Body dissatisfaction in adolescence: does it cause eating disorders and depression later?
More than half of teenagers today are unhappy with their bodies (Hock et al., 2025). This widespread body dissatisfaction – the gap between how we look and how we wish we looked – isn’t just about vanity or social media pressure. It’s increasingly recognised as a serious public health concern linked to eating disorders (EDs), obesity, and depression (Department of Health & Social Care, 2023).
But here’s the challenge that has puzzled researchers for years: Does body dissatisfaction actually cause these health problems, or do they simply tend to occur together? This distinction matters enormously. If body dissatisfaction directly triggers mental and physical health issues, then prevention programs should prioritise helping people develop healthier body image (see Helen’s Mental Elf blog, “Can schools prevent eating disorders?”). If not, resources might be better directed elsewhere.
Previous studies attempting to answer this question have hit roadblocks, such as being too small or not adequately accounting for confounding factors. For instance, if teenagers from lower-income families tend to experience both body dissatisfaction and depression, it might be their economic circumstances, not their body image, driving both outcomes.
Constantini and colleagues (2025) have taken an innovative approach to cut through this confusion, using data from thousands of twins to reveal a clearer picture of whether adolescent body dissatisfaction itself drives health problems, or if other mechanisms may be at play.
Does body image dissatisfaction contribute to mental and physical health problems? This question was addressed by Constantini and colleagues using data from almost 14,000 twins.
Methods
Data was analysed from 13,945 twin pairs born in the UK between 1994 and 1996, who were part of the Twins Early Development Study (TEDS). They focused on participants who completed questionnaires about their body image at age 16, then tracked their health outcomes through their early twenties, specifically looking at ED symptoms (age 21 only), depression, and body mass index (BMI) at ages 21 and 26.
The genius of using twins lies in their unique ability to help researchers separate nature from nurture. The team employed two complementary approaches:
First, they compared different individuals. They asked: Do teenagers with more body dissatisfaction at 16 have worse health outcomes in young adulthood compared to those who felt better about their bodies? To ensure they weren’t mistaking correlation for causation, they statistically accounted for numerous factors that might muddy the waters, including family income, BMI, and parental mental health.
Second, they compared twins to each other. This approach asks: When one twin is more dissatisfied with their body than the other at 16, does that twin tend to have worse health outcomes later? Since twins share their family environment (and identical twins share all their genes), this comparison naturally controls for certain factors.
Running both analyses and comparing the results allowed the researchers to spot where hidden factors might be complicating the relationship between body dissatisfaction and health problems. The team also explored whether genetics or environment played a bigger role in explaining why body dissatisfaction, ED symptoms, depression, and BMI tend to cluster together.
Results
The study followed 2,183 participants, mostly female and White, from their teens into their twenties, and the initial pattern was clear. Teenagers with higher body dissatisfaction at 16 experienced:
- More ED symptoms at 21 (B = 2·42, 95% CI [2.19 to 2.66]), which was stronger among girls than boys
- Higher rates of depression at both 21 and 26 (B = 0·69, 95% CI [0.58 to 0.80])
- Higher BMI at ages 21 and 26 (B = 0·50, 95% CI [0.39 to 0.61])
These connections held strong even after accounting for dozens of potential confounding factors, suggesting body dissatisfaction isn’t just a marker for other problems, but potentially a driver of them. However, the twin comparisons revealed a more nuanced story.
When researchers compared twins to each other, they found:
- The link between body dissatisfaction and depression remained strong, even when comparing identical twins. This is crucial evidence for causation, as sharing the same genes and same environment reduces the likely influence of additional factors.
- The connection to ED symptoms weakened but persisted, dropping by about half when comparing identical twins. This suggests shared genetic factors for body dissatisfaction and ED symptoms play a role in the association, but aren’t the whole story, and that there is a causal influence of body dissatisfaction on ED symptoms.
- The BMI connection disappeared entirely in identical twin comparisons, indicating this link is primarily driven by shared genetic factors rather than body dissatisfaction causing weight changes.
