Clinical Takeaway
A 15-year Canadian cohort study tracked adolescents into early adulthood to examine how body image concerns and disordered eating in youth predict later eating disorders, mental health conditions, and substance use. The findings reinforce that psychosocial risk factors identified in adolescence are meaningful predictors of multimorbid health outcomes in young adults. Clinicians should screen early for disordered eating and body image distress as part of routine adolescent care.
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, mental health comorbidities, and substance use into early adulthood in a Canadian population. Understanding these long-term developmental pathways is essential for identifying high-risk adolescents who would benefit from early intervention and for tailoring prevention and treatment strategies that address the multimorbid nature of eating disorders in clinical practice. The study’s prospective design and extended follow-up period overcome significant limitations in existing research by establishing temporal relationships between adolescent risk factors and adult health outcomes rather than relying on retrospective recall.
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 behaviors and body image predict adult mental health outcomes, this study’s relevance to cannabis medicine practice depends critically on how cannabis use was measured, what confounders were controlled for, and whether cannabis exposure was examined as an independent variable or merely as one health outcome among many. The 15-year follow-up design is methodologically strong for establishing temporal relationships, but we should note that adolescent cannabis use patterns, frequency, potency, and individual vulnerability factors (psychiatric history, genetic predisposition) are likely heterogeneous and may not have been granularly assessed in ways that allow clinicians to counsel patients about cannabis-specific risks in eating disorder or body image populations. Most importantly, this appears to be primarily an epidemiologic study of eating disorder trajectories rather than a cannabis intervention or mechanistic study, so direct clinical guidance about cannabis use in patients with eating disorders or disordered eating remains limited. Clinically, this work underscores
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