Clinical Takeaway
A 15-year Canadian cohort study tracked adolescents into early adulthood to examine how early risk factors like body image concerns and disordered eating predict later eating disorders, mental health conditions, and substance use problems. The findings highlight that psychosocial vulnerabilities established in adolescence have measurable, lasting effects on multiple health outcomes in young adulthood. Clinicians should consider early screening for disordered eating and body image distress as part of routine adolescent care to reduce downstream multimorbidity.
#6 Research on Eating and Adolescent Lifestyle (REAL) 2.0: 15-year follow-up study of eating disorders and weight-related trajectories, mental health and substance use health from early adolescence to early adulthood-a Canadian cohort profile.
Citation: Obeid Nicole et al.. Research on Eating and Adolescent Lifestyle (REAL) 2.0: 15-year follow-up study of eating disorders and weight-related trajectories, mental health and substance use health from early adolescence to early adulthood-a Canadian cohort profile.. BMJ open. 2026. PMID: 41526025.
Design: 0 Journal: 3 N: 4 Recency: 3 Pop: 3 Human: 1 Risk: -2
This 15-year longitudinal study provides critical evidence on how adolescent psychosocial factors, particularly body image and disordered eating, predict eating disorders, weight dysregulation, and comorbid mental health conditions in early adulthood within a Canadian population. Understanding these long-term developmental trajectories enables clinicians to identify high-risk adolescents for earlier intervention and to better anticipate and manage the multimorbid psychiatric and metabolic complications that often accompany eating disorders into adulthood. The extended follow-up period and Canadian cohort data address a significant gap in the literature regarding the naturalistic progression of adolescent eating and weight-related concerns and their relationship to substance use and mental health outcomes.
Quality Gate Alerts:
- Preclinical only
Methodological Considerations:
- Cross-sectional design — causal inference not possible
Abstract: PURPOSE: Few studies have examined how psychosocial risk and protective factors in adolescence shape mental health outcomes and other multimorbid conditions in adulthood, particularly among Canadian youth. The Research on Eating and Adolescent Lifestyle (REAL) 2.0 study was a 15-year follow-up cohort study designed to investigate how early etiological factors, including body image and disordered eating symptoms in adolescence, contribute to the development of eating, weight-related concerns, mental health and substance use health problems in early adulthood. In this paper, we describe the REAL 2.0 cohort’s demographic and clinical characteristics alongside an overview of the study procedures, laying the groundwork for collaboration on future learnings with this unique data. PARTICIPANTS: The cross-sectional REAL study initially surveyed middle and high school students from 2004 to 2010 (n=3043) across 43 schools in the Ottawa, Canada region. Of those, respondents in grade 7 or 9 (n=1197 from 25 of the 43 original schools) were asked to participate in a longitudinal arm of the study that consisted of yearly follow-ups. From the longitudinal cohort, there were 278 participants (29.1% male; Mage=28.6) from those who consented to be re-contacted (n=912), who completed the REAL 2.0 survey electronically (30.4%), providing comprehensive data on demographic, clinical, eating and weight-related behaviour, psychological, social, environmental and substance use health factors in adulthood. FINDINGS TO DATE: 9.4% of REAL 2.0 participants met DSM-5 criteria for an eating disorder, while 17.6% met criteria for disordered eating. Moderate to severe anxiety was reported by 28% of participants, while 21.6% experienced moderate to severe depressive symptoms. Regarding substance use, 16.9% engaged in hazardous drinking, 16.9% used cannabis daily or almost daily, and 4.3% reported daily tobacco use. FUTURE PLANS: REAL 2.0 has the potential to answer multiple research questions about s
🧠 While the REAL 2.0 cohort provides valuable longitudinal data on how adolescent eating and body image concerns track into adulthood, the abstract excerpt does not appear to report cannabis-specific findings, making direct clinical application to cannabis medicine practice unclear. The study’s examination of multimorbid mental health and substance use trajectories over 15 years could potentially inform understanding of cannabis use patterns within populations experiencing disordered eating or body image disturbance, yet we would need the full results to evaluate whether cannabis use was meaningfully assessed or analyzed as either an exposure or outcome. Notably, confounders such as concurrent psychiatric medications, timing and frequency of cannabis use, product type and cannabinoid ratios, and socioeconomic factors influencing both eating disorder risk and substance use access are not addressed in the available abstract. Clinically, this study underscores the importance of screening adolescent and young adult patients for eating disorders and body image concerns during cannabis consultations, as untreated underlying disordered eating may