Clinical Takeaway
A 15-year Canadian cohort study tracked adolescents into early adulthood to understand how body image concerns and disordered eating in youth contribute to later eating disorders, mental health conditions, and substance use problems. The findings highlight that psychosocial risk factors identified in early adolescence can predict a range of co-occurring health issues decades later. Early screening and intervention for disordered eating behaviors in young people may help reduce the burden of multiple interrelated conditions in adulthood.
#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 risk factors, particularly disordered eating and body image concerns, predict the development of eating disorders, weight-related conditions, and comorbid mental health and substance use disorders into early adulthood. Understanding these long-term trajectories in a Canadian population enables clinicians to identify high-risk adolescents early and implement targeted interventions to prevent progression to more severe multimorbid conditions. The findings directly inform clinical screening protocols and inform whether early intervention on body image and eating concerns in adolescence can reduce the burden of eating disorders and their associated psychiatric and medical complications in adulthood.
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 study provides valuable longitudinal data on how adolescent eating behaviors and body image concerns track into adulthood, it is important to note that this is a descriptive cohort profile rather than a cannabis-specific intervention study, and the abstract provided does not detail any cannabis-related findings or outcomes. Cannabis use patterns among adolescents with disordered eating or body image concerns represent an understudied area, and any associations between early eating pathology and later cannabis use would require careful interpretation given the numerous confounding variables (peer influence, trauma history, comorbid anxiety or depression, socioeconomic factors) that could drive both conditions independently. The 15-year follow-up design does offer a valuable opportunity to examine whether cannabis use trajectories differ between those with versus without adolescent eating disorders, though the retrospective or concurrent reporting of substance use in this population may be subject to recall bias and underreporting. For clinicians managing young adults with histories of eating disorders or distorted body image