Prevalence and Correlates of Caregiver-Reported Disordered Eating Behaviors and Concerns Among US Children and Adolescents Aged 6 to 17 Years, 2022

Lydie A. Lebrun-Harris, PhD, MPH¹; Ariel B. Beccia, PhD^2,3,4; S. Bryn Austin, ScD, SM^2,3,4; Jason M. Fields, PhD, MPH⁵ (View author affiliations)

Suggested citation for this article: Lebrun-Harris LA, Beccia AB, Austin SB, Fields JM. Prevalence and Correlates of Caregiver-Reported Disordered Eating Behaviors and Concerns Among US Children and Adolescents Aged 6 to 17 Years, 2022. Prev Chronic Dis 2026;23:250353. DOI: http://dx.doi.org/10.5888/pcd23.250353.

PEER REVIEWED

Abstract

Introduction

Disordered eating behaviors are increasingly recognized among children and adolescents in the US, making it critical to understand their prevalence and associated risk factors to support early identification and intervention. The objective of this study was to estimate the prevalence and correlates of caregiver-reported disordered eating behaviors and concerns among US children and adolescents aged 6 to 17 years.

Methods

We analyzed data from the 2022 National Survey of Children’s Health (n = 34,362), estimating age- and sex-stratified prevalence of past-year child’s concerns about body weight, shape, or size; disordered eating behaviors; and caregiver concerns about those behaviors. We conducted bivariate analyses identifying sociodemographic, economic, health-related, and caregiver/family-related correlates.

Results

The most prevalent behaviors were extremely picky eating (24.5% among children aged 6–11 y; 19.3% among adolescents aged 12–17 y), low interest in food (11.1% and 10.6%, respectively), and skipping meals/fasting (6.8% and 13.4%, respectively). About one-quarter of caregivers were “very much” or “somewhat” concerned about their child’s behaviors. Several factors were associated with disordered eating behaviors/concerns, including food insufficiency; mental/emotional/behavioral conditions; frequent bullying; high levels of screentime; worse caregiver mental/emotional health; and adverse childhood experiences.

Conclusion

Based on caregiver reports, nearly one-third of children and adolescents in our study population engaged in at least 1 form of disordered eating in the past year. Caregivers may be well-positioned to observe and report early behavior changes, potentially enabling earlier clinical assessment and intervention and improved prognosis.

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Introduction

Only a few national data sources are available to provide up-to-date epidemiologic information on eating disorders among children and adolescents, despite growing public health concerns and substantial health consequences and economic costs (1,2). From 2001 through 2004, the estimated lifetime prevalence of eating disorders (anorexia nervosa, bulimia nervosa, binge eating) among US adolescents aged 13 to 18 years was 2.7% (3). A more recent analysis that included the diagnosis of other specified feeding and eating disorders, based on nationally representative surveys from 2007 and 2011, indicated a much higher prevalence of eating disorders, peaking at age 21 years (10.3% among females, 7.4% among males) (4).

Subthreshold disordered eating behaviors are also highly prevalent among young people (5). A meta-analysis of 32 studies across 16 countries published from 1999 through 2022 estimated that 22% of young people aged 6 to 18 years screened positive for disordered eating (6). In the US, the biennial Youth Risk Behavior Survey (YRBS) previously assessed past-month fasting, purging, and diet pill use, but those questions were removed from the questionnaire in 2015 (7). The most recent YRBS estimates, from 2013, showed a prevalence of disordered eating among high school students ranging from 20% to 29% among girls and 8% to 13% among boys, depending on race and ethnicity (8). Other research also indicates that eating disorder and disordered eating caseloads in hospitals and emergency departments doubled during the COVID-19 pandemic (9–11), underscoring the need for surveillance data.

A gap in knowledge pertaining to young children also exists, despite recent findings that prodromal symptoms (eg, concerns over body weight, shape, or size) may emerge as early as 6 years of age (12). Moreover, evidence is growing of a disproportionate prevalence among girls, young people belonging to racial and ethnic minority groups, and young people experiencing food insecurity and other forms of socioeconomic disadvantage (8,13,14). However, nationally representative estimates of the current prevalence among subgroups of US children are lacking.

While most data on disordered eating behaviors among young people are obtained through self-report, data reported by parents or caregivers (henceforth “caregivers”) are also informative, particularly in contexts where young people may deny, minimize, or fail to recognize symptoms. Young people with eating disorders may underreport symptoms and behaviors compared with their caregivers (15,16). However, caregivers may be better positioned to observe and report early changes in certain behaviors, especially for younger children, which can potentially lead to professional assessments, earlier intervention, and improved prognosis (17). In addition, caregiver perspectives may offer a broader context of the child’s environment (eg, family stressors, resources), which may influence disordered eating.

