Open research questions in Eating Disorders and Behaviors

What the literature leaves open

• However, changes in self-perceptions during supervised PA interventions remain insufficiently understood, particularly regarding their temporal dynamics and maintenance after intervention completion.

  Changes in self-esteem, body dissatisfaction, and body appreciation during face-to-face and digital supervised physical activity interventions in women with obesity: A dual-study investigation · 2026 · DOI

• Current estimates suggest a range of 1–28% prevalence of ED in elite athletes, reflecting methodological heterogeneity, underreporting, and limited research focus.

  Study protocol of the eating and nutritional habits in athletes and controls longitudinal examination – ENHANCE Study · 2026 · DOI

• Given the binary reporting of gender and sex across studies, future work might consider a more nuanced interpretation of gender, considering links with constructs such as identity, social relationships, eating behaviour, and body image (e. Facets of identity, and relationships with HCPs, friends and family, appear influential in the development and main- tenance of insulin-related disordered eating behaviour: future research should investigate potential implications of this in recovery.

  Insulin-Related Disordered Eating Behaviour: A Scoping Review of Evidence · 2026 · DOI

• Despite decades of use, little is known about how change is produced in CBT across mental illnesses, and there has been no empirical validation of the causal structure of change for CBT treatment of eating disorders.

  How does CBT work? Causal discovery modelling locates the mechanisms of change in cognitive behavioural treatment for eating disorders · 2026 · DOI

• Although it remains unknown which factors drive binge eating (BE) episodes, there are indications that variability in nucleus accumbens (NAcc) responses could lead to increased variability in food intake.

  Obesity is associated with greater variability of reward signals in the nucleus accumbens · 2026 · DOI

• Abstract Introduction Despite growing interest, empirical evidence remains limited for the efficacy of intensive outpatient programmes (IOPs) for eating disorders (EDs), particularly outside the USA.

  The intensive outreach programme for child and adolescent eating disorders: an uncontrolled case series of clinical characteristics and treatment outcomes · 2026 · DOI

• This study encountered some limitations. First, this sample consisted mainly of female students. Secondly, due to the cross-sectional nature of the study, causality of the relationships could not be evaluated. Third, current results are based on self-reports, which may be subject to potential bias.

  The Relationship Between Orthorexia Nervosa Tendencies, Eating Attitudes, and Obsessive Compulsive Symptoms of Nursing Students: A Cross-Sectional Study · 2026 · DOI

• Despite the growing literature on the epidemiological and clinical features of EOAN, knowledge of specific treat- ments and prognoses remains scarce in the absence of extensive standardized data collection and few age-specific clinical research protocols.

  Early-onset anorexia nervosa in prepubertal male twin: A case report · 2026 · DOI

• While previous studies in other eating disorders have found correlations between parental hostility, critical comments, and treatment outcomes, the ways that parents display their emotions and thoughts have not been evaluated in families of children with ARFID.

  What's being said: exploring parental comments during a family meal session in family based treatment for avoidant/restrictive food intake disorder · 2026 · DOI

• Second‐wave ICBT focused on restructuring negative thoughts and behaviours has been explored as a potential intervention for elevated BMI and mental health concerns, but its effectiveness remains to be fully established, making further evaluation essential.

  Effectiveness of Internet‐Delivered Cognitive Behavioural Therapy ( <scp>ICBT</scp> ) in Improving Weight‐Loss and Psychosocial Well‐Being Among Adults With High <scp>BMI</scp> : A Systematic Review · 2026 · DOI

