The prevalence of eating difficulties in children and young people in England: A large, cross-sectional school survey

Background: Accurate population prevalence estimates of eating difficulties in children and young people provide essential information for the design and implementation of prevention efforts. We aimed to (I) explore the proportion of students reporting eating difficulties in a large English secondary school sample, (II) analyse factors associated with increased odds of eating difficulties and (III) estimate a weighted prevalence of eating difficulties in England. Methods: 19,797 students in school years 7–11 (aged 11–16 years) and 3037 in school years 12–13 (aged 16–19 years) from the OxWell Student Survey completed questions from the Development and Well-Being Assessment. A further 2664 had answers imputed using multiple imputation by chained equations, resulting in n = 25,498 students. The survey happened during February and March 2023. Logistic regression models estimated associations between gender, year group, ethnic group and eating difficulties. For students in Years 7–11, we estimated the prevalence of eating difficulties weighted to England's population. Results: The most endorsed difficulty was students thinking they were fat when others said they were very thin (47.3%; 11,277/23,837) and the least endorsed was self-induced vomiting (17.7%; 4203/23,748). Girls (aOR 3.1, 95% CI 2.9, 3.2) and gender diverse/gender non-disclosing young people (aOR 3.3, 95% CI 2.9, 3.9) had higher odds of having eating difficulties compared to boys, with increasing odds in older year groups. The weighted prevalence of eating difficulties in students in school years 7–11 was 62.5% (95% CI: 61.8, 63.3). Conclusion: The findings show that eating difficulties are common in secondary school students with more than half of our sample self-reporting at least one type of eating difficulty. These data provide insight for clinical services, and the high prevalence further suggests that early intervention in community settings may have a valuable role in reducing the demand on eating disorder services.