What Are the Effects of Restrictive Eating Disorders on Growth and Puberty and Are Effects Permanent? A Systematic Review and Meta-Analysis

J Adolesc Health. 2020 Feb;66(2):144-156. doi: 10.1016/j.jadohealth.2019.08.032. Epub 2019 Nov 23.


Purpose: The objective of the study was to examine (1) the effect of restrictive eating disorders (EDs) on growth and pubertal development in children and young people (CYP) and (2) potential reversibility of this with recovery and associated factors. EDs can impact growth and puberty in CYP, but reports have conflicted over effect on height and permanence of growth impairment and pubertal delay.

Methods: This is a systematic review and meta-analysis, searching PubMed, EMBASE, PsycINFO, and Web of Science from May 31, 2018, to inception. We included observational studies or systematic reviews regarding growth and puberty in EDs in CYP aged <18 years or in studies reporting outcomes in adults known to have had an ED under age 18 years. Cross-sectional studies were pooled for meta-analysis for effects on height.

Results: A total of 27 studies were included. Growth and pubertal delay were commonly reported, but evidence for catch-up growth found in the majority. However, catch-up growth was not seen in all and may be suboptimal. Meta-analysis of 459 subjects (213 with anorexia nervosa and 246 controls) found no significant difference in height at baseline, with weighted mean difference -.13 cm (95% CI -2.64 to 2.38 cm; p = .9; I2 = 68.5%). Younger age and longer duration of illness are potential risks for growth delay; weight gain appears protective for catch-up growth. Findings are primarily generalisable to females, given limited data on males.

Conclusions: CYP with restrictive EDs are at risk of growth impairment and pubertal delay, though potentially reversible. Attention to growth in EDs is important, especially in the young. Weight restoration should be encouraged to avoid adverse effects and allow opportunity for catch-up.

Keywords: Anorexia nervosa; Catch-up growth; Growth impairment; Pubertal delay.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Anorexia Nervosa
  • Body Height
  • Body Weight
  • Child
  • Cross-Sectional Studies
  • Feeding and Eating Disorders / complications*
  • Female
  • Growth Disorders / etiology*
  • Humans
  • Male
  • Puberty*
  • Weight Gain