How many people will struggle with an eating disorder during their lifetime?
It sounds like an obvious, easy-to-answer question, but it’s more complicated than you might think. Since the vast majority of people with eating disorders never seek formal treatment for their disorder or are formally diagnosed (Hart
et al., 2011), researchers can’t just search medical records. Still, scientists in the US and around the world are trying to gather data to give sufferers, loved ones, and the general community more information about how many people have eating disorders.
Researchers calculate the frequency of eating disorders using two main measurements:
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Incidence- the number of people who first develop an eating disorder during a specific period of time (usually one year)
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Prevalence- the total number of people who have an eating disorder during a specific period of time
Population-Wide Statistics
NEDA has gathered data on the prevalence of eating disorders from the U.S., UK, and Europe to try and get a better idea of exactly how common eating disorders are. Older data from other countries that use more strict definitions of anorexia and bulimia give lower prevalence estimates:
? In a study of 31,406 Swedish twins born from 1935-1958, 1.2% of the women had strictly defined anorexia nervosa during their lifetime, which increased to 2.4% when a looser definition of anorexia was used (Bulik
et al., 2006).
? For twins born between 1975 and 1979 in Finland, 2.2-4.2% of women (Keski-Rahkonen
et al., 2007) and 0.24% of men (Raevuori et al., 2009) had experienced anorexia during their lifetime.
? At any given point in time between 0.3-0.4% of young women and 0.1% of young men will suffer from anorexia nervosa, 1.0% of young women and 0.1% of young men will suffer from bulimia, with similar rates for binge eating disorder (Hoek & van Hoeken, 2003).
Several more recent studies in the US have used broader definitions of eating disorders that resulted in a higher prevalence of eating disorders but ones that more accurately reflect the range of disorders that occur.
? A 2007 study asked 9282 English-speaking Americans about a variety of mental health conditions, including eating disorders. The results, published in
Biological Psychiatry, found that
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0.9% of women and 0.3% of men had anorexia during their life
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1.5% of women and 0.5% of men had bulimia during their life
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3.5% of women and 2.0% of men had binge eating disorder during their life (Hudson et al., 2007).
? When researchers followed a group of 496 adolescent girls for 8 years (Stice
et al., 2010), until they were 20, they found:
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5.2% of the girls met criteria for DSM-V anorexia, bulimia, or binge eating disorder.
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When the researchers included FEDNEC criteria, a total of 13.2% of the girls had suffered from a DSM-V eating disorder by age 20.
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Feeding and Eating Disorders Not Elsewhere Classified (FEDNEC) encompasses atypical anorexia nervosa, subthreshold bulimia and binge eating disorder, and purging disorder.
? Combining information from several sources, Eric Stice and Cara Bohon (2012) found that
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Between 0.9% and 2.0% of females and 0.1% to 0.3% of males will develop anorexia
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Subthreshold anorexia occurs in 1.1% to 3.0% of adolescent females
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Between 1.1% and 4.6% of females and 0.1% to 0.5% of males will develop bulimia
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Subthreshold bulimia occurs in 2.0% to 5.4% of adolescent females
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Between 0.2% and 3.5% of females and 0.9% and 2.0% of males will develop binge eating disorder
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Subthreshold binge eating disorder occurs in 1.6% of adolescent females
Averaging these data, we estimate that 6.15% of women have a full-blown eating disorder and an additional 7% have a subthreshold condition. Approximately 2.0% of males have a full-blown eating disorder. Estimates of subthreshold eating disorders in men aren’t currently available.
This means that 19 million women in the US have an eating disorder, and an additional 21 million women have a subthreshold disorder. 6 million men also have an eating disorder.
Eating disorder diagnosis over time
Have these numbers changed over time? That question isn’t clear. It does appear that, at least for the last two decades, the rates of new diagnoses of anorexia and bulimia have remained relatively stable in recent years.
? An ongoing study in Minnesota has found incidence of anorexia increasing over the last 50 years only in females aged 15 to 24. Incidence remained stable in other age groups and in males (Lucas
et al., 1999).
