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 patterns contribute to later eating disorders, mental health conditions, and substance use problems. The findings highlight that psychosocial vulnerabilities identified in early adolescence can predict a range of interconnected health outcomes decades later. Clinicians should recognize disordered eating and body image distress in young patients as early warning signs warranting proactive, multidisciplinary follow-up.
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 trajectories of eating disorders, weight-related conditions, and comorbid mental health and substance use disorders into early adulthood. Understanding these developmental pathways is clinically essential for identifying high-risk adolescents who warrant early intervention and for informing prevention strategies that address the multimorbid nature of eating and mental health conditions. The Canadian population-specific data fills a significant gap in longitudinal evidence, enabling clinicians to better anticipate and manage the complex, interconnected health outcomes that emerge from adolescent eating and weight-related concerns.
- 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 study provides valuable longitudinal data on how adolescent psychosocial factors predict adult mental health and substance use outcomes in a Canadian population, it does not appear to directly examine cannabis use as either an exposure or outcome, making it of limited direct relevance to clinical cannabis medicine practice. The study’s strength lies in documenting trajectories of eating disorders, body image concerns, and comorbid mental health conditions over 15 years, which may help contextualize cannabis use patterns in patients with these histories, but clinicians should be cautious about drawing cannabis-specific conclusions from this data. The significant overlap between disordered eating, depression, anxiety, and substance use documented in long-term cohorts like this underscores the importance of comprehensive screening when evaluating adolescents or young adults who present with cannabis use, as underlying eating disorders or distorted body image may be driving self-medication patterns. For family physicians considering cannabis in patients with a history of adolescent eating or weight-related concerns, this
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