Prevalence and Correlates of Disordered Eating Behaviors Among Young Adults with Overweight or Obesity
Clinical and community samples indicate that eating disorders (EDs) and disordered eating behaviors (DEBs) may co-occur among adolescents and young adults at a weight status classified as overweight or obese.
To determine the prevalence of EDs and DEBs among young adults at a weight status classified as overweight or obese using a nationally representative sample and to characterize differences in prevalence by sex, race/ethnicity, sexual orientation, and socioeconomic status.
Cross-sectional nationally representative data collected from Wave III of the National Longitudinal Study of Adolescent to Adult Health (Add Health).
Young adults ages 18–24 years old.
ED diagnosis and DEBs (self-reported binge eating or unhealthy weight control behaviors including vomiting, fasting/skipping meals, or laxative/diuretic use to lose weight). Covariates: age, sex, race/ethnicity, sexual orientation, weight status, and education.
Of the 14,322 young adults in the sample, 48.6% were at a weight status classified as overweight or obese. Compared to young adults at a weight status classified as underweight or normal weight, those at a weight status classified as overweight or obese reported a higher rate of DEBs (29.3 vs 15.8% in females, 15.4 vs 7.5% in males). Logistic regression analyses demonstrated that odds of engaging in DEBs were 2.32 (95% confidence interval 2.05–2.61) times higher for females compared to males; 1.66 (1.23–2.24) times higher for Asian/Pacific Islander compared to White; 1.62 (1.16–2.26) times higher for homosexual or bisexual compared to heterosexual; 1.26 (1.09–1.44) times higher for high school or less versus more than high school education; and 2.45 (2.16–2.79) times higher for obesity compared to normal weight, adjusting for all covariates.
The high prevalence of DEBs particularly in young adults at a weight status classified as overweight or obese underscores the need for screening, referrals, and tailored interventions for DEBs in this population.
KEY WORDSobesity eating disorders anorexia nervosa bulimia nervosa binge eating weight control behaviors young adult
Thanks to Nicole Capdarest-Arest for help with literature searches. This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website (http://www.cpc.unc.edu/addhealth). No direct support was received from grant P01-HD31921 for this analysis.
Jason Nagata is a Fellow in the Pediatric Scientist Development Program (K12HD000850-33). This project was supported by grants from the American Academy of Pediatrics (AAP), the American Pediatric Society (APS), and the Norman Schlossberger Research Fund from the University of California, San Francisco. A.K.G. was supported by NIH 5R01HD082166-02. S.B.M was supported by K23 MH115184.
Compliance with Ethical Standards
The University of North Carolina Institutional Review Board approved all Add Health study procedures, and the University of California, San Francisco Institutional Review Board deemed this specific project exempt. Written informed consent was obtained from each subject.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 1.Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United states, 2011–2014. NCHS Data Brief. 2015;(219):1–8.Google Scholar
- 4.Hudson JI, Hiripi E, Pope HG, Jr., Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. 2007;61:348–58.Google Scholar
- 19.Stroud C, Walker LR, Davis M, Irwin CE, Jr. Investing in the health and well-being of young adults. J Adolesc Health 2015;56(2):127–9.Google Scholar
- 28.Harris KM, Halpern CT, Witsel E, et al. The national longitudinal study of adolescent to adult health: research design. Available at: http://www.cpc.unc.edu/projects/addhealth/design/researchdesign_3618_regular.pdf. Accessed 24 May 2018.
- 29.Fairburn CG, Beglin S. Eating Disorder Examination Questionnaire. In: Fairburn CG, editor. Cognitive Behavior Therapy and Eating Disorders. New York: Guilford Press; 2008. p. 309–313.Google Scholar
- 37.Centers for Disease Control and Prevention (CDC). Defining adult overweight and obesity. Available at: https://www.cdc.gov/obesity/adult/defining.html. Accessed 24 May 2018.
- 38.Harris KM. The Add Health study: design and accomplishments. Carolina Population Center, University of North Carolina at Chapel Hill; 2013.Google Scholar
- 39.Chen P. Appropriate analysis in add health: correcting for design effects & selecting weights. Carolina Population Center, University of North Carolina at Chapel Hill; 2014.Google Scholar
- 41.Murray SB, Griffiths S, Nagata JM. Community-based eating disorder research in males: a call to action. J Adolesc Health. 2018;62(6):649–650. Google Scholar
- 43.Nagata JM, Golden NH, Peebles R, et al. Assessment of sex differences in bone deficits among adolescents with anorexia nervosa. Int J Eat Disord. 2017;50(4):352–358.Google Scholar
- 48.American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th Edition ed. Washington, D.C.: American Psychiatric Association; 1990.Google Scholar
- 49.Golden NH, Schneider M, Wood C, Committee on Nutrition, Committee on Adolescence, Section on Obesity. Preventing obesity and eating disorders in adolescents. Pediatrics. 2016;138(3): https://doi.org/10.1542/peds.2016-1649.