Eating Disorders and Obesity:

How Are They Related?
Eating disorders and obesity are usually seen as

very different problems but actually share many

similarities. In fact, eating disorders, obesity, and

other weight-related disorders may overlap as girls

move from one problem, such as unhealthy dieting,

to another, such as obesity. This information sheet

is designed to help parents, other adult caregivers,

and school personnel better understand the links

between eating disorders and obesity so they can

promote healthy attitudes and behaviors related to

weight and eating. 

2
Eating disorders and obesity are part 

of a range of weight-related problems. 

These problems include anorexia nervosa, 

bulimia nervosa, anorexic and bulimic behaviors, 

unhealthy dieting practices, binge eating disorder,

and obesity. Adolescent girls may suffer from 

more than one disorder or may progress from one

problem to another at varying degrees of severity. 

It is important to understand this range of weightrelated problems in order to avoid causing one

disorder, such as bulimia, while trying to prevent

another, such as obesity.1

Body dissatisfaction and unhealthy dieting

practices are linked to the development 

of eating disorders, obesity, and other

problems. High numbers of adolescent girls are

reporting that they are dissatisfied with their 

bodies and are trying to lose weight in unhealthy

ways, including skipping meals, fasting, and 

using tobacco. A smaller number of girls are 

even resorting to more extreme methods such as 

self-induced vomiting, diet pills, and laxative use.2

These attitudes and behaviors place girls at a

greater risk for eating disorders, obesity, poor

nutrition, growth impairments, and emotional

problems such as depression.3 Research shows, 

for example, that overweight girls are more

concerned about their weight, more dissatisfied 

with their bodies, and more likely to diet than 

their normal-weight peers.4

Binge eating is common among people 

with eating disorders and people who are

obese. People with bulimia binge eat and then

purge by vomiting, using laxatives, or other means.

Binge eating that is not followed by purging may

also be considered an eating disorder and can 

lead to weight gain. More than one-third of obese

individuals in weight-loss treatment programs report

difficulties with binge eating.5 This type of eating

behavior contributes to feelings of shame, loneliness,

poor self-esteem, and depression.6 Conversely, these

kinds of feelings can cause binge eating problems.7

A person may binge or overeat for emotional 

reasons, including stress, depression, and anxiety.8

Depression, anxiety, and other mood

disorders are associated with both eating

disorders and obesity. Adolescents who are

depressed may be at an increased risk of becoming

obese. One recent study found that depressed

adolescents were two times more likely to become

obese at the one year follow up than teens who 

did not suffer from depression.9 In addition, many

people with eating disorders suffer from clinical

depression, anxiety, personality or substance abuse

disorders, or in some cases obsessive compulsive

disorder.10 Therefore, a mental health professional

may need to be involved in treating an adolescent

who is obese or suffers from an eating disorder or

other weight-related problem.

The environment may contribute to 

both eating disorders and obesity. The 

mass media, family, and peers may be sending

children and adolescents mixed messages about

food and weight that encourage disordered 

eating.11 Today’s society idealizes thinness and

stigmatizes fatness, yet high-calorie foods are 

widely available and heavily advertised.12 At the

same time, levels of physical activity are at 

record lows as television and computers replace

more active leisure activities, travel by automobile

has replaced walking, and many communities lack 

space for walking and recreation.13

HOW ARE EATING DISORDERS AND OBESITY RELATED?

3
4

HEALTH RISKS

Most teens don't suffer from

either anorexia or obesity.

They are more likely to

engage in disordered eating

behaviors such as bingeing,

purging, and dieting. These

behaviors are associated

with serious physical and

emotional health problems.

We’ve got to get back to

three square meals a day,

healthy meal planning,

nutritious snacks, and 

regular physical activity.14

— RICHARD KREIPE, M.D., CHIEF, DIVISION OF ADOLESCENT

MEDICINE, UNIVERSITY OF ROCHESTER MEDICAL CENTER

Eating disorders may lead to

◆ Stunted growth

◆ Delayed menstruation

◆ Damage to vital organs such as the 

heart and brain

◆ Nutritional deficiencies, including

starvation

◆ Cardiac arrest

◆ Emotional problems such as depression 

and anxiety

Obesity increases the risk for

◆ High blood pressure

◆ Stroke

◆ Cardiovascular disease

◆ Gallbladder disease

◆ Diabetes

◆ Respiratory problems

◆ Arthritis

◆ Cancer

◆ Emotional problems such 

as depression and anxiety
Changing habits is never easy, but switching to a healthier diet and

