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• An estimated 9% of the U.S. population , or 28.8 million Americans, will have an eating disorder in their lifetime. 2
• 15% of women will suffer from an eating disorder by their 40s or 50s, but only 27% receive any treatment for it. 64
• Fewer than 6% of people with eating disorders are medically diagnosed as “underweight.” 7, 16 . In fact,  people in larger bodies are at the highest risk  of having developed an eating disorder in their lives, and among people in larger bodies,  the higher the BMI, the higher the risk . 60, 59
• In a sample from an American emergency room,  16% of adult patients screened positive for an eating disorder . 37
• Anorexia has the highest case mortality rate and second-highest crude mortality rate of any mental illness. 2
• 10,200 deaths each year are the direct result of an eating disorder—that’s one death every 52 minutes. 2
• Eating disorder sufferers with the highest symptom severity are  11 times more likely to attempt suicide than their peers without eating disorder symptoms, and even those with sub-threshold symptoms are 2 times more likely. 60   Patients with anorexia have a risk of suicide 18 times higher  than those without an eating disorder. 120
• The economic cost of eating disorders is $64.7 billion every year. 2

BIPOC* Eating Disorder Statistics

• While  BIPOC people are affected by eating disorders at similar rates  overall as their white peers,  they are about half as likely to be diagnosed . 63, 93
• BIPOC patients with eating and weight concerns are  significantly less likely to be asked about eating disorder symptoms by their doctors  than are non-minority patients.  3
• When therapists were presented with descriptions of a fictional patient—identical except for race—they were  less likely to recognize eating disorder symptoms in the Black and Hispanic patient  compared to the white patient.  66
• In a study of adolescents age 11 to 25 who were suffering malnutrition from an eating disorder,  only 40% received the recommended treatment , and patients who  used public insurance   were   only one third as likely to receive the recommended mental health treatment  for their eating disorders as youth with private insurance. Latinx patients were about  half as likely to receive the necessary treatment  as their white peers.  30
• Asian American college students report higher rates of restriction  compared with their white peers and higher rates of purging, muscle building, and cognitive restraint than their white or non-Asian BIPOC peers.  5
• Asian American college students report higher levels of body dissatisfaction  and negative attitudes toward obesity than their non-Asian BIPOC peers.  5
• Members of the LGBTQ+ community are at a  higher risk of having an eating disorder  than heterosexual people. Overall,  LGBTQ+ youth are three times more likely to have an eating disorder  when compared to their straight peers with homosexual and bisexual girls at 2.5 times and homosexual and bisexual boys at 6 times higher rates. 69, 71, 72
• About  1 in 3 sexual minority teenagers say they engaged in dangerous weight control behaviors  within the past month.  Gay and bisexual boys are four times more likely , and  lesbian and bisexual girls are twice as likely , to do so than their heterosexual peers.  70
• About  75% of transgender college students with eating disorders attempt suicide .  56
• Transgender college students are diagnosed with eating disorders at four times the rate  of their cisgender classmates.  73
• 32% of transgender people report using their eating disorder to modify their body  without hormones, such as to reduce curves or halt menstruation. Even so, 56% of transgender people with eating disorders  believe their disorder is not related to their physical body .  8

People with Co-Occurring Conditions Eating Disorder Statistics

• Over 70% of people with eating disorders also have other conditions , most commonly anxiety and mood disorders.  74
• People with disabilities  may have body image concerns related to their disability  that lead to developing and sustaining an eating disorder.  77
• Women with certain physical disabilities may be more likely to have  eating disorder behavior.  75
• People with diet-related chronic conditions —like diabetes and irritable bowel disease— may be at a higher risk of disordered eating.  112
• In a study, girls with type 1 diabetes aged 9-13 were evaluated for 14 years, and  by the time they were in their 20s, 40.8% met criteria for a full- or sub-threshold eating disorder , and 59.2% took part in dangerous disordered eating behavior.  113
• Eating disorders in people with type I diabetes are associated with a significantly higher risk of severe medical complications , including more frequent and longer hospitalizations, and a greater risk of ketoacidosis and retinopathy.  124
• People with eating disorders typically have between one and four other psychiatric disorders . Indeed, the majority of adolescents with eating disorders have at least one other psychiatric disorder, ranging from a low of 55% for anorexia to a high of 88% for bulimia.  21, 35
• Between  13 to 58% of ARFID patients also have Autism Spectrum Disorder . In a study of children with ASD and severe food limitations,  78% ate a diet that put them at risk for five or more nutritional deficiencies.  79, 80, 81, 82
• Between 6 and 17%  of eating disorder patients  also have ADHD.  86-87
• Girls with ADHD are 3.6 times more likely to have an eating disorder  in general and 5.6 times more likely to have bulimia in particular.  88
• Between  10 and 35% of patients with eating disorders have OCD  unrelated to the eating disorder.  118
• In a study of college and university students,  just 2% of those who met criteria for eating disorders were “underweight.”  93
• For the overall populace, the figure is usually  estimated to be less than 6% .  60
• People in larger bodies  are at higher risk of using unhealthy weight control behaviors.  21, 52, 98
• About  40% of “overweight“ girls and 20% of “overweight“ boys use disordered eating behaviors.   99
• Patients meeting the standard diagnostic criteria for anorexia were 14 times more likely to receive the recommended treatment  than those with  atypical anorexia . 30
• Among those who experience weight stigma,  two-thirds were stigmatized by doctors , leading many to avoid seeking healthcare.  102
• People who experience weight discrimination  are 60% more likely to die.  94
• Athletes report higher rates of excessive exercise  than non‐athletes.  14
• Female athletes are twice as likely to engage in eating disorder behavior than male athletes; however,  both men (77%) and women (80%) participating in weight-dependent sports report using compensatory behaviors.  43
• Eating disorders may be particularly hard to detect among athletes  due in part to secretiveness, stigma, and symptom presentation.  47
• Athletes may be less likely to seek treatment  for an eating disorder due to stigma, accessibility, and sport‐specific barriers.  14
• Certain aspects of military life are thought to contribute to developing or exacerbating eating disorders,  including weight and fitness requirements, the stress of combat exposure, and sexual trauma.  62
• Body dysmorphic disorder affects   13.0% of male military members and 21.7% of female military members , more than  five times the rates for the overall population .  107
• One-third of overweight military personnel engage in unhealthy weight loss behavior to “make weight”  while in the service, and  they are more likely to suffer from eating disorder behavior later in life  as veterans.  39
• Over 16% of female military personnel and veterans have suffered from an eating disorder , with associations between the eating disorder and sexual trauma and PTSD.  108
• In the five years studied—from 2017 to 2021– the incidence rates of eating disorders among active service  members increased by 79% .  61
• In a study of military personnel from Iraq and Afghanistan, an estimated  32.8% of female and 18.8% of male veterans showed signs of probable eating disorders , highest being atypical anorexia nervosa (13.6% of women and 4.9% of men), bulimia nervosa (6.1% of women and 3.5% of men), and binge-eating disorder (4.4% of women and 2.9% of men).  109
• At age 6 to 10, girls start to worry about their weight, and by 14,  60 to 70% are trying to lose weight .  35
• A survey found that  77% of children and adolescents as young as 12 dislike their bodies , and  45% say they are regularly bullied about how they look .  128
• Weight-related teasing is  a primary way kids are bullied , and  kids in bigger bodies are significantly more likely to be bullied  than their smaller-bodied classmates. 103, 104
• Girls who were teased about their weight were  two times more likely to be “overweight,”  1.5 times more likely to binge eat, and 1.5 times more likely to use extreme methods of weight control five years later.  99
• 22% of children and adolescents have unhealthy eating behaviors  that could lead to or indicate an eating disorder.  89
• A study found  8% of 15-year-old girls diet at a severe level , and their risk of developing an eating disorder was  18 times greater  than her non-dieting peers. 90
• About  12% of adolescent girls have some form of eating disorder .  126
• Just  20% of adolescents with eating disorders disorders seek treatment .  38
• Men represent up to 25% of people with eating disorders .  45
• Even so,  women are up to five times more likely to be diagnosed  and 1.5 times more likely to be treated for an eating disorder than men are.  93
• Men with eating disorders tend not to recognize their symptoms as problematic , in part due to the stereotype of eating disorders as being a “woman’s problem.”  110
• By the time men with eating disorder symptoms present in healthcare settings, their cases tend to be more severe , in part due to their denial of symptoms, anticipated or encountered prejudice, and even denial of treatment because of their gender.  44
• Healthcare professionals tend to minimize the symptoms of men with eating disorders.  46

Older Adults Eating Disorder Statistics

• While most older adults with eating disorders have had symptoms since adolescence,  life transitions and stressors common in older adulthood —such as children leaving the home and menopause— can make eating disorders much worse .  70
• Among women age 50 and over,  71.2% say they are currently trying to lose weight , and 79.1% said their weight or shape had a “moderate” effect on or was “the most important” part of their self-esteem.  125
• 41% of women over 50 have current or previous core eating disorder symptoms , divided into 13.3% who have current and 27.7% with past symptoms.  125
• Compare to other patients, eating disorder patients who receive mentorship  report significant improvement in 7 of 12 areas related to quality of life, and greater psychological, emotional, and physical well-being. 129
• Patients in eating disorder treatment are  119% more likely to attend appointments  with their providers when they also receive mentorship. 129
• Eating disorder patients who receive mentorship from peers who have recovered from an eating disorder  see greater reduction in body dissatisfaction and anxiety  than those who received support from people without lived experience. 130
• Parents and families  supporting someone with an eating disorder got  significant value out of connecting with a mentor . They benefited greatly from the support, information, and compassion received. 131
• Research suggests that using trained mentors to deliver mental health care  could increase the number of youth receiving evidence-based mental health care.   132

