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. 2025 Jun 10;58(9):1644–1661. doi: 10.1002/eat.24483

The Prevalence of Eating Disorders and Disordered Eating in Adults Seeking Obesity Treatment: A Systematic Review With Meta‐Analyses

Hannah Melville 1,✉, Natalie B Lister 1, Sol Libesman 2, Anna Lene Seidler 2,3, Hoi Yuk Cheng 4, Yuen Lam Kwan 4, Sarah P Garnett 1,5, Louise A Baur 1, Hiba Jebeile 1
PMCID: PMC12423590  PMID: 40491294

ABSTRACT

Objective

To estimate the prevalence of eating disorders and disordered eating in adults seeking obesity treatment.

Method

Databases, MEDLINE, Embase, and PsycINFO, were searched to 20th March 2025. Studies reporting the prevalence of eating disorders or disordered eating at presentation to obesity treatment in adults (≥ 18 years) with overweight (BMI 25 to < 30 kg/m2) or obesity (BMI ≥ 30 kg/m2), with ≥ 325 participants to ensure a representative sample, were included. A random‐effects model was used to pool prevalence estimates of eating disorders and disordered eating.

Results

85 studies were included (n = 94,295, 75.9% female, median (IQR) age 44 (5) years, BMI 46 (10) kg/m2). When assessed by clinical interview, the pooled prevalence of binge‐eating disorder (Diagnostic and Statistical Manual of Mental Disorders‐5) was 14% (95% CI: 7 to 22, prediction interval [PI]%: 0 to 43, k = 10, n = 8534), and bulimia nervosa 1% (95% CI: 0 to 1, PI%: 0 to 2, k = 9, n = 9448, τ2 = 0). When assessed using the Binge Eating Scale, the prevalence of self‐reported moderate severity binge eating was 26% (95% CI: 23 to 28, PI%: 18 to 33, k = 12, n = 8113, τ2 = 0.001) and severe binge eating was 12% (95% CI: 8 to 16, PI%: 0 to 31, k = 18, n = 12,136, τ2 = 0.01).

Discussion

Obesity and eating disorders or disordered eating do co‐occur. There was variability between studies and between the prevalence of eating disorders and disordered eating in adults presenting for obesity treatment. It is critical that clinicians are well resourced to effectively identify individuals with eating disorders and disordered eating and provide appropriate treatment pathways.

Keywords: binge eating, binge‐eating disorder, bulimia nervosa, disordered eating, eating disorders, high weight, obesity, prevalence, treatment

Summary.

  • Most data on the prevalence of eating disorders with obesity focuses on binge‐eating disorder and binge‐eating behaviors.

  • Obesity and eating disorders or disordered eating do co‐occur, with prevalence varying by both disorder type and severity of behavior.

  • Clinicians need to be resourced so they can identify co‐occurring obesity and eating disorders/disordered eating behaviors and provide appropriate treatment pathways.

1. Background

The global prevalence of obesity has nearly tripled since 1975, with 24% of the population predicted to have obesity by 2035 (World Obesity Federation 2023). Adults with obesity have a high risk of eating disorders and disordered eating behaviors, with binge‐eating disorder and binge eating being the most studied (Da Luz et al. 2018). Further, adults with these co‐occurring conditions are at high risk of both medical and psychosocial complications (Da Luz et al. 2018). Adults with eating disorders are more likely to seek and receive weight loss‐focused treatments than eating disorder treatment (Hart et al. 2011). This is concerning as adults with both obesity and eating disorders may not be receiving appropriate care.

Prevalence rates of eating disorders and disordered eating in adults seeking obesity treatment vary. A 2007 narrative review of 29 studies reported prevalence of binge‐eating disorder in adults seeking bariatric surgery ranging from 2% to 49% (Niego et al. 2007). Similarly, a 2011 narrative review of nine studies in Latin America reported prevalence of binge‐eating disorder from 16% to 51.6% in adults presenting for undefined “weight loss programs” (Palavras et al. 2011). A 2019 narrative review of eight studies found binge‐eating symptoms ranged from 6.1% to 79% (Nightingale and Cassin 2019) and a 2022 systematic review of six studies reported the presence of night eating syndrome in up to 25% of adults presenting for obesity treatment (Kaur et al. 2022).

There are fewer studies reporting the prevalence of other eating disorders. For example, a systematic review from 2021 reported on the prevalence of atypical anorexia nervosa and found that it ranged from 0.15% to 13% in females with obesity depending on the criteria applied and that this occurred more frequently than (low weight) anorexia nervosa in the community (Harrop et al. 2021). There is limited literature on the prevalence of avoidant/restrictive food intake disorder (ARFID) in adults seeking obesity treatment; however, community samples in adolescents with obesity estimate prevalence at 2.6% (Van Buuren et al. 2023). This suggests ARFID and atypical anorexia nervosa may have higher prevalence in adults seeking obesity treatment.

These previous reviews have not included the full spectrum of eating disorders or meta‐analyses and have focused on binge‐eating disorder and binge‐eating behaviors, with many combining assessment methods. The variability of reported prevalence rates of eating disorders and disordered eating in people with obesity makes it difficult to determine the mental health support services needed by individuals seeking obesity treatment. Therefore, a more complete understanding of eating disorder prevalence, across the spectrum of disorders, is needed to inform screening practices within obesity treatment.

Given the current lack of consistent prevalence data and vulnerability of individuals with co‐occurring obesity and eating disorders, it is critical that a more comprehensive estimate of prevalence is formed. Therefore, the aim of this review was to estimate the prevalence of eating disorders and disordered eating in adults seeking obesity treatment.

2. Method

This systematic review with meta‐analyses of prevalence studies was prospectively registered on PROSPERO (CRD42023461340) and reported in accordance with the JBI Manual for Evidence Synthesis (Aromataris and Munn 2020) and Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) (Page et al. 2021). A protocol was not prepared for this review.

2.1. Eligibility Criteria

Studies with adults (≥ 18 years) seeking any obesity treatment, or a mixed sample of adolescents and adults with mean age ≥ 18 years, with overweight (BMI 25 to < 30 kg/m2) or obesity (BMI ≥ 30 kg/m2) were included. Included studies reported a diagnosis of eating disorders or disordered eating by clinical interview or validated self‐report questionnaires, such as the Binge Eating Scale (Gormally et al. 1982) and Night Eating Questionnaire (Allison et al. 2008) at the time of entry into obesity treatment. All eating disorders were included, such as atypical anorexia nervosa (atypical AN), bulimia nervosa (BN), binge‐eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), rumination disorder, pica, unspecified feeding or eating disorder (UFED), other specified feeding or eating disorder (OSFED) (including night eating syndrome, purging disorder and low frequency/duration binge‐eating disorder or bulimia nervosa). Disordered eating behaviors were included, such as loss of control eating, binge eating, purging behaviors, extreme dietary restraint, or drive for thinness. Google Lens was used to translate all foreign language studies (k = 15). Studies of participants seeking co‐treatment for eating disorders and obesity, or with participants with syndromic obesity (e.g., Prader Willi Syndrome) were excluded.