? A Dutch study published in the
International Journal of Eating Disorders found that new diagnoses of anorexia and bulimia remained relatively steady in the Netherlands from 1985-1989 to 1995-1999 (van Son et al., 2006).
? An analysis of many studies from Europe and North America revealed that rates of anorexia increased sharply until the 1970s, where they have stabilized.
? Rates of bulimia increased during the 1980s and early and 1990s, where they have remained the same or decreased slightly (Smink, van Hoeken, & van Hoek, 2012).
? A British study also found stability in new anorexia and bulimia diagnoses in both males and females, although rates of EDNOS diagnoses increased in both groups (Micali
et al., 2013).
? Eating disorder symptoms are beginning earlier in both males and females, which agrees with both formal research (Favaro
et al., 2009) and clinical reports.
Eating disorders in males
Long written off as just a “woman’s disease,” new research is showing that substantial numbers of men also suffer from eating disorders.
? Previous studies indicated that only 1 in 10 eating disorder sufferers were male (Andersen & Holman, 1997). Newer studies show that as many as 1 in 3 eating disorder sufferers are male (Hudson
et al., 2007).
? Several small studies indicate that males are more likely to have been overweight before the onset of the eating disorder than females (Sharp
et al., 1994; Carlat & Camargo, 1991).
? Males are more likely to engage in excessive exercise as a purging method than females (Weltzin
et al., 2005).
? Although eating disorders affect a higher proportion of males with eating disorders identify as gay or bisexual than females, the majority of males with eating disorders are straight (Strother
et al., 2012).
? Males have eating disorders that are just as severe as those found in females, and also have similar responses to treatment (Weltzin
et al., 2012).
Eating disorders in LGBT populations
Eating disorders affect people of all sexual orientations.
? 15% of gay and bisexual males had a full or subthreshold eating disorder at some point in their life, compared to 4.6% of heterosexual males (Feldman & Meyer, 2007).
? Eating disorder prevalence in lesbian and bisexual females were no different than those in heterosexual females: 9.7% vs 8% (Feldman & Meyer, 2007).
? Compared with heterosexual men, gay and bisexual men had a significantly higher prevalence of lifetime full syndrome bulimia, subclinical bulimia, and any subclinical eating disorder (Ray, 2007)
? No studies of prevalence in the transgender community have been conducted to date
Eating disorders in minority populations
Minority populations are not immune to eating disorders. Research suggests that these disorders can strike minorities at higher rates than white populations.
? The National Comorbidity Survey Replication found no difference in eating disorder prevalence in adults in any racial or ethnic group (Hudson
et al., 2007).
? Adolescent Hispanics were significantly more likely to suffer from BN, and the researchers reported a trend towards a higher prevalence of binge eating disorder in all minority groups (Swanson
et al., 2011).
? Despite similar rates of eating disorders as whites, minorities are significantly less likely to receive help for their eating issues (Marques
et al., 2011; Becker et al., 2003).
Eating disorder related hospitalizations
Hospitalizations among eating disorder patients are on the increase in the US. According to a 2009 report from the Agency for Healthcare Research and Quality,
? Eating disorder related hospitalizations increased 18 percent from 1999-2000 to 2005-2006. Anorexia nervosa hospitalizations increased 17 percent, bulimia nervosa hospitalizations decreased 7 percent, and all other eating disorder hospitalizations increased 38 percent.
? Hospitalization of males with eating disorders increased 37 percent between 1999 and 2006.
? Rates of hospitalization of children under 12 for an eating disorder increased 112 percent during this time (Zhao & Encinosa, 2009).
A 2011 update to this study found that
? In 2008-2009, there were 29,533 eating disorder-related hospital stays, which increased by 24 percent compared to 1999-2000.
? Between 2007-2008 and 2008-2009, total eating disorder hospitalizations declined by 23 percent.
? The total cost of eating disorder hospitalizations peaked in 2007-2008 at $296 million (Zhao & Encinosa, 2011).
Mortality in eating disorders
? A review of nearly fifty years of research confirms that anorexia nervosa has the highest mortality rate of any psychiatric disorder (Arcelus
et al., 2011).