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• Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders.  Archives of General Psychiatry ,  68 (7), 724. https://doi.org/10.1001/archgenpsychiatry.2011.74 
• Deloitte Access Economics.  The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020. Available at: https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.
• Becker, A. E., Franko, D. L., Speck, A., & Herzog, D. B. (2003). Ethnicity and differential access to care for eating disorder symptoms.  International Journal of Eating Disorders ,  33 (2), 205–212. https://doi.org/10.1002/eat.10129 
• Sala, M., Reyes-Rodríguez, M. L., Bulik, C. M., & Bardone-Cone, A. (2013). Race, ethnicity, and eating disorder recognition by peers.  Eating Disorders ,  21 (5), 423–436.  https://doi.org/10.1080/10640266.2013.827540
• Uri, R. C., Wu, Y., Baker, J. H., & Munn-Chernoff, M. A. (2021). Eating disorder symptoms in Asian American college students.  Eating Behaviors,   https://doi.org/10.1016/j.eatbeh.2020.101458
• Eating Disorders in LGBTQ+ Populations . National Eating Disorder Association. (2018, February 21). Retrieved February 22, 2021, from  https://www.nationaleatingdisorders.org/learn/general-information/lgbtq
• Muhlheim, L. (2020, June 20). Eating Disorders in Transgender People. Retrieved February 22, 2021, from 
• Duffy, M. E., Henkel, K. E., & Earnshaw, V. A. (2016). Transgender clients’ experiences of eating disorder treatment.  Journal of LGBT Issues in Counseling, 10 (3), 136-149.  https://doi.org/10.1080/15538605.2016.1177806
• Ekern, B. (2023, March 6).  The connection between disabilities and eating disorders . Eating Disorder Hope. Retrieved February 22, 2021, from  https://www.eatingdisorderhope.com/blog/connection-disabilities-eating-disorders#:~:text=While%20there%20is%20little%20research,likely%20to%20develop%20eating%20disorders .
• Solmi, F., Bentivegna, F., Bould, H., Mandy, W., Kothari, R., Rai, D., Skuse, D., & Lewis, G. (2020). Trajectories of autistic social traits in childhood and adolescence and disordered eating behaviours at age 14 years: A UK general population cohort study.  Journal of Child Psychology and Psychiatry ,  62 (1), 75–85. https://doi.org/10.1111/jcpp.13255 
• Greenblatt, J. (2019, December 27). ADHD and disordered eating .  Walden Eating Disorders .Retrieved February 22, 2021, from  https://www.waldeneatingdisorders.com/blog/adhd-and-disordered-eating/
• People living in larger bodies & eating disorders.  National Eating Disorders Collaboration .(2017). Retrieved February 22, 2021, from  https://nedc.com.au/eating-disorders/eating-disorders-explained/people-living-in-larger-bodies-and-eating-disorders/
• Nagata, J. M., Garber, A. K., Tabler, J. L., Murray, S. B., &; Bibbins-Domingo, K. (2018). Prevalence and correlates of disordered eating behaviors among young adults with overweight or obesity.  Journal of General Internal Medicine, 33 (8), 1337-1343.  https://doi.org/10.1007/s11606-018-4465-z
• Flatt, R., Thornton, L., Fitzsimmons‐Craft, E., Balantekin, K., Smolar, L., Mysko, C., Wilfley, D. E., Taylor, C. B., DeFreese, J. D., Bardone‐Cone, A. M., & Bulik, C. M. (2021). Comparing eating disorder characteristics and treatment in self‐identified competitive athletes and non‐athletes from the National Eating Disorders Association Online Screening Tool.  International Journal of Eating Disorders ,  54 (3), 365–375. https://doi.org/10.1002/eat.23415 
• Mobbs, M. (2018, November 20).  What’s eating our veterans?  Psychology Today. https://www.psychologytoday.com/us/blog/the-debrief/201811/whats-eating-our-veterans   https://www.psychologytoday.com/us/blog/the-debrief/201811/whats-eating-our-veterans
• Flament, M. F., Henderson, K., Buchholz, A., Obeid, N., Nguyen, H. N. T., Birmingham, M., & Goldfield, G. (2015). Weight status and DSM-5 diagnoses of eating disorders in adolescents from the community.  Journal of the American Academy of Child & Adolescent Psychiatry ,  54 (5). https://doi.org/10.1016/j.jaac.2015.01.020 
• LGBTQ youth and body dissatisfaction . The Trevor Project. (2023, January 31).  https://www.thetrevorproject.org/research-briefs/lgbtq-youth-and-body-dissatisfaction-jan-2023/
• Mikhail, M. E., & Klump, K. L. (2020). A virtual issue highlighting eating disorders in people of black/African and Indigenous heritage.  International Journal of Eating Disorders ,  54 (3), 459–467. https://doi.org/10.1002/eat.23402
• Marques, L., Alegria, M., Becker, A. E., Chen, C. N., Fang, A., Chosak, A., & Diniz, J. B. (2011). Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders.  International Journal of Eating Disorders ,  44 (5), 412–420.  https://doi.org/10.1002/eat.20787
• Goeree, M. S., Ham, J. C., & Iorio, D. (2011). Race, social class, and bulimia nervosa.  Social Science Research Network . https://doi.org/10.2139/ssrn.1877636
•  Swanson, S. A., Crow, S. J., LaGrange, D., Swendsen, J., & Merikangas, K. R. (2011). Prevalence and correlates of eating disorders in adolescents.  Archives of General Psychiatry ,  68 (7), 714-723. https://doi.org/10.1001/archgenpsychiatry.2011.22
• Perez, M., Ohrt, T. K., & Hoek, H. W. (2016). Prevalence and treatment of eating disorders among Hispanics/Latino Americans in the United States.  Current Opinion in Psychiatry, 29 (6), 378–382. https://doi.org/10.1097/yco.0000000000000277
• Hayes, S. & Tantleff-Dunn, S.(2010). Am I too fat to be a princess? Examining the effects of popular children’s media on young girls’ body image.  British Journal of Developmental Psychology, 28 (2), 413–426. https://doi.org/10.1348/026151009×424240 
• Rosen, D. S. & the Committee on Adolescence. (2010). Identification and management of eating disorders in children and adolescents.  Pediatrics, 126 (6), 1240–1253. https://doi.org/10.1542/peds.2010-2821 
• Quittkat, H. L., Hartmann, A. S., Düsing, R., Buhlmann, U., & Vocks, S. (2019). Body dissatisfaction, importance  of appearance, and body appreciation in men and women over the lifespan.  Frontiers in Psychiatry, 10 . https://doi.org/10.3389/fpsyt.2019.00864
• Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence  and correlates of eating disorders in the national comorbidity survey replication.  Biological Psychiatry ,  61 (3), 348–358. https://doi.org/10.1016/j.biopsych.2006.03.040
• National Eating Disorder Association (NEDA). (2013).  Eating Disorders on the College Campus: A National Survey of Programs and Resources . https://www.nationaleatingdisorders.org/sites/default/files/CollegeSurvey/CollegiateSurveyProject.pdf
• American College Health Association. (2010).  American College Health Association-National College Health Assessment II: Reference Group Data Report Spring 2010.   https://www.acha.org/documents/ncha/ACHA-NCHA-II_ReferenceGroup_DataReport_Spring2010.pdf
• Moreno, R., Buckelew, S. M., Accurso, E. C., & Raymond-Flesch, M. (2023). Disparities in access to eating disorders treatment for publicly-insured youth and youth of color: a retrospective cohort study.  Journal of Eating Disorders, 11 (1). https://doi.org/10.1186/s40337-022-00730-7
• Cicmil, N., & Eli, K. (2014). Body image among eating disorder patients with disabilities: A review of published case studies.  Body Image, 11 (3), 266–274. https://doi.org/10.1016/j.bodyim.2014.04.001
• Behar, R, Arancibia, M, Sepúlveda, E, & Muga, A. (2016) Child sexual  abuse as a risk factor in eating disorders. In N. Morton (Ed.),  Eating Disorders: Prevalence, Risk Factors and Treatment Options.  (pp. 149-172) Nova Science Publishers, Inc. 
• Galmiche, M., Déchelotte, P., Lambert, G., & Tavolacci, M. P. (2019). Prevalence of eating disorders over the 2000–2018 period: A systematic literature review.  The American Journal of Clinical Nutrition ,  109 (5), 1402–1413. https://doi.org/10.1093/ajcn/nqy342 .
• Fichter, M. M., Naab, S., Voderholzer, U., & Quadflieg, N. (2020). Mortality in males as compared to females treated for an eating disorder: A large prospective controlled study.  Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity ,  26 (5), 1627–1637. https://doi.org/10.1007/s40519-020-00960-1
• Andersen, A.E. (2022). Diagnosis and treatment of the eating disorder spectrum in primary care medicine. In P.S. Mehler and A.E. Andersen (Eds.)  Eating disorders: A comprehensive guide to medical care and complications (4th ed.)  (pp. 1-106). Baltimore, Maryland: Johns Hopkins University Press. http://dx.doi.org/10.1007/s40519-022-01479-3
• Keski-Rahkonen, A., & Mustelin, L. (2016). Epidemiology of eating disorders in Europe.  Current Opinion in Psychiatry ,  29 (6), 340–345. https://doi.org/10.1097/yco.0000000000000278 
• Dooley‐Hash, S., Adams, M., Walton, M. A., Blow, F. C., & Cunningham, R. M. (2019). The prevalence and correlates of eating disorders in adult emergency department patients.  International Journal of Eating Disorders ,  52 (11), 1281–1290. https://doi.org/10.1002/eat.23140
• Forrest, L. N., Smith, A. R., & Swanson, S. A. (2017). Characteristics of seeking treatment among U.S. adolescents with eating disorders.  International Journal of Eating Disorders ,  50 (7), 826–833. https://doi.org/10.1002/eat.22702
• Masheb, R. M., Kutz, A. M., Marsh, A. G., Min, K. M., Ruser, C. B., & Dorflinger, L. M. (2019). “Making weight” during military service is related to binge eating and eating pathology for veterans later in life.  Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity ,  24 (6), 1063–1070. https://doi.org/10.1007/s40519-019-00766-w
• Martinsen, M., & Sundgot-Borden, J. (2013). Higher prevalence of eating disorders among adolescent elite athletes than controls.  Medicine & Science in Sports & Exercise ,  45 (6), 1188–1197. https://doi.org/10.1249/mss.0b013e318281a939 
• Wollenberg, G., Shriver, L. H., & Gates, G. E. (2015). Comparison of disordered eating symptoms and emotion regulation difficulties between female college athletes and non-athletes. Eating Behaviors, 18, 1–6. https://doi.org/10.1016/j.eatbeh.2015.03.008 
• Andersen, A.E., and Cost, J. (2022). Athletes and eating disorders. In P.S. Mehler and A.E. Andersen (Eds.)  Eating disorders: A comprehensive guide to medical care and complications (4th ed.)  (pp. 315-339). Baltimore, Maryland: Johns Hopkins University Press. http://dx.doi.org/10.1007/s40519-022-01479-3
• Giel, K. E., Hermann-Werner, A., Mayer, J., Diehl, K., Schneider, S., Thiel, A., & Zipfel, S. (2016). Eating disorder pathology in elite adolescent athletes.  International Journal of Eating Disorders ,  49 (6), 553–562. https://doi.org/10.1002/eat.22511 
• Andersen, A.E. (2022). Males with eating disorders. In P.S. Mehler and A.E. Andersen (Eds.)  Eating disorders: A comprehensive guide to medical care and complications (4th ed.)  (pp. 340-378). Baltimore, Maryland: Johns Hopkins University Press. http://dx.doi.org/10.1007/s40519-022-01479-3