2.2. Sample Size

Inclusion was limited to studies with a minimum sample size of 325, to ensure a representative sample as calculated using the Sample Size Calculator using R & RStudio for Single Proportion (Naing et al. 2022). Using a previously estimated prevalence of 26% (He et al. 2017) for binge and loss of control eating in treatment‐seeking children and adolescents with overweight and obesity, the required sample size was 297 for absolute precision of 5% in estimating the prevalence with 95% confidence. With this sample size, the anticipated 95% confidence interval (CI) was 21% to 31%. Using an estimated prevalence of 4.53% (Duncan et al. 2017) for the past 12‐month DSM‐IV eating disorder diagnosis among adult women with obesity, the required sample size was 325 for absolute precision of 2.3% in estimating the prevalence with 95% confidence. With this sample size, the anticipated 95% CI was 2.3% to 6.8%. The higher minimum participant sample size (n = 325) was selected for this review.

2.3. Search Strategy

Three databases, MEDLINE, Embase, and PsycINFO were searched to 20th March 2025 to identify eligible studies (see Table S1 for search strategy).

2.4. Study Selection

Identified studies were uploaded to Covidence (Covidence 2024) for title and abstract and full text screening, quality assessment, and data extraction. Covidence is a web‐based collaboration software platform that streamlines the production of systematic and other literature reviews (Covidence 2024). Screening was independently conducted in duplicate (H.M., Y.L.K., H.Y.C., and H.J.) with conflicts resolved by discussion or a third reviewer.

2.5. Data Extraction

A study specific data extraction form was developed, including author, title, country, timeframe of data collection, treatment, selection criteria, sample size, participant characteristics (age, sex, ethnicity/race, BMI/weight, and socioeconomic status indices), prevalence data and assessment method (Aromataris and Munn 2020). Data were independently extracted by one reviewer (Y.K. and H.Y.C.), checked for accuracy (H.M.) and disagreements resolved by discussion (H.J.). Methodological quality was independently assessed by one reviewer (Y.L.K. and H.Y.C.) and checked for accuracy (H.M.) using the JBI Critical Appraisal Checklist for studies reporting prevalence data (Munn et al. 2015). For studies that met eligibility criteria with data in the incorrect format, the corresponding and/or senior author were contacted up to two times to request data. Authors of 28 studies were contacted, with data for five studies provided.

2.6. Data Synthesis

Categorical variables were summarized where possible and continuous variables were summarized with medians and IQRs. Meta‐analysis was conducted on R version 4.2.2 (2022‐10‐31) (R Core Team 2022) using meta (Balduzzi et al. 2019) and metafor (Viechtbauer 2010) statistical packages. A random‐effects model was used to pool prevalence estimates of eating disorders and disordered eating. Heterogeneity was measured using 95% prediction intervals (PI), which present the estimated range of likely future means, and between study variation (τ2). To examine final year of data collection as a driver of heterogeneity, meta‐regressions were conducted for outcomes with ≥ 10 studies (Deeks et al. 2019). Subgroup analyses were conducted by treatment type, where bariatric surgery treatments were compared against other treatments, and by sex. Q_M tests evaluated subgroup differences. Subgroup analyses by country was examined visually, however, data were too sparse and heterogeneous for coherent analyses. Publication bias and small study effects were examined through visual inspection of funnel plots and Egger's test (Schmid et al. 2020).

3. Results

From 5762 articles screened, 85 studies (k) were included (see Figure 1 for PRISMA flow diagram). Studies were published between 1985 and 2025, with most conducted in the United States (k = 43) and Italy (k = 17). Across all participants (n = 94,295, 75.9% females), median age was 44 years (IQR = 5) and BMI 46 kg/m2 (IQR = 10). One study (Leone et al. 2016) reported a median BMI < 30 kg/m2. Participants were presenting for bariatric surgery (k = 49), behavioral weight management (k = 9), multiple treatment options (k = 8), low/very low energy diets (k = 3), pharmacotherapy (k = 1), behavioral/psychodynamic rehabilitation (k = 1) or undefined obesity treatments (k = 14). Further study characteristics were summarized in Table S2. Prevalence rates were reported across multiple eating disorders and disordered eating behaviors; see Table 1 for the summary of results grouped by symptomology. Most studies reported on binge‐eating disorder (k = 46), followed by self‐report binge eating (k = 32). The most common assessment method was clinical interview (k = 34), followed by the Binge Eating Scale (Gormally et al. 1982) (k = 21). No studies reported on avoidant/restrictive food intake disorder, pica, rumination, or purging disorder. Five studies (Bianciardi, Fabbricatore, et al. 2019; Calugi et al. 2025; Dalle Grave, Misconel, et al. 2020; Dalle Grave, Ruocco, et al. 2020; Imperatori et al. 2020; Micanti et al. 2017) reported excluding participants based on the presence of eating disorders and/or disordered eating. Of these, three studies (Calugi et al. 2025; Dalle Grave, Misconel, et al. 2020; Dalle Grave, Ruocco, et al. 2020; Micanti et al. 2017) reported the number of participants that were excluded according to these criteria, and data were extracted and included in this review. These data included eating disorder diagnoses of bulimia nervosa and/or low frequency bulimia nervosa, night eating syndrome, and other specified feeding or eating disorders. Two studies (Bianciardi, Fabbricatore, et al. 2019; Imperatori et al. 2020; Imperatori et al. 2016) excluded participants with purging and non‐purging compensatory behaviors, and the number of participants excluded were not reported. For these studies, data from the Binge Eating Scale data were extracted.

FIGURE 1.

FIGURE 1

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PRISMA flow diagram.

TABLE 1.

Summary of results stratified by symptomology.

Eating disorder/disordered eating behaviors Assessment tool Number of studies, combined sample size (n) Prevalence range (%)
Eating disorders (type of eating disorder was not specified) Clinical interview 9 (Björkman et al. 2024; Duarte‐Guerra et al. 2015; Friedman et al. 2007; Kiser et al. 2023; Lagerros et al. 2020; Legenbauer et al. 2007; Legenbauer et al. 2009; Legenbauer et al. 2011; Lin et al. 2013; Marek et al. 2024; Zimmerman et al. 2007), n = 27,329 1.3% – 31.9%
SCOFF 1 (Arnal‐Couderc et al. 2020), n = 330 47.0%
EDE‐Q global score > 3.5 1 (Castellini et al. 2008), n = 397 20.9%
QEWP 1 (Bergstrom and Elfhag 2007), n = 550 9.8%
EAT‐26 (score > 20) 1 (Altun et al. 2023), n = 1248 20.8%
EAT‐40 (score > 30) 1 (Eladawi et al. 2018), n = 400 65.0%
Binge eating
Binge‐eating disorder Clinical interview – all criteria 29 (Albert et al. 2025; Azarbad et al. 2010; Beutel et al. 2006; Bianciardi, Di Lorenzo, et al. 2019; Bianciardi, Gentileschi, et al. 2021; Bianciardi, Imperatori, et al. 2021; Bonnefond et al. 2016; Busetto et al. 2005; Calderone et al. 2015; Castellini et al. 2014; Castellini et al. 2008; Costello et al. 2023; Dalle Grave, Misconel, et al. 2020; Dalle Grave, Ruocco, et al. 2020; Duarte‐Guerra et al. 2017, 2018; Duarte‐Guerra et al. 2015; Grupski et al. 2013; Hilbert et al. 2022; Kiser et al. 2023; Lin et al. 2013; Marek, Williams, et al. 2017; Marek et al. 2014; Marek, Ben‐Porath, et al. 2017; Marek et al. 2024; Marek et al. 2015; Melchionda et al. 2003; Ricca et al. 2009; Schafer et al. 2017; Sockalingam et al. 2017; Vamado et al. 1997; Walsh et al. 2017; Webb et al. 2011; Wolnerhanssen et al. 2008; Zimmerman et al. 2007), n = 21,145 1.3% – 41.1%