regular physical activity will bring children and their families 

many benefits, including improved health, more energy, and a better

quality of life.15

— JONELLE C. ROWE, M.D., OFFICE ON WOMEN’S HEALTH

HELP ADOLESCENTS DEVELOP HEALTHY EATING 

ATTITUDES AND BEHAVIORS 

Be a positive role model. Children look to parents

and other adult caregivers as they develop their 

own attitudes and behaviors toward eating and 

weight. For example, children of overweight parents

are more likely to be overweight than their peers. 

Also, daughters of mothers who diet are more 

likely to diet than other girls.16 Teach young people

how to eat healthily through your own actions. Avoid 

unhealthy habits such as skipping meals to lose 

weight, complaining about your body, or using food 

as a reward. 

Help children learn to control their own

eating. Parents and other adults can help children get

in touch with their feelings of hunger and fullness. For

example, encourage young people to stop eating when

satisfied. Avoid forcing children to eat certain foods,

requiring that they “clean their plates,” or forbidding

particular foods, as it may even increase their

preference for and intake of those foods.17 Studies

show that when mothers try to restrict their children’s

food, the children actually tend to eat more when they

are not being supervised.18

Offer young people a variety of healthy foods

at meal and snack times. Plan meals in advance,

and make sure they include vegetables, whole grains,

protein, and other foods that are low in sugar and

saturated fat. Pack a healthy school lunch for your

child. Keep plenty of healthy snacks such as nuts and

fruit available at home. 

Eat dinner together as a family most days 

of the week. Meals are an important social activity, 

and help parents and caregivers keep track of what

young people are eating, as well as their activities 

and moods. Make mealtime a relaxed and enjoyable

occasion.

Be aware of your child’s emotional health.

Depression, anxiety, and other mood disorders are

associated with obesity, eating disorders, and other

weight-related problems. Consult a mental health

professional if you think your child may be suffering

from a more serious emotional problem than typical

adolescent mood swings.

Provide opportunities for children to

participate in sports, dance, swimming, or

other physical activities. Take your child regularly

to parks, beaches, and other places where he or she

can be physically active. Take walks, hikes, or bike

rides as a family. Keep exercise clothing and equipment

available. Limit and monitor time spent watching

television, which encourages sedentary behavior and

exposes children to junk food advertisements. Remove

televisions from kids’ bedrooms.

Counteract harmful media messages about

body image. Watch television with children and 

talk about messages regarding body image. Discuss

how advertisers use thin models to market products 

and manipulate photos and other images to make

bodies look perfect. Praise the child for his or her

talents and abilities, and encourage a focus on health

rather than on appearance. 

Don’t be afraid to seek help. Take your child to a

family doctor if you think he or she has a weight-related

problem. A doctor can suggest ways to maintain a

healthy weight, assess your child for any underlying

emotional problems, or recommend a program that

promotes healthy food choices and exercise. Many of

these programs include family members, so you may

benefit personally from it too.

5
DEFINITIONS

Body image is how you see yourself when you look in the mirror

or picture yourself in your mind.

Obesity means having an abnormally high proportion of body 

fat. A person is considered obese if he or she has a body mass

index (BMI) of 30 or greater. BMI is calculated by dividing a

person’s weight in kilograms by height in meters squared. You 

can also calculate your BMI by going to an online BMI calculator 

at www.fns.usda.gov/tnrockyrun/diff.htm.

Overweight refers to an excess of body weight compared to 

set standards. The excess weight may come from muscle, bone, fat,

and/or body water. A person can be overweight without being

obese (for example, athletes who have a lot of muscle). However,

many people who are overweight are considered obese due to

excess fat on their bodies. A person may be considered overweight

if he or she has a BMI of 25-29.9. 

Anorexia nervosa is self-starvation. People with this disorder 

eat very little even though they are thin. They have an intense and

overpowering fear of body fat and weight gain.

Bulimia nervosa is characterized by cycles of binge eating 

and purging, either by vomiting or taking laxatives or diuretics

(water pills). People with bulimia have a fear of body fat even

though their size and weight may be normal.

Binge eating disorder means eating large amounts of food in 

a short period of time, usually alone, without being able to stop

when full. The overeating and bingeing are often accompanied 

by feeling out of control and followed by feelings of depression,

guilt, or disgust.

