Childhood Recurrent Abdominal Pain Linked to Fasting Behaviours in Adolescence, Study Finds

Summary: Children aged 7 to 9 who experience recurring abdominal pain are more likely to adopt fasting and other weight-control behaviours by age 16.

Source: Oxford University

New research indicates that children who suffer from recurrent abdominal pain (RAP) may be at increased risk of developing disordered eating behaviours in their teenage years. The findings, published in the International Journal of Eating Disorders, provide prospective evidence of an association between childhood RAP and later fasting to control weight.

The collaborative study, carried out by researchers at the University of Oxford, Duke University (USA), and the University of Bristol, drew on data from the ALSPAC cohort—also known as the “Children of the 90s”—which includes more than 14,000 participants across the UK. The researchers examined whether children who experienced recurrent abdominal pain at ages 7 and 9 were more likely to report fasting for weight control at age 16.

Lead author Dr. Kate Stein, Department of Psychiatry at the University of Oxford, commented on rising referrals to eating disorder services and the potential role of early gastrointestinal problems. She noted that while eating disorders have complex origins, repeated abdominal pain in childhood could be one contributing factor for a subset of patients. Some children may begin to avoid foods they associate with pain, which over time can evolve into restrictive or fasting behaviours during adolescence.

Key clinical recommendations

• Ask about a history of recurrent abdominal pain in patients presenting with eating disorders.
• Screen for disordered eating among patients with childhood gastrointestinal conditions, such as RAP.
• Address anxiety and distress related to gastrointestinal sensations when treating eating disorders.

Dr. Stein emphasized that routinely enquiring about childhood gastrointestinal symptoms could help clinicians identify patients whose early pain experiences contributed to subsequent food avoidance, allowing more tailored and effective treatment. Likewise, assessing eating behaviours in children with chronic GI complaints could create opportunities for early intervention and prevention of unhealthy patterns.

The analysis revealed a notable nuance: when childhood RAP was defined as three or more pain episodes per year (RAP 3+), there was a statistically significant association with fasting for weight control at age 16. However, when RAP was defined more stringently as five or more pain episodes per year (RAP 5+), the association was not statistically significant after adjustment for confounders. The authors suggest that the frequency measure captured by the study may not fully reflect other important dimensions such as pain severity, distress, or the extent to which pain disrupts a child’s daily functioning.

About the research

Source: Oxford University
Contact: Press Office – Oxford University
Image: Image credited to Oxford University

Original Research (open access): “Do children with recurrent abdominal pain grow up to become adolescents who control their weight by fasting? Results from a UK population‐based cohort” by Kate Stein et al., International Journal of Eating Disorders. DOI: 10.1002/eat.23513

Abstract — Study overview

Objective

Gastrointestinal (GI) symptoms frequently occur alongside eating disorders, but it is unclear whether GI problems often precede disordered eating. Recurrent abdominal pain (RAP) is the most common GI problem in childhood. This study examined longitudinal associations between persistent RAP at ages 7 and 9 and fasting for weight control at age 16.

Method

The Avon Longitudinal Study of Parents and Children (ALSPAC) provided data for this population-based UK cohort. Childhood RAP was reported by mothers and defined in two ways: as RAP 5+ (five or more pain episodes in the past year) for the primary analysis, and RAP 3+ (three or more episodes) for a sensitivity analysis. Adolescents self-reported fasting to control weight at age 16. Logistic regression models assessed associations while adjusting for potential confounders.

Results

After adjustment, RAP 5+ in childhood was not significantly associated with fasting at 16 (OR 1.30, 95% CI 0.87–1.94, p = .197). By contrast, RAP 3+ was associated with later fasting in the fully adjusted model (OR 1.50, 95% CI 1.16–1.94, p = .002), and this association remained after excluding participants with pre-existing anxiety (OR 1.52, 95% CI 1.17–1.97, p = .002).

Discussion

The findings support a possible independent contribution of childhood recurrent abdominal pain to the later risk of fasting for weight control. The study highlights that measures of pain frequency captured in cohort data may not fully reflect the aspects of pain—such as severity or functional impairment—that matter most for long-term outcomes. Clinicians assessing eating disorders should consider asking about a history of childhood RAP, and those treating childhood GI problems should be alert to signs of emerging disordered eating.