Clinical Takeaway
Eating disorders and disordered body image in adolescence are linked to lasting mental health and substance use challenges into early adulthood. This 15-year Canadian cohort study tracked these trajectories to identify which early risk and protective factors matter most. Clinicians should screen adolescent patients for disordered eating early, as these patterns rarely resolve on their own and often predict broader multimorbid outcomes.
#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 cohort study provides critical evidence on how adolescent psychosocial risk factors, particularly disordered eating and body image disturbance, predict the trajectory of eating disorders, weight-related conditions, and comorbid mental health and substance use disorders into early adulthood. Understanding these developmental pathways in a Canadian population enables clinicians to identify high-risk adolescents who may benefit from early intervention and to anticipate which patients are at greatest risk for multimorbid conditions requiring integrated treatment approaches. The long-term follow-up design strengthens causal inference regarding prevention and treatment strategies, informing clinical guidelines for managing eating and weight-related disorders across the lifespan.
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 relevance to cannabis medicine practice requires careful interpretation given that the abstract does not detail cannabis-specific exposure assessment or outcomes. The 15-year follow-up design is methodologically strong for understanding multimorbidity patterns, but without clarity on cannabis use measurement, frequency, potency, route of administration, or age of initiation, we cannot reliably attribute any observed mental health or substance use associations to cannabis specifically rather than to confounding lifestyle or psychiatric factors. Clinically, this study reminds us that adolescent disordered eating and body image concerns often co-occur with early substance use initiation and mental health vulnerabilities, which is relevant context when counseling young patients about cannabis use risks during critical developmental windows. For those considering cannabis for eating disorder-related anxiety or mood symptoms, this cohort data underscores the importance of addressing underlying psychosocial factors and monitoring