The Health Resources and Services Administration’s (HRSA’s) Maternal and Child Health Bureau added content on the National Survey of Children’s Health (NSCH) in 2022 to capture caregiver-reported disordered eating behaviors and concerns among children and adolescents aged 6 to 17 years. This study sought to answer the following questions: 1) What is the prevalence of concerns among children and adolescents about their body weight, shape, or size, as reported by their caregivers? 2) What is the prevalence of caregiver-reported disordered eating behaviors among children and adolescents? 3) What is the prevalence of caregiver concerns about their child’s disordered eating behaviors? and 4) How does the prevalence of caregiver-reported disordered eating behaviors and concerns differ by sociodemographic, economic, health-related, and family characteristics?

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Methods

Data source

We analyzed cross-sectional data from the NSCH, an annual, address-based probability survey of noninstitutionalized children from birth through 17 years in all 50 US states and the District of Columbia, funded and directed by the Maternal and Child Health Bureau and administered by the US Census Bureau. The 2022 NSCH drew a stratified random sample of approximately 360,000 residential addresses from the Census Bureau’s Master Address File, using administrative-record flags to oversample addresses likely to include children. During data collection, a household screener identified eligible children, and 1 child was randomly selected in each household to be the subject of an age-specific topical questionnaire completed by a parent or caregiver via web or paper, with telephone assistance available. Child-level survey weights, constructed by the US Census Bureau, incorporate the probability of selection, nonresponse adjustments, and poststratification (raking) to state-level and national-level population controls, allowing estimates to be generalized to the US population of noninstitutionalized children. Detailed survey procedures are described elsewhere (18). Data are publicly available and deidentified; therefore, institutional review board approval for human subjects research did not apply. The interview completion rate (ie, the probability that an occupied household who initiated the survey completed both the screener and topical questionnaires) was 79%. The overall response rate (ie, the probability that a sampled address was confirmed to be an occupied household and completed the survey) was 39% (19). The analytic sample included 15,334 children aged 6 to 11 years and 19,028 adolescents aged 12 to 17 years. Records with missing data on disordered eating behaviors and concerns were excluded from analyses; missingness ranged from 0.2% (caregiver concerns about disordered eating behaviors) to 1.2% (binge eating).

Measures

We examined caregiver reports of their child’s body-related concerns by using the question, “During the past 12 months, how concerned was this child about their weight, body shape, or body size?” and identified the proportion of respondents who answered, “very much,” “somewhat,” or “not at all.”

Caregivers reported whether their child engaged in any of 8 disordered eating behaviors during the past 12 months: 1) skipping meals or fasting (excluding for religious reasons); 2) purging or vomiting after eating; 3) using diet pills, laxatives, or diuretics to lose or maintain weight without a doctor’s orders; 4) low interest in food; 5) extremely picky eating; 6) not eating due to fear of vomiting or choking; 7) binge eating; and 8) overexercising. We created a combined “restrictive eating” category that included skipping meals or fasting, purging or vomiting and using diet pills, laxatives, or diuretics, and a combined “avoidant eating” category that included low interest in food, extremely picky eating, and not eating due to vomiting/choking fears.

Caregivers who reported their child engaged in at least 1 disordered eating behavior were then asked, “During the past 12 months, how concerned were you about this child engaging in these behaviors?” We identified the proportion of respondents who answered, “very much,” “somewhat,” or “not at all.”

Correlates included sociodemographic, economic, health-related, and family factors. Sociodemographic characteristics included child sex, race and ethnicity, and household language. Economic factors included family income-to-poverty ratio as a percentage of the federal poverty level (FPL), food insufficiency, and health insurance status. Health-related factors included child’s general health status; sex-specific body mass index (BMI) percentile categories; current mental, emotional, or behavioral conditions (depression, anxiety, behavioral or conduct problems, autism spectrum disorder, attention deficit/hyperactivity disorder [ADHD]); bullying victimization; screentime during weekdays (excluding schoolwork); usual source of sick care; personal doctor or nurse; preventive medical visit in the past year; and whether a doctor ever told the caregiver their child was overweight. Family characteristics included highest education level of caregivers in the household, caregiver mental and emotional health, caregiver concerns about their child’s weight, how well caregiver and child share ideas and talk together, frequency of family meals, and number of adverse childhood experiences.

Statistical analysis

We estimated prevalence and 95% CIs for the measures of caregiver-reported disordered eating behaviors and concerns among children aged 6 to 11 years and adolescents aged 12 to 17 years, overall and by sex for each age group. To account for complex sample design, all estimates were based on a multistage weighting process and iterative raking to population controls from American Community Survey estimates. Within each age group, we calculated the observed prevalence among subpopulations and conducted Rao–Scott design-adjusted χ² tests of independence to assess the associations between sociodemographic, economic, health-related, and family factors and each measure. Because we found sex differences in the prevalence estimates among adolescents, we further stratified the bivariate analyses by sex for this age group.

