Abstract
This cross-sectional study assesses the prevalence of disordered eating in children and its associations with sex, pubertal maturation, and weight.
Eating disorders often begin in adolescence, affecting more than 28 million people in the US,1 although the prevalence of disordered eating behaviors (DEBs) is even greater.1,2 Data on DEBs among children younger than age 12 years are scant. Ascertaining the prevalence of DEBs in children is critical because rapid maturational and weight-related changes in puberty are independently associated with DEBs,3 and some youth may experience different rates of growth and weight gain vs their peers. We sought to characterize DEB prevalence in US children aged 9 to 10 years and the associations of DEBs with sex, pubertal maturation, and weight.
Methods
We conducted a cross-sectional analysis of children aged 9 to 10 years using ABCD Study baseline data collected from 2016 to 2018. The University of California, San Diego Institutional Review Board approved the study and waived the requirement for informed consent because only deidentified data were used. We followed the STROBE reporting guideline.
Using parent-informed diagnostic assessments (Kiddie-Structured Assessment for Affective Disorders and Schizophrenia for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition),4 we examined 3 DEBs: (1) compensatory behaviors to prevent weight gain (ever or at least once per week for 3 months); (2) binge eating (ever or at least once per week for 3 months); and (3) ever vomiting for weight control. Multivariable logistic regression models using proc surveylogistic in SAS, version 9.4 accounted for complex sampling weights5 and regressed each DEB outcome by sex assigned at birth; pubertal maturation; and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) percentile-based weight status. Models were adjusted for race and ethnicity, and adjusted odds ratios (ORs) and 95% CIs were reported (Table). P = .05 was considered statistically significant. Data were analyzed October 14, 2021, to April 7, 2022.
Table. Prevalence of Disordered Eating Behaviors in Children Aged 9 to 10 Years and Their Associations With Birth Sex, Pubertal Maturation, and Weighta.
| Weighted/raw population, No. | Adjusted odds ratio (95% CI) | ||||||
|---|---|---|---|---|---|---|---|
| Compensatory behaviors to prevent weight gain (ever)b | P value | Compensatory behaviors to prevent gain (at least 1/wk/3 mo)b | P value | Vomiting for weight control (ever) | P value | ||
| Population, weighted/raw, No. (%) | 8 111 539/11 725 | 194 112 (2.4)/257 (2.2) | NA | 58 626 (0.7)/75 (0.6) | NA | 40 157 (0.5)/48 (0.4) | NA |
| Sex assigned at birth | |||||||
| Female | 4 005 680/5682 | 1 [Reference] | .63 | 1 [Reference] | .20 | 1 [Reference] | .16 |
| Male | 4 205 925/6196 | 0.93 (0.70-1.15) | 0.68 (0.38-1.23) | 1.68 (0.82-3.44) | |||
| Pubertal maturationc | NA | 1.47 (1.53-1.88) | .002 | 1.09 (0.68-1.77) | .72 | 1.70 (.92-3.16) | .09 |
| BMI weight statusd | |||||||
| 5th Percentile to <85th percentile | 5 108 734/7602 | 1 [Reference] | .47 | 1 [Reference] | .09 | 1 [Reference] | .29 |
| <5th Percentile | 307 309/467 | 1.45 (0.53-3.91) | 3.01 (0.85-10.74) | 2.90 (0.41-20.71) | |||
| 85th to <95th Percentile | 1 304 141/1804 | 2.36 (1.57-3.54) | <.001 | 2.13 (1.02-4.44) | .04 | 2.23 (.88-5.64) | .09 |
| ≥95th Percentile | 1 484 829/1993 | 4.50 (3.21-6.32) | <.001 | 3.54 (1.93-6.52) | <.001 | 3.99 (1.91-8.35) | <.001 |
Abbreviations: BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); NA, not applicable.
Models were adjusted for participant race and ethnicity (including parent report of their child’s race and ethnicity as Asian, Hispanic or Latinx, Native American and Alaska Native, Native Hawaiian and Pacific Islander, non-Hispanic Black, non-Hispanic White, other races and ethnicities, and more than 1 race and ethnicity or who refused to answer or did not know) and presented a complete case analysis as the maximum amount of listwise case deletion per model was 1.2% because of a combination of missing data on Kiddie-Structured Assessment for Affective Disorders and Schizophrenia for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition disordered eating behavior outcomes (n = 130), BMI (n = 12), or Pubertal Development Scale (n = 5).
Compensatory behaviors to prevent weight gain include misuse of laxatives, diuretics, enemas, or other medications; diet pill use; food restriction; or excessive exercise.
Pubertal maturation was measured as the mean score on the parent report on the Pubertal Development Scale, ranging from 1 (no development) to 4 (completed development). The mean (SD) score for the total population was 1.61 (0.50).
BMI weight status was categorized as follows: underweight, less than 5th percentile; healthy, 5th to less than 85th percentile; overweight, 85th to less than 95th percentile; or obese, 95th percentile or greater. Data were missing for 12 individuals.
Results
In this study of 11 878 children, no sex differences in DEBs were found. Advanced pubertal maturation was associated with elevated odds of ever engaging in compensatory behaviors to prevent weight gain (Table). Children with higher BMI had elevated odds of compensatory behaviors to prevent weight gain (ever or at least once per week for 3 months) or ever vomiting. The prevalence of ever binge eating was 5.0% (weighted, 5.5%) and of binge eating at least once per week for 3 months was 2.2% (weighted, 2.5%). The association of pubertal maturation (measured by the Pubertal Development Scale [PDS]) with binge eating differed by weight status. Weight status–stratified models found that, among children with BMI ranging from the 5th percentile to less than the 85th percentile, advanced pubertal maturation was associated with elevated odds of ever binge eating (OR, 1.88; 95% CI, 1.35-2.60; P < .001) or binge eating at least once per week for 3 months (OR, 2.13; 95% CI, 1.21-3.76; P = .01). Among children whose BMI ranged from the 85th to less than 95th percentile, advanced pubertal maturation was associated with elevated odds of ever binge eating (OR, 1.55; 95% CI, 1.04-2.33; P = .03).
Discussion
Sex differences in DEBs were minimal in children aged 9 to 10 years, consistent with full-threshold eating disorder diagnoses at these ages.6 Children with higher BMIs were at elevated risk for DEBs. Although advanced pubertal maturation was associated with greater report of compensatory behaviors to prevent weight gain, the association of pubertal maturation with binge eating differed by weight status. Parents might interpret eating behaviors differentially in the context of their child’s weight and development, such that overeating in the context of advanced pubertal maturation may be perceived as binge eating among children with lower BMI but not among similarly developed children with BMIs in the 95th percentile or greater. Findings underscore the importance of parental education around discerning DEBs. Limitations of the study include reliance on parental report and the relatively low prevalence of DEBs, which may impact the statistical power in discerning smaller yet meaningful consequences.
References
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