Clinical Takeaway
The REAL 2.0 study tracked Canadian youth for 15 years to examine how adolescent risk factors like body image concerns and disordered eating contribute to eating disorders, mental health conditions, and substance use problems in early adulthood. The research confirms that psychosocial vulnerabilities identified in early adolescence can predict a range of multimorbid health outcomes decades later. Clinicians should recognize adolescence as a critical window for screening and early intervention across these interconnected conditions.
#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 disordered eating and body image disturbance, predict eating disorders, weight-related morbidity, and comorbid mental health and substance use conditions in adulthood. Understanding these developmental trajectories in a Canadian population enables clinicians to identify high-risk adolescents and implement targeted early interventions that may prevent or mitigate multimorbid psychiatric and metabolic outcomes. The study’s extended follow-up period and examination of interconnected outcomes addresses a significant gap in the literature regarding the long-term clinical consequences of untreated adolescent eating and weight-related psychopathology.
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 study provides valuable longitudinal data on how adolescent eating and body image concerns track into adulthood, its relevance to cannabis medicine specifically remains unclear from the available abstract, which does not detail cannabis use patterns, frequency, age of initiation, or cannabinoid profiles among the cohort. The study’s strength lies in its 15-year Canadian follow-up examining multimorbidity including mental health and substance use, yet we cannot yet determine whether cannabis use was examined as an independent variable, a confounder, or a mediator in the relationship between adolescent psychosocial factors and adult outcomes. For clinicians evaluating cannabis use in young adults with histories of disordered eating or body image disturbance, this cohort could ultimately illuminate whether cannabis initiation timing, patterns, or co-occurring substance use in adolescence modify the trajectory toward eating disorders or related mental health conditions. Until the full results are published, we should remain cautious about assuming cannabis played a measured role in these