Eating disorders symptoms and associated risk factors among medical students in France: a nationwide cross-sectional study

Medical students are exposed to multiple stressors that increase their vulnerability to mental health disorders, including eating disorders (ED). Despite growing concern, limited data are available in France regarding ED symptoms and associated psychosocial, behavioral, and environmental factors in this population.

To (1) estimate the risk of ED symptoms among French medical students according to gender and academic stage; (2) identify associated risk factors, including psychological, social, and economic determinants; and (3) explore relationships between ED symptoms and mental health indicators.

A nationwide cross-sectional survey was conducted from June to July 2024 among medical students in France, from the second year of training through residency. Participants completed a questionnaire assessing sociodemographic characteristics, mental health, experiences of humiliation and sexual violence, risky behaviors, and healthcare access. ED symptoms were screened using the French version of the SCOFF questionnaire (cutoff ≥ 2). Multivariable logistic regression was used to identify factors independently associated with ED symptoms.

Among the 7506 respondents included in the analysis, the overall estimated risk of ED symptoms was 26.2% (95% CI [25.2-27.2]), with significantly higher rates among women (30.9%) and non-binary students (26.0%) compared to men (14.4%) (p < 0.0001). Estimated risk of ED symptoms decreased with academic progression: 36.8% in pre-clinical students, 31.2% in clinical students, and 25.2% in residents (p < 0.001 for trend). In multivariable analysis, ED symptoms were associated with female or non-binary gender, earlier academic stage, anxiety, depression, suicidal ideation, alcohol misuse, tobacco use, experiences of humiliation, sexual harassment or assault, financial hardship, and having forgone healthcare due to financial or confidentiality-related barriers.

ED symptoms are highly prevalent among medical students, particularly women, gender minorities, and students in the early years of training. This burden is compounded by mental health symptoms, exposure to violence, financial insecurity, and care avoidance. These findings underscore the need for targeted, multidimensional prevention strategies and easily accessible mental health services tailored to the needs of medical students.