Disordered eating refers to troublesome eating behaviors, 

such as restrictive dieting, bingeing, or purging, which occur less

frequently or are less severe than those required to meet the full

criteria for the diagnosis of an eating disorder.

Did you know...

◆ In American high schools,

30 percent of girls and 

16 percent of boys schools

suffer from disordered

eating, including bingeing,

vomiting, fasting, laxative

and diet pill use, and

compulsive exercise19

◆ Childhood obesity has more

than tripled in the last 30

years. By the year 2000, 

15 percent of children and

adolescents ages 6 to 19

were obese.20

◆ Studies suggest that about

70 percent of overweight

adolescents will become

obese adults.21

◆ A personal or family 

history of obesity is a risk

factor for later development

of bulimia.22

◆ The average child in the

U.S. watches 10,000

television advertisements for

food each year, 95% of

which are for foods in one 

of four categories: sugared 

cereals, candy, fast foods,

and soft drinks.23

6
THE DIET TRAP

◆ The risk for obesity may be 324 percent

greater for adolescent girls who describe

themselves as dieters than girls who do 

not diet.24

◆ Up to one in four 11-year-old girls have

already tried to diet at least once.25

◆ Children who diet may actually end 

up gaining more weight in the long term 

than children who do not diet. This is

because dieting may cause a cycle of

restrictive eating, followed by overeating 

or binge eating.26

◆ People who are obese or at risk of

becoming obese are more likely to use

unhealthy weight loss practices, such as

vomiting and using diet pills or laxatives.27

◆ Disordered eating and dieting have been

linked to serious risk-taking behaviors 

such as drug, alcohol and tobacco use,

delinquency, unprotected sexual activity,

dating violence, and suicide attempts.28

7

...the potential consequences 

of body dissatisfaction and

unhealthy weight control

behaviors are of considerable

public health significance,

because these negative

cognitions and behaviors 

are associated with the

development of both eating

disorders and obesity.29

— DIANNE NEUMARK-SZTAINER, PH.D., M.P.H., R.D., 

DIVISION OF EPIDEMIOLOGY, UNIVERSITY OF

MINNESOTA SCHOOL OF PUBLIC HEALTH
End Notes

1 Neumark-Sztainer, D. “Obesity and Eating Disorder Prevention: An Integrated

Approach?” Adolescent Medicine, Feb;14(1):159-73 (Review), 2003.

2 Neumark-Sztainer, D., Story, M., Hannan, P.J., et al. “Weight-Related Concerns

and Behaviors Among Overweight and Non-Overweight Adolescents:

Implications for Preventing Weight-Related Disorders.” Archives of Pediatrics and

Adolescent Medicine, Feb;156(2):171-8, 2002. 

3 Neumark-Sztainer, D. “Obesity and Eating Disorder Prevention: An Integrated

Approach?” 2003.

4 Burrows, A., Cooper, M. “Possible Risk Factors in the Development of Eating

Disorders in Overweight Pre-Adolescent Girls.” International Journal of Obesity

and Related Metabolic Disorders, Sept;26(9):1268-1273, 2002; Davison, K.K.,

Markey, C.N., Birch, L.L. “Etiology of Body Dissatisfaction and Weight Concerns

Among 5-year-old Girls.” Appetite, Oct;35(2):143-151, 2000; Vander Wal,

J.S., Thelen, M.H. “Eating and Body Image Concerns Among Obese and

Average-Weight Children.” Addictive Behavior, Sep-Oct;25(5):775-778, 2000.

5 Yanovski, S.Z. “Binge Eating in Obese Persons.” In Fairburn, C.G., Brownell,

K.D. (eds), Eating Disorders and Obesity, 2nd ed. New York: Guilford Press,

403-407, 2002.

6 Waller, G. “The Psychology of Binge Eating.” In Fairburn, C.G., Brownell, 

K.D. (eds) Eating Disorders and Obesity, 2nd ed. New York: Guilford Press, 

98-102, 2002.

7 Fairburn, C., Overcoming Binge Eating. New York: The Guilford Press, 1995,

pp. 80-99.

8 Goodman, E, Whitaker, R. “A Prospective Study of the Role of Depression in

the Development and Persistence of Adolescent Obesity.” Pediatrics. 2002

Sep;110(3):497-504. Lumeng JC, Gannon K, Cabral HJ, Frank DA, Zuckerman

B. “Association between clinically meaningful behavior problems and overweight

in children.” Pediatrics. 2003 Nov;112(5):1138-45.