• Sweeting, H., Walker, L., MacLean, A., Patterson, C., Räisänen, U., & Hunt, K. (2015). Prevalence of eating disorders in males: a review of rates reported in academic research and UK mass media.  International Journal of Men’s Health ,  14 (2). https://doi.org/https://doi.org/10.3149%2Fjmh.1402.86 
• Richardson, C., & Paslakis, G. (2020). Men’s experiences of eating disorder treatment: A qualitative systematic review of men‐only studies. Journal of Psychiatric and Mental Health Nursing, 28(2), 237–250. https://doi.org/10.1111/jpm.12670 
• Eichstadt, M., Luzier, J., Cho, D., & Weisenmuller, C. (2020). Eating disorders in male athletes.  Sports Health: A Multidisciplinary Approach ,  12 (4), 327–333. https://doi.org/10.1177/1941738120928991 
• Strobel, C., Quadflieg, N., Naab, S., Voderholzer, U., & Fichter, M. M. (2019). Long‐term outcomes in treated males with anorexia nervosa and bulimia nervosa—a prospective, gender‐matched study.  International Journal of Eating Disorders ,  52 (12), 1353–1364. https://doi.org/10.1002/eat.23151 
• Yu, J., Hildebrandt, T., & Lanzieri, N. (2015). Healthcare professionals’ stigmatization of men with anabolic androgenic steroid use and eating disorders.  Body Image ,  15 , 49–53. https://doi.org/10.1016/j.bodyim.2015.06.001 
• Golden, N.H. (2022). Atypical anorexia nervosa. In P.S. Mehler and A.E. Andersen (Eds.)  Eating disorders: A comprehensive guide to medical care and complications (4th ed.)  (pp. 429-445). Baltimore, Maryland: Johns Hopkins University Press. http://dx.doi.org/10.1007/s40519-022-01479-3
• Tanner, A.B., & Spaulding-Barclay, M. (2022). Special considerations for eating disorders in children and young adolescents. In P.S. Mehler and A.E. Andersen (Eds.)  Eating disorders: A comprehensive guide to medical care and complications (4th ed.)  (pp. 379-428). Baltimore, Maryland: Johns Hopkins University Press. http://dx.doi.org/10.1007/s40519-022-01479-3
• Rodgers, R. F., Watts, A. W., Austin, S. B., Haines, J., & Neumark-Sztainer, D. (2016). Disordered eating in ethnic minority adolescents with overweight.  International Journal of Eating Disorders ,  50 (6), 665–671. https://doi.org/10.1002/eat.22652 
• Sawyer, S. M., Whitelaw, M., Le Grange, D., Yeo, M., & Hughes, E. K. (2016). Physical and psychological morbidity in adolescents with atypical anorexia nervosa.  Pediatrics ,  137 (4). https://doi.org/10.1542/peds.2015-4080 
• Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., & Duncan, A. E. (2015). Gender Identity, sexual orientation, and eating-related pathology in a national sample of college students.  Journal of Adolescent Health ,  57 (2), 144–149. https://doi.org/10.1016/j.jadohealth.2015.03.003 
• Coelho, J. S., Suen, J., Clark, B. A., Marshall, S. K., Geller, J., & Lam, P.-Y. (2019). Eating disorder diagnoses and symptom presentation in transgender youth: A scoping review.  Current Psychiatry Reports ,  21 (11). https://doi.org/10.1007/s11920-019-1097-x 
• Duffy, M. E., Henkel, K. E., & Joiner, T. E. (2019). Prevalence of self-injurious thoughts and behaviors in transgender individuals with eating disorders: A national study.  Journal of Adolescent Health ,  64 (4), 461–466. https://doi.org/10.1016/j.jadohealth.2018.07.016 
• Duplicate of 21 
• Micali, N., Martini, M. G., Thomas, J. J., Eddy, K. T., Kothari, R., Russell, E., Bulik, C. M., & Treasure, J. (2017). Lifetime and 12-month prevalence of eating disorders amongst women in mid-life: A population-based study of diagnoses and risk factors.  BMC Medicine ,  15 (1). https://doi.org/10.1186/s12916-016-0766-4 
• Duncan, A. E., Ziobrowski, H. N., & Nicol, G. (2017). The prevalence of past 12-month and lifetime DSM-IV eating disorders by BMI category in US men and women.  European Eating Disorders Review ,  25 (3), 165–171. https://doi.org/10.1002/erv.2503 
• Lipson, S. K., & Sonneville, K. R. (2019). Understanding suicide risk and eating disorders in college student populations: Results from a national study.  International Journal of Eating Disorders ,  53 (2), 229–238. https://doi.org/10.1002/eat.23188 
• Murray, J.H., Manila, S.L., & McQuistan, A.A. (2023) Trends in the incidence of eating disorders among active component service members, 2017 to 2021.  Military Health  System .  https://www.health.mil/News/Articles/2023/01/01/Incidence-of-Eating-Disorders?type=Articles
• Bartlett, B. A., & Mitchell, K. S. (2015). Eating disorders in military and veteran men and women: A systematic review.  International Journal of Eating Disorders ,  48 (8), 1057–1069. https://doi.org/10.1002/eat.22454 
• Cheng, Z. H., Perko, V. L., Fuller-Marashi, L., Gau, J. M., & Stice, E. (2019). Ethnic differences in eating disorder prevalence, risk factors, and predictive effects of risk factors among young women.  Eating Behaviors ,  32 , 23–30. https://doi.org/10.1016/j.eatbeh.2018.11.004 
• Gordon, K. H., Brattole, M. M., Wingate, L. R., & Joiner, T. E. (2006). The impact of client race on clinician detection of eating disorders.  Behavior Therapy ,  37 (4), 319–325. https://doi.org/10.1016/j.beth.2005.12.002 
• Taylor, J. Y., Caldwell, C. H., Baser, R. E., Faison, N., & Jackson, J. S. (2007). Prevalence of eating disorders among blacks in the National Survey of American Life.  International Journal of Eating Disorders ,  40 (S3). https://doi.org/10.1002/eat.20451 
• Duplicate to 53
• Parker, L. L., & Harriger, J. A. (2020). Eating disorders and disordered eating behaviors in the LGBT population: A review of the literature.  Journal of Eating Disorders ,  8 (1). https://doi.org/10.1186/s40337-020-00327-y 
• Hadland, S. E., Austin, S. B., Goodenow, C. S., & Calzo, J. P. (2014). Weight misperception and unhealthy weight control behaviors among sexual minorities in the general adolescent population.  Journal of Adolescent Health ,  54 (3), 296–303. https://doi.org/10.1016/j.jadohealth.2013.08.021 
• Milsom, R. (2021).  Growing up LGBT+: The impact of school, home, and coronavirus on LGBT+ young people.  Just Like Us. https://www.justlikeus.org/wp-content/uploads/2021/11/Just-Like-Us-2021-report-Growing-Up-LGBT.pdf 
• Just Like Us. (2021, November 25).  LGBT+ young people are three times more likely to have an eating disorder, research finds .   Just Like Us.  https://www.justlikeus.org/blog/2021/11/25/lgbt-young-people-three-times-more-likely-eating-disorder/ 
• Gross, S. M., Ireys, H., & Kinsman, S. L. (2000). Young women with physical disabilities.  Journal of Developmental & Behavioral Pediatrics ,  21 (2), 87–96. https://doi.org/10.1097/00004703-200004000-00002 
• Westwood, H., & Tchanturia, K. (2017). Autism spectrum disorder in anorexia nervosa: An updated literature review.  Current Psychiatry Reports ,  19 (7). https://doi.org/10.1007/s11920-017-0791-9 
• Cicmil, N., & Eli, K. (2014). Body image among eating disorder patients with disabilities: A review of published case studies.  Body Image ,  11 (3), 266–274. https://doi.org/10.1016/j.bodyim.2014.04.001 
• Westwood, H., Eisler, I., Mandy, W., Leppanen, J., Treasure, J., & Tchanturia, K. (2015). Using the autism-spectrum quotient to measure autistic traits in anorexia nervosa: A systematic review and meta-analysis.  Journal of Autism and Developmental Disorders ,  46 (3), 964–977. https://doi.org/10.1007/s10803-015-2641-0 
• Bourne, L., Mandy, W., & Bryant‐Waugh, R. (2022). Avoidant/restrictive food intake disorder and severe food selectivity in children and young people with autism: A scoping review.  Developmental Medicine & Child Neurology ,  64 (6), 691–700. https://doi.org/10.1111/dmcn.15139 
• Sharp, W. G., Postorino, V., McCracken, C. E., Berry, R. C., Criado, K. K., Burrell, T. L., & Scahill, L. (2018). Dietary intake, nutrient status, and growth parameters in children with autism spectrum disorder and severe food selectivity: An electronic medical record review.  Journal of the Academy of Nutrition and Dietetics ,  118 (10), 1943–1950. https://doi.org/10.1016/j.jand.2018.05.005 
• Farag, F., Sims, A., Strudwick, K., Carrasco, J., Waters, A., Ford, V., Hopkins, J., Whitlingum, G., Absoud, M., & Kelly, V. B. (2021). Avoidant/restrictive food intake disorder and autism spectrum disorder: Clinical implications for assessment and Management.  Developmental Medicine & Child Neurology ,  64 (2), 176–182. https://doi.org/10.1111/dmcn.14977 
• Nicely, T. A., Lane-Loney, S., Masciulli, E., Hollenbeak, C. S., & Ornstein, R. M. (2014). Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders.  Journal of Eating Disorders ,  2 (1). https://doi.org/10.1186/s40337-014-0021-3 
• Westwood, H., Mandy, W., Simic, M., & Tchanturia, K. (2017). Assessing ASD in adolescent females with anorexia nervosa using clinical and developmental measures: A preliminary investigation.  Journal of Abnormal Child Psychology ,  46 (1), 183–192. https://doi.org/10.1007/s10802-017-0301-x 
• Maenner, M. J., Warren, Z., Williams, A. R., Amoakohene, E., Bakian, A. V., Bilder, D. A., Durkin, M. S., Fitzgerald, R. T., Furnier, S. M., Hughes, M. M., Ladd-Acosta, C. M., McArthur, D., Pas, E. T., Salinas, A., Vehorn, A., Williams, S., Esler, A., Grzybowski, A., Hall-Lande, J., … Shaw, K. A. (2023). Prevalence and characteristics of autism spectrum disorder among children aged 8 years — autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2020.  MMWR. Surveillance Summaries ,  72 (2), 1–14. https://doi.org/10.15585/mmwr.ss7202a1 
• Brede, J., Babb, C., Jones, C., Elliott, M., Zanker, C., Tchanturia, K., Serpell, L., Fox, J., & Mandy, W. (2020). “For me, the anorexia is just a symptom, and the cause is the autism”: Investigating restrictive eating disorders in autistic women.  Journal of Autism and Developmental Disorders ,  50 (12), 4280–4296. https://doi.org/10.1007/s10803-020-04479-3 
• Yates, W. R., Lund, B. C., Johnson, C., Mitchell, J., & McKee, P. (2009). Attention-deficit hyperactivity symptoms and disorder in eating disorder inpatients.  International Journal of Eating Disorders ,  42 (4), 375–378. https://doi.org/10.1002/eat.20627 
• Wentz, E., Lacey, J. H., Waller, G., Råstam, M., Turk, J., & Gillberg, C. (2005). Childhood onset neuropsychiatric disorders in adult eating disorder patients.  European Child & Adolescent Psychiatry ,  14 (8), 431–437. https://doi.org/10.1007/s00787-005-0494-3 
• Biederman, J., Ball, S. W., Monuteaux, M. C., Surman, C. B., Johnson, J. L., & Zeitlin, S. (2007). Are girls with ADHD at risk for eating disorders? results from a controlled, five-year prospective study.  Journal of Developmental & Behavioral Pediatrics ,  28 (4), 302–307. https://doi.org/10.1097/dbp.0b013e3180327917 
• López-Gil, J. F., García-Hermoso, A., Smith, L., Firth, J., Trott, M., Mesas, A. E., Jiménez-López, E., Gutiérrez-Espinoza, H., Tárraga-López, P. J., & Victoria-Montesinos, D. (2023). Global proportion of disordered eating in children and adolescents.  JAMA Pediatrics ,  177 (4), 363. https://doi.org/10.1001/jamapediatrics.2022.5848 
• Patton, G. C., Selzer, R., Coffey, C., Carlin, J. B., & Wolfe, R. (1999). Onset of adolescent eating disorders: Population based cohort study over 3 years.  BMJ ,  318 (7186), 765–768. https://doi.org/10.1136/bmj.318.7186.765 
