Journal of Health Research and Reviews (in Developing Countries)

: 2021  |  Volume : 8  |  Issue : 1  |  Page : 13--17

Eating and weight disorders: How are they related? A narrative review

Lubna A G Mahmood1, Lorraine Matthews2,  
1 Dietetics and Nutrition Department, Hamad Medical Corporation, Doha, State of Qatar
2 Columbus County Department of Public Health, North Carolina, USA

Correspondence Address:
Lubna A G Mahmood
Dietetics and Nutrition Department, Hamad Medical Corporation, Doha.
State of Qatar


Background: Eating disorders are conditions that include abnormal eating behaviors such as excessive or insufficient intake, and which can lead to mental and physical health. Rates of mortality were high among socially isolated individuals as they can be more stressed and depressed. Thus, these disorders must be treated instantly to prevent the deteriorations. In this narrative review, we focus on the association between eating disorders and obesity especially among adolescents. Materials and Methods: A search of periodical literature by the author involving eating disorders and obesity was carried out. Items were identified initially through health-oriented indexing services such as Medline, Health STAR, and Cinahl, looking up for articles published in English language, from 2010 to 2020. Results: Obesity rates were more among adolescents who used to skip their main meals. Whereas, skipping meals were also reported among adolescents who suffered from eating disorders. Both obesity and eating disorders were thought treated by psychological, physical, and dietary approaches. Conclusion: This review is focused on the eating disorders that result in obesity. There is much need for research and development of medications and new innovative treatments to address this growing problem. Research will shed new light on pathways in the brain, which once revealed as related to the abnormal patterns of eating behavior can be modified and changed to successfully help these patients.

How to cite this article:
Mahmood LA, Matthews L. Eating and weight disorders: How are they related? A narrative review.J Health Res Rev 2021;8:13-17

How to cite this URL:
Mahmood LA, Matthews L. Eating and weight disorders: How are they related? A narrative review. J Health Res Rev [serial online] 2021 [cited 2022 Sep 26 ];8:13-17
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Eating disorders are not just about food and weight. They are also not about vanity or will-power. Eating disorders are serious and potentially life-threatening mental illnesses in which a person experiences severe disturbances in eating and exercise behaviors because of distortions in thoughts and emotions, especially those relating to body image or feelings of self-worth. People in all age groups, genders, socio-economic and cultural backgrounds can be affected by eating disorders.[1] A person with an eating disorder can be underweight, within a healthy weight range, or overweight. Binge eating, Anorexia, and Bulimia nervosa are the three main types of eating disorders.[2],[3] The associations between eating habits and obesity were studied but the exact mechanism remains unclear.[4],[5] This narrative review focuses on the association between eating disorders and obesity especially among adolescents.

 Materials and Methods

Research criteria and methodology

A search of periodical literature by the author involving eating disorders and obesity was carried out. Items were identified initially through health-oriented indexing services such as Medline, Health STAR and Cinahl, looking up for articles published in English language, from 2010 to 2020. Keywords included “Eating disorder”; “Anorexia Nervosa”; “Bulimia”; “Binge eating”; and “Adolescents.” An extensive search was also carried out on educational database ERIC [Figure 1]. Through an electronic search, 60 studies were identified. We excluded studies published in other languages because we lacked the resources for translation.{Figure 1}


The question above includes the PICO elements:

P (Problem or Patient or Population): adolescents with eating disorders

I (intervention/indicator): Healthy eating behaviors

C (comparison): unhealthy eating; healthy eating

O (outcome of interest): reduced obesity risk

Risk of bias

Publication bias is understood as the tendency to publish results that are systematically different from reality. Failure to publish results may be due to the decision of the author or funder of the study, who does not submit for publication unfavorable findings, or from editors of scientific journals, who may not be interested in disclosing negative findings. That’s why, it is essential to ensure that the studies included in have comparable methodological quality and the necessary information to allow the identification of selection, gauging, and confounding biases were avoided.