Clinical interview

DSM‐IV only

19 (Azarbad et al. 2010; Beutel et al. 2006; Busetto et al. 2005; Calderone et al. 2015; Castellini et al. 2008; Duarte‐Guerra et al. 2017, 2018; Duarte‐Guerra et al. 2015; Grupski et al. 2013; Lin et al. 2013; Marek, Williams, et al. 2017; Marek et al. 2014; Marek, Ben‐Porath, et al. 2017; Marek et al. 2015; Melchionda et al. 2003; Ricca et al. 2009; Sockalingam et al. 2017; Vamado et al. 1997; Walsh et al. 2017; Webb et al. 2011; Wolnerhanssen et al. 2008; Zimmerman et al. 2007), n = 13,447 1.3% – 41.1%

Clinical interview

DSM‐5 only

10 (Bianciardi, Di Lorenzo, et al. 2019; Bianciardi, Gentileschi, et al. 2021; Bianciardi, Imperatori, et al. 2021; Bonnefond et al. 2016; Castellini et al. 2014; Costello et al. 2023; Dalle Grave, Misconel, et al. 2020; Dalle Grave, Ruocco, et al. 2020; Hilbert et al. 2022; Kiser et al. 2023; Marek et al. 2014; Marek et al. 2024; Schafer et al. 2017), n = 8534 3.4% – 27.9%
QEWP 17 (Ames et al. 2015; Ames et al. 2017; Bergstrom and Elfhag 2007; Björkman et al. 2024; Björkman et al. 2020; Chao et al. 2020; Gorin et al. 2008; Grilo et al. 2005; Gustafson et al. 2006; Jeffery et al. 2004; Koball et al. 2021; Kolotkin et al. 2004; Levy et al. 2005; Mazzeo et al. 2005, 2006; Mitchell et al. 2015; Rubinstein et al. 2010; Vamado et al. 1997), n = 19,848 2.6% – 25.3%
Eating Disorder Diagnostic Scale 1 (Smith et al. 2020), n = 341 16.1%
Subthreshold/binge‐eating disorder Clinical interview 1 (Micanti et al. 2017), n = 1828 10.2%
Subthreshold binge‐eating disorder Clinical interview 2 (Hilbert et al. 2022; Ricca et al. 2009), n = 1186 2.7% – 33.3%
QEWP 1 (Holgerson et al. 2021), n = 1034 9.4%
Binge eating (moderate severity, scores 18–26, 17–25, 17–26) BES, score 18–26 (k = 10), 17–25 (k = 1), 17–26 (k = 1) 12 (Ariel and Perri 2016; Cheung et al. 2022; Corsica et al. 2012; Dalle Grave et al. 2013; Heinberg et al. 2012; Hood et al. 2013; Imperatori et al. 2016; Innamorati et al. 2014; Innamorati et al. 2015; McGarrity et al. 2019; Nasirzadeh et al. 2018; Shakory et al. 2015; Soulliard et al. 2021), n = 8113 20.3% – 32.0%
Binge eating (moderate to severe, scores > 16, > 17, > 18) BES, score > 16 (k = 1), > 17 (k = 2), > 18 (k = 3) 6 (Bianciardi, Fabbricatore, et al. 2019; Franklin et al. 2020; Grupski et al. 2013; Imperatori et al. 2020; Leone et al. 2016; Marchesini et al. 2004; Sockalingam et al. 2017), n = 9415 16.3% – 39.3%
Binge eating (severe, scores > 27, ≥ 27, > 26, > 25) BES, score > 27 (k = 10), ≥ 27 (k = 4), > 26 (k = 3), > 25 (k = 1) 18 (Ariel and Perri 2016; Azarbad et al. 2010; Bianciardi, Fabbricatore, et al. 2019; Cheung et al. 2022; Corsica et al. 2012; Dalle Grave et al. 2013; Grupski et al. 2013; Heinberg et al. 2012; Hood et al. 2013; Imperatori et al. 2020; Imperatori et al. 2016; Innamorati et al. 2014; Innamorati et al. 2015; Marchesini et al. 2004; Marcus et al. 1985; McGarrity et al. 2019; Nasirzadeh et al. 2018; Shakory et al. 2015; Sherwood et al. 1999; Soulliard et al. 2021), n = 12,136 2.2% – 46.0%
Binge eating Clinical interview (undefined presence of binge eating) 3 (Levin et al. 2014; Marek et al. 2024; Vamado et al. 1997), n = 2142 9.4% – 25.6%
QEWP (undefined presence of binge eating) 6 (Butt et al. 2021; Butt et al. 2023; Gorin et al. 2008; Mitchell et al. 2015; Still et al. 2011; Vamado et al. 1997), n = 9817 9.1% – 40.6%
Survey for eating disorders (binge eating for past 3 months) 1 (Kvalem et al. 2016), n = 555 29.0%
Frequency of binge eating Clinical interview (1 binge episode per week) 1 (Marek et al. 2015), n = 517 28.0%
EDE‐Q (≥ 1 binge episode per week) 1 (Grilo et al. 2005), n = 340 22.4%
EDE‐Q (1 day of binge eating in past month) 1 (McGarrity et al. 2019), n = 394 56.1%
EDE‐Q (binge eating > 5 days in past month) 1 (McGarrity et al. 2019), n = 394 15.0%
QEWP (≥ 2 binge episode per week) 1 (Jeffery et al. 2004), n = 2213 41.6%
Objective binge eating Clinical interview 3 (Dalle Grave, Misconel, et al. 2020; Dalle Grave, Ruocco, et al. 2020; Hilbert et al. 2022; Levin et al. 2014), n = 2701 12.2% – 32.0%
EDE‐Q 1 (Parker et al. 2016), n = 378 49.5%
Subjective binge eating Clinical interview 3 (Dalle Grave, Misconel, et al. 2020; Dalle Grave, Ruocco, et al. 2020; Hilbert et al. 2022; Levin et al. 2014), n = 2700 9.6% – 12.3%
Loss of control eating Clinical interview 2 (Hilbert et al. 2022; Marek et al. 2024), n = 1602 20.8% – 22.5%
QEWP 1 (Butt et al. 2023), n = 587 6.3%
EDE‐Q 2 (McGarrity et al. 2019; White et al. 2010), n = 755 53.0% – 61.2%
Episodic overeating QEWP 1 (Still et al. 2011), n = 690 14.1%
EDE‐Q (≥ 1 episode of eating an unusually large amount of food in past month) 1 (McGarrity et al. 2019), n = 394 67.0%
Bulimia
Bulimia nervosa Clinical interview 9 (Calugi et al. 2025; Costello et al. 2023; Dalle Grave, Misconel, et al. 2020; Dalle Grave, Ruocco, et al. 2020; Duarte‐Guerra et al. 2017, 2018; Duarte‐Guerra et al. 2015; Hilbert et al. 2022; Lin et al. 2013; Micanti et al. 2017; Walsh et al. 2017; Zimmerman et al. 2007), n = 9448 0.1% – 3.6%
QEWP 1 (Bergstrom and Elfhag 2007), n = 550 3.1%
Subthreshold/probable bulimia nervosa Clinical interview 3 (Calugi et al. 2025; Dalle Grave, Misconel, et al. 2020; Dalle Grave, Ruocco, et al. 2020; Hilbert et al. 2022), n = 2511 1.5% – 2.8%
The Bulimia Test‐Revised, score ≥ 104 1 (Canivet et al. 2020), n = 388 3.6%
Compensatory behaviors
Any compensatory behavior Clinical interview 1 (Hilbert et al. 2022), n = 747 0.4%
Diuretic misuse Clinical interview 2 (Dalle Grave, Misconel, et al. 2020; Dalle Grave, Ruocco, et al. 2020; Hilbert et al. 2022), n = 1882 0.3% – 0.4%
Laxative misuse Clinical interview 3 (Dalle Grave, Misconel, et al. 2020; Dalle Grave, Ruocco, et al. 2020; Hilbert et al. 2022; McGarrity et al. 2019), n = 2276 0.2% – 3.0%
Self‐induced vomiting Clinical interview 3 (Dalle Grave, Misconel, et al. 2020; Dalle Grave, Ruocco, et al. 2020; Hilbert et al. 2022; McGarrity et al. 2019), n = 2276 0.0% – 2.0%
Other compensatory behaviors (other than exercise, purging, diuretics, laxatives) Clinical interview 1 (Hilbert et al. 2022), n = 747 0.4%
Night eating
Night eating syndrome Clinical interview 5 (Albert et al. 2025; Hilbert et al. 2022; Micanti et al. 2017; Schafer et al. 2017; Sockalingam et al. 2017), n = 4488 0.8% – 10.1%
NEQ, score ≥ 18 (k = 1) 1 (Kara et al. 2020), n = 421 21.9%
NEQ, score ≥ 25 (k = 1), > 25 (k = 2) 3 (Breen et al. 2019; Lent et al. 2022; Nasirzadeh et al. 2018), n = 2572 4.7%–28.0%
NEQ, score ≥ 30 (k = 2), > 30 (k = 1) 3 (Atik et al. 2019; Dalle Grave et al. 2015; Dalle Grave et al. 2013; Nasirzadeh et al. 2018), n = 2145 3.1%–13.1%
Presence of night eating QEWP 1 (Björkman et al. 2020), n = 1132 13.0%
Clinical interview 4 (Björkman et al. 2024; Busetto et al. 2005; Hilbert et al. 2022; Marek et al. 2024), n = 3099 4.2% – 21.5%
NEQ 1 (Mitchell et al. 2015), n = 2456 17.5%
Atypical anorexia nervosa
Atypical anorexia nervosa Clinical interview 2 (Hilbert et al. 2022; Lin et al. 2013), n = 1584 0% – 0.2%
Extreme dietary restraint Clinical interview 2 (Hilbert et al. 2022; Marek et al. 2024), n = 1576 0.6% – 11.8%
Other eating disorders
Other eating disorders a Clinical interview 7 (Duarte‐Guerra et al. 2015; Friedman et al. 2007; Kiser et al. 2023; Lagerros et al. 2020; Legenbauer et al. 2007; Legenbauer et al. 2009; Legenbauer et al. 2011; Lin et al. 2013; Zimmerman et al. 2007), n = 26,014 0.3% – 32%
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Abbreviations: BES, binge eating scale; BULIT, bulimia test; EAT, eating attitudes test; EDE‐Q, eating disorder examination questionnaire; NEQ, night eating questionnaire; QEWP, questionnaire on eating and weight patterns; SCOFF, sick control one fat food.

