Multivariate Trajectories of Eating Disorder Symptoms and Weight Status in 10‐ to 17‐Year‐Old Children and Adolescents

ABSTRACT Objective Eating disorders (EDs) often emerge in adolescence, but developmental trajectories across different core features remain largely unclear. Method The prospective, community‐based study included N = 898 participants aged 9.5–17.5 years (47.6% female, age 11.8 ± 1.4 years) with annual follow‐up over 2–6 (3.4 ± 1.2) years. Multivariate trajectories of binge eating, restraint, weight‐compensatory behaviors (Eating Disorder Examination‐Questionnaire for Children), and body mass index‐standard deviation score (BMI‐SDS) derived from objective anthropometrics were analyzed using group‐based multi‐trajectory modeling (GBMTM) separately for girls and boys. ED and general psychopathology were used for validation and outcome comparisons. Results GBMTM identified five distinct trajectories of ED symptoms and BMI‐SDS in girls and six in boys. Low‐symptom trajectories at lower, normal, and higher BMI‐SDS were most common and showed only mild, transient ED symptoms. In boys, trajectories were largely characterized by stable ED symptoms at different BMI‐SDS levels, whereas in girls, ED symptoms showed more pronounced change over time. In both sexes, two high‐risk subgroups reflected bulimic and binge‐eating patterns and followed trajectories with elevated or increasing ED symptoms across ages, which in girls were particularly associated with increased ED and general psychopathology at last assessment. Discussion GBMTM results support the developmental specificity of bulimic/binge‐eating syndromes and noneating‐disordered overweight across adolescence. High‐risk subgroups in both sexes—and their particularly unfavorable outcomes in girls—underscore the need for sex‐specific early identification strategies that consider longitudinal constellations of multiple ED symptoms and weight status rather than single indicators.