Preadolescent Disordered Eating Predicts Subsequent Eating Dysfunction

There is reason to believe that we should investigate disordered eating in children before puberty. Disordered eating can take many forms, including binge eating (eating an unusually large amount of food while feeling a loss of control), purging one’s food (through inducing vomiting), engaging in compensatory behaviors like diuretic use or laxative use, and restricting one’s intake in an effort to lose weight. Assessment most often occurs in early adolescence because body image, weight, and eating disturbances are substantially present for girls at the start of adolescence (Beato-Fernandez, Rodriguez-Cano, Belmonte-Llario, & Martinez-Delgado, 2004; Bryant-Waugh & Lask, 1995; Cotrufo, Cella, Cremato, & Labella, 2007; Franko & Omori, 1999; Gardner, Stark, Friedman, & Jackson, 2000; Killen et al., 1994; Smith, Simmons, Flory, Annus, & Hill, 2007). Disordered eating behaviors are also highly predictive of diagnosable eating disorders by late adolescence, including a ninefold increase in bulimia nervosa diagnosis and a 20-fold increase in anorexia nervosa diagnosis (Killen et al., 1994; Kotler, Cohen, Davies, Pine, & Walsh, 2001). Disordered eating at a young age also is associated with a broad range of physical and mental health problems during early adulthood (Johnson, Cohen, Kasen, & Brook, 2002). Although assessment typically occurs during adolescence, there are indications that preadolescent disordered eating behavior is predictive of subsequent dysfunctional behavior and eating disorder diagnosis. Although most eating disorder research on children has, to date, focused on determining appropriate diagnostic criteria for young children and determining the prevalence of eating issues in children (Bravender et al., 2010; Nicholls, Lynn, & Viner, 2011), two prospective studies have suggested the importance of preadolescent eating and weight-related difficulties. An extensive case–control investigation found that even a single medical consultation to address weight- or eating-related problems predicted anorexia nervosa diagnosis during adolescence (Lask et al., 2005). One extensive longitudinal investigation has been conducted, and results indicated that loss of control eating in children of mean age 10 years predicted the subsequent development of partial or full-syndrome binge eating disorder, assessed later between 4 and 5 years (Tanofsky-Kraff et al., 2011). The behavior of loss of control eating proved to be the important predictor; weight, shape, eating concerns, or negative affect did not predict subsequent binge eating behavior. We highlight two features of this existing literature on prospective prediction from childhood behavior. The first is that, in one study, a single medical consultation expressing concern predicted future dysfunction (Lask et al., 2005); in the other, the behavior of loss of control eating predicted future dysfunction (Tanofsky-Kraff et al., 2011). In neither study was it necessary for a fully diagnosable disorder to be present in children to predict adolescent disordered eating. Second, Tanofsky-Kraff et al. (2011) found that approximately half of the children who reported loss of control eating at age 10 years continued to report that behavior 4–5 years later, and half showed a reduction in loss of control eating. This indicates that for some children, there may be a protective developmental trajectory that reduces loss of control eating. However, the children who continue to engage in loss of control eating are at the greatest risk for future disordered eating behaviors even after puberty and well into adolescence. In the current study, we extended this previous research by assessing several disordered eating behaviors during the spring of fifth grade (the last year of elementary school), and then twice during sixth grade or the first year of middle school. In addition to binge eating, purging, and restricting food intake, we assessed diuretic use and laxative use. We also examined another factor associated with disordered eating behavior, pubertal onset. Pubertal onset is associated with increased risk for disordered eating, even holding age constant (Klump, McGue, & Iacono, 2003). Because of the relative paucity of research on dysfunctional eating in children this young, we were not in a position to form specific hypotheses about prospective relationships between each dysfunctional behavior and other such behaviors. We hypothesized, based on previous literature described earlier, the following: (1) sixth grade (middle school) dysfunctional eating behaviors could be predicted from fifth grade (elementary school) dysfunctional eating reports, (2) binge eating would predict current and future purging and purging would predict current and future binge eating, (3) purging would predict current and future restriction of intake (as they are both weight maintenance behaviors), and (4) early pubertal onset would predict some disordered eating behavior and predictions will differ between boys and girls. We explored the roles of diuretic and laxative use, as they are usually not reported in child disordered eating literature.