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J Adolesc Health. 2014 May;54(5):574-81. doi: 10.1016/j.jadohealth.2013.10.200. Epub 2013 Dec 17.

Frequency and patterns of eating disorder symptoms in early adolescence.

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Institute of Child Health, Behavioral and Brain Sciences Unit, University College London, London, United Kingdom. Electronic address:
Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, United Kingdom.
Eating Disorders Research Unit, Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom.



There are still uncertainties about manifestations of early adolescent eating disorders (ED) and their effects. We aimed to determine the prevalence of ED symptoms in early adolescence, derive symptoms dimensions, and determine their effects on social and psychological outcomes and subsequent body mass index (BMI).


Data on 7,082 adolescents aged 13 years from the Avon Longitudinal Study of Parents and Children were obtained on ED symptoms, resulting impairment and family burden and emotional and behavioral disorders using the parental version of the Developmental and Well-being Assessment. Exploratory structural equation models were used to derive ED symptoms dimensions separately by sex and to relate these to contemporary outcomes (impairment, burden, and emotional and behavioral disorders) and a distal outcome (objective BMI at age 15 years).


Extreme levels of fear of weight gain, avoidance of fattening foods, and distress about weight and shape were common among girls (11%). Three ED symptoms dimensions were identified: bingeing/overeating, weight/shape concern and weight-control behaviors, and food restriction. Bingeing/overeating was strongly associated with higher functional impairment, family burden, and comorbid psychopathology. Bingeing/overeating and weight/shape concern and weight-control behaviors predicted higher BMI 2 years later, whereas food restriction predicted lower BMI. These effects did not change when BMI at age 13 years was included in the model.


Eating disorder cognitions are common among young teenage girls. Eating disorder symptoms have adverse cross-sectional and distal consequences, in particular on increasing body weight 2 years later. These findings have important implications for early identification of adolescents engaging in ED behaviors and for obesity prevention.


Adolescents; Avon Longitudinal Study of Parents and Children; Dimensions; Eating disorders; Exploratory structural equation modeling; Longitudinal; Weight

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