Abstract
OBJECTIVE: To estimate the prevalence of eating disorders and disordered eating in adults seeking obesity treatment. METHOD: Databases, MEDLINE, Embase, and PsycINFO, were searched to 20th March 2025. Studies reporting the prevalence of eating disorders or disordered eating at presentation to obesity treatment in adults (≥ 18 years) with overweight (BMI 25 to < 30 kg/m(2)) or obesity (BMI ≥ 30 kg/m(2)), with ≥ 325 participants to ensure a representative sample, were included. A random-effects model was used to pool prevalence estimates of eating disorders and disordered eating. RESULTS: 85 studies were included (n = 94,295, 75.9% female, median (IQR) age 44 (5) years, BMI 46 (10) kg/m(2)). When assessed by clinical interview, the pooled prevalence of binge-eating disorder (Diagnostic and Statistical Manual of Mental Disorders-5) was 14% (95% CI: 7 to 22, prediction interval [PI]%: 0 to 43, k = 10, n = 8534), and bulimia nervosa 1% (95% CI: 0 to 1, PI%: 0 to 2, k = 9, n = 9448, τ(2) = 0). When assessed using the Binge Eating Scale, the prevalence of self-reported moderate severity binge eating was 26% (95% CI: 23 to 28, PI%: 18 to 33, k = 12, n = 8113, τ(2) = 0.001) and severe binge eating was 12% (95% CI: 8 to 16, PI%: 0 to 31, k = 18, n = 12,136, τ(2) = 0.01). DISCUSSION: Obesity and eating disorders or disordered eating do co-occur. There was variability between studies and between the prevalence of eating disorders and disordered eating in adults presenting for obesity treatment. It is critical that clinicians are well resourced to effectively identify individuals with eating disorders and disordered eating and provide appropriate treatment pathways.