Eating disorders diagnosis

These disorders in general include abnormal eating behaviors such as insufficient or excessive intake, and which can lead to mental and physical health.[1] The major types of eating disorders include anorexia nervosa, bulimia nervosa, and binge eating.[1] Media pressure, dietary habits, and parental influence can all play a significant role in developing eating disorders especially among adolescents.[4]

Anorexia nervosa

Anorexia nervosa is characterized by food restriction, inappropriate eating habits, irrational fear of gaining weight, distorted body self-perception, as well as obsession with having a thin figure. Accordingly, individuals restricting the amount of food they consume. It is usually diagnosed among females than males. Patients with anorexia nervosa frequently experience lack of energy, dizziness, headaches, drowsiness, and appetite loss.[6] Anorexia nervosa can affect the individual’s ability to evaluate his or her body image, food intake, and habits. Caloric intake of 600 to 800 calories/day, was the average calories consumed by the majority of anorexia nervosa patients.[7] Hypokalemia, a decrease in blood potassium is often the first sign in which it develops to fatigue, paralysis, muscle weakness, abnormal heart rhythms, and constipation. Whereas, more than 50% of individual diagnosed with anorexia nervosa found to be suffered from depression.[8]

Food rituals may also be experienced and individual start refusing to eat around others, hiding or discarding food ,or they may also engage in compulsive, strenuous, and frequent exercise.[9] The treatment plan usually includes the medical treatment of presenting physical symptoms along with dietary and psychiatric care including family-based treatment, cognitive behavioral therapy, and cognitive remediation therapy. Initial dietary plans may start with a meal low in calories which helps to build ease in eating, to be gradually increased. Food variety is also very important as well as inclusion of energy-density foods. Whereas, with deteriorated cases, supplementation may be vital to replenish the decreased stores of essential nutrients.[5]

Bulimia nervosa

It is a serious psychiatric disorder characterized by purging after consuming meals within a short period of time. Moreover, some individuals might use other options like taking laxatives or even forced vomiting.[2] Warning signs may include extreme consciousness of calories, intake and weight, low self-esteem, and may reach to severe depression.[10] The cycle of repeated forced vomiting after eating may cause gastroesophageal reflux, electrolyte imbalance, dehydration, ulceration, and upper GI inflammation.[11],[12]

Binge eating disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, there are specific criteria for binge eating disorder (BED), and at least three of them must be presented in order to classify a person’s behaviors as BED. These criteria include: binge eating that occurs at least twice a week for 6 months; the person usually feels disgusted, depressed, or guilty after binge eating.[12]

A correlation between the occurrence of binge eating and dietary restraint has been convincingly shown in several investigative studies. Whereas binge eaters usually seem to be lacking in self-control, the main reason for such behavior may be linked to dieting practices. Binge eating can also begin when an individual recovers from adoption of rigid eating habits and behaviors. When under a strict diet or in a starvation situation, the body will begin to prepare for a new type of behavior pattern, such as consuming a large amount of food in a relatively short period of time.[5]

Dietary habits among adolescents

Poor eating habits and nutritional behaviors have become major public health concerns especially among adolescents. Peer pressure, stress, and lack of time are factors that can affect their eating habits.[13] The rapid economic change can affect adult eating habits since the traditional dietary habits might be changed to unhealthy dietary habits.[13] Most adolescents prefer tasty, quick, and fashionable meals despite the health concerns behind their consumption.[14] Students spend most of their time at school where they have at least one or two meals there. These students are highly exposured to vending machines which provide almost unhealthy snacks.[15] Most of these students acquire poor dietary patterns related to their preference for fast foods, regularly having their meals outside the home, and skipping breakfast. It has been found that female students who had their regular meals were more relaxed, less hungry, and more satisfied with their weight and body image.[16],[17] The country’s culture may also affect the eating behavior of its population. For example, regular meal consumption is important in the Chinese traditional dietary pattern but skipping meals is particularly serious in Hong Kong.[18] Friends, peers, and broader social networks influence both eating habits and physical activity during adolescence and adulthood as well. It has been found that students eat more than in the presence of peers. Moreover, similar effects have been found among college students—where it was found that students who were eating with strangers consumed less food than those who were eating with their siblings.[19]