9 Goodman, E., Whitaker, R.C. “A Prospective Study of the Role of Depression

in the Development and Persistence of Adolescent Obesity.” Pediatrics.

Sep;110(3):497-504, 2002.

10 National Mental Health Association. “Teen Eating Disorders.” 1997. 

11 Irving, L.M., Neumark-Sztainer, D. “Integrating the Prevention of Eating

Disorders and Obesity: Feasible or Futile?” Preventive Medicine, 34:299-309,

2002. Stice, E. “Sociocultural Influences on Body Image and Eating

Disturbance.” In Fairburn, C.G., Brownell, K.D. (eds) Eating Disorders and

Obesity, 2nd ed. New York: Guilford Press, 103-107, 2002.

12 Battle, E.K., Brownell, K.D. “Confronting a Rising Tide of Eating Disorders

and Obesity: Treatment vs. Prevention and Policy.” Addictive Behavior,

21:755-65 (Review), 1996. 

13 French, S.A, Story, M., Jeffery, R. “Environmental Influences on Eating and

Physical Activity. Annual Review of Public Health, 22:309-35 (Review), 2001. 

14 Kreipe, R. Personal communication. November 9, 2003.

15 Rowe, J.C. Personal communication. October 31, 2003.

16 Steinberg, A.B., Phares, V. “Family Functioning, Body Image, and Eating

Disturbances.” In Thompson, J.K., Smolak, L. (eds), Body Image, Eating

Disorders, and Obesity in Youth. Washington, DC: American Psychological

Association, 127-147, 2001.

17 Fisher, J.O., Birch, L.L. “Early Experience with Food and Eating: Implications

for the Development of Eating Disorders. In Thompson, J.K., Smolak, L. (eds),

Body Image, Eating Disorders, and Obesity in Youth. Washington, DC: American

Psychological Association, 23-39, 2001.

18 Birch, L. “Acquisition of Food Preferences and Eating Patterns in Children. In

Fairburn, C.G., Brownell, K.D. (eds), Eating Disorders and Obesity, 2nd ed.

New York: Guilford Press, 75-79, 2002.

19 Austin, B., Ziyadeh, N., Leliher, A., Zachary, A. & Forman, S. “Screening

High School Students for Eating Disorders: Results of a National Initiative.”

Journal of Adolescent Health, 28(2), 96, 2001.

20 Ogden, C.L., Flegal, K.M., Carroll, M.D., Johnson,C.L. “Prevalence and

Trends in Overweight Among US Children and Adolescents, 1999-2000.”

JAMA. 2002;288:1728-1732.

21 Dietz, W.H. “Medical Consequences of Obesity in Children and Adolescents.

In Fairburn, C.G., Brownell, K.D., (eds), Eating Disorders and Obesity, 2nd ed.

New York: Guilford Press, 473-476, 2002.

22 Fairburn, C.G., Stice, E., Cooper, Z., Doll, H.A., Norman, P.A., O'Connor,

M.E. “Understanding Persistence in Bulimia Nervosa: A 5-year Naturalistic

Study. Journal of Consulting and Clinical Psychology, Feb;71(1):103-9, 2003.

23 Brownell, K.D. “The Environment and Obesity.” In Fairburn, C.G., Brownell,

K.D. (eds) Eating Disorders and Obesity, 2nd ed. New York: Guilford Press, 

403-407, 2002.

24 Stice, E., Cameron, R.P., Killen, J.D., et al. “Naturalistic Weight-Reduction

Efforts Prospectively Predict Growth in Relative Weight and Onset of Obesity

among Female Adolescents. Journal of Consulting and Clinical Psychology,

Dec;67(6):967-74, 1999.

25 Hill, A.J. “Prevalence and Demographics of Dieting.” In Fairburn, C.G.,

Brownell, K.D. (eds) Eating Disorders and Obesity, 2nd ed. New York: Guilford

Press, 80-83, 2002. 

26 Field, A.E., Austin, S.B., Taylor, C.B., Malspeis, S., Rosner, B., Rockett, H.R.,

Gillman, M.W., Colditz, G.A. “Relation Between Dieting and Weight Change

Among Preadolescents and Adolescents.” Pediatrics, Oct;112(4):900-6, 2003.