• The study design with several recruitment settings, including six clinical centers and the community, enhances the external validity of findings by capturing a broader spectrum of ARTICLE IN PRESSACCEPTED MANUSCRIPTARTICLE IN PRESS individuals with obesity or overweight. Moreover, regression models accounted for key covariates of obesity-related QoL, such as age, gender, BMI, depressive symptoms and binge eating, strengthening the internal validity of findings, in particular the independent relationships between IWS and the emotional, social and sexual dimensions of obesity-related QoL. Further strengths of this study are the assessment of six QoL domains using the Laval Questionnaire, which allowed to detect a previously unexplored association between IWS and the hygiene domain, and the adoption of a conservative alpha threshold that controlled for the inflation of standards errors due to the clustered data and that adds robustness to findings. However, several limitations should be considered when interpreting the results of this study. First, multiple regression models did not account for the clustering of participants within clinical centers. Although the alpha level was adjusted to.005 to reduce the risk of Type I error, this conservative threshold may have increased the likelihood of Type II error. Moreover, the lack of clustering adjustment implies that the regression results may not be equally generalizable to all centers, especially for variables that showed significant between-center differences. It is therefore possible that some significant associations - such as those between IWS and specific dimensions of obesityrelated QoL - do not hold across all clinical centers. Instead, these effects may be disproportionately driven by data from clinical centers with larger sample sizes, such as Center 4. A further limitation relates to the unequal distribution of participants across clinical centers, which prevented the use of multilevel modeling techniques. This methodological constraint limits the precision of estimates and weakens the ability to detect center-specific variability. Second, the cross-sectional design of the study precludes causal inferences. Although associations were identified between IWS and various dimensions of QoL, it remains unclear whether IWS contributed to diminished QoL or whether the reverse is true. For example, it is plausible that persistent impairments in the social domain of QoL - such as isolation, exclusion, or lack of close relationships - could foster or reinforce the internalization of weight stigma over time. Similarly, reduced emotional well-being or sexual satisfaction might precede the adoption of stigmatizing beliefs about one self. Evidence from qualitative research supports this possibility: Davidsen et al.

  Internalized weight stigma and obesity-related quality of life in adults with obesity or overweight: a cross-sectional study across clinical and community settings · 2026 · DOI

• This study provides novel insights in multidimensional body image in ON and EA, overcoming previous limi- tations of using invalid ON measures [51, 95]. To our knowledge, this is the first study examining body image in EA beyond appearance, highlighting the need for fur- ther research in this area. The latent profile analysis with a large sample size allowed for nuanced profile differ- entiation, addressing measurement error and revealing underlying patterns. However, the profile solution was not cross-validated, and the results may be sensitive to the specific characteristics of our sample, which included a relatively high proportion of female participants. Con- sequently, the stability and generalizability of the iden- tified profiles to other populations, particularly more gender-balanced or -specific samples, remains uncer- tain. We note that issues of the factor structure of the questionnaires DOS, EAI-R, and EDE-Q8 warrant fur- ther examination. Overall, the findings suggest that the EAI-R may lack specificity, often capturing instrumental exercise rather than symptoms of a behavioral addiction. Moreover, the high uniqueness and residual variances of most DOS items suggest potential confounding, such as a non-pathological interest in healthy eating [21, 25]. Notably, the item measuring a positive attitude towards healthy eating was the least well-represented by the fac- tor structure, further supporting this interpretation. Another limitation is that the use of convenience sam- pling, combined with the study title, likely resulted in a predominantly female, highly educated sample, with notable rates of participants reporting current eating disorders (7.9%), and risks for ON (8.5%) or EA (7.5%). In addition to this selection bias, social desirability may have biased responses on the explicit self-report mea- sures. Furthermore, the cross-sectional design does not allow any causal conclusions regarding the nature of rela- tionships of ON, EA, disordered eating with body image and self-esteem, which may serve as risk, outcome, or maintenance factors [96, 97]. Overall, these findings Page 11 of 15 emphasize the importance of assessing disordered eating when examining ON and EA.

  Multidimensional body image and self-esteem: a latent profile analysis differentiating orthorexia nervosa and exercise addiction from disordered eating · 2026 · DOI