a

Other eating disorders included unspecified feeding or eating disorder (UFED), other specified feeding or eating disorder (OSFED) and eating disorders not otherwise specified (EDNOS).

3.1. Binge‐Eating Disorder and Binge‐Eating Behaviors

The pooled prevalence of binge‐eating disorder, assessed by clinical interview using DSM‐IV criteria, was 17% (95% CI: 12 to 22, k = 19 [Azarbad et al. 2010; Beutel et al. 2006; Busetto et al. 2005; Calderone et al. 2015; Castellini et al. 2008; Duarte‐Guerra et al. 2017, 2018; Duarte‐Guerra et al. 2015; Grupski et al. 2013; Lin et al. 2013; Marek, Williams, et al. 2017; Marek et al. 2014; Marek, Ben‐Porath, et al. 2017; Marek et al. 2015; Melchionda et al. 2003; Ricca et al. 2009; Sockalingam et al. 2017; Vamado et al. 1997; Walsh et al. 2017; Webb et al. 2011; Wolnerhanssen et al. 2008; Zimmerman et al. 2007], n = 13,447, τ2 = 0.01) with a prediction interval of 0% to 42%. Using DSM‐5 criteria, pooled prevalence was 14% and the prediction interval was 0% to 43% (95% CI: 7 to 22, k = 10 [Bianciardi, Di Lorenzo, et al. 2019; Bianciardi, Gentileschi, et al. 2021; Bianciardi, Imperatori, et al. 2021; Bonnefond et al. 2016; Castellini et al. 2014; Costello et al. 2023; Dalle Grave, Misconel, et al. 2020; Dalle Grave, Ruocco, et al. 2020; Hilbert et al. 2022; Kiser et al. 2023; Marek et al. 2014; Marek et al. 2024; Schafer et al. 2017], n = 8534, τ2 = 0.02) (Figures 2 and 3). When assessed using the self‐report Questionnaire on Eating and Weight Patterns, pooled prevalence of binge‐eating disorder was 12% (95% CI: 9 to 16, k = 17 [Ames et al. 2015; Ames et al. 2017; Bergstrom and Elfhag 2007; Björkman et al. 2024; Björkman et al. 2020; Chao et al. 2020; Gorin et al. 2008; Grilo et al. 2005; Gustafson et al. 2006; Jeffery et al. 2004; Koball et al. 2021; Kolotkin et al. 2004; Levy et al. 2005; Mazzeo et al. 2005, 2006; Mitchell et al. 2015; Rubinstein et al. 2010; Vamado et al. 1997], n = 19,848, τ2 = 0.002) with a prediction interval of 0% to 29% (Figure S1). Egger's tests for funnel plot asymmetry were significant, indicating the possibility of bias for binge‐eating disorder DSM‐IV (z = 8.64, p < 0.0001, b = −0.0512, 95% CI: −0.1054 to 0.0031), binge‐eating disorder DSM‐5 (z = 3.75, p = 0.0002, b = −0.1332, 95% CI: −0.2848 to 0.0184), and binge‐eating disorder as measured by the Questionnaire on Eating and Weight Patterns (z = 3.63, p = 0.0003, b = 0.0049, 95% CI: −0.0646 to 0.0744). These funnel plot asymmetry tests showed prevalence increased as study size decreased.