• Field, A. E., Austin, S. B., Taylor, C. B., Malspeis, S., Rosner, B., Rockett, H. R., Gillman, M. W., & Colditz, G. A. (2003). Relation between dieting and weight change among preadolescents and adolescents.  Pediatrics ,  112 (4), 900–906. https://doi.org/10.1542/peds.112.4.900 
• Neumark-Sztainer, D., Paxton, S. J., Hannan, P. J., Haines, J., & Story, M. (2006). Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males.  Journal of Adolescent Health ,  39 (2), 244–251. https://doi.org/10.1016/j.jadohealth.2005.12.001 
• Sonneville, K. R., & Lipson, S. K. (2018). Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students.  International Journal of Eating Disorders ,  51 (6), 518–526. https://doi.org/10.1002/eat.22846 
• Sutin, A. R., Stephan, Y., & Terracciano, A. (2015). Weight discrimination and risk of mortality.  Psychological Science ,  26 (11), 1803–1811. https://doi.org/10.1177/0956797615601103 
• Sabin, J. A., Marini, M., & Nosek, B. A. (2012). Implicit and Explicit Anti-Fat Bias among a Large Sample of Medical Doctors by BMI, Race/Ethnicity and Gender.  PLoS ONE ,  7 (11). https://doi.org/10.1371/journal.pone.0048448 
• Tomiyama, A. J., Finch, L. E., Belsky, A. C., Buss, J., Finley, C., Schwartz, M. B., & Daubenmier, J. (2014). Weight bias in 2001 versus 2013: Contradictory attitudes among obesity researchers and health professionals.  Obesity ,  23 (1), 46–53. https://doi.org/10.1002/oby.20910 
• Chen, C., & Gonzales, L. (2022). Understanding weight stigma in eating disorder treatment: Development and initial validation of a treatment-based stigma scale.  Journal of Health Psychology ,  27 (13), 3028–3045. https://doi.org/10.1177/13591053221079177 
• Darby, A., Hay, P., Mond, J., Rodgers, B., & Owen, C. (2007). Disordered eating behaviours and cognitions in young women with obesity: relationship with psychological status.  International Journal of Obesity ,  31 (5), 876–882. https://doi.org/10.1038/sj.ijo.0803501 
• Neumark-Sztainer, D. R., Wall, M. M., Haines, J. I., Story, M. T., Sherwood, N. E., & van den Berg, P. A. (2007). Shared Risk and Protective Factors for Overweight and Disordered Eating in Adolescents.  American Journal of Preventive Medicine ,  33 (5). https://doi.org/10.1016/j.amepre.2007.07.031 
• Stice, E., Rohde, P., Shaw, H., & Desjardins, C. (2020). Weight suppression increases odds for future onset of anorexia nervosa, bulimia nervosa, and purging disorder, but not binge eating disorder.  The American Journal of Clinical Nutrition ,  112 (4), 941–947. https://doi.org/10.1093/ajcn/nqaa146 
• Udo, T., & Grilo, C. M. (2018). Prevalence and Correlates of DSM-5–Defined Eating Disorders in a Nationally Representative Sample of U.S. Adults.  Biological Psychiatry ,  84 (5), 345–354. https://doi.org/10.1016/j.biopsych.2018.03.014 
• Puhl, R. M., Lessard, L. M., Himmelstein, M. S., & Foster, G. D. (2021). The roles of experienced and internalized weight stigma in healthcare experiences: Perspectives of adults engaged in weight management across six countries.  PLoS ONE ,  16 (6). https://doi.org/10.1371/journal.pone.0251566 
• Puhl, R. M., Luedicke, J., & Heuer, C. (2011). Weight-Based Victimization Toward Overweight Adolescents: Observations and Reactions of Peers.  Journal of School Health ,  81 (11), 696–703. https://doi.org/10.1111/j.1746-1561.2011.00646.x 
• van Geel, M., Vedder, P., & Tanilon, J. (2014). Are overweight and obese youths more often bullied by their peers? A meta-analysis on the relation between weight status and bullying.  International Journal of Obesity ,  38 (10), 1263–1267. https://doi.org/10.1038/ijo.2014.117 
• Mancine, R. P., Gusfa, D. W., Moshrefi, A., & Kennedy, S. F. (2020). Prevalence of disordered eating in athletes categorized by emphasis on leanness and activity type – a systematic review.  Journal of Eating Disorders ,  8 (1). https://doi.org/10.1186/s40337-020-00323-2 
• Werner, A., Thiel, A., Schneider, S., Mayer, J., Giel, K. E., & Zipfel, S. (2013). Weight-control behaviour and weight-concerns in young elite athletes – a systematic review.  Journal of Eating Disorders ,  1 (1). https://doi.org/10.1186/2050-2974-1-18 
• Campagna, J. D., & Bowsher, B. (2016). Prevalence of body dysmorphic disorder and muscle dysmorphia among entry-level military personnel.  Military Medicine ,  181 (5), 494–501. https://doi.org/10.7205/milmed-d-15-00118 
• Forman-Hoffman, V. L., Mengeling, M., Booth, B. M., Torner, J., & Sadler, A. G. (2012). Eating disorders, post-traumatic stress, and sexual trauma in women veterans.  Military Medicine ,  177 (10), 1161–1168. https://doi.org/10.7205/milmed-d-12-00041 
• Masheb, R. M., Ramsey, C. M., Marsh, A. G., Snow, J. L., Brandt, C. A., & Haskell, S. G. (2021). Atypical anorexia nervosa, not so atypical after all: Prevalence, correlates, and clinical severity among United States military veterans.  Eating Behaviors ,  41 , 101496. https://doi.org/10.1016/j.eatbeh.2021.101496 
• Räisänen, U., & Hunt, K. (2014). The role of gendered constructions of eating disorders in delayed help-seeking in men: A qualitative interview study.  BMJ Open ,  4 (4). https://doi.org/10.1136/bmjopen-2013-004342 
• Marques, L., Alegria, M., Becker, A. E., Chen, C., Fang, A., Chosak, A., & Diniz, J. B. (2010). Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders.  International Journal of Eating Disorders ,  44 (5), 412–420. https://doi.org/10.1002/eat.20787 
• Quick, V. M., Byrd-Bredbenner, C., & Neumark-Sztainer, D. (2013). Chronic illness and disordered eating: A discussion of the literature.  Advances in Nutrition ,  4 (3), 277–286. https://doi.org/10.3945/an.112.003608 
• Colton, P. A., Olmsted, M. P., Daneman, D., Farquhar, J. C., Wong, H., Muskat, S., & Rodin, G. M. (2015). Eating disorders in girls and women with type 1 diabetes: A longitudinal study of prevalence, onset, remission, and recurrence.  Diabetes Care ,  38 (7), 1212–1217. https://doi.org/10.2337/dc14-2646 
• Colton, P., Rodin, G., Bergenstal, R., & Parkin, C. (2009). Eating disorders and diabetes: Introduction and overview.  Diabetes Spectrum ,  22 (3), 138–142. https://doi.org/10.2337/diaspect.22.3.138 
• 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.  World Psychiatry ,  20 (3), 448–449. https://doi.org/10.1002/wps.20904 
• Steinhausen, H.-C. (2009). Outcome of eating disorders.  Child and Adolescent Psychiatric Clinics of North America ,  18 (1), 225–242. https://doi.org/10.1016/j.chc.2008.07.013 
• Centers for Disease Control and Prevention. (2021, November 10).  Incidence and relative survival by stage at diagnosis for common cancers . Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/uscs/about/data-briefs/no25-incidence-relative-survival-stage-diagnosis.htm 
• Herrin, M., & Larkin, M. (2013).  Nutrition counseling in the treatment of eating disorders  (2nd ed .). Routledge. 
• Sallet, P. C., de Alvarenga, P. G., Ferrão, Y., de Mathis, M. A., Torres, A. R., Marques, A., Hounie, A. G., Fossaluza, V., do Rosario, M. C., Fontenelle, L. F., Petribu, K., & Fleitlich-Bilyk, B. (2010). Eating disorders in patients with obsessive-compulsive disorder: Prevalence and clinical correlates.  International Journal of Eating Disorders . https://doi.org/10.1002/eat.20697 
• Smith, A. R., Zuromski, K. L., & Dodd, D. R. (2018). Eating disorders and suicidality: What we know, what we don’t know, and suggestions for future research.  Current Opinion in Psychology ,  22 , 63–67. https://doi.org/10.1016/j.copsyc.2017.08.023 
• Gaudiani, J. L. (2019).  Sick enough: A guide to the medical complications of eating disorders . Routledge. 
• Nielsen, S., Emborg, C., & Mølbak, A.-G. (2002). Mortality in concurrent type 1 diabetes and anorexia nervosa.  Diabetes Care ,  25 (2), 309–312. https://doi.org/10.2337/diacare.25.2.309 
• Goebel-Fabbri, A. E., Fikkan, J., Franko, D. L., Pearson, K., Anderson, B. J., & Weinger, K. (2008). Insulin restriction and associated morbidity and mortality in women with type 1 diabetes.  Diabetes Care ,  31 (3), 415–419. https://doi.org/10.2337/dc07-2026 
• Scheuing, N., Bartus, B., Berger, G., Haberland, H., Icks, A., Knauth, B., Nellen-Hellmuth, N., Rosenbauer, J., Teufel, M., & Holl, R. W. (2014). Clinical characteristics and outcome of 467 patients with a clinically recognized eating disorder identified among 52,215 patients with type 1 diabetes: A multicenter German/Austrian study.  Diabetes Care ,  37 (6), 1581–1589. https://doi.org/10.2337/dc13-2156 
• Gagne, D. A., Von Holle, A., Brownley, K. A., Runfola, C. D., Hofmeier, S., Branch, K. E., & Bulik, C. M. (2012). Eating disorder symptoms and weight and shape concerns in a large web-based convenience sample of women ages 50 and above: Results of the gender and Body Image (GABI) study.  International Journal of Eating Disorders ,  45 (7), 832–844. https://doi.org/10.1002/eat.22030 
• Stice, E., Marti, C. N., Shaw, H., & Jaconis, M. (2009). An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents.  Journal of Abnormal Psychology ,  118 (3), 587–597. https://doi.org/10.1037/a0016481 
• Hartman-Munick, S. M., Lin, J. A., Milliren, C. E., Braverman, P. K., Brigham, K. S., Fisher, M. M., Golden, N. H., Jary, J. M., Lemly, D. C., Matthews, A., Ornstein, R. M., Roche, A., Rome, E. S., Rosen, E. L., Sharma, Y., Shook, J. K., Taylor, J. L., Thew, M., Vo, M., … Richmond, T. K. (2022). Association of the COVID-19 pandemic with adolescent and Young Adult Eating Disorder Care Volume.  JAMA Pediatrics ,  176 (12), 1225. https://doi.org/10.1001/jamapediatrics.2022.4346 
• stem4. (2022). Body image among young people: Negative perceptions and damaging content on social media, combined with pandemic fallout, contribute to a low sense of self-worth and a rise in eating difficulties, new survey reveals . https://stem4.org.uk/wp-content/uploads/2022/12/Body-image-among-young-people-Negative-perceptions-and-damaging-content-on-social-media…-new-survey-reveals-Dec-22.pdf 
• Perez, M., Van Diest, A.K. & Cutts, S. Preliminary examination of a mentor-based program for eating disorders.  J Eat Disord   2 , 24 (2014). https://doi.org/10.1186/s40337-014-0024-0
• Ranzenhofer, Lisa & Wilhelmy, Mylene & Hochschild, Annabella & Sanzone, Kaitlin & Walsh, B. & Attia, Evelyn. (2020). Peer mentorship as an adjunct intervention for the treatment of eating disorders: A pilot randomized trial. International Journal of Eating Disorders. 53. 10.1002/eat.23258.
• https://www.feast-ed.org/project-heal-and-f-e-a-s-t-report-on-primary-caregiver-peer-support-2020/  
• Aarons, G.A. ,  Fettes, D.L. ,  Flores, L.E.  &  Sommerfeld, D.H.  ( 2009 )  Evidence-based practice implementation and staff emotional exhaustion in children’s services .  Behaviour Research and Therapy ,  47 ( 11 ),  954 – 960  https://doi.org/10.1016/j.brat.2009.07.006.https://onlinelibrary.wiley.com/doi/10.1002/ajcp.12546