27 Neumark-Sztainer, D., Story, M., Falkner, N.H., et al . “Sociodemographic

and Personal Characteristics of Adolescents Engaged in Weight Loss and

Weight/Muscle Gain Behaviors: Who is Doing What?” Preventive Medicine,

28:40, 1999. Neumark-Sztainer, D., Story, M., French, S., Hannan, P., Resknick,

M., Blum, R.W. “Psychosocial Concerns and Health-Compromising Behaviors

among Overweight and Non-overweight Adolescents.” Obesity Research,

May;5(3):237-49, 1997.

28 Neumark-Sztainer, D., Story, M., French, S.A. “Covariations of an Unhealthy

Weight Loss Behaviors and Other High-Risk Behaviors among Adolescents.

Archives of Pediatric Adolescent Medicine, 150(3), 304-308, 1996.

29 Neumark-Sztainer, D. “Obesity and Eating Disorder Prevention: An Integrated

Approach?” 2003

Eating Disorders and Obesity Companion Piece

RESOURCES

The National Women’s Health

Information Center (NWHIC)

Telephone: (800) 994-9662

TDD: (888) 220-5446

Web site: www.4woman.gov

www.4girls.gov

NWHIC is a federal government Web 

site and toll-free call center that provides

free, reliable women’s health information.

Sponsored by the Department of Health

and Human Services’ Office on Women’s

Health, NWHIC features special sections

on body image and girls’ health. The

4girls.gov Web site gives girls between 

the ages of 10 and 16 reliable, current

health information designed to motivate

them to choose healthy behaviors.

National Institute of Diabetes 

and Digestive and Kidney Disease

(NIDDK)

Telephone: (877) 946-4627

Web site: www.niddh.nih.gov

NIDDK offers statistics, research, and

educational information on its Web 

site and manages The Weight-control

Information Network (WIN), which

provides resources on obesity, eating

disorders and other weight-related issues.

The National Heart, Lung, and

Blood Institute (NHLBI)

Telephone: (301) 592-8573

Web site: www.nhlbi.nih.gov

E-mail: NHLBinfo@rover.nhlbi.nih.gov

The NHLBI Information Center and 

the Obesity Education Initiative provide

information about weight control, including

tools such as an online BMI calculator 

for adults and a menu planner. The NHLBI 

also operates a program called Hearts

N’Parks, a partnership with the National

Recreation and Parks Association, which

helps provide activities for kids and 

adults that encourage healthy lifestyle

choices to reduce the risk of obesity and

heart disease.

American Dietetic Association

Nutrition hotline: (900) 225-5267 

Publications: (800) 877-1600 ext. 5000

Web site: www.eatright.org

The American Dietetic Association 

operates a nutrition hotline that provides

the public with nutrition information for 

a small fee. The association also offers

publications and other resources to the

general public, health care providers and

other professionals, teachers, and parents.

National Eating Disorders

Association (NEDA)

Telephone: (206) 382-3587 

Information and Referral Helpline: 

(800) 931-2237

Web site: www.nationaleatingdisorders.org

NEDA is the largest eating disorders

prevention and advocacy organization 

in the world. The association provides

treatment referrals to those suffering from

anorexia, bulimia, binge eating disorder

and to those concerned with body image

and weight issues. NEDA also develops

prevention programs for a wide range 

of audiences, publishes and distributes

educational materials, conducts an annual

conference, and operates a toll-free 

eating disorders helpline.

The Body Positive

Telephone: (510) 548-0101

Web site: www.thebodypositive.org

E-mail: Info@thebodypositive.org

The Body Positive is a non-profit

organization that educates people 

to think about self-esteem, health and 

body image in a new way. Their 

resources include a guidebook on how 

to create comprehensive, youth-led 

eating disorders prevention programs 

in schools and youth organizations, 

as well as videos on body image and 

self-esteem for girls, families, health 

care providers and educators.

BodyWise and BodyWorks are initiatives of the U.S. Department of Health and Human Services

Office on Women's Health. BodyWise provides school personnel and other adults who interact with

students ages 9 to 12 with information to help prevent disordered eating and eating disorders.

BodyWorks is a toolkit on physical activity and nutrition for parents and other adult caregivers of

girls ages 11 to 13. Print copies of BodyWise and BodyWorks are available at www.4woman.gov.

Office on Women’s Health