FIGURE 2.

FIGURE 2

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Forest plot of binge‐eating disorder diagnosed by clinical interview (DSM‐IV).

FIGURE 3.

FIGURE 3

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Forest plot of binge‐eating disorder diagnosed by clinical interview (DSM‐5).

The pooled prevalence of self‐report moderate severity binge eating, defined as Binge Eating Scale scores 17–26, was 26% (95% CI: 23 to 28, k = 12 [Ariel and Perri 2016; Cheung et al. 2022; Corsica et al. 2012; Dalle Grave et al. 2013; Heinberg et al. 2012; Hood et al. 2013; Imperatori et al. 2016; Innamorati et al. 2014; Innamorati et al. 2015; McGarrity et al. 2019; Nasirzadeh et al. 2018; Shakory et al. 2015; Soulliard et al. 2021], n = 8113, τ2 = 0.001) with a prediction interval of 18% to 33%. Self‐report severe binge eating, with Binge Eating Scale scores > 25, had a pooled prevalence of 12% (95% CI: 8 to 16, k = 18 [Ariel and Perri 2016; Azarbad et al. 2010; Bianciardi, Fabbricatore, et al. 2019; Cheung et al. 2022; Corsica et al. 2012; Dalle Grave et al. 2013; Grupski et al. 2013; Heinberg et al. 2012; Hood et al. 2013; Imperatori et al. 2020; Imperatori et al. 2016; Innamorati et al. 2014; Innamorati et al. 2015; Marchesini et al. 2004; Marcus et al. 1985; McGarrity et al. 2019; Nasirzadeh et al. 2018; Shakory et al. 2015; Sherwood et al. 1999; Soulliard et al. 2021], n = 12,136, τ2 = 0.01) with a prediction interval of 0% to 31% (Figures 4 and 5). Post hoc sensitivity analysis examined severe binge eating after removing the 1985 study (Marcus et al. 1985). This study was a substantial outlier and the oldest included study, occurring 40 years prior to this review. After removing this study, the pooled prevalence was 10% (95% CI: 8 to 12, k = 17 [Ariel and Perri 2016; Azarbad et al. 2010; Bianciardi, Fabbricatore, et al. 2019; Cheung et al. 2022; Corsica et al. 2012; Dalle Grave et al. 2013; Grupski et al. 2013; Heinberg et al. 2012; Hood et al. 2013; Imperatori et al. 2020; Imperatori et al. 2016; Innamorati et al. 2014; Innamorati et al. 2015; Marchesini et al. 2004; McGarrity et al. 2019; Nasirzadeh et al. 2018; Shakory et al. 2015; Sherwood et al. 1999; Soulliard et al. 2021], n = 11,706, τ2 = 0.0014) with a prediction interval of 2% to 19% (Figure S2). Egger's tests for funnel plot asymmetry were significant and showed prevalence increased as study size decreased. This indicated the possibility of bias for self‐report severe binge eating (z = 4.84, p < 0.0001, b = −0.0976, 95% CI: −0.1900 to −0.0053); however, there was no significant asymmetry for moderate severity binge eating.

FIGURE 4.

FIGURE 4

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Forest plot of moderate binge eating measured using the Binge Eating Scale (scores 17–26).

FIGURE 5.

FIGURE 5

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Forest plot of severe binge eating measured using the Binge Eating Scale (scores > 25).

3.2. Other Eating Disorders

When assessed by clinical interview, the pooled prevalence of night eating syndrome was 5% with a prediction interval of 0% to 17% (95% CI: 2 to 9, k = 5 [Albert et al. 2025; Hilbert et al. 2022; Micanti et al. 2017; Schafer et al. 2017; Sockalingam et al. 2017], n = 4488, τ2 = 0.002, Figure S3), bulimia nervosa was 1% with a prediction interval of 0% to 2% (95% CI: 0 to 1, k = 9 [Calugi et al. 2025; Costello et al. 2023; Dalle Grave, Misconel, et al. 2020; Dalle Grave, Ruocco, et al. 2020; Duarte‐Guerra et al. 2017, 2018; Duarte‐Guerra et al. 2015; Hilbert et al. 2022; Lin et al. 2013; Micanti et al. 2017; Walsh et al. 2017; Zimmerman et al. 2007], n = 9448, τ2 = 0) (Figure S4) and that of disorders where the type was not specified was 11% with a prediction interval of 0% to 36% (95% CI: 4 to 18, k = 9 [Duarte‐Guerra et al. 2015; Friedman et al. 2007; Kiser et al. 2023; Lagerros et al. 2020; Legenbauer et al. 2007; Legenbauer et al. 2009; Legenbauer et al. 2011; Lin et al. 2013; Zimmerman et al. 2007], n = 27,329, τ2 = 0.01, Figure S5). Egger's tests for funnel plot asymmetry were significant for bulimia nervosa (z = 5.58, p < 0.001, b = −0.0007, CI: −0.0020 to 0.0007) and eating disorders when not specified (z = 3.84, p = 0.0001, b = −0.0495, CI: −0.1396 to 0.0407) indicating possible evidence of bias and showing that prevalence increased as study size decreased, but not for night eating syndrome. The prevalence of atypical anorexia nervosa, assessed by clinical interview, was 0.2% in one study (Lin et al. 2013) and a second study (Hilbert et al. 2022) reported no cases.

3.3. Sensitivity Analyses

Egger's tests for funnel plot asymmetry were significant for most outcomes and showed prevalence increased as study size decreased. To examine the potential bias of smaller studies post hoc sensitivity analyses were conducted, filtering studies for a minimum sample size of 750 participants (see Table S3). Egger's tests remained significant for all outcomes except severe binge eating, indicating larger studies tended to be associated with lower prevalence. The pooled estimates for studies with a minimum sample of 750 participants, when compared to the original minimum sample of 325 participants, were similar. The exception was binge‐eating disorder when assessed by the clinical interview (DSM‐5), where the pooled prevalence increased from 14% to 20%.

3.4. Meta‐Regression

Meta‐regression showed the final year of data collection was significantly associated with the prevalence of self‐report severe binge eating (using Binge Eating Scale scores > 25) where prevalence decreased over time (p < 0.01; Figure S6). There were no associations for other outcomes including bulimia nervosa (clinical interview), binge‐eating disorder (DSM‐IV, DSM‐5, Questionnaire on Eating, and Weight Patterns), binge eating (Binge Eating Scale scores 17–26), night eating syndrome (clinical interview), and eating disorders when the type not specified (clinical interview).

