In 2022, the global prevalence of obesity in adults (≤18 years) was around 16%, more than double what it was in 1990 (World Health Organization, 2025). Adults with obesity are more at risk for disordered eating and eating disorders (EDs), with binge-eating and binge-eating disorder (BED) the most frequently studied (Da Luz et al., 2018).
Research on other EDs is less extensive. However, a systematic review from 2021 reported atypical anorexia nervosa (AAN; having the symptoms of anorexia without being underweight; read Eleana’s blog to learn more) to be present in 0.15% to 13% of females with obesity. Interestingly, this was more prevalent than those presenting with anorexia with low weight within the community, yet was referred for ED care less often (Harrop et al., 2021).
As such, research has found that adults with EDs are more likely to receive weight-loss treatment over treatment for their ED (Hart et al., 2011; Kaur et al., 2022; Palavras et al., 2011). This is a cause for concern, as it suggests that this population of individuals with EDs are not receiving appropriate care.
However, evidence for the full spectrum of EDs and disordered eating behaviours is lacking. There needs to be a more complete understanding of how prevalent EDs are amongst adults seeking obesity treatment, as it is currently difficult to determine the type and scale of mental health support needed. Therefore, the aim of this systematic review and meta-analysis (Melville et al, 2025) was to estimate the prevalence of disordered eating and EDs in adults seeking treatment for obesity.
Three databases were searched for studies that contained:
All EDs and disordered eating behaviours (e.g., loss of control eating, drive for thinness) were included. Studies were excluded if they contained participants (1) seeking both obesity and ED treatment, or (2) with obesity as part of a broader syndrome. Foreign language studies were translated using Google Lens so that they could also be included.
Studies were double screened independently by four authors. Data was independently extracted from included studies by two reviewers and methodological quality of studies was independently assessed by one reviewer, with accuracy checks by another reviewer.
A random-effects model was used in the meta-analysis to pool prevalence estimates of EDs and disordered eating behaviours. Subgroup analyses and tests for publication bias and small study effects were also conducted.
The review was prospectively registered on PROSPERO (CRD42023461340) and reported in accordance with the JBI Manual for Evidence Synthesis and PRISMA guidelines.
Eighty-five studies were included in this systematic review, published between 1985 and 2025. Most studies were published either in the USA (n = 43) or Italy (n = 17). Data came from 94,295 participants (75.9% female, median age = 44 years [IQR = 5], median BMI = 46 kg/m2 [IQR = 10]). The most reported obesity treatments were bariatric surgery (n = 49), behavioural weight management (n = 9), or multiple treatment options (n = 8).
Prevalence rates were reported for multiple EDs and disordered eating behaviours, but BED (n = 46) and self-report binge eating (n = 32) were the most common. No studies reported on avoidant/restrictive food intake disorder, pica, rumination, or purging disorder.
For those reporting BED, the pooled prevalence was:
The authors also found evidence of publication bias and small study effects for all three BED prevalences, where the prevalence of BED increased as the study sample decreased.
For those reporting binge eating behaviour according to the Binge Eating Scale, the pooled prevalence was:
Again, there was a possibility of bias for self-report severe binge eating, but this was not found for moderate severity self-report binge eating behaviour.
When assessed by clinical interview, the pooled prevalence of:
Only two studies reported AAN, with the prevalence 0.2% in one study assessed by clinical interview (Lin et al., 2013). The second study had no reported cases (Hilbert et al., 2022). Egger’s tests were significant for bulimia nervosa and eating disorders when not specified, indicating possible evidence of bias where prevalence increased as study sample size decreased.
Post-hoc sensitivity analyses examined the potential bias of smaller studies, given that prevalence estimates commonly increased as study sample sizes decreased. Aside from BED when assessed by DSM-5 clinical interview, tests remained significant when the minimum sample size increased, demonstrating that prevalence tended to decrease with larger samples.
The final year of data collection was found to be significantly associated with the prevalence of self-report severe binge eating, where binge eating decreased over time (p < 0.01).