Interestingly, genetics accounted for a substantial portion of why body dissatisfaction tends to occur alongside these health problems. 77% of the co-occurrence of body dissatisfaction and EDs was due to genetic influences; genetic factors also explained 66-78% of the overlap between body dissatisfaction and depression, and 85-91% for body dissatisfaction and BMI. In other words, genetic risk for elevated body dissatisfaction is associated with increased risk for mental and physical health conditions.
Additionally, genetic correlation analyses revealed a high genetic correlation between body dissatisfaction and EDs (75%), indicating a shared genetic architecture. The genetic correlation between body dissatisfaction and the other outcomes was lower (~40%), suggesting the genetic risk factors were moderately similar. This collection of results explains why the association between body dissatisfaction and EDs was cut in half when genetics were controlled for in the identical twin analysis – because genetic influences on these two traits are highly similar and thus substantially contribute to the overlap in occurrence.
Comparing twins helped the researchers show that body dissatisfaction in adolescence may well cause eating disorder and depressive symptoms later in young adulthood.
Conclusions
This research demonstrated that adolescents, particularly females, with higher body dissatisfaction at age 16 were more likely to experience elevated ED symptoms at age 21 and depressive symptoms at age 26, even when accounting for unobserved shared genetic and environmental influences. Therefore, the authors concluded that the research strengthens,
the plausibility that body dissatisfaction causes [later eating disorder and depressive symptoms].
Of note, the authors also found that shared genetic factors may play a greater role in the association between body dissatisfaction and ED symptoms than between body dissatisfaction and depressive symptoms, which could be a result of specific genes influencing multiple traits. It could also be that the specific genes affecting body image indirectly influence other traits (e.g., anxiety, food restriction) that contribute to the development of ED symptoms.
Common genetic factors seem to influence the co-occurrence of body image dissatisfaction and eating disorder symptoms, but do not represent the whole story.
Strengths and limitations
This is the first study to investigate the association between body dissatisfaction in adolescence and later symptoms of EDs, depression, and BMI in twins. The sample size was large, which prevents the risk of false positive and false negative findings. In addition, the authors carefully accounted for observed and hidden influences to more clearly evaluate the unique role of body dissatisfaction, allowing for greater confidence in the results reflecting true causal relationships.
The most significant limitation of this research, which the authors note, is that it claims to investigate the predictive role of body dissatisfaction on later mental health and weight outcomes without accounting for baseline levels of these outcomes. Consequently, it is not possible to determine whether body dissatisfaction at age 16 causes ED symptoms at age 21, or whether greater body dissatisfaction at age 16 is due to concurrent ED symptoms which persist and are first measured at these later timepoints. Given that body dissatisfaction is a core symptom of many EDs and that ED onset commonly occurs in late adolescence, one might expect that the body dissatisfaction measured at the first time point is correlated with unmeasured ED symptoms that are also present. However, we cannot make a determination one way or the other about this hypothesis on the basis of this study. Similarly, it is unclear whether the elevated depressive symptoms found at the third timepoint (age 26) are a result of earlier body dissatisfaction, or if they are instead due to elevated ED symptoms or depression at either ages 16 or 21.
As is the case with many studies examining body dissatisfaction, the current study was also limited by the self-report nature of the measures, which can introduce measurement error. Body dissatisfaction is hard to objectively quantify, but techniques like comparing actual and ideal body size using visual tools (Nearman et al., 2019) may provide more accurate data relative to questionnaire-based assessments. There are also limitations to generalisability given lack of diversity in the sample, and the potential for unaccounted influential factors.
Future longitudinal research examining body dissatisfaction and later mental health outcomes needs a more diverse sample for generalisability, and should account for baseline symptoms to parse out causality.
Implications for practice
As a clinician, it is common to see patients with EDs and/or depression struggle on the road to recovery. As researchers, we are often trying to understand the critical pieces underlying remission of symptoms after treatment because of how frequently individuals relapse (Berends et al., 2018). EDs have among the highest morbidity and mortality rates of any psychiatric illness and understanding how to effectively intervene has many challenges (Krug et al., 2025). Being able to prevent the onset or worsening of ED and depression symptoms, even if only in a percentage of individuals, is a worthwhile cause.
