Objective: To describe the prevalence of eating disorders risk and analyze the role of physical exercise habits and mental health pressure on the risk of restrictive eating and binge eating among students at My Duc B High School, Hanoi, in 2025.
Methods: A cross-sectional study was conducted among 426 students aged 15-18 years, selected via stratified random sampling by grade. Eating disorders risk was assessed using the EAT‑26 (restrictive eating, cut-off ≥ 20) and the BITE (binge eating, cut-off ≥ 10); mental health pressure was measured using the DASS‑21. Data were analyzed using the Chi-square test, the t-test, and the multivariable logistic regression.
Results: The prevalence of restrictive eating risk (EAT‑26 ≥ 20) was 32.63%. The proportion at high risk for binge eating (BITE ≥ 20) was unusually high (69.48%; 28.87% at moderate risk, 11-19) compared with international and local literature; therefore, BITE-related findings should be interpreted with caution and are not considered the primary results of this study. In the multivariable model focusing on restrictive eating, physical exercise habit (a binary measure) was independently associated with a 50% lower risk of restrictive eating (AOR = 0.50; 95% CI: 0.31 to 0.81; p = 0.005); conversely, each one-point increase in anxiety raised this risk by 1.07 times (AOR = 1.07; 95% CI: 1.02 to 1.12; p = 0.005).
Conclusion: Physical exercise was independently associated with a lower risk of restrictive eating (within the limits of a binary measure), whereas anxiety was the strongest driver of restrictive eating behavior. Integrating evidence-based exercise counseling and mental health care into school‑based interventions is warranted.