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• W167157665 abstract "Editor—Patton et al reported a positive association between dieting and the development of eating disorders in adolescents.1 A causal effect of dieting on the development of these serious psychiatric conditions was implied in the conclusion. We believe, however, that the data presented did not support the suggested causal effect.2Unlike in a randomised clinical trial, in a cohort study the participants select themselves; in this case the exposure of interest was dieting. Participants at risk of developing eating disorders may have been more likely to expose themselves to dieting. To avoid bias the exposed and unexposed participants in a cohort study should be similar for other important determinants of outcome.3 There is no evidence that this was true in this study. In fact, after adjustment for psychiatric disorders at baseline the hazard ratio of severe dieting decreased threefold, which suggests that the exposed and unexposed groups differed for other, unadjusted, factors.In a cohort study the participants must be free of the disease at inclusion.3 Although the 37 incident cases may not have displayed, at baseline, all the signs necessary for the diagnosis of an eating disorder, some of those who were on a diet at the beginning of the study may actually have been in the early stages of an eating disorder; dieting might be an early, non-specific sign of later development of eating disorders and not a cause.Although some of these points were raised in the discussion, the conclusion and key messages emphasised that adolescents who diet are at increased risk of developing an eating disorder. We agree that inappropriate dietary behaviours should be discouraged; given the global epidemic of obesity, the importance of promoting a healthy lifestyle, including weight control by a reasonable diet and exercise, should be emphasised for all adolescents." @default.
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• W167157665 date "1999-06-26" @default.
• W167157665 modified "2023-09-26" @default.
• W167157665 title "Onset of adolescent eating disorders" @default.
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• W167157665 doi "https://doi.org/10.1136/bmj.318.7200.1761" @default.
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