Differential associations of restrained, emotional, and external eating with eating disorder risk among urban adolescents in Bangladesh

Eating disorders are an emerging public health concern among adolescents and are often associated with unhealthy eating behaviors. Eating behavior phenotypes such as restrained, emotional, and external eating may increase vulnerability to eating disorder. However, evidence from low- and middle-income countries, including Bangladesh, remains limited. This study examined the associations between these eating behaviors and the risk of eating disorders among urban adolescents in Bangladesh. A school-based cross-sectional study was conducted among 428 adolescents aged 12–17 years from selected secondary schools in Dhaka South City Corporation area between February and August 2025. The participants were selected using a multistage cluster random sampling design. Data were collected via a structured questionnaire that included socio-demographic and lifestyle information, the Dutch Eating Behavior Questionnaire, and the Eating Attitudes Test-26. Eating disorder risk was defined as an EAT-26 score ≥ 20. Group differences were examined using independent-samples t tests and chi-square tests. Logistic regression analyses were performed to estimate crude and adjusted odds ratios after controlling for age, sex, BMI category, breakfast skipping, sleep duration, screen time, physical activity, and household income. Among the 428 adolescents, 123 (28.7%) were identified as being at risk of eating disorder. Eating disorder risk was significantly greater among females than among males (33.3% vs. 24.2%; p = 0.037). Breakfast skipping and shorter sleep duration were also significantly associated with greater risk (p < 0.001 and p = 0.015). Compared with those not at risk, adolescents at risk were associated with significantly higher restrained eating scores (2.38 ± 0.81 vs. 1.84 ± 0.56; p < 0.001). According to the multivariable analysis, restrained eating was associated with higher odds of having an eating disorder (OR = 2.42, 95% CI: 1.85–3.16; p < 0.001). External eating was not significantly associated with eating disorder risk. Adolescents in the highest tertile of restrained eating had markedly greater odds of eating disorder risk (OR = 5.84, 95% CI: 3.25–10.50; p < 0.001). Restrained eating was the behavior most associated with eating disorder risk among urban adolescents in Bangladesh. Early identification of unhealthy eating behaviors may support prevention strategies in adolescent populations. Eating disorders and unhealthy eating behaviors are becoming important health concerns among adolescents. Different eating behavior patterns, such as restrained eating (trying to restrict food intake to control weight), emotional eating (eating in response to emotions), and external eating (eating triggered by food cues), may influence the risk of developing eating disorder. However, few studies have examined these behaviors among adolescents in Bangladesh. In this study, we investigated how these eating behavior patterns are associated with eating disorder risk among 428 school-going adolescents aged 12–17 years in urban Dhaka. The participants completed questionnaires assessing their eating behaviors, lifestyle factors, and eating disorder risk. We found that nearly one in three adolescents were at risk of eating disorder. Restrained eating showed the strongest association with eating disorder risk, indicating that adolescents who frequently tried to restrict their food intake were much more likely to exhibit signs of eating disorder. Emotional eating showed only a weak association, whereas external eating was not significantly related. We also observed that skipping breakfast and sleeping fewer hours were associated with higher risk.