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Eating Disorder Facts and Statistics: What You Need to Know

Eating disorders overview.

• By Ethnicity
• By Age and Gender
• Mortality Rates

Frequently Asked Questions

• Next in Eating Disorders Guide Types of Eating Disorders

Eating disorders are mental health conditions that involve disturbed patterns of thinking and behavior related to food, weight, and body shape.  

Around 30 million people in the U.S. (including an estimated 20 million women and 10 million men) will meet the criteria for at least one eating disorder during their lifetime. Research suggests that eating disorders are on the rise. Eating disorder prevalence rates increased from about 3.5% from 2000 to 2006 to 7.8% from 2013 to 2018.

This article will discuss eating disorders, including key facts, statistics, mortality rates, and causes.

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Eating disorders are serious, potentially life-threatening mental illnesses that involve disturbed eating behaviors. Many people with eating disorders eat too little or too much. They may also have a distorted body image , a fixation on their weight, and/or low self-esteem.

There are several different types of eating disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition ( DSM-5 ), including:

• Anorexia nervosa (AN) : Involves severely restricting food intake for the purpose of achieving extreme thinness.
• Bulimia nervosa (BN) : Involves episodes of binging (eating a lot of food in a short amount of time) and purging (“compensating” for binging by using laxatives, vomiting, or exercising excessively).
• Binge eating disorder (BED) : Involves repeated binging episodes and feeling out of control while overeating.
• Avoidant restrictive food intake disorder (ARFID) : Involves being very selective about food intake for reasons unrelated to weight or appearance.

If left untreated, eating disorders can have serious medical consequences, such as dehydration , electrolyte imbalances , malnutrition , and organ damage. In some cases, they may be fatal. 

Treatment for eating disorders typically involves psychotherapy and/or medication. Residential treatment may be necessary in severe cases.

How Common Are Eating Disorders?

Eating disorders affect millions of people in the U.S. every year. The following statistics offer a snapshot of how widespread eating disorders are:

• About 30 million American adults will have an eating disorder at some point in their lifetime.  
• An estimated 1 in 5 U.S. women will experience an eating disorder before the age of 40.
• About 1 in 7 American men develop an eating disorder before turning 40.  

Some eating disorders are more common than others. A 2018 study found the following lifetime and 12-month prevalence rates of anorexia , bulimia , and binge eating disorder among U.S. adults:

ARFID prevalence rates are less well-known. However, some studies suggest that around 5% to 14% of children and youth in inpatient eating disorder programs and about 22.5% of children and teens in day treatment programs for eating disorders meet the diagnostic criteria for ARFID.

Eating disorders appear to have become more common in recent years. One review of worldwide data found that eating disorder diagnoses more than doubled from 2000 to 2018. This trend was consistent across different regions, age groups, and genders.

Amid the COVID-19 pandemic, healthcare providers noticed a particularly significant uptick in the number of people seeking treatment for eating disorders.

For example, the overall incidence of eating disorders among teen girls and young women rose by 15.3% in 2020 in comparison to previous years. According to a 2021 study, the number of people entering inpatient treatment for an eating disorder doubled between 2018 and 2020.

Eating Disorders by Ethnicity

Researchers have noted that eating disorder rates vary somewhat by ethnicity. These differences may be due in part to differences in risk factors, cultural influences, and socioeconomic status. 

However, access to healthcare also likely plays a role. People of color report that they are significantly less likely to be asked about eating disorder symptoms by healthcare providers.  

A 2018 study found that the overall prevalence of eating disorders was similar across different racial and ethnic groups. However, the likelihood of developing a particular eating disorder varied by ethnicity, as follows:

Other important facts and statistics to know about racial disparities in eating disorder rates include:

• Black teenagers are approximately 50% more likely to display symptoms of bulimia , such as binging and purging, than their White peers.
• In comparison to White college students, Asian-American college students are about 1.5 times likelier to restrict their food intake, 1.2 times likelier to report dissatisfaction with their body, and 2.2 times likelier to exhibit purging behaviors.
• Binge eating disorder and bulimia nervosa are the most common eating disorders among Hispanics/Latinos in the U.S.

Eating Disorders by Age and Gender

Regardless of their age, gender, weight, appearance, or socioeconomic status , anyone can develop an eating disorder. Still, anorexia and other eating disorders are especially common among younger people and women.

An estimated 1 in 4 people with an eating disorder is male. Women are about four times likelier than men to develop anorexia and three times likelier to be diagnosed with binge eating disorder.

People whose gender identity does not match the sex assigned at birth have a higher risk of being diagnosed with an eating disorder or reporting that they engage in disordered eating. Because this is a highly varied group, research is ongoing into which individuals may be more at risk.

Researchers believe that this disparity is due in part to social pressures that disproportionately affect women. In addition, many men report that they feel too ashamed to seek treatment for an eating disorder due to mental health stigma .  

Adolescents and young adults are particularly vulnerable to eating disorders. Estimated annual rates of eating disorder diagnoses rise steadily throughout the teen years among Americans. The highest average annual prevalence rate is age 21 in men (7.4%) and women (10.3%). Approximately 95% of first-time eating disorder cases are diagnosed before age 25.  

Among young people, teen girls and college-aged women are disproportionately likely to develop eating disorders. Some estimates suggest that between 1 in 50 and 1 in 100 adolescent girls will develop anorexia.

Meanwhile, approximately half of teenage girls and one-third of teenage boys in the U.S. resort to unhealthy weight loss methods, such as extremely restrictive dieting, abusing laxatives , and exercising excessively.

Eating Disorders in Children and Teens

Eating disorders are common among children and teens. In fact, nearly 1 in 5 youth aged 11 to 17 exhibit symptoms of disordered eating patterns.

Causes of Eating Disorders and Risk Factors

Researchers haven’t identified one unifying cause for eating disorders . Instead, the interaction between a combination of factors—such as genetics, environment, and trauma—increases the likelihood of developing an eating disorder.

Risk factors for eating disorders include:

• Family history : Some eating disorders may be passed down in families due to a combination of genetics , early childhood experiences, and/or learned behavior. Up to 50% of the estimated eating disorder risk can be attributed to genetic factors.
• Environment : Research indicates that cultural and social factors—such as peer pressure, certain careers, and media beauty standards—play a role in the prevalence of eating disorders.
• Personality : High rates of certain personality traits, such as perfectionism , have been noted among people with eating disorders.
• Comorbid mental health conditions : Many people with eating disorders have other mental health conditions at the same time, such as major depressive disorder (MDD), generalized anxiety disorder (GAD), and substance use disorder (SUD). Around 25% to 35% of people with bulimia and 10% to 20% of people with anorexia attempt suicide at least once during their lifetime.  
• Trauma : Around 50% of people with eating disorders have a history of childhood trauma, such as sexual abuse .

Eating Disorders and Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a particularly common mental health condition among people with eating disorders. Estimates suggest that between 20% to 60% of people with an eating disorder have met the criteria for OCD at some time during their life.

What Are the Mortality Rates for Eating Disorders?

Due to associated risks such as malnutrition, heart disease , and suicide, eating disorders have some of the highest mortality rates of any mental health condition. An estimated 10,200 people die each year in the U.S. as a direct result of an eating disorder.

If left untreated, anorexia is associated with a particularly heightened risk of fatal complications. People with anorexia nervosa are about 5 to 6 times likelier to die than members of the general population.

Relative to other young adults, people with anorexia between the ages of 16 and 24 have approximately 10 times the risk of death. Meanwhile, people with bulimia or BED are about twice as likely to die in a given year in comparison to their same-aged peers.

However, treatment works to prevent many potential deaths related to eating disorder symptoms. If you or someone you know has an eating disorder, it’s important to seek treatment as soon as possible. 

One study found that current eating disorder treatments prevent about 42 deaths per 100,000 people under 40 in the U.S. The same review estimated that increasing treatment access to more people with eating disorders could prevent around 70.5 deaths for every 100,000 people before the age of 40.

Eating disorders are mental health conditions that involve disturbed patterns in how someone eats and thinks about their food intake, weight, body shape, and/or appearance. Common eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant restrictive food intake disorder. 

About 30 million Americans, including approximately 1 in 5 women and 1 in 7 men, will experience an eating disorder during their lifetime. Eating disorders appear to be on the rise, with global rates more than doubling between 2000 and 2018.

While anyone can develop eating disorders, they are especially common among teen girls and young women. Over 9 in 10 first-time eating disorder cases are diagnosed in people under 25. 

Eating disorders are also some of the deadliest mental health diagnoses. Anorexia is associated with particularly high mortality rates . People with anorexia nervosa are about 5 to 6 times more likely to die than their peers in the general population.

Studies link using social media platforms like Instagram regularly to an increased risk of eating disorders among adolescents and young adults.

One 2021 study found that participants who frequently compared their appearance to their social media followers were more likely to struggle with unhealthy eating patterns and low self-esteem. Young adults who said they “always” compared their appearance to others’ were 9.2 times likelier to exhibit disordered eating behaviors.

