Narrative Review Maps Binge Eating Disorder Risks Across Lifespan

A narrative review published in Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity examines the vulnerabilities and resilience factors associated with binge eating disorder (BED) among female populations and transgender individuals across the lifespan. The study, led by Nagaia Madini and colleagues, synthesizes evidence from 28 human studies to understand how biological, psychological, and sociocultural factors interact to influence the onset and maintenance of BED. By adopting an integrated sex- and gender-based approach, the review addresses a gap in existing literature that has often focused on specific life stages or selected populations without providing a comprehensive lifespan perspective.

Binge eating disorder is characterized by recurrent episodes of consuming large quantities of food, often rapidly and to the point of discomfort, accompanied by feelings of loss of control and significant distress. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), these symptoms must cause marked distress to meet clinical criteria. The review highlights that BED is a significant public health concern due to its profound psychological, physical, and economic consequences. Individuals with BED frequently experience body dissatisfaction, emotional distress, anxiety, depression, and chronic stress, which can lead to social withdrawal and delays in seeking medical or psychological support.

The review distinguishes between sex, defined by genetic and physiological traits, and gender, which refers to social norms and roles. This distinction is crucial because BED risk factors are linked to both female biological transitions, such as hormonal fluctuations during menstruation, pregnancy, and menopause, and gender-related experiences like stigma and minority stress. The authors note that while BED affects both men and women, prevalence is higher among females, and the disorder is often underreported in males due to stigma and societal expectations of masculinity.

In the context of childhood and adolescence, the review identifies several key risk factors for BED. A study by Cella and colleagues involving 1,046 Italian students found that low self-esteem had a direct effect on binge eating behavior, partially mediated by body image feelings and body protection. Other contributing factors include the pursuit of thin beauty ideals, negative affect, and impaired interpersonal functioning. Longitudinal data from Stice and colleagues, involving 1,272 female adolescents, showed that 5.5% presented with BED, while 29% reported recurrent binge eating symptoms. Elevated thin-ideal internalization and body dissatisfaction were significant risk factors for subthreshold BED.

Pregnancy represents another critical period for BED vulnerability. Prevalence estimates vary across studies, with a prospective cohort study reporting a rate of 4.8% at 17 weeks of gestation, while a systematic review indicated lower rates of 1.8%. A large-scale meta-analysis found that BED is the most common eating disorder before and during pregnancy, with prevalence rates of 3.3% and 3.8%, respectively. BED during pregnancy is clinically relevant due to its association with increased risks of miscarriage, excessive gestational weight gain, gestational diabetes, and adverse neonatal outcomes. Factors associated with BED incidence during pregnancy include history of abuse, depression, anxiety, low self-esteem, and poor partner relationship satisfaction.

For menopausal and postmenopausal women, the review indicates that BED remains prevalent, with evidence suggesting it is the most common eating disorder in middle age. The transition to menopause, combined with concerns about aging and body dissatisfaction, may increase vulnerability to psychological distress and eating disorders. Women with BED in this age group often exhibit greater body dissatisfaction, depressive symptoms, and higher body mass index. The onset of binge eating is often linked to stressful life events such as divorce, retirement, or bereavement. However, the review notes a paucity of evidence regarding BED in midlife and beyond, highlighting the need for more research on outreach and treatment programs for older adults.

The review also addresses the specific challenges faced by transgender individuals. LGBTQ+ populations encounter unique health challenges, including elevated risks of mental health disorders and barriers to healthcare access due to discrimination and stigma. Transgender individuals face significant challenges in accessing gender-affirming healthcare, and the association between transgender identity and heightened risk of eating disorders is well-established. This risk is largely driven by minority stress, which includes societal pressures to conform to gender norms and the thin ideal. Studies indicate that among transgender and nonbinary adolescents, eating disorder prevalence ranges from 5 to 18%, while in transgender adults, it may affect 20–50% of the population.

Key risk factors for BED in transgender individuals include body dissatisfaction, higher body mass index, and concerns about weight and shape. Food insecurity is also a significant contributor, linked to depressive and anxiety symptoms as well as binge eating behaviors. Gender-affirming hormone therapy shows complex associations with binge eating episodes, with differences observed between transgender men and women. Social factors such as stigma are central determinants of vulnerability, while self-compassion and supportive family and school environments act as protective factors. The review emphasizes the need for an integrated approach to managing BED in this population, including gender-affirming care, psychological interventions, and anti-stigma strategies.

The authors conclude that BED in the female population is strongly influenced by both sex-related biological changes and gender-based sociocultural factors. Sociocultural pressures, such as body dissatisfaction and internalized weight stigma, exacerbate the risk of BED onset and persistence. The prevalence of binge eating appeared to increase across the lifespan, with rates averaging 11% among adolescents aged 13–18 years, 20% among pregnant women, and 30% among women undergoing menopause. In transgender populations, the highest prevalence was reported during adolescence and young adulthood, possibly reflecting the combined influence of identity affirmation processes and exposure to minority stress.

Despite the insights provided, the review acknowledges significant limitations. The included studies showed substantial heterogeneity in design, sample characteristics, and diagnostic approaches, limiting direct comparability across findings. Many studies relied on cross-sectional methodologies or self-reported measures, which reduce the ability to establish causal relationships. Additionally, there is an uneven distribution of evidence, with transgender individuals and women in midlife or late adulthood remaining underrepresented in the literature. The narrative review approach does not allow for quantitative synthesis or formal assessment of study quality, which should be considered when interpreting the conclusions.

The review underscores the need for inclusive clinical research that considers the specific vulnerabilities of marginalized groups. Overcoming the stigma and shame experienced by individuals with BED, especially women and transgender individuals, requires systemic change at both the clinical and policy levels. Addressing BED effectively requires multidisciplinary collaboration, early intervention, and the dismantling of societal stigmas surrounding disordered eating and body image. The authors call for more comprehensive research to develop tailored, holistic interventions and improve healthcare providers’ preparedness to address these disparities.

In conclusion, this narrative review provides a comprehensive overview of the factors contributing to binge eating disorder across the lifespan in female and transgender populations. It highlights the complex interplay of biological, psychological, and sociocultural influences that shape BED risk and presentation. By identifying these vulnerabilities and resilience factors, the review aims to inform the development of targeted prevention and treatment strategies that address the specific challenges faced by these groups. Further research is warranted to reduce disparities in healthcare access and to dismantle structural barriers and stigma, ensuring equitable and culturally competent care for all individuals affected by BED.

Subject of Research: Vulnerabilities and resilience factors in binge eating disorder among female and transgender populations across the lifespan

Article Title: Understanding vulnerabilities and resilience in binge eating disorder among female population and transgender individuals across the lifespan: a narrative review

Article References: Madini, N., Breda, C., El Masri, D., Rizzo, C. R., Lanati, S., Stanford, F. C., Vincenti, A., Cena, H., & De Giuseppe, R. (2026). Understanding vulnerabilities and resilience in binge eating disorder among female population and transgender individuals across the lifespan: a narrative review. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 31(1), Article 79. https://doi.org/10.1007/s40519-026-01891-z

Image Credits: AI Generated

DOI: 10.1007/s40519-026-01891-z

Keywords: binge eating disorder, narrative review, transgender health, eating disorders, lifespan perspective, public health, stigma, psychological risk factors, Understanding, vulnerabilities, resilience, binge