3.5. Prevalence by Subgroup

3.5.1. Treatment

Subgroup analyses compared bariatric surgery treatments against non‐bariatric surgery treatments, such as behavioral weight management, pharmacotherapy, multiple interventions, or undefined treatments. The prevalence of binge‐eating disorder diagnosed by clinical interview using DSM‐IV in adults presenting for bariatric surgery treatment was 18% (95% CI: 11 to 25, k = 13 [Azarbad et al. 2010; Busetto et al. 2005; Calderone et al. 2015; Duarte‐Guerra et al. 2015; Grupski et al. 2013; Marek, Williams, et al. 2017; Marek et al. 2014; Marek, Ben‐Porath, et al. 2017; Marek et al. 2015; Sockalingam et al. 2017; Walsh et al. 2017; Webb et al. 2011; Wolnerhanssen et al. 2008; Zimmerman et al. 2007], n = 9881), and 15% in non‐bariatric surgery treatment (95% CI: 8 to 23, k = 6 [Beutel et al. 2006; Castellini et al. 2008; Lin et al. 2013; Melchionda et al. 2003; Ricca et al. 2009; Vamado et al. 1997], n = 3566) (Figure S7). When binge‐eating disorder was diagnosed using DSM‐5 criteria, the prevalence in adults presenting for bariatric surgery treatments was 14% (95% CI: 5 to 22, k = 8 [Bianciardi, Gentileschi, et al. 2021; Bianciardi, Imperatori, et al. 2021; Bonnefond et al. 2016; Costello et al. 2023; Hilbert et al. 2022; Kiser et al. 2023; Marek et al. 2014; Marek et al. 2024; Schafer et al. 2017], n = 6155), and 17% (95% CI: 0 to 38, k = 2 [Castellini et al. 2014; Dalle Grave, Misconel, et al. 2020; Dalle Grave, Ruocco, et al. 2020], n = 2379) in non‐bariatric surgery treatments (Figure S8). For bulimia nervosa diagnosed by clinical interview, the prevalence was 1% in both bariatric surgery (95% CI: 0 to 2, k = 5 [Costello et al. 2023; Duarte‐Guerra et al. 2015; Hilbert et al. 2022; Walsh et al. 2017; Zimmerman et al. 2007], n = 5016) and non‐bariatric surgery treatments (95% CI: 0 to 1, k = 4 [Calugi et al. 2025; Dalle Grave, Misconel, et al. 2020; Dalle Grave, Ruocco, et al. 2020; Lin et al. 2013; Micanti et al. 2017], n = 4432) (Figure S9). There were insufficient data to reliably interpret the subgroup analysis for night eating syndrome when diagnosed by clinical interview (Figure S10). All Q_M tests for subgroup differences revealed no significant differences between treatment groups for any eating disorder or disordered eating outcomes. For further subgroup analyses results, see Figures S11–S14. For summarized results by treatment, see Table S4.

3.5.2. Clinical Interview Categories

Post hoc subgroup analyses compared clinical interview categories for all outcomes diagnosed by clinical interview. Interview categories included the Eating Disorder Examination (EDE) and Structured Clinical Interview DSM Disorders (SCID), with all other interviews and undefined interviews combined into one category. The prevalence of binge‐eating disorder diagnosed by the SCID using DSM‐IV was 11% (95% CI: 5 to 16, k = 7 [Calderone et al. 2015; Duarte‐Guerra et al. 2015; Grupski et al. 2013; Lin et al. 2013; Ricca et al. 2009; Walsh et al. 2017; Zimmerman et al. 2007], n = 13,447), and 22% using other/undefined interviews (95% CI: 15 to 29, k = 11 [Azarbad et al. 2010; Beutel et al. 2006; Busetto et al. 2005; Castellini et al. 2008; Marek et al. 2014; Marek, Ben‐Porath, et al. 2017; Marek et al. 2015; Sockalingam et al. 2017; Vamado et al. 1997; Webb et al. 2011; Wolnerhanssen et al. 2008], n = 6195) (see Figure S15). When binge‐eating disorder was diagnosed by the EDE using DSM‐5 criteria, the prevalence was 10% (95% CI: 0 to 22, k = 4 [Castellini et al. 2014; Dalle Grave, Misconel, et al. 2020; Hilbert et al. 2022; Schafer et al. 2017], n = 3497) and 17% (95% CI: 7 to 27, k = 6 [Bianciardi, Gentileschi, et al. 2021; Bianciardi, Imperatori, et al. 2021; Bonnefond et al. 2016; Costello et al. 2023; Kiser et al. 2023; Marek et al. 2014; Marek et al. 2024], n = 5037) using the other/undefined interviews (see Figure S16). For bulimia nervosa, the prevalence was 1% for the EDE (95% CI: 0 to 1, k = 3 [Calugi et al. 2025; Dalle Grave, Misconel, et al. 2020; Dalle Grave, Ruocco, et al. 2020; Hilbert et al. 2022], n = 2511), the SCID (95% CI: 0 to 2, k = 4 [Duarte‐Guerra et al. 2015; Lin et al. 2013; Walsh et al. 2017; Zimmerman et al. 2007], n = 4779) and other/undefined interviews (95% CI: 0 to 1, k = 2 [Costello et al. 2023; Micanti et al. 2017], n = 2158) (see Figure S17). For night eating syndrome, the prevalence was 3% (95% CI: 0 to 8, k = 2 [Hilbert et al. 2022; Schafer et al. 2017], n = 1114) for the EDE and 6% for other/undefined interviews (95% CI: 1 to 11, k = 3 [Albert et al. 2025; Micanti et al. 2017; Sockalingam et al. 2017], n = 3374) (see Figure S18). For eating disorders not specified, the prevalence was 11% (95% CI: 2 to 20, k = 3 [Duarte‐Guerra et al. 2015; Lin et al. 2013; Zimmerman et al. 2007], n = 1734) when the SCID was used, and similarly 12% (95% CI: 1 to 24, k = 5 [Friedman et al. 2007; Kiser et al. 2023; Lagerros et al. 2020; Legenbauer et al. 2007; Marek et al. 2024], n = 25,134) for other/undefined interviews (see Figure S19). All Q_M tests for subgroup differences revealed no significant differences between clinical interview category for eating disorder outcomes, except for binge‐eating disorder when using DSM‐IV criteria (p = 0.04).

