Summary: A new study finds that young adults who are overweight or obese are nearly twice as likely as their lower-weight peers to engage in bingeing, purging, or other unhealthy weight-control behaviors. Researchers also identified higher risk among Asian/Pacific Islander individuals and sexual minorities.
Source: UCSF
Young adults who are overweight or obese are more likely to binge, purge, use laxatives or diuretics, or force themselves to vomit to control their weight, according to a new study led by UCSF Benioff Children’s Hospitals.
Researchers describe these actions as disordered eating behaviors, which increase the risk of depression, substance use, poor nutrition, and long-term weight gain. The findings were published in the Journal of General Internal Medicine on June 12, 2018.
The study analyzed data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), focusing on a nationally representative sample of 14,322 young adults aged 18 to 24.
Overall, nearly half (48.6%) of the participants were classified as overweight or obese. Among females in the overweight or obese group, 29.3% reported using unhealthy weight-control methods, compared with 15.8% of females who were underweight or of normal weight. Among males, the corresponding rates were 15.4% for those overweight or obese and 7.5% for underweight or normal-weight peers.
Disordered Eating Can Be Under-Recognized in Heavier Young Adults
Although formal diagnoses of eating disorders such as anorexia and bulimia were more common among young adults of underweight or normal weight, first author Jason Nagata, MD, suggests this pattern may reflect under-recognition of eating disorders in heavier young people. He is a fellow in the Division of Adolescent and Young Adult Medicine and the Eating Disorders Program at UCSF Benioff Children’s Hospitals.
“Clinicians and parents should recognize that eating disorders occur across the weight spectrum, including in people who are overweight or obese,” Nagata said. “It is important to ask how young people are attempting to lose weight and to discourage unsafe practices that can lead to severe illness and hospitalization.”
Paradoxically, unhealthy weight-control methods can contribute to weight gain over time. Nagata cites twin studies showing that among identical twins with the same baseline body mass index, the twin using unhealthy dieting strategies sometimes ended up weighing more than the sibling who did not diet.
“Unhealthy weight-control behaviors may increase the risk of developing eating disorders, reduce self-regulation, and trigger compensatory eating—often of calorie-dense foods—which can lead to greater overall consumption and weight gain,” he explained.
The study also confirmed that disordered eating is more than twice as common among females as males. Beyond sex differences, the analysis revealed notable disparities by race and sexual orientation. Young adults who self-identified as Asian or Pacific Islander had 1.66 times the odds of reporting disordered eating behaviors compared with those identifying as White. Individuals who identified as homosexual, lesbian, or bisexual had 1.62 times the odds compared with heterosexual peers.
“Young adulthood is a distinct developmental phase that has received insufficient clinical and research attention,” said senior author Kirsten Bibbins-Domingo, MD, PhD, MAS, a general internist and professor of medicine at UCSF. “Although young adults are often assumed to be healthy, many have poor health behaviors and are less engaged in routine medical care.”
Funding: The study was supported by the American Academy of Pediatrics, the American Pediatric Society, and the Norman Schlossberger Research Fund at UCSF.
Authors and contributors: The study was led by Jason M. Nagata with co-authors Andrea K. Garber, PhD; Stuart B. Murray, PhD; Jennifer L. Tabler, PhD; and Kirsten Bibbins-Domingo, MD, PhD, MAS.
Publication: The research appeared in the Journal of General Internal Medicine on June 11–12, 2018 under the title “Prevalence and Correlates of Disordered Eating Behaviors Among Young Adults with Overweight or Obesity.” DOI: 10.1007/s11606-018-4465-z
Background: Clinical and community data suggest that eating disorders and disordered eating behaviors can co-occur in adolescents and young adults who are overweight or obese.
Objective: To determine the prevalence of eating disorders and disordered eating behaviors among young adults classified as overweight or obese in a nationally representative sample, and to examine differences by sex, race/ethnicity, sexual orientation, and socioeconomic status.
Design and participants: Cross-sectional analysis of Wave III data from Add Health, including 14,322 young adults ages 18–24.
Main measures: Self-reported eating disorder diagnosis and disordered eating behaviors—binge eating or unhealthy weight-control practices such as vomiting, fasting/skipping meals, or laxative/diuretic use. Analyses adjusted for age, sex, race/ethnicity, sexual orientation, weight status, and education.
Key results: Compared with young adults classified as underweight or normal weight, those classified as overweight or obese reported higher rates of disordered eating behaviors: 29.3% vs. 15.8% in females and 15.4% vs. 7.5% in males. Adjusted models showed higher odds of disordered eating for females versus males (OR 2.32), Asian/Pacific Islander versus White (OR 1.66), homosexual or bisexual versus heterosexual (OR 1.62), lower education (high school or less) versus greater than high school (OR 1.26), and obesity versus normal weight (OR 2.45).
Conclusions: The elevated prevalence of disordered eating behaviors, particularly among young adults classified as overweight or obese, underscores the need for routine screening, appropriate referrals, and tailored interventions for this population.
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