scores was reported among boys. Food restriction predicted lower BMIs by age 15. Binge eating/overeating was associated with emotional and behavioral disorders across genders.

These results emphasize the importance of disordered eating behaviors in early adolescence for later disordered eating, overweight, and obesity.