We conducted analyses using Stata/SE version 18.0 (StataCorp LLC). Statistical significance was assessed by using a 2-sided test (α =.05) and 95% CIs, with no adjustments made for multiple comparisons due to the descriptive nature of the analysis. The public use file provided imputed data for missing values for sex (0.1% missing), ethnicity (0.3% missing), race (1.9% missing), and family income (19.8% missing).

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Results

Prevalence of disordered eating behaviors

The study sample (unweighted n = 34,362) was 51.2% male and 48.8% female; 48.3% were aged 6 to 11 years and 51.7% were aged 12 to 17 years; 47.7% were non-Hispanic White, 13.1% non-Hispanic Black, and 26.8% Hispanic of any race (Table 1). About one-third of children (31.1%) (Table 2A) and adolescents (30.4%) (Table 2B) were reported by their caregiver as displaying 1 or more disordered eating behaviors, representing about 15.4 million US children and adolescents. The prevalence of any disordered eating behavior was significantly higher among adolescent females than males (33.1%; 95% CI, 31.2%–35.0% vs 27.7%; 95% CI, 26.1%–29.6%, P < .001).

Among children aged 6 to 11 years, caregivers reported that 1.8% were “very much” and 13.8% were “somewhat” concerned about their body weight, shape, or size (Table 2A). The most prevalent disordered eating behaviors observed were extremely picky eating (24.5%) and low interest in food (11.1%). Among children engaged in 1 or more behaviors in the past year, 5.2% of caregivers reported being “very much” concerned about their child’s behaviors and another 22.1% were “somewhat” concerned.

Among adolescents aged 12 to 17 years, caregivers reported that 5.6% were “very much” and 27.7% were “somewhat” concerned about their body weight, shape, or size (Table 2B). The most prevalent disordered eating behaviors observed were extremely picky eating (19.3%), skipping meals or fasting (13.4%), and low interest in food (10.6%). Among adolescents engaged in 1 or more behaviors in the past year, 5.1% of caregivers reported being “very much” concerned about their adolescent’s behaviors and another 26.1% were “somewhat” concerned.

The prevalence of caregiver-reported avoidant eating behaviors (ie, low interest in food, extremely picky eating, not eating due to fear of vomiting or choking) was higher among children than adolescents, while skipping meals or fasting, binge eating, and overexercising were higher among adolescents than children. The prevalence of concerns about their body weight, shape, or size was also higher among adolescents than children; however, the prevalence of caregiver concerns about behaviors was similar for both age groups. We found more sex differences among adolescents than among children: compared with adolescent males, adolescent females were reported to have a higher prevalence of skipping meals or fasting, low interest in food, extremely picky eating, and not eating due to fear of vomiting or choking.

Correlates of disordered eating behaviors among children

Among children aged 6 to 11 years, we observed a higher prevalence of most caregiver-reported disordered eating behaviors and related concerns among those experiencing food insufficiency and having public health insurance, compared with food secure and privately insured children, respectively (Table 3A). Non-Hispanic Asian children had lower prevalence of avoidant eating behaviors (19.9%; 95% CI, 15.9%–24.7%) than non-Hispanic White children (26.6%; 95% CI, 25.0%–28.1%). Caregivers of children from lower-income households were also more likely to report that their child binge ate (<100% FPL: 5.4%; 95% CI, 3.8%–7.1%), compared with caregivers of children from higher income households (≥ 400% FPL: 2.4%; 95% CI, 1.5%–3.3%) (Table 3B). Children in good/fair/poor health; children with current mental, emotional, or behavioral conditions; children experiencing more frequent bullying victimization; children with higher levels of screentime; and children whose doctor ever told their caregivers that they were overweight were also found to have a higher prevalence of most outcomes compared with their counterparts who did not experience these factors. Compared with children with lower BMI percentile, those with higher BMI percentile were more likely to have caregivers report that their child binge ate and that their child had concerns about their body weight, shape, or size. In terms of family factors, children whose caregivers had lower levels of education, children with caregivers in good/fair/poor mental/emotional health, children whose caregivers had concerns about their child’s weight, children whose caregivers did not share ideas or talk together, children from families that never or rarely eat meals together, and children with 1 or more adverse childhood experiences were observed to have a higher prevalence of most caregiver-reported outcomes compared with their counterparts.

