Current tobacco smoking prevalence in individuals living with eating disorders: A meta-analysis and meta-regression study

Objectives: A growing body of evidence suggests a potential association between tobacco dependence and eating disorders. Given the appetite-suppressing effects of tobacco, its use may be linked to weight control behaviors among individuals with eating disorders. This study aims to review the prevalence of current smoking among individuals diagnosed with Anorexia Nervosa (AN), Bulimia Nervosa (BN), or Binge Eating Disorder (BED). Methods: A comprehensive literature search was conducted across international scientific databases to identify eligible studies. Smoking prevalence rates were extracted and aggregated using random-effects models. Metaregression and sensitivity analyses were performed to explore factors influencing prevalence rates. Results: The final analysis included 30 studies, encompassing 2970 individuals with AN, 5032 with BN, and 7704 with BED. The pooled prevalence of current smoking was 23.4 % for AN, 19.3 % for BN (adjusted for publication bias), and 11.9 % for BED. Meta-regression revealed that studies with higher proportions of female participants and those using non-DSM diagnostic tools reported significantly lower smoking prevalence in BED. Additionally, higher smoking prevalence in BED was observed in North America and in studies with more recent publication years. No significant covariates were identified in the meta-regression models for AN and BN. Sensitivity analyses confirmed the robustness of these findings. Conclusion: This meta-analysis highlights elevated current smoking rates among individuals with AN and BN compared to the general population, particularly among women. Smoking may serve as a weight control strategy in these groups, underscoring the need for integrated smoking cessation interventions within eating disorder treatment. The findings also reveal distinct regional and demographic influences on smoking behavior in BED, suggesting a nuanced approach to prevention and intervention across eating disorder subtypes.