This study helps us gather information about factors that may be driving psychological symptoms and highlights the importance of addressing body dissatisfaction in mitigating mental health and weight outcomes. It seems important for clinicians and physicians to inquire about body dissatisfaction in their patients, particularly among adolescents, and be aware that those who endorse very elevated body dissatisfaction may be at potential risk for worsening mental health symptoms. Such individuals may be good candidates for additional prevention efforts to mitigate the risk of ED and depressive symptoms – or, if such symptoms are already present, may benefit from earlier intervention to address these symptoms.
Intervening earlier and promoting body acceptance may be critical to preventing the development of EDs and other psychological symptoms. Schools are seemingly an ideal place to deliver prevention interventions to children and adolescents, given these interventions could be delivered at scale, and if delivered early enough, could be administered before severe symptoms onset. The challenge may be in developing effective school-based programs. Existing data suggest that current programs have some beneficial effects on EDs, though longer-term outcomes are less clear (Berry et al., 2025). Notably, some studies have identified that school-based ED prevention interventions have yielded improvements in anxiety, depression and distress (Wong et al., 2024). Given the exorbitant costs associated with the treatment of EDs and depression, improved prevention and management of body dissatisfaction should be prioritised to reduce the public health burden of later associated conditions.
Efforts to prevent future mental health problems may focus on reducing body dissatisfaction in adolescents using evidence-based methods, both in treatment and school settings.
Statement of interests
Drs. Allam and Lloyd have no financial conflicts of interest to disclose. Dr. Lloyd has previously collaborated with three of the study authors.
The authors used Claude (Opus 4.1) to assist in refining the blog post to make it more suitable for a general audience. All initial drafting, critical appraisal and conclusions are the authors’ own.
Edited by
Dr Nina Higson-Sweeney.
Links
Primary paper
Ilaria Costantini, Prof Thalia C Eley, Prof Jean-Baptiste Pingault, Prof Neil M Davies, Helen Bould, Prof Cynthia M Bulik, Georgina Krebs, Prof Glyn Lewis, Prof Gemma Lewis, Prof Clare Llewellyn, Prof Phillippa C Diedrichs, Prof Dasha Nicholls, Prof Francesca Solmi (2025). Longitudinal associations between adolescent body dissatisfaction, eating disorder and depressive symptoms, and BMI: a UK twin cohort study. The Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(25)00333-5
Other references
Berends, T., Boonstra, N., & van Elburg, A. (2018). Relapse in anorexia nervosa: a systematic review and meta-analysis. Current Opinion in Psychiatry, 31(6), 445–455. https://doi.org/10.1097/YCO.0000000000000453
Berry, S. L., Burton, A. L., Rogers, K., Lee, C. M., & Berle, D. M. (2025). A systematic review and meta-analysis of eating disorder preventative interventions in schools. European Eating Disorders Review, 33(2), 390–410. https://doi.org/10.1002/erv.3149
Bould, H. (2014). Can schools prevent eating disorders? The Mental Elf.
Department of Health & Social Care. (2023). The impact of body image on mental and physical health: Government response to the House of Commons Health and Social Care Committee’s second report of session 2022 to 2023. Available at: https://publications.parliament.uk/pa/cm5803/cmselect/cmhealth/114/report.html (accessed December 4, 2025).
Hock, K., Vanderlee, L., White, C. M., & Hammond, D. (2025). Body Weight Perceptions Among Youth From 6 Countries and Associations With Social Media Use: Findings From the International Food Policy Study. Journal of the Academy of Nutrition and Dietetics, 125(1), 24–41. https://doi.org/10.1016/j.jand.2024.06.223
Krug, I., Liu, S., Portingale, J., Croce, S., Dar, B., Obleada, K., Satheesh, V., Wong, M., & Fuller-Tyszkiewicz, M. (2025). A meta-analysis of mortality rates in eating disorders: An update of the literature from 2010 to 2024. Clinical Psychology Review, 116, 102547. https://doi.org/10.1016/j.cpr.2025.102547
Wong, R. S., Chan, B. N. K., Lai, S. I., & Tung, K. T. S. (2024). School-based eating disorder prevention programmes and their impact on adolescent mental health: systematic review. BJPsych Open, 10(6), e196. https://doi.org/10.1192/bjo.2024.795
