Development of Disordered Weight Control Behaviors and Its Progression to Eating Disorders in Canada: A Nationally Representative Microsimulation.

objectiveEating disorders (ED) present a significant health burden to children, adolescents, and young adults globally. Despite the importance of disordered weight control behaviors (DWCB) in ED development, little is known about the progression from DWCB to ED.

methodsWe synthesized available national surveillance and longitudinal data in Canada, as well as broader epidemiologic literature, to develop a state-transition microsimulation model to simulate the natural history of DWCB and ED for a synthetic cohort of 300,000 children. Using the calibrated model, we generated mean estimates and 95% uncertainty intervals (UI) for nationally representative point prevalence, cumulative incidence, and median time to progression of DWCB and ED from age four to 30 years, by sex assigned at birth.

resultsPoint prevalence of DWCB peaked at age 16 years at 32.8% (UI: 24.6%-42.5%) for female and at 11.0% (UI: 6.9%-16.1%) for male individuals. By age 30 years, 67.7% (UI: 60.8%-76.9%) of female and 48.7% (UI: 38.7%-68.0%) of male individuals had ever engaged in DWCBs. Female individuals who engaged in DWCB did so for a median of 3 (UI: 2-4) cumulative years, and 22.5% (UI: 11.5%-37.9%) later developed ED. DISCUSSION: We estimated substantial DWCB engagement among young people in Canada, especially female youth, which contributed to considerable burden of ED. This is the first known study to provide nationally representative estimates of DWCB and ED outcomes in Canada that cannot be obtained directly from empirical data. The results have significant implications for prevention and early intervention among children and adolescents.