Research projects – Eating disorders


On-going studies

I. Neurobiological mechanisms of eating disorders

1. Epigenetic processes


Title: A prospective study of DNA methylation in women and girls with Anorexia Nervosa: Relationship to stage of illness and nutritional status
Principal investigators:  Howard Steiger (nominated PI), PhD; Linda Booij, PhD (co-PI).
Co-investigators: Luis Agellon; Lise Gauvin; Mimi Israël; Ridha Joober; Aurélie Labbe; Annie St-Hilaire; Moshe Szyf; Lea Thaler; Linda Wykes.
Funding: Canadian Institutes of Health Research (CIHR)

We are studying DNA methylation processes in adults and adolescents with anorexia nervosa, individuals who have recovered from Anorexia nervosa and people who never had an eating disorder. We have collected DNA samples and clinical and behavioral measures from more than 300 individuals. Our results to date show DNA methylation alterations in people with anorexia nervosa in genes regulating metabolism, immune function and psychiatric status (Booij et al., 2015; Steiger et al., 2019, 2023). Further, we showed that DNA methylation alterations observed in the active phase of anorexia nervosa are reversible (Steiger et al., 2019, 2023).

2. Brain processes


Title: The neurodevelopmental trajectory of youth with anorexia nervosa: A Canada-wide longitudinal multi-modal imaging study
Principal Investigators: Linda Booij (nominated PI); Paul Arnold; Gina Dimitropoulos (co-PIs).
Co-investigators: Holly Agostino; Nicholas Chadi; Jennifer Coelho; Jennifer Couturier; Guillaume Dumas; Deborah Katzman; Sarosh Khalid-Khan; Andrée-Anne LeDoux; Daniel LeGrange; Frank MacMaster; Mark Norris; Nicole Obeid; Howard Steiger; Danielle Taddeo.
Funding: Canadian Institutes of Health Research (CIHR) 

We developed a brain initiative on anorexia nervosa (Anorexia Nervosa IMaging Adults and TEens; ANIMATE). To date, the search for brain correlates underpinning the clinical features of eating disorders has been unsuccessful. Brain-imaging studies in eating disorders with large sample sizes are a priority for the field to move forward. In collaboration with eight other eating-disorder programs across Canada, the study aims to investigate brain developmental mechanisms and reversibility of nervous system changes in people with anorexia nervosa. The study is led by Dr. Linda Booij at the Eating Disorders Continuum, and is in close collaboration with eating disorder programs at CHU Sainte-Justine, Montreal Children’s Hospital, CHEO (Ottawa), Hotel Dieu Hospital (Kingston), Hospital for Sick Children (Toronto), McMaster Children’s Hospital (Hamilton), Alberta Children’s Hospital (Calgary) and BC Children’s Hospital (Vancouver).

 II. Biopsychosocial predictors and trajectories of treatment response

Individuals treated in our eating-disorder program regularly complete questionnaires during their course of treatment. Whereas data could be used to monitor people’s individual treatment progress, we also aim to use the data for research purposes. Specifically, anonymized questionnaire data are added to a large clinical research database, and we used this database to answer various research questions. This includes for example, projects on the role of motivation for treatment in predicting treatment outcome (Thaler et al., 2016; Steiger et al., 2017; Sansfacon et al. 2018), clinical or treatment features as predictors of treatment course (e.g., Paquin-Hodge et al., 2019; Thaler et al., 2021); and studies on the psychometric properties of eating-disorder questionnaires (Dufour et al. 2023; St-Hilaire et al., 2017, Sansfacon et al., 2019).

III. Development and application of virtual interventions

Our research aims to assess the effectiveness of digital technologies in treatment delivery and in patient outcomes. Some projects on that branch include:

  • The impact of treatment modality (virtual vs. in person) on symptoms and satisfaction among people receiving specialized treatment for eating disorders (e.g. Steiger et al., 2022).
  • Development of a transdiagnostic digital application (ASTrA) for eating disorders and perceptions on implantation in clinical practice (Booij et al., 2023).
  • Effectiveness of a virtual intervention on symptoms among individuals recently referred to specialized ED treatment (ongoing).

IV. Effectiveness of knowledge transfer initiatives

The Eating Disorders Continuum runs a highly successful knowledge transfer program, with the goal to increase primary health-care professionals’ capacity to assess and treat adolescents and adults with eating disorders. Since 2015, we have trained more than 1600 mental health professionals at various CIUSSS and CISSS sites all across Quebec. In our research, we showed the effectiveness of our program in terms of building capacity at local sites and treatment responses in people treated in the community (Thaler et al., 2018, 2022). We continue to train more health professionals in the community. With the results of our research integrated into this knowledge transfer initiative, we continue to adapt and refine our knowledge transfer program.