? Risk of death from suicide or medical complications is markedly increased for individuals with eating disorders (Crow et al., 2009). The researchers state, “Individuals with eating disorder not otherwise specified, which are sometimes viewed as a “less severe” eating disorder, have elevated mortality risks, similar to those found in anorexia nervosa.” This study demonstrated an increased risk of suicide across eating disorder diagnoses.
? Individuals with anorexia are 7.7 times more likely to die in the first 10 years of their illness than someone without an eating disorder. Risk factors for early death are alcohol abuse, low BMI, and difficulties with social functioning (Franko
et al., 2013).
Prevalence vs. funding
Despite the prevalence of eating disorders they continue to receive inadequate research funding.
Illness Prevalence NIH Research Funds (2011)
Alzheimer’s Disease: 5.1 million $450,000,000
Autism: 3.6 million $160,000,000
Schizophrenia: 3.4 million $276,000,000
Eating disorders: 30 million $28,000,000
Research dollars spent on Alzheimer’s Disease averaged $88 per affected individual in 2011. For Schizophrenia the amount was $81. For Autism, $44. For eating disorders the average amount of research dollars per affected individual was just $0.93. (National Institutes of Health, 2011)
Eating disorders are serious illnesses
In August of 2010, American Viewpoint (a nationally recognized public opinion research company) conducted a telephone survey of American adults for the National Eating Disorders Association. The national survey shows an increased public awareness of eating disorders and a shift in how eating disorders are viewed.
The survey polled a nationwide sample of one thousand adults in the United States. Among the findings were the following:
? 82% percent of respondents believe that eating disorders are a physical or mental illness and should be treated as such, with just 12% believing they are related to vanity.
? 85% of the respondents believe that eating disorders deserve coverage by insurance companies just like any other illness.
? 86% favor schools providing information about eating disorders to students and parents.
? 80% believe conducting more research on the causes and most effective treatments would reduce or prevent eating disorders
? 70% believe encouraging the media and advertisers to use more average sized people in their advertising campaigns would reduce or prevent eating disorders.
In October 2010, the NEDA National Survey findings were made available online at http://nationaleatingdisorders.org/uploads/file/NEDA_Survey_Whitepaper.pdf
Heritability of eating disorders
Genetic factors play an important role in the development of eating disorders. In a recent review of the scientific literature, researchers found the following (Thornton, Mazzeo, & Bulik, 2011):
? Close relatives of people with anorexia are 11.3 times more likely to develop anorexia
? Close relatives of people with bulimia are 4.4 to 9.6 times more likely to develop bulimia
? Close relatives of people with binge eating disorder are 1.9 to 2.2 times more likely to develop binge eating disorder
? Genetic effects account for 88% of the liability for developing anorexia and 59 to 83% of the liability for bulimia
Body dissatisfaction, dieting, and the media
Body dissatisfaction and thin ideal internalization are both significant risk factors for the development of eating pathology and eating disorder behaviors like dieting and binge eating (Stice, 2002).
? About 70% of adolescent girls would prefer to be thinner (Wertheim, Paxton, & Blaney, 2009).
? For males body dissatisfaction leads to pursuit of a lean, muscular ideal, and may lead to health-threatening dieting behavior as well as 3-12% of adolescent boys using anabolic steroids (Cafri
et al. 2005).
? Although body image improves for women in late middle age, about 60% continue to be dissatisfied with their body size and shape; these women continue to be at risk for eating disorders (Grogan, 2011).
? 42% of 1st-3rd grade girls want to be thinner (Collins, 1991).
? 81% of 10 year olds are afraid of being fat (Mellin
et al., 1991).
? Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives (Neumark-Sztainer, 2005).
? 35-57% of adolescent girls engage in crash dieting, fasting, self-induced vomiting, diet pills, or laxatives. Overweight girls are more likely than normal weight girls to engage in such extreme dieting (Boutelle
et al., 2002; Neumark-Sztainer & Hannan, 2000; Wertheim et al., 2009).
? 35% of “normal dieters” progress to pathological dieting. Of those, 20-25% progress to partial or full-syndrome eating disorders (Shisslak, Crago, & Estes, 1995).
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