Summary: Children who are picky eaters are at an increased risk of developing anorexia during their teen years. Those who overeat as children are at higher risk of binge eating disorders. Persistent undereating during childhood increased the risk of developing anorexia in teen years by 6% for girls.
Overeating, undereating and ‘fussiness’ in early childhood can be linked to anorexia and binge-eating in adolescence, and the risk is greater for girls, finds a new UCL-led study.
The research, published today in the Royal College of Psychiatrists’ British Journal of Psychiatry, is the most comprehensive study to date to look at the association between childhood eating habits and adolescent eating disorders and diagnoses.
Researchers analyzed data from 4,760 participants from Avon Longitudinal Study of Parents and Children (Children of the 90s), a population-based longitudinal cohort of parents and their children born in the South West of England in 1991 and 1992.
Information from parents reporting on their children’s eating habits was collected at eight points during the ages of one and nine and then linked with eating disorder outcomes at age 16.
The results show that children with increasing levels of overeating throughout childhood have a 6 percentage point increased risk (from 10 to 16%) of engaging in binge eating compared to children with low overeating.
First author, Dr. Moritz Herle (UCL Great Ormond Street Institute of Child Health UCL Institute of Epidemiology & Health Care) said: “From a large robust cohort we were able to identify patterns of eating behaviors at an early age that may be potential markers of later eating disorders.
“Our results suggest that children who show high and persistent levels of fussy eating might be at increased risk of developing anorexia nervosa, and children who overeat persistently are at a higher risk of binge-eating in their teenage years.”
The team also found that persistent undereating during childhood was associated with a 6 percentage point increased risk (from 2 to 8%) of anorexia in adolescents, but only in girls. Children who were fussy eaters throughout childhood had a 2 percentage point risk increase for anorexia (from 1 to 3%), compared to children who were not fussy eaters.
Lead author Dr. Nadia Micali (UCL Great Ormond Street Institute of Child Health) added: “Our study helps us to understand who might be at risk of eating disorders and extends what we know from previous studies and from clinical observations.
“Eating disorders are highly complex and influenced by interactions of biological, behavioral, and environmental factors and this study helps to identify some of the behavioral mechanisms behind these associations.”
Dr. Agnes Ayton, chair of the eating disorders faculty at the Royal College of Psychiatrists, said: “This study shows that early identification and targeted intervention for disordered childhood eating may reduce the future risk of eating disorders.”
“However more research is needed to disentangle the biological, behavioral and environmental risk factors, in order to improve health outcomes for children and teenagers.”
Funding: The study was funded by the Medical Research Council and the Medical Research Foundation. ALSPAC is supported by the Medical Research Council, Wellcome and the University of Bristol.
Jake Hawkes – UCL
The image is adapted from the UCL news release.
Original Research: Closed access
“A longitudinal study of eating behaviours in childhood and later eating disorder behaviours and diagnoses”. Nadia Micali et al.
British Journal of Psychiatry. doi:10.1192/bjp.2019.174
A longitudinal study of eating behaviours in childhood and later eating disorder behaviours and diagnoses
Eating behaviours in childhood are considered as risk factors for eating disorder behaviours and diagnoses in adolescence. However, few longitudinal studies have examined this association.
We investigated associations between childhood eating behaviours during the first ten years of life and eating disorder behaviours (binge eating, purging, fasting and excessive exercise) and diagnoses (anorexia nervosa, binge eating disorder, purging disorder and bulimia nervosa) at 16 years.
Data on 4760 participants from the Avon Longitudinal Study of Parents and Children were included. Longitudinal trajectories of parent-rated childhood eating behaviours (8 time points, 1.3–9 years) were derived by latent class growth analyses. Eating disorder diagnoses were derived from self-reported, parent-reported and objectively measured anthropometric data at age 16 years. We estimated associations between childhood eating behaviours and eating disorder behaviours and diagnoses, using multivariable logistic regression models.
Childhood overeating was associated with increased risk of adolescent binge eating (risk difference, 7%; 95% CI 2 to 12) and binge eating disorder (risk difference, 1%; 95% CI 0.2 to 3). Persistent undereating was associated with higher anorexia nervosa risk in adolescent girls only (risk difference, 6%; 95% CI, 0 to 12). Persistent fussy eating was associated with greater anorexia nervosa risk (risk difference, 2%; 95% CI 0 to 4).
Our results suggest continuities of eating behaviours into eating disorders from early life to adolescence. It remains to be determined whether childhood eating behaviours are an early manifestation of a specific phenotype or whether the mechanisms underlying this continuity are more complex. Findings have the potential to inform preventative strategies for eating disorders.
Declaration of interest
C.M.B. reports conflict of interest with Shire (grant recipient, Scientific Advisory Board member) and Pearson and Walker (author, royalty recipient). All other authors have indicated they have no conflicts of interest to disclose.