Contact information

If you would like to participate in any of our research studies at the Eating Disorders Continuum, please contact the research team at or by phone at 514-761-6131, ext. 2899.

For inquiries about research, including academic training, research positions, media requests or any other relevant information, please contact Dr. Linda Booij, Head of Research and Academic Development. Tel: 514-761-6131, ext. 3522. Email:


Recent and relevant publications from staff members of the Eating Disorders Continuum from the past 5 years

In bold: staff members working at the Eating Disorders Continuum
*student or research assistant supervised by a staff member at the EDC.


*Kirkpatrick, R.H., *Breton, E., Biorac, A., Munoz, D., & Booij, L. (2024). Non-suicidal self-injury among individuals with an eating disorder: A systematic review and prevalence meta-analysis. International Journal of Eating Disorders, 57(2):223-248. doi: 10.1002/eat.24088

*Dufour R., *Breton E., Morin, A.J.S., Côté S., Vitaro F., Boivin M., Dubois L., Tremblay R.E., & Booij L. (2023). Childhood hyperactivity, eating behaviours, and executive functions: Their association with the development of eating-disorder symptoms in adolescence. Journal of Eating Disorders, 11(1):183.  doi: 10.1186/s40337-023-00902-z

Austin, A., De Silva, U., Ilesanmi, C., Likitabhorn, T., Miller, I., Fialho,… ,….., Steiger, H., Tan, E., Trujillo-Chi Vacuán, E., Meg Tseng, M., van Furth, E.F., Wildes, J.E., Peat, C. & Richmond, T. K. (2023). International consensus on patient-centred outcomes in eating disorders. The Lancet Psychiatry. Sep 25:S2215-0366(23)00265-1

Steiger, H. (2023). “You mean it’s more than just an eating disorder?”: Commentary on Wade et al.(2023). International Journal of Eating Disorders, 10, 966–973. doi: 10.1002/eat.24060.

Booij, L., Israel., M., Ferrari, M., St-Hilaire, A., Paquin-Hodge, C., Allard, M., *Blaquière, A., Dornik, J., Freiwald, S., Long, S., Monarque, M., Pelletier, W.D., Thaler, L., Yaffe, M., & Steiger, H. (2023). Development of a transdiagnostic digital interactive application for eating disorders: Psychometric properties, satisfaction, and perceptions on implementation in clinical practice. Journal of Eating Disorders, 11(1):146. doi: 10.1186/s40337-023-00871-3.

Soullane, S., Israël, M., Steiger, H., Chadi, N., Low, N., Dewar, R., … & Auger, N. (2023). Association of hospitalization for suicide attempts in adolescent girls with subsequent hospitalization for eating disorders. International journal of eating disorders. Aug 30.  doi: 10.1002/eat.24052

Steiger, H., Booij, L., St-Hilaire, A., & Thaler, L. (2023). Eating Disorders. In Blaney, P; Krueger, R. Oxford. Textbook of Psychopathology. 4th. Oxford University Press, United States.

Steiger, H., Booij, L., Thaler, L., St-Hilaire, A., Israël, M., *Casey, K.F., *Oliverio, S., *Crescenzi, O., *Lee, V., Turecki, G., Joober, R., Szyf, M., *Bréton, E. (2023). DNA methylation in people with anorexia nervosa: Epigenome-wide patterns in actively ill, long-term remitted, and healthy-eater women. World Journal of Biological Psychiatry, 24(3), 254–259. doi:10.1080/15622975.2022.2089731.

Coelho, J.1, Booij, L.1, Katzman, D., Dimitropoulos, G., & Obeid, N. (2023). The economic impact of eating disorders in children and youth in Canada: a call to action to improve youth eating-disorder research and care. Journal of Eating Disorders, 11(1):74.  doi: 10.1186/s40337-023-00794-z. 1 Shared first author

Alberga, A.S., *Sacco, S., & Booij, L. (2023). Unintended consequences: The overlooked outcomes in pediatric obesity management. JAMA Pediatrics, 177:997-998. doi: 10.1001/jamapediatrics.2023.2190.