Correlates of disordered eating behaviors among adolescents

Given the sex differences among adolescents aged 12 to 17 years, we examined the correlates of disordered eating behaviors and concerns separately for male adolescents (Table 4A and Table 4B) and female adolescents (Table 5A and Table 5B). Patterns of caregiver-reported disordered eating behaviors and related concerns among adolescents were generally similar to those observed among children aged 6 to 11 years. We observed a higher prevalence of several measures among adolescents experiencing food insufficiency and those with public health insurance, compared with food secure and privately insured adolescents, respectively. Non-Hispanic Black male adolescents had higher prevalence of avoidant eating behaviors (27.3%; 95% CI, 22.1%–33.1%) than non-Hispanic White male adolescents (19.8%; 95% CI, 18.3%–21.4%) (Table 4A), and non-Hispanic Asian female adolescents had lower prevalence of avoidant eating behaviors (14.5%; 95% CI, 10.6%–19.6%) than non-Hispanic White females (25.5%; 95% CI, 23.7%–27.3%) (Table 5A). In addition, non-Hispanic multiple race female adolescents had the highest prevalence of restrictive eating behaviors (22.1%; 95% CI, 16.9%–28.2%) and binge eating (12.5%; 95% CI, 8.0%–19.0%) (Table 5B). Caregivers of female adolescents from lower income households were also more likely to report any avoidant eating behaviors (<100% FPL: 31.1%; 95% CI, 25.4%–36.9%), compared with caregivers of female adolescents from higher income households (≥400% FPL: 22.8%; 95% CI, 20.5%–25.0%) (Table 5A).

In terms of health-related factors, both male and female adolescents in good/fair/poor general health, those with current mental, emotional, or behavioral conditions, those experiencing more frequent bullying victimization, those with higher levels of screentime, and those whose doctor had ever told their caregivers that they were overweight were observed to have a higher prevalence of most outcomes compared with their counterparts who did not experience these factors. Adolescents of both sexes with higher BMI percentile were also more likely than those with lower BMI percentile to have caregivers report binge eating and child’s concerns about their weight, shape, or size.

In terms of family factors, both male and female adolescents with caregivers in good/fair/poor mental/emotional health, adolescents whose caregivers were concerned about their child’s weight, adolescents whose caregivers did not share ideas or talk together, adolescents from families that never or rarely eat meals together, and adolescents with 2 or more adverse childhood experiences were observed to have a higher prevalence of most caregiver-reported outcomes compared with their counterparts.

Patterns of association among adolescents differed from those among children in 2 notable ways. First, factors related to health care access (ie, preventive medical visits, usual source of sick care), while not significantly associated with disordered eating behaviors and concerns among children, emerged as significant among adolescents; we observed a higher prevalence of behaviors and related concerns among adolescents whose caregivers reported greater access to health care compared with those with less reported access to health care. For example, adolescent females with a preventive visit in the past year were found to have a higher prevalence of restrictive eating behaviors (16.4%; 95% CI, 14.8–18.2), relative to those with no past-year preventive visit (9.5%; 95% CI, 7.2–12.4) (Table 5A). Second, while household education level was significantly associated with disordered eating behaviors and related caregiver concerns among children, we found no significant associations by household education level among either female or male adolescents.

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Discussion

Eating disorders often begin in childhood or adolescence, have among the highest case fatality rate of any mental health condition, and present substantial social and economic costs (2,20). Ongoing national surveillance is needed to provide up-to-date epidemiologic data on these outcomes and track trends over time. This study found a concerningly high prevalence of caregiver-reported eating disorder–related behaviors, especially among adolescents aged 12 to 17; one-third of adolescents were reported by their caregivers to be “somewhat” or “very much” concerned about their body weight, shape, or size and nearly one-third were reported to have engaged in at least 1 form of disordered eating, with even higher levels observed among female adolescents for select restrictive-type and avoidant-type behaviors. These estimates are consistent with extant studies of self-reported disordered eating among young people (6,8), which have documented prevalences of approximately 20%. They are also consistent with the wealth of studies documenting sex-related differences in both disordered eating and body image concerns, which are likely driven by a complex interplay of biologic factors (eg, pubertal onset) and social experiences (eg, intensified appearance pressures) that often characterize adolescence yet disproportionately elevate risk of restrictive-type disordered eating for girls (21).

Prevalence of disordered eating was not negligible among children aged 6 to 11 years either, especially for avoidant-type behaviors (eg, 24% were reported to have engaged in extremely picky eating). Emerging research on disordered eating and body dissatisfaction among children suggests that avoidant-type behaviors are increasingly common among children younger than 12 years and that early signs of body dissatisfaction and related disordered eating may emerge during these years (12,22,23). We did not find evidence of any sex-related eating behavior differences among children, unlike among adolescents, possibly because such differences do not emerge until adolescence (21). Conversely, sex-related differences among adolescents may be an artifact of caregivers being less likely to recognize disordered eating and/or body image concerns among male adolescents due to stigma and stereotypes.

We found significant associations between sociodemographic and economic characteristics and concerns about body weight/shape/size and disordered eating. Specifically, children and adolescents belonging to some racial and ethnic minority groups and those experiencing food insufficiency, who were publicly insured, and were from lower income households had higher prevalences of most outcomes compared with their more advantaged peers, with the largest gaps observed among female adolescents. These results extend a burgeoning literature that challenges prevailing notions about who is affected by eating disorders and related outcomes, by revealing differential risks according to racial and ethnic group and socioeconomic status, likely due to varying sociocultural experiences and exposures (8,14,24).

