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 problems (EDs), with binge-eating and binge-eating dysfunction (BED) essentially the most regularly studied (Da Luz et al., 2018).
Analysis on different EDs is much less in depth. Nonetheless, a scientific overview from 2021 reported atypical anorexia nervosa (AAN; having the signs of anorexia with out being underweight; learn Eleana’s weblog to be taught extra) to be current in 0.15% to 13% of females with weight problems. Curiously, this was extra prevalent than these presenting with anorexia with low weight throughout the neighborhood, but was referred for ED care much less usually (Harrop et al., 2021).
As such, analysis has discovered that adults with EDs usually tend to obtain weight-loss remedy over remedy for his or her ED (Hart et al., 2011; Kaur et al., 2022; Palavras et al., 2011). This can be a trigger for concern, because it means that this inhabitants of people with EDs aren’t receiving acceptable care.
Nonetheless, 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 searching for weight problems remedy, as it’s at present tough to find out the sort and scale of psychological well being assist wanted. Subsequently, the goal of this systematic overview and meta-analysis (Melville et al, 2025) was to estimate the prevalence of disordered consuming and EDs in adults searching for remedy for weight problems.
Most analysis to this point on the prevalence of consuming problems in these with weight problems has centered on binge-eating dysfunction and binge-eating behaviours, which means a considerable portion of the image is lacking.
Strategies
Three databases have been looked for research that contained:
- Adults or a blended pattern of adolescents and adults the place the imply age was ≥18 years with both an chubby or overweight BMI.
- These searching for weight problems remedy.
- A prognosis of an ED or disordered consuming behaviour by scientific interview or validated questionnaire on the time of entry into weight problems remedy.
- A minimal pattern measurement of 325 contributors.
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 contributors (1) searching for each weight problems and ED remedy, or (2) with weight problems as a part of a broader syndrome. Overseas 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 carried out.
The overview was prospectively registered on PROSPERO (CRD42023461340) and reported in accordance with the JBI Guide for Proof Synthesis and PRISMA pointers.
Outcomes
Research traits
Eighty-five research have been included on this systematic overview, 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 contributors (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 remedy 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 commonest. 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 scientific interview utilizing DSM-IV standards with a prediction interval (an estimate of the place a future remark will seemingly 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 response to the Binge Consuming Scale, the pooled prevalence was:
- 26% (95% CI [23 to 28], 12 research) for average 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%.
- Nonetheless, extreme self-report binge consuming was re-examined following the removing of 1 examine from 1985 (Marcus et al., 1985) as a consequence of 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 risk of bias for self-report extreme binge consuming, however this was not discovered for average severity self-report binge consuming behaviour.
Different EDs
When assessed by scientific interview, the pooled prevalence of:
- Evening 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%.
- Issues the place the sort 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 scientific interview (Lin et al., 2013). The second examine had no reported instances (Hilbert et al., 2022). Egger’s checks have been important for bulimia nervosa and consuming problems when not specified, indicating potential proof of bias the place prevalence elevated as examine pattern measurement decreased.
Sensitivity analyses
Submit-hoc sensitivity analyses examined the potential bias of smaller research, provided that prevalence estimates generally elevated as examine pattern sizes decreased. Apart from BED when assessed by DSM-5 scientific interview, checks remained important when the minimal pattern measurement elevated, demonstrating that prevalence tended to lower with bigger samples.
Meta-regression
The ultimate yr of information 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 carried out, together with remedy kind, scientific interviews, and intercourse, however no important 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 usually 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 a couple of research reporting prevalence charges on evening consuming dysfunction, bulimia nervosa, and atypical anorexia nervosa.
Conclusions
This was the primary complete overview to estimate the prevalence of each EDs and disordered consuming behaviours inside adults searching for remedy for weight problems. General, analysis has primarily centered on BED and binge-eating behaviours, with restricted analysis on different sorts of EDs or disordered consuming behaviours.
As such, this overview estimates that:
- roughly 14% of adults searching for weight problems remedy can also have binge-eating dysfunction (BED),
- an estimated 26% could have self-reported average binge-eating,
- 5% could have evening consuming syndrome, and
- 1% could have bulimia nervosa.
Binge-eating dysfunction happens in roughly 14% of adults searching for remedy for weight problems, with 26% reporting average binge-eating. Analysis on different sorts of consuming problems and disordered consuming behaviours is proscribed.
Strengths and limitations
This examine had numerous strengths, together with however not restricted to:
- Using rigorous strategies. This overview recognized articles from a number of related databases, employed double unbiased screening strategies, contacted authors of eligible research for lacking data, and investigated potential publication and small pattern biases. Methods comparable to this assist to make sure that related research aren’t missed, and that conclusions are dependable.
- The cumulative pattern was giant, 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 when it comes to informing screening of weight problems therapies sooner or later.