Novack, K., *Dufour, R., Picard, L., Taddeo, D., Nadeau, P-O, Katzman, D., Booij, L., & Chadi, N. (2023). Canadian pediatric eating disorder programs and virtual care during the COVID-19 pandemic: A mixed-methods approach to understanding clinicians’ perspectives. Annals of General Psychiatry, 22(1):16. doi: 10.1186/s12991-023-00443-4

*Breton, E., Cote S., Dubois L., Vitaro, F., Boivin, M., Tremblay, R.E., & Booij, L. (2023). Childhood overeating and disordered eating from early adolescence to young adulthood: a longitudinal study on the mediating role of BMI, victimization and desire for thinness. Journal of Youth and Adolescence, 52(8):1582-1594. doi: 10.1007/s10964-023-01796-5.

*Breton, E., Juster, R-P, & Booij. L. (2023). Gender and sex in eating disorders: A narrative review of the current state of knowledge, research gaps, and recommendations. Brain & Behavior, 13(4):e2871. doi: 10.1002/brb3.2871.

Loose, T., Geoffrey, M-C., Orri, M., Chadi, N., *Scardera, S., Booij, L., *Breton, E., Tremblay, R.E., Boivin, M., Côté, S. (2023) Pathways of association between disordered eating in adolescence and mental health outcomes in young adulthood during the COVID-19 pandemic. Canadian journal of public health, 114(1), 22–32. doi:10.17269/s41997-022-00715-8.

Steiger, H. (2023). A Canadian case of ‘lifespan’ programming for people with eating disorders. Australasian Psychiatry, 31(1), 106–107. doi:10.1177/1039856221105465

Auger, N, Steiger, H, Luu, TM, Chadi, N, Low, N, Bilodeau-Bertrand, M, Healy-Profitós, J, Ayoub, A, Brousseau, É, Israël, M.(2023). Shifting age of child eating disorder hospitalizations during the Covid-19 pandemic. Journal of Child Psychology and Psychiatry, 64(8):1176-1184. doi: 10.1111/jcpp.13800.

Auger, N., Low, N., Chadi, N., Israël, M., Steiger, H., Lewin, A., Ayoub, A., Healy-Profitós, J., Luu, T. M. (2023). Suicide attempts in children 10-14 years of age during the first year of the COVID-19 pandemic. Journal of Adolescent Health, 72, 899-905. doi: 10.1016/j.jadohealth.2023.01.019.

Himmerich, H., Lewis, Y.D., Mutwalli, C.C.H., Andreas Karwautz, …Steiger, H., … World Federation of Societies of Biological Psychiatry (WFSBP) guidelines update 2023 on the pharmacological treatment of eating disorders (2023). World Journal of Biological Psychiatry, 24, 1-64. doi: 10.1080/15622975.2023.2179663

Thaler, L., Paquin-Hodge, C., Leloup, A.G., Wallace, A., *Oliverio, S., Freiwald, S., Israël, M., & Steiger, H. (2022). Barriers and facilitators to the implementation of an eating disorders knowledge exchange program for non-specialist professionals. The Journal of Behavioral Health Services & Research, 50(3), 365-380.  doi: 10.1007/s11414-022-09822-3.

*Oliverio, S., Steiger, H., St-Hilaire, A., Paquin-Hodge, C., Leloup, A. G., Israël, M., & Thaler, L. (2022). Barriers and facilitators to providing autonomy supportive counselling to individuals seeking treatment for an eating disorder. Eating and Weight Disorders, 27(7), 2919–2929. doi:10.1007/s40519-022-01395-6

Thaler, L., Booij, L., *Burnham, N., *Kenny, S., *Oliverio, S., Israël, M., &

Steiger, H. (2022). Predictors of non‐completion of a day treatment program for adults with eating disorders. European eating disorders review, 30(2), 146–155. doi:10.1002/erv.2879.

Steiger, H., Booij, L., *Crescenzi, O., *Oliverio, S., *Singer, I., Thaler, L., St-Hilaire, A., & Israël, M. (2022). In-person versus virtual therapy in outpatient eating-disorder treatment: A COVID-19 inspired study. International Journal of Eating Disorders, 55(1), 145–150. doi:10.1002/eat.23655.

*Dufour, R., Novack, K. Chadi, N., & Booij, L. (2022) The use of technology in the treatment of youth with eating disorders: A scoping review. Journal of Eating Disorders, 10(1):182. doi:10.1186/s40337-022-00697-5.

*Breton, E., *Fotso-Soh, J., & Booij, L. (2022). Immunoinflammatory processes: overlapping mechanisms between obesity and eating disorders? Neuroscience and Biobehavioral Reviews, 138:104688. doi: 10.1016/j.neubiorev.2022.104688.

