In 2022, the worldwide prevalence of weight problems in adults (≤18 years) was round 16%, greater than double what it was in 1990 (World Well being Group, 2025). Adults with weight problems are extra in danger for disordered consuming and consuming issues (EDs), with binge-eating and binge-eating dysfunction (BED) essentially the most incessantly studied (Da Luz et al., 2018).
Analysis on different EDs is much less intensive. Nevertheless, a scientific evaluation from 2021 reported atypical anorexia nervosa (AAN; having the signs of anorexia with out being underweight; learn Eleana’s weblog to study extra) to be current in 0.15% to 13% of females with weight problems. Apparently, this was extra prevalent than these presenting with anorexia with low weight inside the neighborhood, but was referred for ED care much less typically (Harrop et al., 2021).
As such, analysis has discovered that adults with EDs usually tend to obtain weight-loss therapy over therapy for his or her ED (Hart et al., 2011; Kaur et al., 2022; Palavras et al., 2011). It is a trigger for concern, because it means that this inhabitants of people with EDs will not be receiving applicable care.
Nevertheless, proof for the total spectrum of EDs and disordered consuming behaviours is missing. There must be a extra full understanding of how prevalent EDs are amongst adults in search of weight problems therapy, as it’s at the moment troublesome to find out the kind and scale of psychological well being assist wanted. Subsequently, the purpose of this systematic evaluation and meta-analysis (Melville et al, 2025) was to estimate the prevalence of disordered consuming and EDs in adults in search of therapy for weight problems.
Most analysis to this point on the prevalence of consuming issues in these with weight problems has targeted on binge-eating dysfunction and binge-eating behaviours, that means a considerable portion of the image is lacking.
Strategies
Three databases have been looked for research that contained:
- Adults or a combined pattern of adolescents and adults the place the imply age was ≥18 years with both an obese or overweight BMI.
- These in search of weight problems therapy.
- A analysis of an ED or disordered consuming behaviour by medical interview or validated questionnaire on the time of entry into weight problems therapy.
- A minimal pattern dimension of 325 members.
All EDs and disordered consuming behaviours (e.g., lack of management consuming, drive for thinness) have been included. Research have been excluded in the event that they contained members (1) in search of each weight problems and ED therapy, or (2) with weight problems as a part of a broader syndrome. International language research have been translated utilizing Google Lens in order that they is also included.
Research have been double screened independently by 4 authors. Information was independently extracted from included research by two reviewers and methodological high quality of research was independently assessed by one reviewer, with accuracy checks by one other reviewer.
A random-effects mannequin was used within the meta-analysis to pool prevalence estimates of EDs and disordered consuming behaviours. Subgroup analyses and checks for publication bias and small examine results have been additionally performed.
The evaluation was prospectively registered on PROSPERO (CRD42023461340) and reported in accordance with the JBI Handbook for Proof Synthesis and PRISMA pointers.
Outcomes
Research traits
Eighty-five research have been included on this systematic evaluation, printed between 1985 and 2025. Most research have been printed both within the USA (n = 43) or Italy (n = 17). Information got here from 94,295 members (75.9% feminine, median age = 44 years [IQR = 5], median BMI = 46 kg/m2 [IQR = 10]). Probably the most reported weight problems therapies have been bariatric surgical procedure (n = 49), behavioural weight administration (n = 9), or a number of therapy choices (n = 8).
Prevalence charges have been reported for a number of EDs and disordered consuming behaviours, however BED (n = 46) and self-report binge consuming (n = 32) have been the most typical. No research reported on avoidant/restrictive meals consumption dysfunction, pica, rumination, or purging dysfunction.
Prevalence estimates
BED and binge consuming behaviours
For these reporting BED, the pooled prevalence was:
- 17% (95% CI [12 to 22], 19 research) as assessed by medical interview utilizing DSM-IV standards with a prediction interval (an estimate of the place a future remark will probably fall) of 0% to 42%.