• the cross-sectional design limits causal inference. Secondary analyses, including regression were exploratory and not adjusted for multiple comparisons, which may increase the risk of type I error. Some subgroup analyses, particularly those involving EDI-II across academic grades, were based on relatively small sample sizes, which may limit statistical power and increase the risk of unstable estimates. These findings should therefore be interpreted with caution. Hawary El et al. Middle East Current Psychiatry (2026) 33:33 Page 8 of 8 5. 8. 7. 9. 6. 12. 10. 14. 13. 15. 11. 16. -Wolff GE, Crosby RD, Roberts JA, Wittrock DA (2000) Differences in daily stress, mood, coping, and eating behavior in binge eating and nonbinge eating college women. Addict Behav 25(2):205–216 -Alhyas L, McKay A, Balasanthiran A, Majeed A (2011) Prevalences of overweight, obesity, hyperglycaemia, hypertension and dyslipidaemia in the Gulf: systematic review. JRSM short Rep 2(7):1–16 - Dessouki M Anglo Egyptian Bookshop, Cairo, Egypt. • 21-Taylor, Bagby GJ, R. M., Parker JD (2002) (2003). The 20-Item Toronto Alexithymia Scale: IV. Reliability and factorial validity in different languages and cultures. Journal of psychosomatic research, 55(3), 277–283 - Okasha A (1988) Okasha’s clinical psychiatry (Arabic version of General Health Questionnaire).

  Prevalence of eating disorders among a sample of Egyptian medical students · 2026 · DOI

• Funding This scoping review synthesized the research on food addiction in India. The prevalence estimates in the included studies range from 7.3 to 44.1%, with a median of 15.3%. The literature was pre- dominantly cross-sectional, descriptive, and focused on the non- clinical, general population. Consistent associations were identified between FA and obesity. Associations with gender and age were inconsistent and diverged from global trends. Academic stress and hostel environments emerged as unique risk factors among stu- dents, while social gatherings and festivals constituted additional context-specific risk factors. Future research should prioritize the cultural validation of the Yale Food Addiction Scale (YFAS) or the development of indigenous assessment tools for food addiction in both clinical and non-clinical populations. Furthermore, there is a clear need for longitudinal and mixed-methods research utilizing geographically diverse samples to better understand the clinical and sociocultural evolution of food addiction in India.

  Food addiction research in India: a scoping review · 2026 · DOI

• The review is limited by a literature base dominated by cross-sectional, observational studies that cannot estab- lish causality or longitudinal directionality between digital media use and mental health outcomes in adolescent boys and young men [2, 3]. Much of the evidence is also based on self-reported data, which are associated with potential recall and social desirability biases and often fail to capture the content-level and algorithmically curated nature of expo- sure (e.g., what participants actually use, with whom they interact, and how platform features shape engagement). As a result, mechanisms linking specific digital experiences to outcomes such as MD symptoms, ED symptoms, risk-taking behaviors, and APEDS use remain incompletely character- ized. Evidence is particularly sparse for rapidly evolving exposures that are shaped by platform algorithms and vary widely by user, including manosphere-related material and recommender-driven “rabbit hole” pathways. Similar gaps apply to generative AI and AI companion tools, where exper- imental, epidemiologic, and sex- and age-disaggregated studies remain scarce [16, 74, 79, 81]. Across studies, ado- lescents are often analyzed in aggregate without adequately accounting for developmental stage or social context, mask- ing meaningful heterogeneity in exposure pathways and risk trajectories for adolescent boys and young men specifically.

  Digital Media Use and Psychosocial Health among Adolescent Boys and Young Men · 2026 · DOI

• Future research should prioritize prospective, experimental, and quasi-experimental studies that capture content-level digi- tal exposures, motives for use, interaction quality, and devel- opmental change over time in adolescent boys and young men. Measurement should move beyond reliance on self- report through approaches such as passive sensing, privacy- preserving feed audits, and product-level safety evaluation. Across social media, gaming, and AI, research should clar- ify mechanisms of risk and resilience, report functional and implementation outcomes, and more consistently stratify anal- yses by sex, gender and developmental stage while including marginalized and neurodivergent adolescent boys and young men. Domain-specific priorities are summarized in Table 2.

