BACKGROUND: The use of e-cigarettes/vaping, has surged among adolescents and young adults, raising concerns about its association with nicotine addiction. Simultaneously, eating disorders (EDs) remain a significant public health issue in this population, with high morbidity and mortality. Despite emerging evidence suggesting an overlap between vaping and EDs, limited research has systematically quantified this association. This systematic review and meta-analysis aim to evaluate the relationship between vaping and EDs and the behavioral and societal factors driving this relationship.
METHODS: This review was conducted in accordance with PRISMA guidelines. A systematic search of MEDLINE, EMBASE, and Web of Science was performed for articles published up to December 2023, with no language restrictions. Eligible studies included primary research on individuals aged 14 years or older with data on vaping and EDs. Two authors independently performed data extraction and bias assessment using the JBI Critical Appraisal Tools. Meta-analysis was conducted using a random-effects model, with heterogeneity assessed through the I² statistic.
RESULTS: Out of 2.517 records, seven studies with a total of 467.316 participants were included. The pooled prevalence of EDs among vapers was 33%, compared to 5% among non-vapers. Adolescents and young adults aged 18–24 years exhibited the highest prevalence, with females and transgender individuals reporting disproportionately higher rates compared to males. Meta-analysis revealed that vapers had 1.31 times higher odds (95% CI: 1.12–1.53) of having an ED compared to non-vapers. Weight control and appetite suppression were key motivations for vaping, with sweet-flavored e-liquids commonly used to curb cravings. Vapers using e-cigarettes for weight management exhibited higher levels of pathological eating behaviors and body dissatisfaction, particularly among dual users (vaping and smoking).
CONCLUSIONS: This review highlights a significant association between vaping and EDs, emphasizing the urgent need for targeted prevention and intervention strategies. Further research is required across diverse cultural and geographic contexts.