- 14% (95% CI [7 to 22], 10 research) when assessed by DSM-5 standards with a prediction interval of 0% to 43%.
- 12% (95% CI [9 to 16], 17 research) from self-report questionnaires.
The authors additionally discovered proof of publication bias and small examine results for all three BED prevalences, the place the prevalence of BED elevated because the examine pattern decreased.
For these reporting binge consuming behaviour in line with the Binge Consuming Scale, the pooled prevalence was:
- 26% (95% CI [23 to 28], 12 research) for reasonable binge consuming severity with a prediction interval of 18% to 33%.
- 12% (95% CI [8 to 16], 18 research) for extreme binge consuming severity with a prediction interval of 0% to 31%.
- Nevertheless, extreme self-report binge consuming was re-examined following the removing of 1 examine from 1985 (Marcus et al., 1985) resulting from this examine being an outlier. Following the removing of this examine, the pooled prevalence was 10% (95% CI [8 to 12], 17 research) with a prediction interval of two% to 19%.
Once more, there was a chance of bias for self-report extreme binge consuming, however this was not discovered for reasonable severity self-report binge consuming behaviour.
Different EDs
When assessed by medical interview, the pooled prevalence of:
- Night time consuming syndrome was 5% (95% CI [2 to 9], 5 research) with a prediction interval of 0% to 17%.
- Bulimia nervosa was 1% (95% CI [0 to 1], 9 research) with a prediction interval of 0% to 2%.
- Problems the place the kind was not specified was 11% (95% CI [4 to 18], 9 research) with a prediction interval of 0% to 36%.
Solely two research reported AAN, with the prevalence 0.2% in a single examine assessed by medical interview (Lin et al., 2013). The second examine had no reported circumstances (Hilbert et al., 2022). Egger’s checks have been vital for bulimia nervosa and consuming issues when not specified, indicating attainable proof of bias the place prevalence elevated as examine pattern dimension decreased.
Sensitivity analyses
Publish-hoc sensitivity analyses examined the potential bias of smaller research, provided that prevalence estimates generally elevated as examine pattern sizes decreased. Except for BED when assessed by DSM-5 medical interview, checks remained vital when the minimal pattern dimension elevated, demonstrating that prevalence tended to lower with bigger samples.
Meta-regression
The ultimate yr of knowledge assortment was discovered to be considerably related to the prevalence of self-report extreme binge consuming, the place binge consuming decreased over time (p < 0.01).
Subgroup-analyses
Varied post-hoc subgroup analyses have been performed, together with therapy kind, medical interviews, and intercourse, however no vital variations have been discovered.
High quality evaluation
While no research have been excluded primarily based on the standard evaluation, inadequate reporting meant that two domains have been typically chosen as ‘unclear’: (1) the reliability of measurements and (2) clearly described response charges.
Binge consuming dysfunction and binge consuming behaviour remained essentially the most studied outcomes within the context of weight problems therapies, with just a few research reporting prevalence charges on evening consuming dysfunction, bulimia nervosa, and atypical anorexia nervosa.
Conclusions
This was the primary complete evaluation to estimate the prevalence of each EDs and disordered consuming behaviours inside adults in search of therapy for weight problems. General, analysis has primarily targeted on BED and binge-eating behaviours, with restricted analysis on different forms of EDs or disordered consuming behaviours.
As such, this evaluation estimates that:
- roughly 14% of adults in search of weight problems therapy might also have binge-eating dysfunction (BED),
- an estimated 26% could have self-reported reasonable binge-eating,
- 5% could have evening consuming syndrome, and
- 1% could have bulimia nervosa.
Binge-eating dysfunction happens in roughly 14% of adults in search of therapy for weight problems, with 26% reporting reasonable binge-eating. Analysis on different forms of consuming issues and disordered consuming behaviours is proscribed.
