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J Am Acad Child Adolesc Psychiatry. 2019 Feb;58(2):191-199. doi: 10.1016/j.jaac.2018.11.008. Epub 2018 Dec 13.

Developmental Premorbid Body Mass Index Trajectories of Adolescents With Eating Disorders in a Longitudinal Population Cohort.

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University of North Carolina at Chapel Hill.
University of North Carolina at Chapel Hill; Karolinska Institutet, Stockholm, Sweden.
Icahn School of Medicine at Mount Sinai, New York, NY; the University of Geneva, Switzerland; and the Institute of Child Health, University College London, UK. Electronic address:



To examine whether childhood body mass index (BMI) trajectories are prospectively associated with later eating disorder (ED) diagnoses.


Using a subsample from the Avon Longitudinal Study of Parents and Children (N = 1,502), random-coefficient growth models were used to compare premorbid BMI trajectories of individuals who later developed anorexia nervosa (n = 243), bulimia nervosa (n = 69), binge-eating disorder (n = 114), and purging disorder (n = 133) and a control group without EDs or ED symptoms (n = 966). BMI was tracked longitudinally from birth to 12.5 years of age and EDs were assessed at 14, 16, and 18 years of age.


Distinct developmental trajectories emerged for EDs at a young age. The average growth trajectory for individuals with later anorexia nervosa veered significantly below that of the control group before 4 years of age for girls and 2 years for boys. BMI trajectories were higher than the control trajectory for all other ED groups. Specifically, the mean bulimia nervosa trajectory veered significantly above that of controls at 2 years for girls, but boys with later bulimia nervosa did not exhibit higher BMIs. The mean binge-eating disorder and purging disorder trajectories significantly diverged from the control trajectory at no older than 6 years for girls and boys.


Premorbid metabolic factors and weight could be relevant to the etiology of ED. In anorexia nervosa, premorbid low weight could represent a key biological risk factor or early manifestation of an emerging disease process. Observing children whose BMI trajectories persistently and significantly deviate from age norms for signs and symptoms of ED could assist the identification of high-risk individuals.


Avon Longitudinal Study of Parents and Children (ALSPAC); development; eating disorders; premorbid body mass index; prospective


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