The contribution of social and family factors in adolescents’ dietary habits

Researchers in Poland found that 86.6% of adults whose parents had a higher level of education, consumed smaller, more frequent, and light snacks compared with those whose parents had only primary education.[20] Adults with less-educated parents were more likely to skip their meals. In particular, research has found an increased likelihood of obesity among adolescents from low-income families. In fact, African Americans who often experience higher poverty rates than other US minorities may experience a higher prevalence of obesity than whites, since poverty can limit the accessibility of having healthy meals.[21],[22] Parental eating behaviors can encourage the whole family’s dietary habits.[23] Families may influence adolescents’ eating behaviors in many ways. Cultural values, portion size, and food availability, mealtime structure, meal preparation, and feeding styles are all factors that can influence the eating patterns of the whole family. Therefore, the family can play a vital role in preventing obesity and eating disorders among adolescents.[23]

Eating disorders and obesity

Obesity has become a major public health problem. It is defined as body fat accumulations with a body mass index (BMI) of more than 30kg/m2. It is associated with increased risk of medical complications, such as diabetes, stroke, hypertension, heart disease, some types of cancer, sleep apnea, gallbladder disease, premature mortality, and osteoarthritis.[23] Adolescents experience rapid changes in their psychosocial development and physical growth which can put them at risk of increasing their requirements with nutritionally inadequate food that may not meet their dietary needs.[24]

Students may suffer from skipping meals and eating away from home. Away-from-home foods are generally defined as “full meals and single ready-to-eat items (including take-away foods) purchased at restaurants, prepared-food counters at grocery stores, and other outlets.” Away-from-home foods are higher in fat and lower in fibers and frequent consumption of fast food, in particular, is associated with poorer diet quality and risk for obesity for both children and adults.[25] It has been reported that 78% of those adolescents who had normal body weight and BMI used to eat their regular.[25] High intake of soft drinks and fatty foods too were proposed as factors related to the increased obesity rates among adolescents.[26]

Eating disorders have been known as (Western culture-bound syndromes), because of the excessive emphasis on appearance, weight, and shape in societies.[27] It is believed the treatment of both types of disorders, obesity and eating disorders, would be better served by putting attention on both the psychosocial and biological component of both disorders. Moreover, teenagers who suffered from any of these disorders, whether obesity or eating disorders, experienced similar conditions (i.e. low self-esteem, dieting, and body image dissatisfaction).[22]

Researchers found that most of the depressed adolescents were more likely to become obese. Whereas, more than one-third of obese individuals were reporting difficulties with binge eating.[23] Therefore, a mental health treatment must be included in the treatment plan along with dietary treatment and family support.[27],[28]


Good care should be provided to adolescents with eating disorders. There is much need for research and development of medications and new innovative treatments to address this growing problem.

Challenging issues now confronting the field include how the eating disorders should be categorized, what factors underlie their development and persistence, and how they are best treated. New efforts based on the analysis of genetic factors, on the use of brain imaging and on the detailed analysis of behavioral disturbances hold promise for significantly advancing our understanding of these disorders in the next decade. The data provided in this study can be used as a sole base for the upcoming researches.

Ethical approval and consent to participate

Not applicable.


This research was supported/partially supported Hamad Medical Corporation, dietetics department. We are thankful to our colleagues who provided expertise that greatly assisted the research.

Financial support and sponsorship


Conflict of interest

There are no conflicts of interest.

Data availability statement

The data that support the findings of this study are available from the corresponding author (LM) upon reasonable request.