We found that caregiver-reported body image concerns and disordered eating behaviors among children and adolescents were strongly associated with a range of mental, emotional, and behavioral conditions, as well as with factors related to health care access. The associations between mental, emotional, and behavioral conditions and disordered eating-related outcomes are consistent with prior research documenting high rates of psychiatric comorbidities among adolescents with eating disorders (25); we extend this work by showing that such comorbidities may be present among younger children as well. Our finding that greater health care access was positively associated with concerns about body weight/shape/size and disordered eating among adolescents was somewhat surprising; we hypothesize that caregivers who regularly interact with the health care system on behalf of their child may have more awareness about child and adolescent health, and thus may be more likely to detect and report their child’s body concerns and/or disordered eating. More research is needed to explore this hypothesis. We also note that prevalence of disordered eating behaviors and concerns was higher among children and adolescents whose doctor told their caregiver that they were overweight, and that differences in prevalence by weight status emerged in childhood and widened in adolescence, findings which are consistent with and extend the literature that identifies weight stigma as a key driver of body dissatisfaction and disordered eating among young people (26).

This study has several limitations. First, while the caregiver perspective is valuable, it may underestimate the prevalence of disordered eating behaviors, particularly for those that occur in secrecy or those that their children do not disclose. Additionally, caregivers may be less likely to recognize or report behaviors that do not align with their beliefs or perceptions about disordered eating, especially for behaviors that may initially present as less severe, potentially underestimating the magnitude of the problem for some population groups. Another limitation is the small sample sizes for some behaviors and subgroups, which produced unreliable estimates that should be interpreted with caution. The potential for misclassification also exists, particularly if caregivers interpreted some survey questions as referring to milder eating behaviors, such as picky eating, rather than more serious disordered eating patterns. Finally, the study’s cross-sectional design precludes causal inferences; while we identified numerous associations between disordered eating patterns and various factors, we cannot confirm the temporal ordering of these relationships.

Despite these limitations, this study has several strengths. It provides up-to-date, nationally representative estimates of caregiver-reported disordered eating behaviors and concerns among US children and adolescents, and the use of an annual survey will allow for tracking changes in these measures over time. The inclusion of children aged 6 to 11 years is another strength because it broadens the scope of the existing literature to include age groups that are often overlooked in research on disordered eating. Furthermore, the study captures the caregiver perspective, which is crucial to consider for promoting access to prevention, screening, diagnosis, and treatment for children and adolescents.

Addressing eating disorders among young people at a national level has important implications. From a research perspective, future studies could compare caregiver-reported data with data reported by children and adolescents, examine how caregiver perceptions affect access to care for disordered eating, explore the drivers behind observed differences between groups, and investigate potential interactions between various sociodemographic and economic factors and eating disorders. The results also suggest a need for ongoing population-based data collection on disordered eating behaviors among young people to inform efforts to reduce eating disorders and improve mental health (27). The findings underscore the need for diagnosis, treatment, and resource allocation, particularly for young populations who may be disproportionately affected (28–30). Prevention efforts (eg, active monitoring, caregiver interviews), could be helpful in identifying and addressing eating disorders before they become more severe; more research is needed to develop and test pediatric screening tools and to assess the balance of benefits and harms of universal screening (31,32). Also needed are increased awareness and education for caregivers to recognize and address disordered eating behaviors early as well as for health care providers to identify eating disorders among children and adolescents and engage families in prevention and treatment (33,34).

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Acknowledgments

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. No financial or material support was received for this work. No copyrighted material, surveys, instruments, or tools were used in the research described in this article. The views expressed in this article are those of the authors and do not necessarily reflect the official policies of the US Department of Health and Human Services (HHS), HRSA, or the US Census Bureau, nor does mention of HHS, HRSA, or the US Census Bureau imply endorsement by the US government. Dr. Fields is retired from the US Census Bureau.

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Author Information

Corresponding Author: Lydie A. Lebrun-Harris, PhD, MPH, US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Office of Epidemiology and Research, 5600 Fishers Ln, Rockville, MD 20857 (LHarris2@hrsa.gov).

Author Affiliations: ¹US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland. ²Boston Children’s Hospital, Boston, Massachusetts. ³Harvard Medical School, Boston, Massachusetts. ⁴Harvard T.H. Chan School of Public Health, Boston, Massachusetts. ⁵US Census Bureau, Social, Economic, and Housing Statistics Division, Washington, District of Columbia.

