Incentivizing social support in the randomized mobile Lifestyle Intervention for Food and Exercise study: the impact of gamification on social support perceptions, provision, and receipt.

Disordered eating is characterized by severe and persistent disturbance in eating or weight control behaviors and affects between 5.2% and 22.4% of children and adolescents globally (American Psychiatric Association ; Faria et al. ; López‐Gil et al. ). Prevalence of disordered eating among U.S. children and adolescents ranges from 5.6% to 22.5% (López‐Gil et al. ). These disorders can lead to serious physical health problems and are associated with bone fractures, anemia, osteoporosis, malnutrition, electrolyte imbalance, dental erosion, obesity, diabetes, hypertension, high cholesterol, and high triglycerides (Attia and Walsh ; Faje et al. ; Udo and Grilo ). Eating disorders also have among the highest mortality rates of any psychiatric illness (Krug et al. ; Semchishen et al. ). Eating disorders are highly comorbid with other psychiatric disorders (Convertino and Blashill ; Sanzari et al. ; Tsai et al. ). The specific mechanisms undergirding this comorbid relationship are not well understood and appear to be a multifaceted combination of genetic, epigenetic, neurobiological, psychological, developmental, sociocultural, familial, and environmental factors (Hambleton et al. ; Momen et al. ; Sanzari et al. ). There is evidence of potential genetic links between disordered eating and anxiety (Hambleton et al. ). Emotional dysregulation is associated with impulsive eating disorder behaviors and attention‐deficit/hyperactivity disorder (ADHD) (Reinblatt ) and is also common in the psychopathology of eating disorder and eating‐related symptoms (Lavender et al. ; Prefit et al. ). Several studies that include adolescents show high rates of psychiatric disorders among individuals with eating disorders, namely anxiety, mood disorders, obsessive‐compulsive disorder (OCD), ADHD, and post‐traumatic stress disorder (Convertino and Blashill ; Katzman et al. ; Sanzari et al. ; Tsai et al. ). Prevalences of these comorbidities among adolescents are difficult to assess as these studies often combine findings for children, adolescents, and adults (Katzman et al. ; Lin et al. ; Tsai et al. ). Other limitations of these studies include small sample sizes and results from mostly clinically referred samples (Fisher et al. ; Katzman et al. ). An older study using data from adolescents in a small community sample found that adolescents with eating disorders were more likely to have panic disorders or mood disorders, and that OCD was predictive of eating disorders (Zaider et al. ). Little is known about comorbid neuropsychiatric disorders among children younger than 12 years old with disordered eating behaviors (Sanchez‐Cerezo et al. ). Two notable exceptions are studies that found that anxiety disorders, ADHD, disruptive/impulse control disorders, mood disorders, and OCD were more prevalent among children aged 9–10 years diagnosed with eating disorders compared with their counterparts without the disorders (Convertino and Blashill ; Sanzari et al. ).