Clinical Takeaway
The REAL 2.0 study tracked Canadian youth over 15 years to examine how early adolescent factors like body image and disordered eating contribute to mental health and substance use outcomes in early adulthood. Findings from this cohort reinforce that disordered eating patterns and poor body image in adolescence are meaningful predictors of multimorbid conditions later in life. Clinicians should screen for these risk factors early, as they do not resolve on their own and tend to compound over time.
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 eating disorders and body image disturbances predict adult mental health outcomes and multimorbidity patterns in a Canadian population, filling a significant gap in the developmental psychopathology literature. Understanding these long-term trajectories is essential for identifying high-risk adolescents who may benefit from early intervention and for establishing whether prevention of disordered eating in youth could reduce the burden of comorbid psychiatric and substance use disorders 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 provides valuable longitudinal data on how adolescent psychosocial factors predict adult mental health and substance use trajectories in a Canadian population, the study’s focus on eating disorders and body image does not appear to directly examine cannabis use patterns or cannabis medicine as a therapeutic intervention. For clinicians considering cannabis recommendations in patients with comorbid eating disorders or disordered eating behaviors, this study offers important context about underlying psychiatric vulnerability and substance use risk, but we should remain cautious about assuming cannabis safety or efficacy in this population given the documented associations between cannabinoid exposure and appetite dysregulation, particularly during critical neurodevelopmental windows. The confounding effects of concurrent substance use, the long-term neurobiological changes from adolescent cannabis exposure, and individual variation in eating disorder phenotypes all complicate any therapeutic application. Practitioners should use this cohort’s insights to better understand their patients’ developmental trajectories and comorbidity patterns, while maintaining a conservative stance on cannabis recommendations until more direct evidence
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