*Breton, E., *Dufour, R., Coté, S.M., Dubois, L., Vitaro, F., Boivin, M., Tremblay, R.E., & Booij, L. (2022). Developmental trajectories of eating disorder symptoms: A longitudinal study from early adolescence to young adulthood. Journal of Eating Disorders,10(1):84. doi: 10.1186/s40337-022-00603-z.

Auger, N., Potter, B.J., Ukah, U.V., Low, N., Israël, M., Steiger, H., Healy-Profitós, J., Paradis, G. (2021). Anorexia nervosa and the long-term risk of mortality in women. (Letter to the Editor). World Psychiatry, 20(3), 448. doi:10.1002/wps.20904

*Sansfaçon, J.1, Booij, L.1, Gauvin, L., *Fletcher, E., Islam, F., Israël, M., & Steiger, H. (2020). Pre-treatment motivation and therapy outcomes in eating disorders: A systematic review and meta-analysis. International Journal of Eating Disorders, 53(12), 1879–1900. doi:10.1002/eat.23376. 1 Shared first author

Booij, L. & Steiger, H. (2020). Applying epigenetic science to the understanding of eating disorders: A promising paradigm for research and practice. Current opinion Psychiatry, 33(6), 515–520. doi:10.1097/YCO.0000000000000632

Wonderlich, S.A, Bulik, C.M., Schmidt, U., Steiger, H., & Hoek, H.W.  (2020). Severe and enduring Anorexia Nervosa: Update and observations about the current clinical reality. International Journal of Eating Disorders, 53(8), 1303–1312. doi:10.1002/eat.23283

Steiger, H. & Booij, L. (2020). Eating disorders, heredity and environmental activation: Getting epigenetic concepts into practice: Journal of Clinical Medicine, 9(5), E1332. doi:10.3390/jcm9051332

*Burdo, J., Booij, L., *Kahan, E., Thaler, L., Israël, M., Agellon, L.B., Nitschmann, E., Wykes, L., & Steiger, H. (2020). Plasma levels of one-carbon metabolism nutrients in women with Anorexia Nervosa. International Journal of Eating Disorders, 53(9), 1534–1538. doi:10.1002/eat.23292

Linnaranta, O., Bourguignon, C., *Crescenzi, O., Sibthorpe, D., Buyukkurt, A., Steiger, H., & Storch, K-F. (2020). Late and unstable sleep phasing is associated with irregular eating patterns in eating disorders. Annals of behavioral medicine, 54(9), 680–690. doi:10.1093/abm/kaaa012

Thaler, L., *Brassard, S., Booij, L., *Kahan, E., McGregor, K., Labbe, A., Israël, M., & Steiger, H. (2020). Methylation of the OXTR gene in women with Anorexia Nervosa: Relationship to social behavior. European Eating Disorders Review, 28(1), 79–86. doi:10.1002/erv.2703

Paquin-Hodge, C., Gauvin, L., St-Hilaire, A., Israël, M., Azzi, M., *Kahan, E., Thaler, L., Dansereau, E., & Steiger, H. (2019). A naturalistic comparison of two inpatient treatment protocols for adults with Anorexia Nervosa: Does reducing duration of treatment and external controls compromise outcome? International Journal of Eating Disorders, 52(9):1015–1023. doi:10.1002/eat.23150

Steiger, H., Booij, L., *Kahan, E., McGregor, K., Thaler, L., *Fletcher, E., Labbe, A., Joober, R., Israël, M., Szyf, M., Agellon, L.B., Gauvin, L., St-Hilaire, A., & *Rossi, E. (2019). A longitudinal, epigenome-wide study of DNA methylation in anorexia nervosa: results in actively ill, partially weight restored, long-term remitted, and non-eating-disordered women. Journal of psychiatry & neuroscience, 44(3), 205–213. doi:10.1503/jpn.170242

Thaler, L., Freiwald, S., Paquin-Hodge C., *Fletcher, E., *Cottier, D., *Kahan, E., *Rossi, E., Piat, M., Lal, S., Israël, M. & Steiger, H. (2018). A tertiary-care/primary-care partnership aimed at improving care for people with eating disorders. Community Mental Health Journal, 54(8), 1154–1161. doi:10.1007/s10597-018-0290-4.

*Sansfaçon, J., Gauvin, L., *Fletcher, E., *Cottier, D., *Rossi, E., *Kahan, E., Israël, M. & Steiger, H. (2018). Prognostic value of autonomous and controlled motivation in outpatient eating-disorder treatment. International Journal of Eating Disorders, 51(10):1194–1200. doi:10.1002/eat.22901.


Research at the Eating Disorders Continuum