Various post-hoc subgroup analyses were conducted, including treatment type, clinical interviews, and sex, but no significant differences were found.
Whilst no studies were excluded based on the quality assessment, insufficient reporting meant that two domains were often selected as 'unclear': (1) the reliability of measurements and (2) clearly described response rates.
This was the first comprehensive review to estimate the prevalence of both EDs and disordered eating behaviours within adults seeking treatment for obesity. Overall, research has mainly focused on BED and binge-eating behaviours, with limited research on other types of EDs or disordered eating behaviours.
As such, this review estimates that:
This study had various strengths, including but not limited to:
Despite this, there were still some limitations:
Given the estimated prevalence of EDs and disordered eating behaviours co-occurring with obesity, routine screening of ED symptoms should be conducted before entry into obesity treatment programmes to ensure individuals are referred for the most suitable treatment. It would be beneficial if this screening coincides with further training of clinicians within these programmes to recognise signs and symptoms of EDs, including binge eating and BED, alongside other EDs found to be prevalent in this review's population, such as night time eating and bulimia nervosa. This would help to identify not only the presence of an ED but what type, to assist in decisions around most suitable treatment.
Further research in this area is also needed. Firstly, research on the most effective treatment pathways for individuals with co-occurring obesity and EDs/disordered eating is important, to ensure appropriate care and improved long-term outcomes. There should also be an investment in research with under-researched populations, such as ethnic minority groups, those who have not sought formal treatment, or those seeking non-surgical or community-based treatments, to further understand prevalence rates within these populations. Without such research, our understanding of the prevalence of EDs within this population is limited and cannot be generalised to individuals from these groups. To support this, obesity treatment programmes could also implement prevalence monitoring as standard, to further understand prevalence rates over time.
None.
Melville, H., Lister, N. B., Libesman, S., Seidler, A. L., Cheng, H. Y., Kwan, Y. L., Garnett, S. P., Baur, L. A., & Jebeile, H. (2025). The Prevalence of Eating Disorders and Disordered Eating in Adults Seeking Obesity Treatment: A Systematic Review With Meta‐Analyses. International Journal of Eating Disorders, 58(9), 1644-1661. https://doi.org/10.1002/eat.24483
Da Luz, F. Q., Hay, P., Touyz, S., & Sainsbury, A. (2018). Obesity with Comorbid Eating Disorders: Associated Health Risks and Treatment Approaches. Nutrients, 10(7), 829. https://doi.org/10.3390/nu10070829
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Harrop, E. N., Mensinger, J. L., Moore, M., & Lindhorst, T. (2021). Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature. International Journal of Eating Disorders, 54(8), 1328-1357. https://doi.org/10.1002/eat.23519
Hart, L. M., Granillo, M. T., Jorm, A. F., & Paxton, S. J. (2011). Unmet need for treatment in the eating disorders: A systematic review of eating disorder specific treatment seeking among community cases. Clinical Psychology Review, 31(5), 727-735. https://doi.org/10.1016/j.cpr.2011.03.004
Hilbert, A., Staerk, C., Strömer, A., Mansfeld, T., Sander, J., Seyfried, F., Kaiser, S., Dietrich, A., & Mayr, A. (2022). Nonnormative Eating Behaviors and Eating Disorders and Their Associations With Weight Loss and Quality of Life During 6 Years Following Obesity Surgery. JAMA Network Open, 5(8), e2226244. https://doi.org/10.1001/jamanetworkopen.2022.26244
Kaur, J., Dang, A. B., Gan, J., An, Z., & Krug, I. (2022). Night Eating Syndrome in Patients With Obesity and Binge Eating Disorder: A Systematic Review. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.766827
Lin, H.-Y., Huang, C.-K., Tai, C.-M., Lin, H.-Y., Kao, Y.-H., Tsai, C.-C., Hsuan, C.-F., Lee, S.-L., Chi, S.-C., & Yen, Y.-C. (2013). Psychiatric disorders of patients seeking obesity treatment. BMC Psychiatry, 13(1), 1. https://doi.org/10.1186/1471-244X-13-1
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