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References

1. Udo T, Grilo CM. Psychiatric and medical correlates of DSM-5 eating disorders in a nationally representative sample of adults in the United States. Int J Eat Disord. 2019;52(1):42–50. PubMed doi:10.1002/eat.23004
2. Streatfeild J, Hickson J, Austin SB, Hutcheson R, Kandel JS, Lampert JG, et al. . Social and economic cost of eating disorders in the United States: evidence to inform policy action. Int J Eat Disord. 2021;54(5):851–868. PubMed doi:10.1002/eat.23486
3. Merikangas KR, He J-P, Burstein M, Swanson SA, Avenevoli S, Cui L, et al. . Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS–A). J Am Acad Child Adolesc Psychiatry. 2010;49(10):980–989. PubMed doi:10.1016/j.jaac.2010.05.017
4. Ward ZJ, Rodriguez P, Wright DR, Austin SB, Long MW. Estimation of eating disorders prevalence by age and associations with mortality in a simulated nationally representative US cohort. JAMA Netw Open. 2019;2(10):e1912925. PubMed doi:10.1001/jamanetworkopen.2019.12925
5. Kärkkäinen U, Mustelin L, Raevuori A, Kaprio J, Keski-Rahkonen A. Do disordered eating behaviors have long-term health-related consequences? Eur Eat Disord Rev. 2018;26(1):22–28. PubMed doi:10.1002/erv.2568
6. López-Gil JF, García-Hermoso A, Smith L, Firth J, Trott M, Mesas AE, et al. . Global proportion of disordered eating in children and adolescents: a systematic review and meta-analysis. JAMA Pediatr. 2023;177(4):363–372. PubMed doi:10.1001/jamapediatrics.2022.5848
7. Gaffney T. A decade without data: eating disorder researchers say a gap in CDC survey has left them flying blind. Stat. December 9, 2021. Accessed May 11, 2022. https://www.statnews.com/2021/12/09/eating-disorders-research-health-cdc
8. Beccia AL, Baek J, Jesdale WM, Austin SB, Forrester S, Curtin C, et al. . Risk of disordered eating at the intersection of gender and racial/ethnic identity among U.S. high school students. Eat Behav. 2019;34:101299. PubMed doi:10.1016/j.eatbeh.2019.05.002
9. J Devoe D, Han A, Anderson A, Katzman DK, Patten SB, Soumbasis A, et al. . The impact of the COVID-19 pandemic on eating disorders: a systematic review. Int J Eat Disord. 2023;56(1):5–25. PubMed doi:10.1002/eat.23704
10. Lin JA, Hartman-Munick SM, Kells MR, Milliren CE, Slater WA, Woods ER, et al. . The impact of the COVID-19 pandemic on the number of adolescents/young adults seeking eating disorder–related care. J Adolesc Health. 2021;69(4):660–663. PubMed doi:10.1016/j.jadohealth.2021.05.019
11. Otto AK, Jary JM, Sturza J, Miller CA, Prohaska N, Bravender T, et al. . Medical admissions among adolescents with eating disorders during the COVID-19 pandemic. Pediatrics. 2021;148(4):e2021052201. PubMed doi:10.1542/peds.2021-052201
12. Bufferd SJ, Levinson CA, Olino TM, Dougherty LR, Dyson MW, Carlson GA, et al. . Temperament and psychopathology in early childhood predict body dissatisfaction and eating disorder symptoms in adolescence. Behav Res Ther. 2022;151:104039. PubMed doi:10.1016/j.brat.2022.104039
13. Hazzard VM, Loth KA, Hooper L, Becker CB. Food insecurity and eating disorders: a review of emerging evidence. Curr Psychiatry Rep. 2020;22(12):74. PubMed doi:10.1007/s11920-020-01200-0
14. Sonneville KR, Lipson SK. Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students. Int J Eat Disord. 2018;51(6):518–526. PubMed doi:10.1002/eat.22846
15. Salbach-Andrae H, Klinkowski N, Lenz K, Pfeiffer E, Lehmkuhl U, Ehrlich S. Correspondence between self-reported and parent-reported psychopathology in adolescents with eating disorders. Psychopathology. 2008;41(5):307–312. PubMed doi:10.1159/000146068
16. Couturier J, Lock J, Forsberg S, Vanderheyden D, Yen HL. The addition of a parent and clinician component to the eating disorder examination for children and adolescents. Int J Eat Disord. 2007;40(5):472–475. PubMed doi:10.1002/eat.20379
