Clinical Takeaway
Over a 15-year period, Canadian youth were tracked from adolescence into early adulthood to understand how early risk factors like body image concerns and disordered eating contribute to later mental health and substance use outcomes. The study found that psychosocial vulnerabilities identified in adolescence are meaningfully linked to multimorbid conditions in adulthood. Clinicians should screen early for disordered eating and body image distress, as these may signal broader long-term health risks.
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 comorbid mental health and substance use outcomes in Canadian young adults, addressing a significant gap in understanding long-term trajectories of eating disorders in community populations. The extended follow-up period and prospective design enable identification of modifiable protective factors during adolescence that could inform early intervention strategies to reduce the burden of eating disorders and associated psychiatric comorbidities in adulthood.
- 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 eating behaviors and body image concerns track into early adulthood, it is important to recognize that this cohort profile describes primarily observational associations rather than causal mechanisms, and cannabis use patterns in this Canadian population may reflect cultural, legal, and socioeconomic contexts that differ substantially from other regions where clinicians practice. The study’s 15-year follow-up design offers genuine strength in capturing developmental trajectories, but the complex interplay between disordered eating, mental health conditions, and substance use (including cannabis) during adolescence and early adulthood makes it difficult to isolate cannabis as either cause or consequence without examining temporal sequencing, dose-response relationships, and competing risk factors such as trauma, peer influence, and access to treatment. Clinicians should use such findings to inform a comprehensive developmental assessment of young adults presenting with eating disorders or problematic substance use, recognizing that early disordered eating or poor body image may signal vulnerability to
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