1Swanson 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 Psychiatr2011;68:714-23.
2Westerburg DP, Waitz M. Binge-eating disorder. Osteopathic. Fam Physician 2013;5:230-33.
3Kurubaran G, Sami A. Social and psychological factors affecting eating habits among university students in a Malaysian medical school: A cross-sectional study. BioMed J 2012;16:2-7.
4Ayranci U, Erenoglu N, Son O. Eating habits, lifestyle factors, and body weight status among Turkish private educational institution students. Nutrition 2010;26:772-8.
5Yardimci H, Ozdogan Y, Ozcelik A. Fast-food consumption habits of university students: the sample of Ankara. J Nutrit 2012;11:265-9.
6Barzegari A, Ebrahimi M, Azizi M, Ranjbar K. A study of nutrition knowledge, attitudes and food habits of college students. World Appl Sci J 2011;15:1012-7.
7Tin S, Yin Ho S, Mak K, Wan K, Lam T. Lifestyle and socioeconomic correlates of breakfast skipping in Hong Kong. 2011;52:250-3.
8Salvy SJ, de la Haye K, Bowker JC, Hermans RC. Influence of peers and friends on children’s and adolescents’ eating and activity behaviors. Physiol Behav 2012;106:369-78.
9Witold K, Katarzyna S, Marian S. Eating habits of children and adolescents from rural regions depending on gender, education, and economic status of parents. Ann Agric Environ Med 2011;18:393-7.
10Brands B, Egan B, Györei E, López-Robles JC, Gage H, Campoy C, et al. A qualitative interview study on effects of diet on children’s mental state and performance. Evaluation of perceptions, attitudes and beliefs of parents in four European countries. Appetite 2012;58:739-46.
11Anwar K, Mohamed G. The association of breakfast consumption habit, snacking behavior and body mass index among university students. Am J Food Nutrit 2011;1:55-60.
12Volker S, Margit H, Claudia W. Impact of breakfast on daily energy intake - an analysis of absolute versus relative breakfast calories. BioMed J 2011;10:78-82
13Stunkard AJ. Eating disorders and obesity. Psychiatr Clin North Am 2011;34:765-71.
14Hay P, Mitchison D, Collado AEL, González-Chica DA, Stocks N, Touyz S. Burden and health-related quality of life of eating disorders, including avoidant/restrictive food intake disorder (ARFID), in the Australian population. J Eat Disord 2017;5:21.
15Galmiche M, Déchelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000-2018 period: A systematic literature review. Am J Clin Nutr 2019;109:1402-13.
16Udo T, Grilo CM. Prevalence and correlates of DSM-5-defined eating disorders in a nationally representative sample of U.S. Adults. Biol Psychiatr 2018;84:345-54.
17Mulders-Jones B, Mitchison D, Girosi F, Hay P. Socioeconomic correlates of eating disorder symptoms in an Australian population-based sample. PLoS One 2017;12:e0170603.
18Le LK, Barendregt JJ, Hay P, Mihalopoulos C. Prevention of eating disorders: A systematic review and meta-analysis. Clin Psychol Rev 2017;53:46-58.
19Hay P, Chinn D, Forbes D, Madden S, Newton R, Sugenor L, et al; Royal Australian and New Zealand College of Psychiatrists. Royal Australian and New Zealand college of psychiatrists clinical practice guidelines for the treatment of eating disorders. Aust N Z J Psychiatr 2014;48:977-1008.
20Hilbert A, Hoek HW, Schmidt R. Evidence-based clinical guidelines for eating disorders: International comparison. Curr Opin Psychiatr 2017;30:423-37.
21Hay PJ, Touyz S, Claudino AM, Lujic S, Smith CA, Madden S. Inpatient versus outpatient care, partial hospitalisation and waiting list for people with eating disorders. Cochrane Database Syst Rev 2019;1:CD010827.
22Le Grange D, Hughes EK, Court A, Yeo M, Crosby RD, Sawyer SM. Randomized clinical trial of parent-focused treatment and family-based treatment for adolescent anorexia nervosa. J Am Acad Child Adolesc Psychiatr 2016;55:683-92.
23Dalle Grave R, Calugi S, Sartirana M, Fairburn CG. Transdiagnostic cognitive behaviour therapy for adolescents with an eating disorder who are not underweight. Behav Res Ther 2015;73:79-82.
24Zipfel S, Wild B, Groß G, Friederich HC, Teufel M, Schellberg D, et al; ANTOP study group. Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): Randomised controlled trial. Lancet 2014;383: 127-37.
25Attia E, Steinglass JE, Walsh BT, Wang Y, Wu P, Schreyer C, et al. Olanzapine versus placebo in adult outpatients with anorexia nervosa: A randomized clinical trial. Am J Psychiatr 2019;176:449-56.
26Hilbert A, Petroff D, Herpertz S, Pietrowsky R, Tuschen-Caffier B, Vocks S, et al. Meta-analysis of the efficacy of psychological and medical treatments for binge-eating disorder. J Consult Clin Psychol 2019;87:91-105.
27Schorr M, Klibanski A. Anorexia nervosa and bone. Curr Opin Endocr Metab Res 2018;3:74-82.
28Keast R, Nicklas A, O’Neil E. Snacking is associated with reduced risk of overweight and reduced abdominal obesity in adolescents: National Health and Nutrition Examination Survey (NHANES) 1999–2004. Am J Clin Nutr 2010;92:428-35.