Multivariate Trajectories of Eating Disorder Symptoms and Weight Status in 10- to 17-Year-Old Children and Adolescents.

OBJECTIVE

Eating disorders (EDs) often emerge in adolescence, but developmental trajectories across different core features remain largely unclear.

METHOD: The prospective, community-based study included N = 898 participants aged 9.5-17.5 years (47.6% female, age 11.8 ± 1.4 years) with annual follow-up over 2-6 (3.4 ± 1.2) years. Multivariate trajectories of binge eating, restraint, weight-compensatory behaviors (Eating Disorder Examination-Questionnaire for Children), and body mass index-standard deviation score (BMI-SDS) derived from objective anthropometrics were analyzed using group-based multi-trajectory modeling (GBMTM) separately for girls and boys. ED and general psychopathology were used for validation and outcome comparisons.

RESULTS

GBMTM identified five distinct trajectories of ED symptoms and BMI-SDS in girls and six in boys. Low-symptom trajectories at lower, normal, and higher BMI-SDS were most common and showed only mild, transient ED symptoms. In boys, trajectories were largely characterized by stable ED symptoms at different BMI-SDS levels, whereas in girls, ED symptoms showed more pronounced change over time. In both sexes, two high-risk subgroups reflected bulimic and binge-eating patterns and followed trajectories with elevated or increasing ED symptoms across ages, which in girls were particularly associated with increased ED and general psychopathology at last assessment.

DISCUSSION: GBMTM results support the developmental specificity of bulimic/binge-eating syndromes and noneating-disordered overweight across adolescence. High-risk subgroups in both sexes-and their particularly unfavorable outcomes in girls-underscore the need for sex-specific early identification strategies that consider longitudinal constellations of multiple ED symptoms and weight status rather than single indicators.