Strengths and limitations
This examine had varied strengths, together with however not restricted to:
- The usage of rigorous strategies. This evaluation recognized articles from a number of related databases, employed double unbiased screening strategies, contacted authors of eligible research for lacking info, and investigated potential publication and small pattern biases. Methods comparable to this assist to make sure that related research will not be missed, and that conclusions are dependable.
- The cumulative pattern was massive, containing over 94,000 individuals from 85 research, spanning a number of nations over 40 years. This helps to make the prevalence estimates extra dependable, consultant, and helpful by way of informing screening of weight problems therapies sooner or later.
- The usage of prediction intervals in addition to confidence intervals additionally improves transparency and future applicability, because it helps to estimate what prevalence may be in future research.
Regardless of this, there have been nonetheless some limitations:
- While the pattern was massive, some teams remained underrepresented. For instance, most members have been White, and from greater socioeconomic backgrounds. Additionally, solely members who have been actively in search of weight problems therapy have been included on this examine. All of this prevents us from with the ability to generalise to different populations (e.g., untreated people) the place prevalence may differ.
- There was an underrepresentation in some therapy settings, with most research reporting on bariatric surgical procedure. Which means that different, non-surgical therapies, have been probably underpowered which could lead to deceptive conclusions, or a bias in direction of particular therapies (comparable to surgical procedure). Nevertheless, the authors set a minimal pattern dimension of 325 members in every examine to assist alleviate this.
- Prevalence estimates may additionally be influenced by modifications in therapy varieties and diagnostic standards over time (e.g., use of DSM-IV to DSM-5), given the 40-year knowledge span included inside this examine. Which means that the identical ED may be recognized or labeled in a different way over time, doubtlessly influencing prevalence estimates and making comparisons throughout time much less legitimate.
This evaluation used rigorous strategies to seize prevalence info on consuming issues and disordered consuming behaviour throughout a 40-year span, together with over 94,000 members.
Implications for observe
Given the estimated prevalence of EDs and disordered consuming behaviours co-occurring with weight problems, routine screening of ED signs ought to be performed earlier than entry into weight problems therapy programmes to make sure people are referred for essentially the most appropriate therapy. It could be helpful if this screening coincides with additional coaching of clinicians inside these programmes to recognise indicators and signs of EDs, together with binge consuming and BED, alongside different EDs discovered to be prevalent on this evaluation’s inhabitants, comparable to evening time consuming and bulimia nervosa. This might assist to determine not solely the presence of an ED however what kind, to help in choices round best suited therapy.
Additional analysis on this space can also be wanted. Firstly, analysis on the best therapy pathways for people with co-occurring weight problems and EDs/disordered consuming is necessary, to make sure applicable care and improved long-term outcomes. There must also be an funding in analysis with under-researched populations, comparable to ethnic minority teams, those that haven’t sought formal therapy, or these in search of non-surgical or community-based therapies, to additional perceive prevalence charges inside these populations. With out such analysis, our understanding of the prevalence of EDs inside this inhabitants is proscribed and can’t be generalised to people from these teams. To assist this, weight problems therapy programmes may additionally implement prevalence monitoring as normal, to additional perceive prevalence charges over time.
Routine screening of consuming issues and disordered consuming behaviours ought to be applied as a part of routine screening to weight problems therapy programmes, to determine and assist people in receiving essentially the most applicable care.
Assertion of pursuits
None.
Hyperlinks
Main paper
Melville, H., Lister, N. B., Libesman, S., Seidler, A. L., Cheng, H. Y., Kwan, Y. L., Garnett, S. P., Baur, L. A., & Jebeile, H. (2025). The Prevalence of Consuming Problems and Disordered Consuming in Adults In search of Weight problems Therapy: A Systematic Assessment With Meta‐Analyses. Worldwide Journal of Consuming Problems, 58(9), 1644–1661. https://doi.org/10.1002/eat.24483
Different references
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