  Digital Media Use and Psychosocial Health among Adolescent Boys and Young Men · 2026 · DOI

• This study has several limitations that should be acknowledged. First, the cross-sectional design precludes causal inferences from the observed associations; the directional paths in our model are based on theoretical assumptions rather than empirical causation. Future research should validate the proposed model using longitudinal designs or experimental interventions. Second, all variables were measured using self-report instruments, which may be susceptible to recall bias and social desirability effects (Caputo, 2017). Future studies could incorporate objective measures of physical activity or multi-informant assessments to enhance measurement validity. Third, although the sample included students from diverse university types across multiple regions in China, the findings may not be fully generalizable to non-student populations or to individuals from other cultural backgrounds. Moreover, the cross-sectional design cannot test reverse causal relationships. While our theoretical model assumes that physical exercise influences restrained eating, the opposite direction may also hold: individuals with higher levels of restrained eating may is related to physical activity due to insufficient energy intake (Forney et al., 2025), or they may increase exercise engagement due to heightened weight concerns (Davis et al., 1994). Future research should employ longitudinal or cross-lagged panel designs to examine these bidirectional relationships. (58.48%), In addition, the sample had a higher proportion of male participants and no gender-group analysis was conducted. Given that restrained eating is more prevalent among females (Welch et al., 2015) and that emotional intelligence and perceived stress may vary by gender, future studies should employ gender-balanced samples and test whether gender moderates the proposed chain mediation model. Furthermore, age and body mass index were not controlled for in the mediation analyses. Although our primary focus was on psychological mechanisms, these demographic and physiological variables may be associated with the observed relationships (Welch et al., 2015; Yong et al., 2021). Future research should include them as covariates to improve the precision of estimated associations. Additionally, the present study did not differentiate between types of physical activity or levels of athletic competition, factors that may influence the relationship between exercise and eating behaviors. Future research should examine these dimensions more closely. Meriç and Yabanci Ayhan (2025) found that intuitive and mindful eating are negatively associated with BMI and eating disorder symptoms, suggesting that promoting adaptive eating styles may represent a promising alternative. Future research should investigate whether physical exercise enhances not only emotional intelligence but also intuitive eating, and whether these factors jointly contribute to healthier eating patterns. this physical exercise, influence emotional Despite these limitations, study enriches empirical research in the field by systematically elucidating the mechanisms through which intelligence, restrained eating behaviors and perceived stress among college students. Findings indicate that promoting physical exercise not only holds direct health benefits but may also indirectly is associated with lower restrained eating behaviors by enhancing emotional intelligence and reducing the perceived stress.

  The cross-sectional study on the association between physical exercise and restrained eating among Chinese college students: the chain mediating roles of emotional intelligence and perceived stress · 2026 · DOI

• However, the pathophysiological underpinnings of sensory processing, encompassing exteroception and interoception, in relation to ED remain underexplored.

  Sensory processing across eating disorders: A systematic review and meta‐analysis of self‐report inventories · 2024 · DOI

• Future research is needed to test target engagement in CBT-AR with adaptive treatment designs, and to identify valid and sensitive measures of candidate mechanisms.

  Cognitive‐behavioral therapy for avoidant/restrictive food intake disorder: <scp>A</scp> proof‐of‐concept for mechanisms of change and target engagement · 2024 · DOI

• INTRODUCTION: There are documented inequities in eating disorders (EDs) by gender and race/ethnicity, yet, little is known about population-level prevalence of ED risk factors, symptoms, and diagnosis at the intersection of diverse gender and racial/ethnic identities.

  Intersecting gender identity and racial/ethnic inequities in eating disorder risk factors, symptoms, and diagnosis among U.S. college students: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy · 2023 · DOI

• However, the relationships between users' engagement with social media content based upon its centering of appearance and eating, the presence of these themes in content suggested to them, and their ED symptoms remains unknown.

  Association between engagement with appearance and eating related TikTok content and eating disorder symptoms via recommended content and appearance comparisons · 2023 · DOI

• With this study, we aimed to advance objectification theory research with sexual minority women by examining the understudied roles of appearance anxiety and interoceptive awareness concomitantly with other key variables, including sexual objectification experiences, internalization of cultural appearance standards, body surveillance, and body shame.

  A Test of Objectification Theory With Sexual Minority Women · 2022 · DOI

• Meta-analyses examined: (1) which of the nine BPD symptoms are especially elevated in individuals with versus without EDs, (2) whether particular ED subtypes have elevated levels of certain BPD symptoms, and (3) which BPD symptoms remain unstudied/understudied in relation to EDs.