3.5.3. Sex

Subgroup analyses were conducted by sex for available outcomes. For binge‐eating disorder diagnosed by clinical interview, the prevalence was 19% (95% CI: 11 to 27, k = 3 [Bonnefond et al. 2016; Duarte‐Guerra et al. 2017, 2018; Duarte‐Guerra et al. 2015; Melchionda et al. 2003], n = 2127) for females, and 16% (95% CI: 3 to 29, k = 3 [Bonnefond et al. 2016; Duarte‐Guerra et al. 2017, 2018; Duarte‐Guerra et al. 2015; Melchionda et al. 2003], n = 598) for males (see Figure S20). The prevalence for binge‐eating disorder assessed by the Questionnaire for Eating and Weight Patterns (self‐reported) was 18% (95% CI: 10 to 27, k = 4 [Björkman et al. 2024; Björkman et al. 2020; Kolotkin et al. 2004; Mazzeo et al. 2005, 2006], n = 2283) for females and 15% (95% CI: 10 to 21, k = 4 [Björkman et al. 2024; Björkman et al. 2020; Kolotkin et al. 2004; Mazzeo et al. 2005, 2006], n = 988) for males (see Figure S21). The prevalence of self‐report moderate to severe binge eating as assessed by the Binge Eating Scale scores ≥ 18 was 26% (95% CI: 13 to 39, k = 2 [Franklin et al. 2020; Leone et al. 2016], n = 3993) for females and 42% (95% CI: 0 to 100, k = 2 [Franklin et al. 2020; Leone et al. 2016], n = 1558) for males (see Figure S22). The prevalence of night eating symptoms assessed by the Questionnaire on Eating and Weight Patterns was 10% (95% CI: 5 to 10, k = 2 [Björkman et al. 2024; Björkman et al. 2020], n = 1557) for females and 12% (95% CI: 8 to 14, k = 2 [Björkman et al. 2024; Björkman et al. 2020], n = 697) for males (see Figure S23). All Q_M tests for subgroup differences indicated no significant differences by sex. Prevalence data was summarized in Table S5.

3.5.4. Additional Subgroups

Meta‐analyses by race and/or ethnicity and by mental health co‐morbidity were not conducted due to limited reporting. Prevalence data were summarized in Tables S6 and S7, respectively.

3.6. Quality Assessment

No studies were excluded based on quality assessment; see Figure S24 for individual results. Two domains were most frequently selected as “unclear” due to insufficient reporting. Forty‐three studies were rated as unclear for whether the condition was measured in a standard and reliable way. Thirty‐nine studies were rated as unclear as the response rate was not well described. For results by question, see Figure S25.

4. Discussion

This is the first study using meta‐analyses to estimate the prevalence of eating disorders and disordered eating behaviors in adults seeking obesity treatment. Most studies assessed binge‐eating disorder and self‐report binge‐eating behaviors, with few studies assessing the full spectrum of eating disorders. Only two studies reported on atypical anorexia nervosa and four on night eating syndrome, with no studies identified assessing avoidant/restrictive food intake disorder or pica. Estimated pooled prevalence rates for binge‐eating disorder (DSM‐5) were 14%, self‐report binge eating between 12% and 26% depending on severity, bulimia nervosa 1%, night eating syndrome 5%, and eating disorder type not specified 11%. These meta‐analyses show eating disorders and disordered eating are present in a proportion of adults seeking obesity treatment. Prevalence estimates varied based on disorder type and severity of behavior, with many measures having wide prediction intervals indicating heterogeneity across studies. Given the estimated prevalence of eating disorders and disordered eating, it is important that clinicians in obesity treatment settings identify these individuals and have appropriate referral pathways to support them. Where reported, approximately half of individuals presenting with eating disorders had additional mental health comorbidities. This further highlights the vulnerability of this population as well as the complexity of management for people with co‐occurring eating disorders and obesity.

Most studies (k = 49, 58%) meeting the sample size requirement were conducted in participants seeking bariatric surgery. Subgroup analyses revealed no significant differences in prevalence rates between studies in bariatric surgery and non‐bariatric surgery treatment settings. These results should be cautiously interpreted, as there were limited studies available in non‐bariatric surgery treatment settings including behavioral weight management and pharmacotherapy. Sensitivity analyses with an increased minimum sample size suggested larger studies were associated with lower prevalences of eating disorder and disordered eating outcomes. More research is needed using standardized assessments and larger samples to have a more accurate prevalence estimate.

This review revealed approximately one in four treatment‐seeking adults with obesity may self‐report moderate binge eating using the Binge Eating Scale, and one in seven may present with binge‐eating disorder assessed by clinical interview (DSM‐5). Compared to community samples, this review found considerably higher rates of binge‐eating disorder in adults presenting for obesity treatment. For example, based on the 2013 United States population survey of 3144 adults, the 3‐month prevalence of self‐report binge‐eating disorder using DSM‐5 criteria was 2.99% in adults with BMI ≥ 35 kg/m2 (Cossrow et al. 2016). Similarly, a 2003 United States survey of 12,337 adults reported the 12‐month prevalence of binge‐eating disorder, assessed by clinical interview, using DSM‐IV criteria for BMI ≥ 30 kg/m2 was 3.51% in women and 1.24% in men (Duncan et al. 2017). Binge‐eating disorder is associated with obesity, and individuals with co‐occurring binge‐eating disorder and obesity are at higher risk of metabolic syndrome and type 2 diabetes mellitus compared to individuals living with obesity alone (Hudson et al. 2010; Raevuori et al. 2015). Despite this comorbidity, obesity and eating disorder treatments are generally siloed (Crone et al. 2023; Hay et al. 2014; Jensen et al. 2014; National Health and Medical Research Council 2013; National Institute for Health and Care Excellence 2014; UK National Guideline Alliance 2017). Recent Australian National Eating Disorder Collaboration guidelines addressed the assessment and treatment of eating disorders in people with higher weight but did not address the cardiometabolic comorbidities associated with higher weight (Ralph et al. 2022). Despite concerns that obesity treatments exacerbate eating disorder risk, previous reviews have shown most adults receiving obesity treatment experience improvements in eating disorder outcomes including global eating disorder risk, binge‐eating severity, and binge‐eating episodes (Da Luz et al. 2015; Jebeile et al. 2023; Peckmezian and Hay 2017). In adults seeking binge‐eating disorder treatment, impact on weight outcomes is variable, with many studies not resulting in significant weight loss (Hilbert et al. 2020; Pacanowski et al. 2018) and cardiometabolic outcomes being infrequently reported (Yurkow et al. 2023). However, in individuals with binge‐eating disorder and obesity who do achieve ≥ 5% to < 10% weight loss during obesity treatment, cardiometabolic risk factors including HDL cholesterol, triglycerides, HbA1c, and fasting glucose have been shown to improve (Yurkow et al. 2023). This demonstrates the importance of measuring outcomes beyond weight and eating disorders to understand the holistic health impact of treatments.

Co‐treatment for binge‐eating disorder and obesity using behavioral weight management, cognitive behavior therapies, and pharmacotherapy is an important and emerging area of research (Grilo and Juarascio 2023). A 2021 randomized controlled trial (RCT) tested the effectiveness of behavioral weight management adapted for binge‐eating disorder and naltrexone‐bupropion (alone and in combination) for 136 adults with co‐occurring binge‐eating disorder and obesity (Grilo et al. 2022). Results showed groups receiving behavioral weight management or naltrexone‐bupropion alone were significantly associated with improvements in binge‐eating disorder, and individuals in the behavioral weight management group were three times more likely to achieve ≥ 5% weight loss compared to those not receiving behavioral weight management (Grilo et al. 2022). However, there was no added benefit for groups receiving both behavioral weight management and naltrexone‐bupropion (Grilo et al. 2022). Further, naltrexone‐bupropion alone was not significantly associated with improvements in any cardiometabolic outcomes, whereas behavioral weight management alone was associated with some improvements such as total cholesterol and HbA1c (Grilo et al. 2022). A multidisciplinary manualized program (HAPIFED), involving enhanced cognitive behavior therapy with behavioral weight management strategies such as self‐monitoring of eating behaviors, combined treatment for 50 adults with overweight or obesity and comorbid binge‐eating disorder or bulimia nervosa (Palavras et al. 2021). The trial reported significant improvements in purging behavior in the HAPIFED group compared to enhanced cognitive behavior therapy alone, with no significant weight loss between groups (Palavras et al. 2021). After 6 months, there were no significant differences in cardiometabolic outcomes between groups (Hay et al. 2022). More recently, an RCT published in 2025 tested the effectiveness of CBT, lisdexamfetamine (LDX), and combined CBT+LDX in 141 participants with obesity and binge‐eating disorder. While this trial found all three groups resulted in significant improvements in binge‐eating disorder, only the LDX and CBT+LDX groups resulted in significant weight loss (Grilo et al. 2025).