Many professional dancers, especially ballet dancers, say they feel immense pressure to be extremely thin and restrict their food intake. One systemic review and meta-analysis found that 16.4% of ballet dancers had at least one eating disorder. Four percent of ballet dancers met the diagnostic criteria for anorexia nervosa.

Research suggests that professional and student athletes are more likely to develop eating disorders. Estimated eating disorder prevalence rates among athletes are up to 19%. Meanwhile, up to 45% of adolescent and adult female athletes meet the criteria for an eating disorder at some point.

MedlinePlus. Eating disorders .

National Eating Disorders Association. What are eating disorders?

Galmiche M, Déchelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000-2018 period: a systematic literature review .  Am J Clin Nutr . 2019;109(5):1402-1413. doi:10.1093/ajcn/nqy342

National Institute of Mental Health. Eating disorders: about more than food .

Ward ZJ, Rodriguez P, Wright DR, Austin SB, Long MW. Estimation of eating disorders prevalence by age and associations with mortality in a simulated nationally representative US cohort .  JAMA Netw Open . 2019;2(10):e1912925. doi:10.1001/jamanetworkopen.2019.12925

Udo T, Grilo CM. Prevalence and correlates of DSM-5-defined eating disorders in a nationally representative sample of U.S. adults .  Biol Psychiatry . 2018;84(5):345-354. doi:10.1016/j.biopsych.2018.03.014

Norris ML, Spettigue WJ, Katzman DK. Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth .  Neuropsychiatr Dis Treat . 2016;12:213-218. doi:10.2147/NDT.S82538

Zipfel S, Schmidt U, Giel KE. The hidden burden of eating disorders during the COVID-19 pandemic .  Lancet Psychiatry . 2022;9(1):9-11. doi:10.1016/S2215-0366(21)00435-1

Asch DA, Buresh J, Allison KC, et al. Trends in US patients receiving care for eating disorders and other common behavioral health conditions before and during the COVID-19 pandemic .  JAMA Netw Open . 2021;4(11):e2134913. doi:10.1001/jamanetworkopen.2021.34913

National Association of Anorexia Nervosa and Associated Disorders. Eating disorder statistics .

Cheng ZH, Perko VL, Fuller-Marashi L, Gau JM, Stice E. Ethnic differences in eating disorder prevalence, risk factors, and predictive effects of risk factors among young women .  Eat Behav . 2019;32:23-30. doi:10.1016/j.eatbeh.2018.11.004

Uri RC, Wu YK, Baker JH, Munn-Chernoff MA. Eating disorder symptoms in Asian American college students .  Eat Behav . 2021;40:101458. doi:10.1016/j.eatbeh.2020.101458

Perez M, Ohrt TK, Hoek HW. Prevalence and treatment of eating disorders among Hispanics/Latino Americans in the United States .  Curr Opin Psychiatry . 2016;29(6):378-382. doi:10.1097/YCO.0000000000000277

Schaumberg K, Welch E, Breithaupt L, et al. The science behind the Academy for Eating Disorders' nine truths about eating disorders .  Eur Eat Disord Rev . 2017;25(6):432-450. doi:10.1002/erv.2553

Diemer EW, White Hughto JM, Gordon AR, Guss C, Austin SB, Reisner SL. Beyond the binary: differences in eating disorder prevalence by gender identity in a transgender sample .  Transgend Health . 2018;3(1):17-23. doi:10.1089/trgh.2017.0043

Sangha S, Oliffe JL, Kelly MT, McCuaig F. Eating disorders in males: how primary care providers can improve recognition, diagnosis, and treatment .  Am J Mens Health . 2019;13(3):1557988319857424. doi:10.1177/1557988319857424

National Eating Disorders Association. Eating disorder statistics & research .

Hilbert A. Childhood eating and feeding disturbances .  Nutrients . 2020;12(4):972. doi:10.3390/nu12040972

Rikani AA, Choudhry Z, Choudhry AM, et al. A critique of the literature on etiology of eating disorders .  Ann Neurosci . 2013;20(4):157-161. doi:10.5214/ans.0972.7531.200409

Groth T, Hilsenroth M, Boccio D, Gold J. Relationship between trauma history and eating disorders in adolescents .  J Child Adolesc Trauma . 2019;13(4):443-453. doi:10.1007/s40653-019-00275-z

Bang L, Kristensen UB, Wisting L, et al. Presence of eating disorder symptoms in patients with obsessive-compulsive disorder .  BMC Psychiatry . 2020;20(1):36. doi:10.1186/s12888-020-2457-0

van Hoeken D, Hoek HW. Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden .  Curr Opin Psychiatry . 2020;33(6):521-527. doi:10.1097/YCO.0000000000000641

Jiotsa B, Naccache B, Duval M, Rocher B, Grall-Bronnec M. Social media use and body image disorders: association between frequency of comparing one's own physical appearance to that of people being followed on social media and body dissatisfaction and drive for thinness .  Int J Environ Res Public Health . 2021;18(6):2880. doi:10.3390/ijerph18062880

Arcelus J, Witcomb GL, Mitchell A. Prevalence of eating disorders amongst dancers: a systemic review and meta-analysis .  Eur Eat Disord Rev . 2014;22(2):92-101. doi:10.1002/erv.2271

Bratland-Sanda S, Sundgot-Borgen J. Eating disorders in athletes: overview of prevalence, risk factors and recommendations for prevention and treatment .  Eur J Sport Sci . 2013;13(5):499-508. doi:10.1080/17461391.2012.740504

By Laura Dorwart Dr. Dorwart has a Ph.D. from UC San Diego and is a health journalist interested in mental health, pregnancy, and disability rights.

Key research and statistics

On this page, overview of eating disorders today, key diagnostic statistics, eating disorders and gender, eating disorders and age, eating disorders and lgbtiqa+ communities, eating disorders and cultural and ethnic diversity, eating disorders and aboriginal and torres strait islander people, eating disorders and co-occurring conditions, eating disorder mortality and suicidality, eating disorder treatment and recovery, eating disorders and economic impact, body image, dieting and social media.

This page provides key research and statistics on issues relating to eating disorders.

Please be aware that some of these statistics relate to confronting issues regarding eating disorder risk factors, suicide/mortality rates and mental illness susceptibility.

It is important to remember that these figures provide a statistical overview only – eating disorders are highly individual and varied and not all research will be applicable to all.  

Please always attribute the statistic to the original source, not Eating Disorders Victoria.  

Eating disorders, when combined with disordered eating, are estimated to affect 16.3% of the Australian population (Hay et al., 2015).   

Latest data estimates that the number of people in Australia with an eating disorder aged over 5 years old is around 1.1 million, or approximately 4.45% of the population (Deloitte Access Economics, 2024, p.27). This number indicates that 286,069 Victorians had an eating disorder in 2023.  

A concerning trend in age distribution shows that 27% of eating disorder cases in Australia are among those aged 10-19. This is has nearly doubled since 2012, highlighting a significant increase in eating disorders among younger age groups (Deloitte Access Economics, 2024, p.10).  

According to the latest data, the most prevalent eating disorders in Australia were Unspecified Feeding and Eating Disorders and Other Specified Feeding and Eating Disorders , affecting approximately 1.5% and 1.1% of the Australian population respectively. In contrast, Anorexia Nervosa and Bulimia Nervosa each occurred in less than 0.5% of the general population (Deloitte Access Economics, 2024, p.27).   

The lifetime prevalence for eating disorders is approximately 10.46% of the Australian population. This estimates that 2,754, 446 Australians had an eating disorder at any time within their life (Deloitte Access Economics, 2024, p.30). This is an increase of 1.46% from conservative estimates in 2012 (NEDC, 2017).  

A recent review found that worldwide, lifetime prevalence of eating disorders was 8.4% (3.3-18.6%) for women and 2.2% (0.8-6.5%) for men. The results also showed that the prevalence has been increasing over time (Galmiche et.al., 2019).   

Eating disorders are serious mental illnesses.

Learn about the different types of eating disorders and signs and symptoms to look out for.

Binge Eating Disorder   

• Based on Australian data, the lifetime prevalence of Binge Eating Disorder is the second highest of all eating disorders at 2.2% (Deloitte Access Economics, 2024, p.30).  
• Binge Eating Disorder has the latest average age of onset of all eating disorders estimated to be about 25 years old (Butterfly Foundation, 2012).   

Learn more about binge eating disorder  

Anorexia Nervosa  

• The lifetime prevalence of Anorexia Nervosa in the Australian population is 1.8% (Deloitte Access Economics, 2024, p.30).  
• The average onset of Anorexia Nervosa is 16-17 years, although more and more younger children are becoming affected (Keski-Rahkonen at al., 2018).   

Learn more about anorexia nervosa  

Bulimia Nervosa    

• The lifetime prevalence of Bulimia Nervosa in the Australian population is estimated to be 1.85% (Deloitte Access Economics, 2024, p.30).  
• The average age of onset of Bulimia Nervosa is 18 years (Volpe et.al., 2016).   

Learn more about bulimia nervosa  

Eating disorders are the third most common chronic illness in young women (Yeo & Hughes, 2011).   

• 67% of people with eating disorders in Australia are female and 33% male (Deloitte Access Economics, 2024, p.28).   
• Women and girls are more likely to experience all types of eating disorders than men and boys, where Binge Eating Disorder prevalence is almost double in women compared to men, and more than doubled for Bulimia Nervosa (Deloitte Access Economics, 2024, p.28).  
• Approximately 80-85% of individuals diagnosed with Anorexia Nervosa or Bulimia Nervosa are female and 15-20% are male (Hay et al., 2008).    
• Eating disorders and disordered eating behaviours in boys and men may present differently than in girls and women, particularly with muscularity-oriented disordered eating (Nagata et al., 2020).   
• Research suggests that transgender people, whose assigned sex at birth does not match their gender identity, are more likely than cisgender people, whose assigned sex at birth matches their gender identity, to have been diagnosed with an eating disorder or to engage in disordered eating (Watson et al., 2017).   
• Research indicates that both transfeminine spectrum (TFS; those assigned male at birth and identifying as women or on the feminine spectrum) and transmasculine spectrum (TMS; those assigned female at birth and identifying as men or on the masculine spectrum) individuals had higher levels of disordered eating and body dissatisfaction than cisgender participants (Witcomb et.al., 2015).    
• An Australian study found that 23% of transgender young people have a current or previous diagnosis of an eating disorder (Strauss et.al., 2017).   

Did you know?

Research indicates that over one third of people experiencing an eating disorder are men ( Koreshe et al., 2023). Many experts believe that this number is likely to be even higher due to underreporting due to gender stereotyping and misdiagnosis.  

Eating disorders can affect people of all ages and have been diagnosed in those younger than 5 years and older than 80 years (NEDC, 2017).   

