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Despite a high prevalence of disordered eating behaviors (DEBs), overweight or obese young adults were less likely than those with normal weight or underweight to receive a clinical diagnosis of an eating disorder, researchers reported.

In a cross-sectional study of young adults 18-24 years, a higher rate of DEBs was reported among those with overweight or obesity compared with those of underweight or normal weight (29.3% versus 15.8% women; 15.4% versus 7.5% men), according to Jason M. Nagata, MD, of the University of California San Francisco, and colleagues.

And compared with young adults of normal weight, those with obesity had 2.45 times greater odds of engaging in DEBs such as unhealthy weight control practices and binge eating (95% CI 2.16-2.79, P<0.001), and had the highest rate of DEBs among all weight categories (25.3%), Nagata's group wrote in the .

Yet overweight and obese individuals were half as likely to receive a clinical diagnosis of an eating disorder from a healthcare provider versus those of normal or underweight (2.6% versus 4.9% women; 0.3% versus 0.6% men).

These findings challenge the common perception that underweight women have the highest risk for disordered eating, Nagata explained to 番茄社区app. "Using a large nationally representative data source, we found that disordered eating behaviors are actually three times more common in young adults with obesity than those who are underweight."

He added that these behaviors are more common in young men than many may have suspected, with 15% of young men with overweight or obesity in the study reporting DEBs. This challenges another common stereotype, that disordered eating behaviors only occur in females, he said.

"Clinicians should be aware that disordered eating behaviors occur in young adults with overweight or obesity," Nagata recommended. "They should ask if, and how, young people are trying to lose weight, and discourage unsafe practices such as vomiting, fasting, or non-prescribed weight loss medications."

The group explained DEBs comprises some of the core DSM-5 criteria for diagnosing an eating disorder. This includes behaviors such as binge eating, vomiting, fasting, or skipping meals, and use of laxatives or diuretics to lose weight.

Moreover, the risk for DEBs also varied in accordance with many demographic factors. Females were 2.32 (95% CI 2.05–2.61, P<0.001) times more likely to engage in these behaviors versus men, and Asian and Pacific Islander individuals were also more likely when compared with white individuals (OR 1.66, 95% CI 1.23-2.24, P=0.001).

Also, young adults who identified as homosexual or bisexual were more likely (OR 1.62, 95% CI 1.16-2.26, P=0.005) than heterosexual peers to engage in DEBs, while those with less education were also more likely compared with those who had more than a high school education (OR 1.26, 95% CI 1.09-1.44, P=0.002).

Drawing on data from Wave III of the National Longitudinal Study of Adolescent to Adult Health study, the analysis included 14,322 young adults who underwent in-person interviews on weight control behaviors. A clinical diagnosis of an eating disorder was self-reported. Among the cohort, nearly 50% of individuals were classified as overweight or having obesity.

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