Testing Whether Established Risk Factors for Future Eating Disorder Onset Predict Future Overweight/Obesity Onset: A Prospective Study

Background/Objectives: The evidence that overweight and obesity often cooccur with eating disorders, overeating and binge eating increase risk for future eating disorder onset, and a prevention program that reduces overeating prevents future eating disorder onset suggests factors that increase risk for eating disorders may also increase risk for unhealthy weight gain. We test whether predictors of future eating disorder onset, which include both risk factors and prodromal symptoms, also predict future onset of overweight or obesity. Subjects/Methods : Data were collected from 1 952 adolescent girls and young women who completed annual assessments over a 3-year period. Among them, our final sample consisted of 1 669 participants ( Mean age = 19.4, SD  = 4.9) who met the inclusion criteria. Logistic regression models tested whether each established eating disorder risk factor predicted future onset of overweight or obesity. Classification tree analysis tested for interactions among the predictors. Results : Body dissatisfaction (OR = 1.43, 95% CI [1.23, 1.66], p  < .001), negative affect (OR = 1.20, 95% CI [1.05, 1.37], p  = .006), and feeling fat (OR = 1.37, 95% CI [1.19, 1.58], p  < .001) increased risk for future onset of overweight/obesity and lower-than-expected body weight reduced risk (OR = 0.62, 95% CI [0.37, 0.83], p  = .014), though only body dissatisfaction (OR = 1.25, 95% CI [1.04, 1.51], p  = .017) and lower-than-expected body weight (OR = 0.65, 95% CI [0.38, 0.87], p  = .026) showed unique predictive effects in a multivariate model. The classification tree model indicated that high body dissatisfaction showed the strongest predictive effect, and that elevated negative affect further amplified risk; results also revealed a distinct risk pathway characterized by low psychosocial impairment. Conclusions : Results identified several risk and protective factors for overweight/obesity onset, which may work together in a synergistic faction to increase risk for overweight/obesity.