Triggers for eating disorder onset in youth with anorexia nervosa across the weight spectrum

ABSTRACT

To aid in more targeted eating disorder (ED) prevention efforts, we sought to identify sociodemographic and weight-related risk factors for identified triggers for the onset of anorexia nervosa (AN) in youth. We conducted a retrospective chart review of youth admitted for medical treatment of AN between January 2015 and February 2020. From multidisciplinary admission notes, we extracted patient-reported reasons for diet/exercise changes. We used qualitative thematic analysis to identify ED triggers, then categorized each trigger as binary variables (presence/absence) for logistic regression analysis of risks associated with each trigger. Of 150 patients, mean (SD) age was 14.1(2.3) years. A total of 129 (86%) were female and 120 (80%) were Non-Hispanic White. Triggers included environmental stressors (reported by 30%), external pressures of the thin/fit ideal (29%), internalized thin/fit ideal (29%), weight-related teasing (19%), and receiving health education (14%). Younger age was associated with higher odds of weight-related teasing (p = .04) and health education (p = .03). Males had greater odds of internalized thin/fit ideal than females (p = .04). Those with premorbid body mass indices ≥85^th percentile for age and sex had greater odds of reporting positive reinforcement (p = .03) and weight-related teasing (p = .04) than those with weights <85^th percentile. We use these findings to detail potential targets for advancing ED prevention efforts.

Acknowledgments

For the purpose of this paper, we refer to body mass index (BMI) numbers as opposed to the diagnosis of ‘overweight or obesity,’ given research that highlights how these terms can be stigmatizing. Where needed, we referred to weight classifications in quotes: ‘overweight/obesity’ and ‘normal.’

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Boston Children’s Hospital House Staff Development Award and also in part by Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of a [MCHB T71MC00009] LEAH training grant. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.