Clinical Takeaway
Over 15 years, the REAL 2.0 cohort study tracked Canadian youth from early adolescence into early adulthood to understand how body image concerns and disordered eating behaviors in youth predict later eating disorders, mental health conditions, and substance use problems. The study highlights that psychosocial risk factors established in adolescence have measurable, lasting effects on multiple health outcomes in young adults.
#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 body image disturbance and disordered eating, predict the trajectory of eating disorders, mental health comorbidities, and substance use into early adulthood in a Canadian population. Understanding these developmental pathways is essential for clinicians to identify high-risk adolescents who require early intervention and to tailor prevention and treatment strategies that address the complex multimorbidity associated with eating and weight-related disorders. The long follow-up period and examination of protective factors offer actionable clinical insights for early identification and management of adolescents at risk for persistent mental health and substance use complications.
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 and body image concerns track into adulthood, this study does not appear to focus specifically on cannabis use as an intervention or primary exposure variable, limiting direct clinical guidance for cannabis medicine practitioners. The study’s strength lies in documenting the natural history of eating disorders and mental health comorbidities over 15 years in a Canadian population, which is relevant context when considering cannabis use patterns in patients with concurrent disordered eating or anxiety, but the abstract provided does not detail cannabis-specific findings or dosing data. Clinicians should recognize that adolescents with early eating disorders or body image disturbance represent a potentially vulnerable population in whom cannabis use might complicate both mental health trajectories and weight-related outcomes, though this cohort study alone cannot establish causality or guide prescribing decisions. When evaluating young adults with a history of eating disorders presenting for cannabis discussions, this research underscores the importance of obtaining detailed developmental and psychiatric history
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