Clinical Takeaway
The REAL 2.0 study followed Canadian youth for 15 years to track how adolescent risk factors like body image concerns and disordered eating relate to mental health and substance use outcomes in early adulthood. This long-term cohort design allows researchers to identify which early psychosocial factors are most predictive of multimorbid conditions later in life. Findings from this study may help inform earlier clinical screening and prevention strategies for at-risk youth.
#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 body image and disordered eating trajectories predict multimorbid outcomes including eating disorders, weight dysregulation, and mental health conditions in early adulthood, addressing a significant gap in Canadian prospective data. Understanding these developmental pathways enables clinicians to identify high-risk adolescents who require early intervention and to better predict which youth will experience persistent versus remitting eating and mental health problems into adulthood. The study’s focus on comorbid substance use and mental health outcomes clarifies the interconnected nature of these conditions, informing more integrated treatment approaches for young adults presenting with multiple concurrent disorders.
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 psychosocial factors track into adulthood, this study’s primary focus on eating disorders, weight trajectories, and mental health does not appear to directly examine cannabis use patterns or outcomes, limiting its direct applicability to cannabis medicine practice. The study’s Canadian context and 15-year follow-up design offer methodological strength for understanding comorbidity between eating disorders and other substance use including cannabis, but clinicians should recognize that any cannabis-related findings would likely be secondary outcomes rather than primary research questions. Given the known associations between cannabis use and both disordered eating and mental health symptoms in adolescents, this cohort could be valuable for identifying subgroups at higher risk for problematic use patterns, though we would need access to the full dataset and specific cannabis-related analyses to draw clinical conclusions. For providers working with young adults who present with both eating pathology and cannabis use, this study underscores the importance of comprehensive assessment across multiple