17. Rosello R, Gledhill J, Yi I, Watkins B, Harvey L, Hosking A, et al. . Recognition and duration of illness in adolescent eating disorders: parental perceptions of symptom onset. Early Interv Psychiatry. 2022;16(8):854–861. PubMed doi:10.1111/eip.13224
18. Ghandour RM, Jones JR, Lebrun-Harris LA, Minnaert J, Blumberg SJ, Fields J, et al. . The design and implementation of the 2016 National Survey of Children’s Health. Matern Child Health J. 2018;22(8):1093–1102. PubMed doi:10.1007/s10995-018-2526-x
19. US Census Bureau. 2022 National Survey of Children’s Health: Methodology Report. 2025. Accessed May 11, 2022. https://www2.census.gov/programs-surveys/nsch/technical-documentation/methodology/2022-NSCH-Methodology-Report.pdf
20. Smink FR, van Hoeken D, Hoek HW. Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep. 2012;14(4):406–414. PubMed doi:10.1007/s11920-012-0282-y
21. Murnen S, Smolak L. Gender and eating disorders. In: Smolak L, Levine MP, eds. The Wiley Handbook of Eating Disorders, Assessment, Prevention, Treatment, Policy, and Future Direction. John Wiley & Sons, Ltd; 2015:352–366.
22. Zohar AH. Picky eating in normally developing children and young adults. In: Patel VB, Preedy VR, eds. Eating Disorders. Springer; 2023:1417–1432.
23. Dunford A, Thomas J. Epidemiology of avoidant/restrictive food intake disorder. Psychiatr Ann. 2024;54(2):e42–e46.
24. Daniel B, Suissa A, Liu J, Bruzzese J-M, Jackman K, Leonard S. Disordered eating in early adolescence: disparities among minoritised youth. J Adv Nurs. 2025;81(6):3308–3315. PubMed doi:10.3928/00485713-20240117-01
25. Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR. Prevalence and correlates of eating disorders in adolescents. Results from the National Comorbidity Survey Replication Adolescent Supplement. Arch Gen Psychiatry. 2011;68(7):714–723. PubMed doi:10.1001/archgenpsychiatry.2011.22
26. Levinson JA, Kinkel-Ram S, Myers B, Hunger JM. A systematic review of weight stigma and disordered eating cognitions and behaviors. Body Image. 2024;48:101678. PubMed doi:10.1016/j.bodyim.2023.101678
27. Eating Disorder Public Health Surveillance Working Group. Assessing Disordered Eating in the Youth Risk Behavior Survey (YRBS): Best Practices and Recommendations for Item Selection. 2024. Accessed March 26, 2025. https://hsph.harvard.edu/wp-content/uploads/2024/11/Working-Group-Assessing-Disordered-Eating.pdf
28. Hahn SL, Burnette CB, Borton KA, Mitchell Carpenter L, Sonneville KR, Bailey B. Eating disorder risk in rural US adolescents: what do we know and where do we go? Int J Eat Disord. 2023;56(2):366–371. PubMed doi:10.1002/eat.23843
29. McGowan A, Barry MR, Sonneville KR, Leung CW. Greater social adversity is associated with more disordered eating attitudes and behaviors among children from Southeast Michigan. Int J Eat Disord. 2022;55(12):1670–1677. PubMed doi:10.1002/eat.23775
30. Moreno R, Buckelew SM, Accurso EC, Raymond-Flesch M. Disparities in access to eating disorders treatment for publicly-insured youth and youth of color: a retrospective cohort study. J Eat Disord. 2023;11(1):10. PubMed doi:10.1186/s40337-022-00730-7
31. US Preventive Services Task Force. Final recommendation statement: eating disorders in adolescents and adults: screening. 2022. Accessed March 26, 2025. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-eating-disorders-adolescents-adults
32. Tanner AB, Williams L, Goldschmidt AB. Screening and monitoring for eating disorders in youth presenting for obesity treatment. Pediatr Open Sci. 2025;1(1):1–4. PubMed doi:10.1542/pedsos.2024-000333
33. Hornberger LL, Lane MA, Breuner C; Committee on Adolescence. Identification and management of eating disorders in children and adolescents. Pediatrics. 2021;147(1):e2020040279. PubMed doi:10.1542/peds.2020-040279
34. National Eating Disorders Association. NEDA Toolkit for Parents. 2012. https://www.nationaleatingdisorders.org/wp-content/uploads/2012/06/ParentToolkit-946.pdf

