Citation
Nagata, Jason M.; Garber, Andrea K.; Tabler, Jennifer L.; Murray, Stuart B.; & Bibbins-Domingo, Kirsten (2018). Disordered eating behaviors among overweight/obese young adults and future cardiometabolic risk in the National Longitudinal Study of Adolescent to Adult Health. Global Adolescent Health Equity. Seattle, WA: Journal of Adolescent Health.Abstract
Purpose: Previous studies limited to single-center, clinical samples suggest that disordered eating behaviors (DEBs) may be under recognized among overweight/obese adolescents and young adults. The objectives of this study were to determine the prevalence of DEBs and eating disorders (EDs) and to identify their association with cardiometabolic risk at seven-year follow-up using a nationally representative sample of overweight/obese young adults. Methods: We used longitudinal cohort data from Wave III (18–24 years old) and Wave IV (24–32 years old) of the National Longitudinal Study of Adolescent to Adult Health (Add Health). We analyzed anthropometric data (height, weight, BMI), ED (ED diagnosis by a doctor), and DEB (self-reported binge eating and unhealthy weight control behavior including vomiting, fasting/skipping meals, or laxative/diuretic use to lose weight) data at Wave III to estimate the prevalence of EDs/DEBs in young adulthood by BMI weight classification. We used anthropometric and laboratory (hemoglobin A1c) data at Wave IV to determine cardiometabolic risk at seven-year follow-up. Multivariate regression analyses were used to determine the association between unhealthy weight control behaviors and BMI change (linear regression) and incident diabetes (logistic regression) at seven-year follow-up, adjusting for race/ethnicity, sex, age, and household income. Results: Of the 15,197 young adults aged 18–24 years old, 48.6% were overweight or obese. Although 20.8% of overweight/obese young adults reported DEBs, only 1.4% were diagnosed with an ED. Multivariate logistic regression analyses demonstrated that female sex (adjusted odds ratio [AOR] 2.45, 95% confidence interval [CI] 2.02–2.96), identifying as homosexual or bisexual (AOR 1.78, 95% CI 1.13–2.81), and higher BMI (AOR 1.02, 95% CI 1.00–1.03) were associated with an ED or DEB among overweight/obese young adults. Overweight/obese young adults with EDs/DEBs had higher BMI (35.24 vs 33.36 kg/m2, p < .001) and greater weight gain (7.39 vs 6.51 kg, p < .001) at seven-year follow-up than those without EDs/DEBs. In multivariate regression models, unhealthy weight control behavior in young adulthood was associated with incident diabetes (AOR 1.32, 95% CI 1.01–1.71) and greater BMI (B = .48, p < .001) at seven-year follow-up, adjusting for age, sex, race/ethnicity, and household income. The AOR for the association between unhealthy weight control behavior and incident diabetes decreased from 1.32 to 1.17 after accounting for BMI change, suggesting that the relationship may be mediated by BMI. Conclusions: Over one fifth of overweight/obese young adults reported DEBs and were largely undiagnosed. The striking under-detection of ED psychopathology in overweight/obese young adults is cause for concern, particularly as the non-detection of these behaviors portends demonstrably greater diabetes risk at seven-year follow-up, a risk that may be explained by weight gain. The significantly higher risk for increased BMI and diabetes incidence in these young adults underscores the need to screen for EDs/DEBs in this population and provide referrals and tailored interventions as appropriate.URL
https://doi.org/10.1016/j.jadohealth.2017.11.036Reference Type
Conference proceedingBook Title
Global Adolescent Health EquityAuthor(s)
Nagata, Jason M.Garber, Andrea K.
Tabler, Jennifer L.
Murray, Stuart B.
Bibbins-Domingo, Kirsten