Social and individual factors associated with eating disorders risk among adolescents in secondary schools of Sicily (south-Italy)

Eating disorders (EDs) are complex medical conditions that primarily affect adolescents. In Italy, EDs are becoming a serious health concern, but the lack of up-to-date epidemiological data makes it difficult to assess their real impact across the country. Early identification of risk factors is crucial for timely intervention. A multicenter cross-sectional survey was conducted among 1,740 students aged 14–16 years in Sicily. Data on socio-demographic factors, EDs behaviors, social media usage, body appreciation, and bullying were collected through an electronic questionnaire. Regression models were used to test the role of gender and interaction effects with key risk factors. Based on Eating Disorder Examination-Questionnaire (EDE-Q) scores, 72.8% of participants were classified as “not at risk”, 17.9% as “at risk” and 9.3% as “at higher risk” of developing EDs using gender-related cut-offs. Girls were overrepresented in the at-risk and higher-risk groups (p < 0.01). Analysis revealed that lower Body Appreciation Scale (BAS) scores, higher BMI, and body comparison on social media predicted higher EDE-Q scores (p < 0.01). Gender interacted with several risk factors, including body appreciation (ß = 0.30. p < 0.01), alcohol use (ß = − 0.14, p < 0.01), and the perceived impact of the COVID-19 pandemic (ß = − 0.06, p < 0.05), with females showing stronger associations. This study highlights the increasing concern about EDs among Italian adolescents and emphasizes the need for targeted screening and early intervention. Understanding the interplay between gender, body image, and social behaviors is key to preventing EDs mitigating their long-term consequences.