Onset of adolescent eating disorders

doi:10.1136/bmj.318.7200.1761

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Dieting may be an early sign, rather than a cause, of eating disorder

Nicolas Stettler, Nutrition fellowa,
Andrew M Tershakovec, Associate professor of paediatrics,
Mary B Leonard, Assistant professor of paediatrics and epidemiology

Department of Gastroenterology and Nutrition, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399, USA
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA
Centre for Adolescent Health, Department of Paediatrics, University of Melbourne, Parkville Victoria 3052, Australia

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.2

Unlike in a randomised clinical trial, in a cohort study the participants select themselves; inthis 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 …