• Research shows that adolescents are at greatest risk, with the average age of onset for an eating disorder between 12 and 25 years (Volpe et al., 2016).   
• The highest prevalence is found in 15 – 19 year olds, where up to 12% of adolescents in this age bracket had an eating disorder in 2023 (Deloitte Access Economics, 2024, p.29).  
• 75% of people diagnosed with Anorexia Nervosa and 83% of people diagnosed with Bulimia Nervosa are between 12 and 25 years (Volpe et al., 2016).   
• 57% of contacts to the Butterfly Foundation National Helpline in 2018-2019 were from young people aged up to 25 years (Butterfly Foundation, 2020a).  

People who are LGBTIQA+ are at a greater risk for disordered eating behaviours (Calzo et al, 2017).  

• Gay, lesbian and bisexual teens may be at higher risk of binge eating than their heterosexual peers (Austin et al., 2009).  
• A review from the United States found that lifetime prevalence for eating disorders is higher among sexual minority adults compared with cisgender heterosexual adults however, more detailed research is required (Nagata et al., 2020).  

Eating disorders occur in all ethnicities, nationalities and cultural backgrounds (Schamberg et al., 2017).  

• A 2019 review found that at any point in time (one-time prevalence) eating disorders occur all over the world, specifically, 4.6% in America, 2.2% in Europe and 3.5% in Asia (Galmiche et al., 2019).  
• It is important to recognise unique cultural nuances and sensitivities, and varied sociocultural factors that influence an individual’s relationship with food, body image, and mental health.  

Though research is limited, it has been estimated that eating disorders incidence is much higher in Indigenous populations with estimates that up to 27% are affected (Burt, et al., 2020).    

• A recent research study found that 28% of Indigenous high school students have an eating disorder compared to 22% of other Australian teens (Burt et al., 2020).   
• Binge eating disorders are as common, if not more common, among Aboriginal and Torres Strait Islander youth (Hay & Carriage, 2012).   
• Research suggests that 30% of Aboriginal and Torres Strait Islander young people are extremely or very concerned about their body image (Hall et al., 2020).   

Eating disorders are frequently associated with other psychological and physical disorders such as depression, anxiety disorders, substance abuse and personality disorders (Hudson et.al, 2007).   

• Approximately 55- 97% of people diagnosed with an eating disorder have a mental illness comorbid condition (NEDC, 2017).   
• Approximately 45-86% of individuals diagnosed with an eating disorder have co-existing depression (O’Brien & Vincent, 2003).   
• Approximately 64% of individuals diagnosed with an eating disorder have co-existing anxiety disorder (Kaye et al., 2004).   
• Approximately 58% of individuals diagnosed with an eating disorder have co-existing personality disorder (NEDC, 2017).   
• Among adolescents, approximately 88% of individuals with Bulimia Nervosa , 84% of individuals with Binge Eating Disorder , and 55% of individuals with Anorexia Nervosa have had one or more co-existing mental illness at some point in their lives (NEDC, 2017).    
• Research indicates that anxiety disorder (especially social anxiety) can precede the onset of an eating disorder (Swinbourne & Touyz, 2007).   
• Higher rates of disordered eating have been described in chronic health conditions that require dietary modification, including Celiac disease, Cystic Fibrosis and Diabetes (Wabich et al., 2020).   
• People with Diabetes (both Type 1 and Type 2) may be two times as likely to develop disordered eating and/or an eating disorder likely due to the nature of the illness including factors such as weight-gain, obsession with food and feelings of loss of control (Pereira and Alvarenga, 2007).   
• Gastrointestinal conditions such as Irritable Bowel Syndrome (IBS) are more prevalent in those diagnosed with an eating disorder though research is unclear if symptoms are resulting from or precede the eating disorder (Marie et al., 2019).   
• Research findings suggest that patients with inflammatory bowel disease (IBD) including Crohn’s disease and Ulcerative Colitis, may struggle with maladaptive attitudes toward eating making them at higher risk for developing disordered eating and/or an eating disorder however more research specific to these conditions is required (Wabich et al., 2020).   

Eating disorders, along with substance use disorders, have the highest mortality rate of all psychiatric disorders (Chesney, Goodwin & Fazel, 2014).   

• The mortality rate of those with Anorexia Nervosa is higher than other eating disorders (Fichter & Quadflieg, 2016).   
• Cardiovascular complications is the leading cause of death among people with Anorexia Nervosa, followed by suicide (Smith, Zuromski & Dodd, 2018).   
• The rate of mortality of individuals with Bulimia Nervosa and Binge Eating Disorder is lower than those with Anorexia Nervosa, but still significantly higher than the general population (NEDC, 2017).   
• People with Anorexia Nervosa are more than 31 times more likely to attempt suicide and those with Bulimia Nervosa 7.5 times more likely to attempt suicide than the general population (Preti et.al, 2011).   
• People with Anorexia Nervosa are 18 times more likely to die by suicide and those with Bulimia Nervosa are 7 times more likely to die by suicide relative to gender and aged matched comparison groups (Smith, Zuromski & Dodd, 2018).   
• Suicidal behaviour is elevated in Binge Eating Disorder relative to the general population (Smith, Zuromski & Dodd, 2018).    
• Suicide risk is higher when eating disorders occur with other psychological conditions (Smith et.al., 2018).   

When skilled and knowledgeable health professionals deliver treatment, full recovery and good quality of life can be achieved for most people with eating disorders (Butterfly Foundation, 2016).  

• It is estimated that 75% of people with an eating disorder don’t seek professional help (Hart et.al., 2011).   
• The reasons/ barriers for not accessing treatment include stigma, shame, denial, failure to perceive the severity of the illness, cost of treatment, low motivation to change, lack of encouragement and lack of knowledge about how to access help resources (Ali et.al, 2017).    
• The most effective treatment for eating disorder is person-centred care, tailored to suit the individual’s illness, situation and needs (Hay et.al., 2014).   
• The average time taken to recover from all types of eating disorders, after seeking treatment, is 1-6 years (Deloitte Access Economics, 2015).  

Learn more about treatment for eating disorders  

Accessing professional, evidence-based treatment for an eating disorder will give you the best possible recovery outcomes.  

• The economic cost has increased by 36% in the last decade, exceeding $66.9 billion in 2023 – this equates to a cost per person of $60,654 (Deloitte Access Economics, 2024).  
• Health system costs (public and private) attributed to eating disorders in 2023 was $251.4 million. Importantly this does not account for all out-of-pocket health system expenses incurred by those impacted by eating disorders (Deloitte Access Economics, 2024).  
• Anorexia nervosa accounts for 75% of the total health system costs, also accounting for the highest per person costs ($4,859) followed by BN ($163) (Deloitte Access Economics, 202
• Body image has been listed in the top four concerns for young Australians from 2009-2018 with 30% concerned about body image (Carlisle et al, 2018).   
• Research shows that up to 80% of young teenage girls report a fear of becoming ‘fat’ (Kearney-Cooke & Tieger, 2015).   
• Nearly 23% of Australian women report a self over evaluation of weight and shape – meaning they think they are larger than they are according to BMI (Mitchison et.al., 2013).   
• It has been reported that more than 55% of Australian girls and 57% boys aged 8 to 9 years are dissatisfied with their body t (Daragnova, 2013).    
• Nearly half of Australian women and one third of Australian men are dissatisfied with their body (NEDC, 2017).   
• Weight related teasing in children is associated with disordered eating, weight gain, binge eating, and extreme weight control measures (Golden, Schneider & Wood, 2016).   
• Social media use has been linked to self-objectification, and using social media for merely 30 minutes, a day can change the way you view your own body (Fardouly & Vartanian, 2015).   
• A study of teen girls reported that social media users were significantly more likely than non-social media users to have internalized a drive for thinness and to engage in body surveillance (Fardouly et.al., 2015).    
• Weight-loss dieting is a risk factor for the development of an eating disorders and. Dieting frequently precedes the onset of an eating disorder (Butryn & Wadden, 2005).   
• Dietary restraint influences binge-eating behaviour (Andres & Saldana, 2014).   
• High frequency dieting and early onset of dieting are associated with poorer physical and mental health, more disordered eating, extreme body dissatisfaction, and more frequent general health problems (Tucci et al., 2007).   

Learn more about dieting and eating disorders

Engaging in weight-loss dieting is the a key behavioural risk factor for developing an eating disorder.

Ali, K., Farrer, L., Fassnacht, D.B., Gulliver, A., Bauer, S., & Griffiths, K.M., (2017). Perceived barriers and facilitators towards help seeking for eating disorders: A systematic review. International Journal of Eating Disorders 50(1), 9-21.   

American Psychiatric Association. (2013).  Diagnostic and statistical manual of mental disorders  (5th ed.). American Psychiatric Association.   

Andrés, A., & Saldaña, C. (2014). Body dissatisfaction and dietary restraint influence binge eating behaviour.  Nutrition Research 34(11), 944–950.   

Arcelus, J., Mitchell, A.J., Wales, J. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Archives of general psychiatry. 68(7):724-731.   

Austin, S.B., Ziyadeh, N.J., Carliss, H.L., Haines, J., Carmargo, C.A., & Field, A.E. (2009). Sexual orientation disparities in purging and binge eating from early to late adolescence. Journal of Adolescent Health. 45(3).   

Australian Institute of Health and Welfare (AIHW). (2007). Young Australians: Their health and wellbeing. Canberra: AIHW.   

Burt, A., Mitchison, D., Dale, E., Bussey, K., Trompeter, N., Lonergan, A., & Hay, P. (2020). Prevalence features and health impacts of eating disorder amongst First-Australian Yiramarang (adolescents) and in comparison with other Australian adolescents. Journal of Eating Disorders, 8(1).    

Burt, A., Mannan, H., Touyz, S., & Hay, P. (2020). Prevalence of DSM-5 diagnostic threshold eating disorders and features amongst Aboriginal and Torres Straight Islander peoples (first Australians). BMC Psychiatry 20, 449.   

Bratland-Sanda, S., Sundgot-Borgen, J. (2013). Eating disorders in athletes: overview of prevalence, risk factors and recommendations for prevention and treatment. European Journal of Sport Science 13(5):499-508.   

Butryn, M. L, & Wadden, T. A. (2005). Treatment of overweight in children and adolescents: Does dieting increase the risk of eating disorders?  The International Journal of Eating Disorders, 37(4), 285–293.    

Butterfly Foundation. (2012).  Paying the price: the economic and social impact of eating disorders in Australia.  Melbourne: Butterfly Foundation.   

Butterfly Foundation (2017). National agenda for eating disorders 2017-2022. Sydney: Butterfly Foundation.   

Butterfly Foundation. (2020a). Eating disorders can affect anyone. Sydney: Butterfly Foundation.   

Butterfly Foundation. (2020b). The reality of eating disorders in Australia. Sydney. Butterfly Foundation.   

Calzo, J.P., Blashill, A.J., Brown, T.A., Argenal, R.L. (2017). Eating disorders and disordered weight and shape control behaviours in sexual minority populations . Current Psychiatry Reports. 19(8).   

