An In-Depth Examination of the Literature on Early Pubertal Timing and Disordered Eating in Women and Girls: A Systematic Review and Meta-Analysis
Doctor of Philosophy (PhD)
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Objective: Extant data indicate that earlier onset of puberty increases risk for disordered eating symptoms in girls and women. However, whether earlier pubertal timing is predictive of all disordered eating symptoms, or whether it exerts differential effects across distinct symptoms (e.g., body dissatisfaction versus binge eating), remains unclear given inconsistencies in the literature and the lack of a systematic analysis. A meta-analytic approach can overcome these limitations by providing pooled estimates of early pubertal timing on disordered eating symptoms and testing for methodological moderators (i.e., disordered eating outcome/symptom type, measurement of pubertal timing, age of sample, type of sample, study design, race, SES) that could contribute to between-study differences in the detection of effects. Thus, this project conducted a meta-analysis of earlier pubertal timing effects on various disordered eating outcomes in females, and tested several potential sources of heterogeneity that could contribute to the magnitude of the effects. Method: A systematic literature search was conducted in PubMed, PsycINFO, and Child Development & Adolescent Studies databases. Additional research was identified via backward searches from previous studies, a request for data to the Academy for Eating Disorders message board, and authors of previously published articles were contacted to request potential unpublished data. Studies were included if they were observational, included girls or women, were available in English, and tested the association between pubertal timing and at least one disordered eating outcome. Associations between pubertal timing and disordered eating symptoms were extracted, along with pubertal timing measure, number of participants, average age of the sample, sample type, study design, internal consistency estimates for measures of disordered eating, country of sample, socioeconomic status of the sample, and racial composition of the sample. Statistical Analyses: Meta-analytic methods were used to estimate effect sizes (both Cohen’s d and Pearson’s r) for the association between earlier pubertal timing and an overall estimate of all disordered eating outcomes. Several potential sources of heterogeneity (disordered eating outcome/symptom type, measurement of pubertal timing measurement, sample age, sample type, sample socioeconomic status, sample race) were tested as moderators when two or more studies were available. Results: After adjusting for potential publication bias, there was a significant, small effect of early pubertal timing and disordered eating when the relation was estimated across all outcomes [r = .08 (.05, .11); d = .16 (.10, .22)]. Heterogeneity due to study variation was very high, except in adolescent studies that utilized pubertal status as a measure of pubertal timing, in adult samples that utilized subjective pubertal timing, and in samples recruited from community clinics. Additionally, the effect of earlier pubertal timing and disordered eating was larger for adolescent samples than adult samples, and for dimensional disordered eating outcomes than clinical diagnoses. Overall, early pubertal timing was significantly associated with most outcomes, including: higher levels of body dissatisfaction, weight preoccupation, dysregulated eating, dietary restraint, global bulimic symptom scores, and binge eating disorder. Early pubertal timing was not significantly associated with compensatory behaviors, excessive exercise, muscle building, global disordered eating symptom scores, anorexia nervosa, bulimia nervosa, or all eating disorder diagnosis measures. Discussion: This project was the first to synthesize the literature on earlier pubertal timing and disordered eating in women and girls while also testing potential sources of heterogeneity in this effect. Findings from this study suggest that early pubertal timing may be a transdiagnostic risk factor associated with most disordered eating symptoms and eating disorder diagnoses.
Eating behavior; Eating disorders; Maturation; Menarche; Meta-analysis; Puberty
University of Nevada, Las Vegas
Shope, Megan Marie, "An In-Depth Examination of the Literature on Early Pubertal Timing and Disordered Eating in Women and Girls: A Systematic Review and Meta-Analysis" (2022). UNLV Theses, Dissertations, Professional Papers, and Capstones. 4535.
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