The study, conducted by researchers at Jahangirnagar University and the Centre for Medical Research and Development, was published in the Journal of Eating Disorders. It offers one of the first systematic looks at how eating behavior phenotypes manifest among adolescents in a low- and middle-income country, a context in which eating disorders have often been assumed to be rare or primarily a phenomenon of high-income Western societies. The findings challenge that assumption and suggest that prevention efforts in rapidly urbanizing countries may need to focus sharply on the dangers of restrictive dieting during adolescence.

Eating behavior researchers typically distinguish three phenotypes. Restrained eating refers to the deliberate attempt to limit food intake in order to control body weight, often through skipping meals, avoiding certain food groups, or rigid calorie counting. Emotional eating describes the tendency to eat in response to negative emotional states such as stress, sadness, or anxiety, rather than in response to hunger. External eating, meanwhile, is the tendency to eat in response to external food-related cues—the sight or smell of appetizing food, for example, or the sight of others eating—regardless of internal hunger signals. Decades of research in Western populations have linked all three patterns to disordered eating outcomes, but their relative importance appears to vary across cultural and economic contexts, making locally grounded studies essential.

To fill this gap, the research team carried out a cross-sectional survey between February and August 2025 among students aged 12 to 17 years enrolled in selected secondary schools in the Dhaka South City Corporation area. Participants were recruited using a multistage cluster random sampling design, a technique in which schools are first randomly selected and then students within them are sampled, helping to reduce selection bias and improve the representativeness of the sample. In total, 428 adolescents completed a structured questionnaire that combined socio-demographic and lifestyle questions with two internationally validated instruments: the Dutch Eating Behavior Questionnaire, which measures restrained, emotional, and external eating, and the Eating Attitudes Test-26, a widely used screening tool for eating disorder symptoms.

The researchers defined eating disorder risk as a score of 20 or higher on the EAT-26, the conventional threshold indicating clinically concerning attitudes and behaviors around food and weight. Group differences were tested with independent-samples t-tests and chi-square tests, and the team then used logistic regression to estimate both crude and adjusted odds ratios. Crucially, the adjusted models controlled for a range of potential confounders, including age, sex, body mass index category, breakfast skipping, sleep duration, screen time, physical activity, and household income. This statistical approach allowed the researchers to isolate the independent contribution of each eating behavior pattern to eating disorder risk, rather than attributing to dieting what might actually be explained by sleep, income, or sedentary lifestyle.

The results were sobering. Of the 428 adolescents surveyed, 123—or 28.7 percent—met the criteria for eating disorder risk, meaning nearly one in three urban school-going adolescents in the sample screened positive. The risk was significantly higher among girls than boys, with 33.3 percent of female participants at risk compared with 24.2 percent of males, a statistically significant difference. Two lifestyle factors also stood out: adolescents who skipped breakfast and those who slept for shorter durations were significantly more likely to screen at risk, with breakfast skipping showing a particularly strong association.

But it was the analysis of eating behavior phenotypes that produced the study’s most striking result. Adolescents at risk of eating disorder had substantially higher restrained eating scores than those not at risk, averaging 2.38 on the Dutch Eating Behavior Questionnaire scale compared with 1.84 among low-risk peers, a highly significant difference. In the multivariable analysis, each unit increase in restrained eating score was associated with roughly two and a half times the odds of eating disorder risk, with an odds ratio of 2.42 and a 95 percent confidence interval of 1.85 to 3.16. When the researchers divided participants into tertiles of restrained eating, the contrast became even more dramatic: adolescents in the highest tertile had nearly six times the odds of eating disorder risk compared with those in the lowest, with an odds ratio of 5.84 and a confidence interval of 3.25 to 10.50.

Emotional eating, by contrast, showed only a weak association with eating disorder risk after statistical adjustment, and external eating was not significantly related to risk at all. This hierarchy of effects is scientifically meaningful. It suggests that in this urban Bangladeshi adolescent population, the psychological drive to restrict food intake—a behavior often socially rewarded and even encouraged as “discipline” or “healthy eating”—is a far more powerful correlate of disordered eating than eating in response to emotions or food cues. The finding aligns with a substantial body of international evidence indicating that dietary restraint can initiate a cascade of psychological and physiological processes, including heightened preoccupation with food, binge-restrict cycles, distorted body image, and metabolic adaptation, that collectively increase vulnerability to clinical eating disorders such as anorexia nervosa and bulimia nervosa.

The authors also note that restrained eating among adolescents frequently arises in response to weight-related concerns, teasing, social media exposure, and cultural ideals of thinness—pressures that are intensifying in urban Bangladesh as globalized media and consumer culture expand. Dhaka, one of the world’s most densely populated megacities, has seen rapid lifestyle change over the past two decades, including increased consumption of ultra-processed foods, reduced physical activity, longer screen time, and altered sleep patterns. The study’s finding that breakfast skipping and short sleep were independently associated with eating disorder risk fits within this broader picture of lifestyle disruption, and suggests that multiple everyday behaviors could serve as accessible red flags for parents, teachers, and clinicians.

For a country like Bangladesh, where adolescent mental health services remain limited and eating disorders are rarely diagnosed, the study has clear public health implications. Screening for restrained eating behaviors in school settings could identify adolescents at heightened risk long before the onset of full clinical syndromes, when intervention is most effective. The authors argue that early identification of unhealthy eating behaviors—particularly rigid dieting—should be integrated into prevention strategies targeting adolescent populations. School-based programs that promote balanced nutrition without moralizing about weight, discourage meal skipping, and address body image pressures may offer a practical and scalable route to prevention.

The study does have limitations typical of cross-sectional research. Because data were collected at a single point in time, the analysis cannot establish whether restrained eating causes eating disorder risk or whether early disordered eating drives restrictive behavior; the relationship is likely bidirectional. The EAT-26 is a screening instrument rather than a diagnostic tool, so the 28.7 percent figure represents risk, not confirmed clinical diagnoses. The sample was drawn from urban Dhaka schools only, meaning the findings may not generalize to rural adolescents or to out-of-school youth. Self-reported questionnaires are also subject to recall and social desirability biases, particularly around sensitive topics like food restriction and body image.

Even with these caveats, the study represents a significant addition to the global evidence base on eating disorders in low- and middle-income countries, where epidemiological data remain sparse despite growing concern among researchers. By demonstrating that the same behavioral phenotype—restrained eating—that predicts eating disorder risk in high-income settings also exerts the strongest association in urban Bangladesh, the findings underscore that eating disorders are not culturally bounded phenomena. As urbanization, digital media exposure, and thinness ideals continue to spread across South Asia, the researchers warn that unhealthy eating behaviors among adolescents are likely to intensify unless met with early, culturally informed prevention efforts. For the nearly one in three Dhaka adolescents screening at risk, the message from this research is unambiguous: the dieting behaviors society often applauds may be the most important early warning signs of all.