Eating disorder trajectories over 3 years: determinants and care-related factors

Background

Eating disorders (EDs) are severe psychiatric conditions with a chronic and often fluctuating course. Understanding factors influencing symptom trajectories is crucial to improve long-term outcomes and guide integrated care. This study aimed to examine symptom evolution and identify prognostic factors across the three main ED subtypes, restrictive, bulimic, and binge-eating disorders, in patients initiating care in a hospital nutrition department.

Methods

Newly referred patients to a university hospital nutrition department were prospectively followed for three years. ED symptom severity was assessed using validated self-report tools, including the Eating Disorder Inventory-2 (EDI-2), alongside measures of anxiety, depression, body dissatisfaction, and sociodemographic and behavioral variables such as smoking. Longitudinal analyses evaluated symptom trajectories and associated predictors.

Results

The cohort included 379 patients (87.6% women; mean age 36.0 ± 13.5 years): binge-eating (n = 222), restrictive (n = 108), and bulimic (n = 49) disorders. Baseline severity was highest in bulimic patients, who showed greater symptom improvement over three years than restrictive and binge-eating profiles (mean EDI-2 change −23.5 vs − 12.1 and −15.2; p = 0.04). Older age and baseline smoking predicted symptom worsening at 36 months. Persistent smoking, anxiety, depression, body dissatisfaction, and lower family life satisfaction were independently associated with less favorable trajectories.

Conclusions

Overall, ED symptoms improved over three years, but trajectories were strongly influenced by psychiatric comorbidities, body dissatisfaction, smoking, and relational factors, while older age and smoking predicted worsening. These findings highlight the importance of addressing modifiable psychological, behavioral, and social determinants to support personalized, integrated care and improve long-term outcomes in patients with EDs.

Key messages

• Eating Disorder symptoms improve over 3 years, but trajectories are shaped by psychiatric comorbidities, body dissatisfaction, smoking, and social factors.

• Older age and smoking predict worsening, highlighting the need to address modifiable behavioral, psychological, and relational determinants in Eating Disorde care.