The role of Glucagon‐Like Peptide‐1 (GLP‐1) medications for treating people with obesity and eating disorders or disordered eating is less clear. There are limited published RCTs measuring eating disorder or disordered eating risk during GLP‐1 based treatment (Jebeile et al. unpublished data). A 2025 systematic review (k = 5) found GLP‐1s significantly reduced weight outcomes and Binge Eating Scale scores across intervention duration, ranging from 12 to 26 weeks (Radkhah et al. 2025). While this review shows promising outcomes for binge eating, the limited data demonstrate a need for more RCTs measuring eating disorders and disordered eating, beyond binge eating, during and following obesity interventions using GLP‐1s. Given the estimated prevalence of eating disorders and disordered eating behaviors in adults seeking obesity treatment, co‐treatment represents a significant opportunity for clinicians to engage with individuals to address both eating and weight concerns to improve holistic health. Future research, however, is necessary to elucidate the role of co‐treatment and its impact on broader health outcomes.

4.1. Strengths and Limitations

This review is the first comprehensive assessment of both eating disorders and disordered eating behaviors in adults seeking obesity treatment. Meta‐analyses were used to estimate the prevalence of a range of eating disorders and behaviors across treatment settings and with exploration of subgroups. There were some limitations. Current assessments may not adequately capture all the disordered eating behaviors in people with obesity (House et al. 2022). The sample size requirement was applied to minimize bias, heterogeneity, and to improve the precision of prevalence estimates within this review. However, this may have led to the underrepresentation of certain treatment settings with smaller sample sizes such as behavioral weight management and pharmacotherapy. Therefore, prevalence estimates may not be generalizable to all settings. For the included studies, the study settings were not well described and difficult to standardize. Future studies should consider how different study settings may influence prevalence estimates. While efforts were made to identify the same samples reported in multiple studies, it is possible samples were accounted for more than once. We speculate that this risk is small; baseline characteristics, enrollment periods, study teams, authors, and country were thoroughly checked to avoid duplication. There were small inconsistencies in cut‐offs used in the Binge Eating Scale and Night Eating Questionnaire scores between studies. Pooling prevalence estimates in studies with high heterogeneity were another limitation, as estimates were surrounded by high uncertainty. The wide prediction intervals indicated prevalence may be influenced by unmeasured confounders. Most proposed factors that may have been driving heterogeneity were unable to be examined quantitatively due to insufficient data. For example, most studies did not report prevalence by race and/or ethnicity, limiting subgroup analyses. It should be noted, where reported, race/ethnicity were primarily White and of higher socioeconomic status which limits the generalizability of findings. Individual‐level drivers of heterogeneity such as BMI and age were not assessed due to the likelihood of aggregation bias (Fisher et al. 2017; Migliavaca et al. 2022). Future research conducted on an individual level is required to thoroughly understand these drivers and how prevalence may differ among subgroups (Lister et al. 2024).

5. Conclusion

In adults seeking obesity treatment, it was estimated that approximately 14% may present with binge‐eating disorder using DSM‐5 criteria, with prediction intervals ranging from 0% to 43%; 26% with self‐reported moderate binge eating, with prediction intervals ranging from 18% to 33%; 5% with night eating syndrome, with prediction intervals ranging from 0% to 17%; and 1% with bulimia nervosa, with prediction intervals ranging from 0% to 2%. Research to date has focused on binge‐eating disorder and binge‐eating behaviors, with few studies reporting on the eating disorder spectrum. Given the estimated prevalence of co‐occurring obesity and eating disorders, it is critical that clinicians are well resourced to effectively identify individuals with eating disorders and disordered eating. More research is needed on effective treatment pathways for people with co‐occurring conditions to improve long‐term health.

Author Contributions

Hannah Melville: conceptualization, methodology, writing – original draft, writing – review and editing, formal analysis, investigation, supervision. Natalie B. Lister: conceptualization, methodology, project administration, writing – review and editing, supervision. Sol Libesman: methodology, formal analysis, supervision, writing – review and editing. Anna Lene Seidler: methodology, supervision, writing – review and editing. Hoi Yuk Cheng: methodology, investigation, project administration, writing – review and editing. Yuen Lam Kwan: writing – review and editing, methodology, investigation, project administration. Sarah P. Garnett: methodology, supervision, writing – review and editing. Louise A. Baur: conceptualization, methodology, supervision, writing – review and editing. Hiba Jebeile: conceptualization, methodology, investigation, project administration, supervision, writing – review and editing.

Conflicts of Interest

L.A.B. has received honoraria for speaking in forums organized by Novo Nordisk in relation to management of adolescent obesity and the ACTION‐Teens study which is sponsored by Novo Nordisk. ACTION‐Teens is a multi‐country on‐line study of attitudes towards and perceptions of obesity held by adolescents living with obesity, their parents and health care professionals and L.A.B. is the Australian lead of the study.

Supporting information

Data S1: Supporting Information.

EAT-58-1644-s001.docx (3.2MB, docx)

Acknowledgments

Open access publishing facilitated by The University of Sydney, as part of the Wiley ‐ The University of Sydney agreement via the Council of Australian University Librarians.

Melville, H. , Lister N. B., Libesman S., et al. 2025. “The Prevalence of Eating Disorders and Disordered Eating in Adults Seeking Obesity Treatment: A Systematic Review With Meta‐Analyses.” International Journal of Eating Disorders 58, no. 9: 1644–1661. 10.1002/eat.24483.

Action Editor: Kelly L. Klump

Funding: H.M. is supported by the University of Sydney Postgraduate Awards (#SC3231) and the Postgraduate Research Scholarship in Eating Disorders In weight‐related Therapy (EDIT) Collaboration (#SC4099). N.B.L. is supported by NHMRC Peter Doherty Early Career Fellowship (#114574). A.L.S. is supported by NHMRC Emerging Leadership (EL1) Investigator Grant (#2009432). L.A.B. is supported by NHMRC Leadership (L3) Investigator Grant (#2009035). H.J. is supported by NHMRC Emerging Leadership (EL1) Investigator Grant (#2017139). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Data S1: Supporting Information.

EAT-58-1644-s001.docx (3.2MB, docx)

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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