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Tables

Abbreviations: ACE, adverse childhood experience; ADHD, attention deficit/hyperactivity disorder.
^a Percentages may add up to more than 100% due to comorbid conditions.
^b Of 9 possible ACEs: parents divorced or separated; parent died; parent incarcerated; interpersonal violence in the home; victim or witness of neighborhood violence; lived with someone who was mentally ill, severely depressed, or suicidal; lived with someone with an alcohol or drug problem; treated unfairly because of race or ethnicity; treated unfairly because of disability or health condition.

^a Determined by Rao–Scott design-adjusted χ² test of independence at significance level of .05.
^b Interpret estimate with caution (relative SE >30%).
^c Estimate suppressed due to unreliability (relative SE >50%).
^d Among children whose caregiver reported ≥1 of the 8 listed disordered eating behaviors.

^a Determined by Rao–Scott design-adjusted χ² test of independence at significance level of .05.
^b Interpret estimate with caution (relative SE >30%).
^c Among children whose caregiver reported ≥1 of the 8 listed disordered eating behaviors.

Abbreviations: ACE, adverse childhood experience; ADHD, attention deficit/hyperactivity disorder; NA, not applicable.
^a Overexercising was excluded due to small sample sizes for children aged 6–11 years.
^b Restrictive eating behaviors are skipping meals or fasting, purging or vomiting after eating, and/or using diet pills, laxatives, or diuretics.
^c Avoidant eating behaviors are low interest in food, extremely picky eating, and/or not eating due to fear of vomiting or choking.
^d Determined by Rao–Scott design-adjusted χ² test of independence at significance level of .05.
^e Estimate suppressed due to unreliability (relative SE >50%).
^f Interpret estimate with caution (relative SE >30%).
^g ACEs include parents divorced or separated; parent died; parent incarcerated; interpersonal violence in the home; victim or witness of neighborhood violence; lived with someone who was mentally ill, severely depressed, or suicidal; lived with someone with an alcohol or drug problem; treated unfairly because of race or ethnicity; treated unfairly because of disability or health condition.

Abbreviations: ACE, adverse childhood experience; ADHD, attention deficit/hyperactivity disorder; NA, not applicable.
^a Overexercising was excluded due to small sample sizes for children aged 6–11 years.
^b Determined by Rao–Scott design-adjusted χ² test of independence at significance level of .05.
^c Estimate suppressed due to unreliability (relative SE >50%).
^d Interpret estimate with caution (relative SE >30%).
^e ACEs include parents divorced or separated; parent died; parent incarcerated; interpersonal violence in the home; victim or witness of neighborhood violence; lived with someone who was mentally ill, severely depressed, or suicidal; lived with someone with an alcohol or drug problem; treated unfairly because of race or ethnicity; treated unfairly because of disability or health condition.

Abbreviations: ACE, adverse childhood experience; ADHD, attention deficit/hyperactivity disorder; NA, not applicable.
^a Restrictive eating behaviors are skipping meals or fasting, purging or vomiting after eating, and/or using diet pills, laxatives, or diuretics.
^b Avoidant eating behaviors are low interest in food, extremely picky eating, and/or not eating due to fear of vomiting or choking.
^c Determined by Rao–Scott design-adjusted χ² test of independence at significance level of .05.
^d Interpret estimate with caution (relative SE >30%).
^e Estimate suppressed due to unreliability (relative SE >50%).
^f ACEs include parents divorced or separated; parent died; parent incarcerated; interpersonal violence in the home; victim or witness of neighborhood violence; lived with someone who was mentally ill, severely depressed, or suicidal; lived with someone with an alcohol or drug problem; treated unfairly because of race or ethnicity; treated unfairly because of disability or health condition.

Abbreviations: ACE, adverse childhood experience; ADHD, attention deficit/hyperactivity disorder; NA, not applicable.
^a Determined by Rao–Scott design-adjusted χ² test of independence at significance level of .05.
^b Interpret estimate with caution (relative SE >30%).
^c Estimate suppressed due to unreliability (relative SE >50%).
^d ACEs include parents divorced or separated; parent died; parent incarcerated; interpersonal violence in the home; victim or witness of neighborhood violence; lived with someone who was mentally ill, severely depressed, or suicidal; lived with someone with an alcohol or drug problem; treated unfairly because of race or ethnicity; treated unfairly because of disability or health condition.

Abbreviations: ACE, adverse childhood experience; ADHD, attention deficit/hyperactivity disorder; NA, not applicable.
^a Restrictive eating behaviors are skipping meals or fasting, purging or vomiting after eating, and/or using diet pills, laxatives, or diuretics.
^b Avoidant eating behaviors are low interest in food, extremely picky eating, and/or not eating due to fear of vomiting or choking.
^c Determined by Rao–Scott design-adjusted χ² test of independence at significance level of .05.
^d Interpret estimate with caution (relative SE >30%).
^e Estimate suppressed due to unreliability (relative SE >50%).
^f ACEs include parents divorced or separated; parent died; parent incarcerated; interpersonal violence in the home; victim or witness of neighborhood violence; lived with someone who was mentally ill, severely depressed, or suicidal; lived with someone with an alcohol or drug problem; treated unfairly because of race or ethnicity; treated unfairly because of disability or health condition.

Abbreviations: ACE, adverse childhood experience; ADHD, attention deficit/hyperactivity disorder; NA, not applicable.
^a Determined by Rao–Scott design-adjusted χ² test of independence at significance level of .05.
^b Estimate suppressed due to unreliability (relative SE >50%).
^c Interpret estimate with caution (relative SE >30%).
^d ACEs include parents divorced or separated; parent died; parent incarcerated; interpersonal violence in the home; victim or witness of neighborhood violence; lived with someone who was mentally ill, severely depressed, or suicidal; lived with someone with an alcohol or drug problem; treated unfairly because of race or ethnicity; treated unfairly because of disability or health condition.

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