  Eating disorders and the nine symptoms of borderline personality disorder: A systematic review and series of meta‐analyses · 2022 · DOI

• The present study aimed to clarify existing research that has inconsistently shown that weight suppression (differences between individuals’ highest and current body weights) is associated with worse eating disorder (ED) behaviors and negative body image among women with lifetime EDs, by examining whether an understudied client-supported protective factor for ED pathology – self-acceptance – moderates these associations.

  Associations among weight suppression, self-acceptance, negative body image, and eating disorder behaviors among women with eating disorder symptoms · 2021 · DOI

• OBJECTIVE: Although multiple pathophysiologic changes develop within the gastrointestinal (GI) system in the setting of malnutrition, the etiology of the reported multitude of symptoms in those with anorexia nervosa and avoidant restrictive intake disorder, as well as their contribution toward disordered eating, remain poorly understood.

  The intersect of gastrointestinal symptoms and malnutrition associated with anorexia nervosa and avoidant/restrictive food intake disorder: Functional or pathophysiologic?—A systematic review · 2021 · DOI

Most-cited papers in Eating Disorders and Behaviors

• Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders · Archives of General Psychiatry · 2011 · 2,335 citations
• The Outcome of Anorexia Nervosa in the 20th Century · American Journal of Psychiatry · 2002 · 1,379 citations
• Prevalence and Correlates of Eating Disorders in Adolescents · Archives of General Psychiatry · 2011 · 1,329 citations
• Risk factors for binge eating onset in adolescent girls: A 2-year prospective investigation. · Health Psychology · 2002 · 559 citations
• Social comparison as a predictor of body dissatisfaction: A meta-analytic review. · Journal of Abnormal Psychology · 2009 · 542 citations
• Research Review: What we have learned about the causes of eating disorders – a synthesis of sociocultural, psychological, and biological research · Journal of Child Psychology and Psychiatry · 2015 · 538 citations
• Neural Correlates of Food Addiction · Archives of General Psychiatry · 2011 · 535 citations
• Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta‐analysis · International Journal of Eating Disorders · 2015 · 491 citations
• The Natural Course of Bulimia Nervosa and Binge Eating Disorder in Young Women · Archives of General Psychiatry · 2000 · 454 citations
• Outcomes of eating disorders: A systematic review of the literature · International Journal of Eating Disorders · 2007 · 445 citations

Most recent work

• Intraminority Body Stigma and Body Dissatisfaction Clarify the Prospective Link Between <scp>LGBTQ</scp> + Community Involvement and Thinness‐Oriented Disordered Eating in Sexual Minoritized Men · International Journal of Eating Disorders · 2026
• Eating Behavior and Depression in Chinese Female College Students: The Role of Social Appearance Anxiety and Physical Activity · International Journal of Mental Health Promotion · 2026
• Media pressure and disordered eating attitudes in middle-aged women: The roles of stress and body appreciation · Body Image · 2026
• IGF-1 and recovery in anorexia nervosa: evidence from population-based and clinical cohorts · The Journal of Clinical Endocrinology & Metabolism · 2026
• Outpatient Strategies for Managing Eating Disorders: When Is Outpatient Care Not Enough? · Pediatric Annals · 2026
• Eating Disorders in Older Age: A Scoping Review · Clinical Gerontologist · 2026
• Interventions for preventing eating disorders in adolescents: A scoping review · Journal of Child and Adolescent Mental Health · 2026
• Prevalence and characteristics of abnormal eating behaviours among young judo athletes in Poland – an analysis of sex differences · Annals of Agricultural and Environmental Medicine · 2026
• The cross-sectional study on the association between physical exercise and restrained eating among Chinese college students: the chain mediating roles of emotional intelligence and perceived stress · Frontiers in Psychology · 2026
• Long‐Term Effectiveness of Inpatient and Day‐Hospital Treatment of Eating Disorders in Departments of Psychosomatic Medicine and Psychotherapy in Germany · European Eating Disorders Review · 2026

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