- Using 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 giant, some teams remained underrepresented. For instance, most contributors have been White, and from increased socioeconomic backgrounds. Additionally, solely contributors who have been actively searching for weight problems remedy 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 remedy settings, with most research reporting on bariatric surgical procedure. Which means different, non-surgical therapies, have been seemingly underpowered which could lead to deceptive conclusions, or a bias in the direction of particular therapies (comparable to surgical procedure). Nonetheless, the authors set a minimal pattern measurement of 325 contributors in every examine to assist alleviate this.
- Prevalence estimates may additionally be influenced by modifications in remedy 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 the identical ED may be recognized or categorized otherwise over time, doubtlessly influencing prevalence estimates and making comparisons throughout time much less legitimate.
This overview used rigorous strategies to seize prevalence data on consuming problems and disordered consuming behaviour throughout a 40-year span, together with over 94,000 contributors.
Implications for follow
Given the estimated prevalence of EDs and disordered consuming behaviours co-occurring with weight problems, routine screening of ED signs must be carried out earlier than entry into weight problems remedy programmes to make sure people are referred for essentially the most appropriate remedy. It will 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 overview’s inhabitants, comparable to evening time consuming and bulimia nervosa. This could assist to establish not solely the presence of an ED however what kind, to help in selections round most fitted remedy.
Additional analysis on this space can also be wanted. Firstly, analysis on the only remedy pathways for people with co-occurring weight problems and EDs/disordered consuming is necessary, to make sure acceptable 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 remedy, or these searching for 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 remedy programmes might additionally implement prevalence monitoring as normal, to additional perceive prevalence charges over time.
Routine screening of consuming problems and disordered consuming behaviours must be carried out as a part of routine screening to weight problems remedy programmes, to establish and assist people in receiving essentially the most acceptable 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 Issues and Disordered Consuming in Adults Looking for Weight problems Therapy: A Systematic Evaluate With Meta‐Analyses. Worldwide Journal of Consuming Issues, 58(9), 1644–1661. https://doi.org/10.1002/eat.24483
Different references
Da Luz, F. Q., Hay, P., Touyz, S., & Sainsbury, A. (2018). Weight problems with Comorbid Consuming Issues: Related Well being Dangers and Therapy Approaches. Vitamins, 10(7), 829. https://doi.org/10.3390/nu10070829
Frisira, E. (2023). “You Don’t Look Anorexic”: unmasking weight stigma in sufferers with atypical anorexia nervosa. The Psychological Elf.
Gormally, J., Black, S., Daston, S., & Rardin, D. (1982). The evaluation of binge consuming severity amongst overweight individuals. Addictive Behaviors, 7(1), 47–55. https://doi.org/10.1016/0306-4603(82)90024-7
Harrop, E. N., Mensinger, J. L., Moore, M., & Lindhorst, T. (2021). Restrictive consuming problems in increased weight individuals: A scientific overview of atypical anorexia nervosa prevalence and consecutive admission literature. Worldwide Journal of Consuming Issues, 54(8), 1328–1357. https://doi.org/10.1002/eat.23519
Hart, L. M., Granillo, M. T., Jorm, A. F., & Paxton, S. J. (2011). Unmet want for remedy within the consuming problems: A scientific overview of consuming dysfunction particular remedy searching for amongst neighborhood instances. Scientific Psychology Evaluate, 31(5), 727–735. https://doi.org/10.1016/j.cpr.2011.03.004
Hilbert, A., Staerk, C., Strömer, A., Mansfeld, T., Sander, J., Seyfried, F., Kaiser, S., Dietrich, A., & Mayr, A. (2022). Nonnormative Consuming Behaviors and Consuming Issues and Their Associations With Weight Loss and High quality of Life Throughout 6 Years Following Weight problems Surgical procedure. JAMA Community Open, 5(8), e2226244. https://doi.org/10.1001/jamanetworkopen.2022.26244
Kaur, J., Dang, A. B., Gan, J., An, Z., & Krug, I. (2022). Evening Consuming Syndrome in Sufferers With Weight problems and Binge Consuming Dysfunction: A Systematic Evaluate. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.766827
Lin, H.-Y., Huang, C.-Ok., Tai, C.-M., Lin, H.-Y., Kao, Y.-H., Tsai, C.-C., Hsuan, C.-F., Lee, S.-L., Chi, S.-C., & Yen, Y.-C. (2013). Psychiatric problems of sufferers searching for weight problems remedy. BMC Psychiatry, 13(1), 1. https://doi.org/10.1186/1471-244X-13-1
Marcus, M. D., Wing, R. R., & Lamparski, D. M. (1985). Binge consuming and dietary restraint in overweight sufferers. Addictive Behaviors, 10(2), 163–168. https://doi.org/10.1016/0306-4603(85)90022-X
Palavras, M. A., Kaio, G. H., Mari, J. de J., & Claudino, A. M. (2011). Uma revisão dos estudos latino-americanos sobre o transtorno da compulsão alimentar periódica. Brazilian Journal of Psychiatry, 33, s81–s94. https://doi.org/10.1590/S1516-44462011000500007
World Well being Group. (2025). Weight problems and chubby. https://www.who.int/news-room/fact-sheets/element/obesity-and-overweight
