Identifying risk factors for eating disorder symptoms may help us develop more evidence-based prevention mentions. Personally not convinced that prevention is really possible with the types of individual-focused programs we have today, I would argue that identifying risk factors may at least help us determine which individuals should be screened in subsequent years. If they do develop eating disorders, they will hopefully be more likely to receive early intervention and treatment.
To identify predictors of eating disorder symptoms, Elizabeth Evans and colleagues (2016) conducted a longitudinal study that measured various putative risk factors at ages 7, 9, and 12 in a group of boys and girls. The authors also wanted to identify correlates of eating disorder symptoms at 12 years of age. They measured eating attitudes and dietary restraint, BMI, body dissatisfaction, and depressive symptoms.
THE STUDY
- 516 participants; 262 girls and 254 boys
- all individuals were residents of Gateshead, located in northeast England
- 98% from white ethnic majority group
- Assessments conducted at 6-8 years (referred to as 7 years), 8-10 years (referred to as 9 years), and 11-13 years (referred to as 12)
MAIN FINDINGS
Differences between Boys and Girls
- Girls had significantly higher depressive symptom scores than boys
- Girls had significantly higher body dissatisfaction than boys at 7, 9 and 12 years of age
- No differences between boys and girls on the eating disorder symptom scores at 9 or 12 years, but scores overall were higher at 9 years than at 12 years
Predictors and Correlates of Eating Disorder Symptoms
For boys, ED symptoms at age 12 were:
- Inversely associated with body esteem at age 12 (i.e., lower body satisfaction = more symptoms)
- Directly associated with ED symptoms at age 9
- Directly associated with dietary restraint at age 7
For girls, ED symptoms at age 12 were:
- Directly associated with depressive symptoms and BMI at age 12
- Inversely associated with body esteem at age 12 (i.e., lower body satisfaction = more symptoms)
- Directly associated with ED symptoms at age 9
For boys, all of the above accounted for a significant variance in eating disorders symptoms at 12 years (26%).
For girls, depressive symptoms, body esteem, and eating disorder symptoms at 9, but not BMI, accounted for a significant variance of eating disorder symptoms at age 12 (49%).
DISCUSSION
The results show that ED symptoms at 9 years predicted higher ED symptoms at 12 years for both girls and boys. For boys, dietary restraint at 7 years also predicted higher ED symptoms at 12 years. Evans et al. (2015) suggest this shows that ED symptoms are fairly stable throughout preadolescence, highlighting the importance of targeting children with higher ED symptoms in preadolescence.
Conversely, body dissatisfaction did not predict ED symptoms at 12 years for boys or girls. However, body dissatisfaction at 12 was associated with ED symptoms at 12, suggesting that body dissatisfaction occurs alongside ED symptoms. (Interestingly, this was the case for me; I only recall experiencing body dissatisfaction when I was already engaging in restrictive eating.) According to the authors, “this provides additional weight to the premise that body dissatisfaction is not a reliable causal risk factor for ED symptoms in childhood.”
Depressive symptoms (at age 12) were associated with higher ED symptoms at age 12 in girls but not in boys. Evans et al. (2015) write:
This fits with previous findings that sex differences in links between depressive and disordered eating symptoms emerge around the age of 13 years (Ferreiro, et al. 2012). It has been proposed that at this age, girls but not boys are more likely to use disordered eating behaviours to relieve depressive symptoms and, reciprocally, disordered eating gives rise to negative self-evaluations and depressed affect (Beato-Fernández et al., 2007).
This is not surprising to me but it is nonetheless interesting. I’d be interested to see more exploration of the differences between girls and boys in preadolescence and early adolescence in terms of anxiety, depression, and emotional regulation and how that relates to disordered eating.
As mentioned above, the (regression) models, which aimed to predict ED symptoms at 12 years based on initial study variables, accounted for twice as much variance in ED symptoms in girls than in boys. This means there are additional factors that were not considered in this study that can predict ED symptoms in boys. The authors suggest that these variables may include “pursuit of muscularity” and “athletic internalization.”
Unfortunately, the authors did not evaluate other putative predictors of ED symptoms, such as thin-ideal internalization and anxiety.
CONCLUSION
From my perspective, the findings are important because they put into question the notion that we should be focusing on body image/body dissatisfaction in our prevention interventions. Perhaps we should instead focus on addressing disordered eating symptoms directly? Or perhaps we should be focusing on providing children and adolescents with tools and support to cope with any negative emotions they may be experiencing?
Given that depressive symptoms were associated with ED symptoms (among girls), perhaps instead of (or in addition to) teaching children that about media literacy and that they should love and accept their bodies, we should provide children and adolescents with opportunities and avenues to discuss their feelings and problems? In my opinion, trying to address disordered eating will not be particularly successful if we don’t simultaneously provide individuals with alternative tools they can use to cope.
I agree with Evans et al.’s (2015) suggestions that future research should continue to address whether body dissatisfaction is a causal risk factor for subsequent ED symptoms. I also agree that researchers should also consider other factors that may contribute to the development of ED symptoms, particularly among boys given that most models are based on data from adolescent female samples and focus on the pressure to be thin, which may not be appropriate or relevant to many boys.
I don’t particularly agree with this statement, however:
Efforts might be profitably aligned with interventions to prevent excess weight gain and/or depression, given the behavioural and possible aetiological overlap between these phenomena.
I am having a hard time envisioning an intervention program that is aimed at preventing excess weight that I can get on board with. (Instead, I envision a terrible PowerPoint aimed at 12-year-olds telling them of the dangers of childhood obesity and junk food. A PowerPoint surely filled with fat-shaming images and photographs of fridges filled with fruits and vegetables.) Moreover, I don’t fully understand why this is even mentioned, given that BMI was not a predictor of ED symptoms at 12 years. But even it were a predictive factor, I would still disagree with the assertion that we should focus on interventions aimed at preventing excess weight gain. If anything, we should be creating healthy public health policies that enable individuals of all ages to be healthy and active.
Reference
Evans, E. H., Adamson, A. J., Basterfield, L., Le Couteur, A., Reilly, J. K., Reilly, J. J., & Parkinson, K. N. (2016). Risk factors for eating disorder symptoms at 12 years of age: A 6-year longitudinal cohort study. Appetite PMID: 27612559