Carlisle, E., Fildes, J., Hall, S., Hicking, V., Perrens, B. and Plummer, J. (2018),  Youth Survey Report 2018 , Mission Australia   

Culbert, K. M., Racine, S. E., & Klump, K. L. (2015). Research Review: What we have learned about the causes of eating disorders – a synthesis of sociocultural, psychological, and biological research. J Child Psychol Psychiatry, 56(11), 1141-1164   

Damiano, S. R., Paxton, S. J., Wertheim, E. H., McLean, S. A., & Gregg, K. J. (2015).  Can social factors influence the dietary restraint of girls as young as five?  Journal of Eating Disorders, 3 (Suppl 1), O23.    

Daragnova G. (2013). Body image of primary school children: The longitudinal study of Australian children annual statistical report. Australian Institute of Family Studies.   

Deloitte Access Economics (2015). Investing in need: cost-effective interventions for eating disorders. Report commissioned for Butterfly Foundation. Sydney: Butterfly Foundation.   

Deloitte Access Economics (2024). Paying the Price, Second Edition: The economic and social impact of eating disorders in Australia. Report commissioned for Butterfly Foundation. Sydney: Butterfly Foundation. https://butterfly.org.au/wp-content/uploads/2024/02/Paying-the-Price_Second-Edition_2024_FINAL.pdf    

Duncan, L., Yilmaz, Z., Gaspar, H., Walters, R., Goldstein, J., Anttila, V., Bulik-Sullivan, B., Ripke, S., Thornton, L. and Hinney, A. (2017). Significant locus and metabolic genetic correlations revealed in genome-wide association study of anorexia nervosa. American journal of psychiatry, 174(9), 850-858.   

Erskine, H.E. & Whiteford, H.A. (2018). Epidemiology of binge eating disorder . Current Opinion in Psychiatry. 31(6), 462-470.   

Fardouly, J., Diedrichs, P. C., Vartanian, L. R., & Halliwell, E. (2015). Social comparisons on social media: The impact of Facebook on young women’s body image concerns and mood. Body Image, 13, 38–45.    

Fardouly, J., & Vartanian, L. R. (2015). Negative comparisons about one’s appearance mediate the relationship between Facebook usage and body image concerns . Body Image, 12, 82–88.    

Fichter, M.M., Quadflieg, N. (2016). Mortality in eating disorders – results of a large prospective clinical longitudinal study . 49(4):391–401.    

Galmiche, M., Déchelotte, P., Lambert, G., & Tavolacci, M. P. (2019). Prevalence of eating disorders over the 2000–2018 period: a systematic literature review. The American Journal of Clinical Nutrition, 109(5), 1402- 1413.   

Golden, N. H., Schneider, M., & Wood, C. (2016). Preventing Obesity and Eating Disorders in Adolescents . Pediatrics, 138(3).      

Hall, S., Fildes, J., Tiller, E., Di Nocola, K. & Plummer, J. (2020). National Aboriginal and Torres Straight Islander youth report: youth survey 2019. Mission Australia: Sydney, NSW.   

Hart, L.M., Granillo, M.T., Jorm, A.F. (2011). Unmet need for treatment in the eating disorders: a systematic review of eating disorder specific treatment seeking among community cases. Clinical Psychology Review 31:727-735.   

Hay, P., & Carriage, C. (2012). Eating disorder features in indigenous Aboriginal and Torres Straight Islander Australian peoples. BMC Public Health. 12.   

Hay, P., Chinn, D., Forbes, D., Madden, S., Newton, R., Sugenor, L., Touyz, S., & Ward, W. (2014). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Australian & New Zealand Journal of Psychiatry, 48(11),1-62.   

Hay, P.J., Mond, J., Buttner, P., Darby, A. (2008)  Eating Disorder Behaviours Are Increasing: Findings from Two Sequential Community Surveys in South Australia.  PLoS ONE 3(2): e1541.    

Hay, P., Girosi, F., & Mond, J. (2015). Prevalence and sociodemographic correlates of DSM-5 eating disorders in the Australian population. Journal of Eating Disorders. 3(19), 1-7.   

Hesney, E., Goodwin, G.M., & Fazel, S., (2014). Risks of all-cause and suicide mortality in mental disorders: a meta-review World Psychiatry. 13(2), 153-60.   

Hübel, C., Leppä, V., Breen, G. and Bulik, C.M., (2018). Rigor and reproducibility in genetic research on eating disorders. International Journal of Eating Disorders, 51(7), 593-607.   

Hudson, J., Hiripi, E., Pope Jr., H., & Kessler, R. (2007).  The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication . Biological Psychiatry 61, 348-358.   

Jones, B. A., Haycraft, E., Murjan, S., & Arcelus, J. (2016). Body dissatisfaction and disordered eating in trans people: A systematic review of the literature. International Review of Psychiatry (Abingdon, England), 28(1), 81–94.   

Kaye, W.H., Bulik, C.M., Thornton, L., Barbarich, N., Masters, K. (2004). Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry, 161(12):2215–2221.    

Kearney‐Cooke, A., & Tieger, D. (2015). Body image disturbance and the development of eating disorders. In L. Smolak & M. D. Levine (Eds.), The Wiley Handbook of Eating Disorders (pp. 283-296). West Sussex, UK: Wiley   

Keski-Rahkonen, A., Raevuori, A., & Hoek, H.W. (2018). Epidemiology of eating disorders: an update. Annual Review of Eating Disorders: CRC Press, 66-76.   

Koreshe, E., Paxton, S., Miskovic-Wheatley, J., Bryant, E., Le, A., Maloney, D., Aouad, P., Barakat, S., Boakes, R., Brennan, L., Bryant, E., Byrne, S., Caldwell, B., Calvert, S., Carroll, B., Castle, D., Caterson, I., Chelius, B., Chiem, L., … National Eating Disorder Research Consortium. (2023). Prevention and early intervention in eating disorders: Findings from a rapid review. Journal of Eating Disorders , 11 (1), 38. https://doi.org/10.1186/s40337-023-00758-3    

Loth, K.A., Maclehose. R., Bucchianeri, M., Crow, S., Neumark-Sztainer, D. (2014). Predictors of dieting and disordered eating behaviors from adolescence to young adulthood. Journal of Adolescent Health, 55(5):705–712.    

Mari, A., Hosadurg, D., Martin, L., Zarate-Lopez, N., Passananti, V., & Emmanuel, A. (2019). Adherence with a low-FODMAP diet in irritable bowel syndrome: are eating disorders the missing link?  European Journal of Gastroenterology & Hepatology,  31 (2), 178–182.    

Mayhew, A.J., Pigeyre, M., Couturier, J. and Meyre, D., (2018). An evolutionary genetic perspective of eating disorders. Neuroendocrinology, 106(3), 292-306.   

Micali, N., Martini, M.G., Thomas, J.J., Eddy, K.T., Kothari, R., Russell, E., Bulik, C.M., & Treasure, J. (2017). Lifetime and 12-month prevalence of eating disorders amongst women in mid-life: a population-based study of diagnoses and risk factors. BMC Medicine. 15(12).   

Mitchison, D., Mond, J., Slewa‐Younan, S., & Hay, P. (2013). Sex differences in health‐related quality of life impairment associated with eating disorder features: A general population study. International Journal of Eating Disorders, 46, 375-380.   

Mitchison, D., Hay, P.J. (2014). The epidemiology of eating disorders: Genetic, environmental, and societal factors . Clinical Epidemiology. 6(1):89–97.    

Nagata, J. M., Ganson, K. T., Murray, S.B. (2020). Eating disorders in adolescent boys and young men: an update, Current Opinion in Pediatrics, 32(4), 476-481.   

Nagata, J. M., Ganson, K.T. & Austin, S. B. (2020). Emerging trends in eating disorders among sexual and gender minorities, Current Opinion in Psychiatry: 33 (6), 562-567.   

National Eating Disorders Collaboration (NEDC). (2010).  Eating disorders prevention, treatment & management: An evidence review . Sydney: NEDC.   

National Eating Disorders Collaboration (NEDC). (2012).  An integrated response to complexity – national eating disorders framework . Sydney: NEDC.   

National Eating Disorders Collaboration (NEDC). (2017). Eating disorders prevention, treatment and management an updated evidence review. Sydney: NEDC.   

O’Brien, K.M., Vincent, N.K. (2003). Psychiatric comorbidity in anorexia and bulimia nervosa: Nature, prevalence, and causal relationships. Clinical Psychology Review, 23(1):57–74.    

Paxton S.J., Hay, P., Touyz, S.W., Forbes, D.M., Sloane Girolsi, F., Doherty, A., Cook, L., & Morgan, C. (2012). Paying the price: The Economic and Social Impact of Eating Disorders in Australia, Sydney: Butterfly Foundation.   

Pereira, R. F., & Alvarenga, M. (2007).  Disordered Eating : Identifying, Treating, Preventing, and Differentiating It From Eating Disorders . Diabetes Spectrum 20(3), 141–148.   

Pettersson, E., Lichtenstein, P., Larsson, H., Song, J., Agrawal, A., Børglum, A.D., Bulik, C.M., Daly, M.J., Davis, L.K., Demontis, D. and Edenberg, H.J. (2019). Genetic influences on eight psychiatric disorders based on family data of 4 408 646 full and half-siblings, and genetic data of 333 748 cases and controls. Psychological medicine, 49(7), 1166-1173.   

Phillipou, Andrea & Meyer, Denny & Neill, Erica & Tan, Eric & Toh, Wei Lin & Van Rheenen, Tamsyn & Rossell, Susan. (2020) . Eating and exercise behaviors in eating disorders and the general population during the COVID ‐19 pandemic in Australia: Initial results from the COLLATE project. International Journal of Eating Disorders. 53. 10.1002/eat.23317.   

Polderman, T.J., Benyamin, B., De Leeuw, C.A., Sullivan, P.F., Van Bochoven, A., Visscher, P.M. and Posthuma, D., (2015). Meta-analysis of the heritability of human traits based on fifty years of twin studies. Nature genetics, 47(7), 702.   

Pratt, B.M., Woolfenden, S. (2009). Interventions for preventing eating disorders in children and adolescents (Review). Cochrane Database of Systematic Reviews, 2009;2.   

Reardon, C.L., Hainline, B., Aron, C.M. (2019). Mental health in elite athletes: International Olympic Committee consensus statement British Journal of Sports Medicine 53(11):667-99.   

Schaumberg, K., Welch, E., Breithaupt, L., Hübel, C., Baker, J. H., Munn-Chernoff, M. A., Yilmaz, Z., Ehrlich, S., Mustelin, L., Ghaderi, A., Hardaway, A. J., Bulik-Sullivan, E. C., Hedman, A. M., Jangmo, A., Nilsson, I., Wiklund, C., Yao, S., Seidel, M., & Bulik, C. M. (2017). The Science Behind the Academy for Eating Disorders’ Nine Truths About Eating Disorders.  European eating disorders review: the journal of the Eating Disorders Association ,  25 (6), 432–450.    

Smith, A.R., Zuromski, K.L., & Dodd, D.R. (2018). Eating disorders and suicidality: what we know, what we don’t know, and suggestions for future research, Current Opinion in Psychology, 22, 63-67.   

Smith, A.R., Ortiz, S.N., Forrest, L.N., Velkoff, E.A., Dodd, D.R. (2018). Which Comes First? An Examination of Associations and Shared Risk Factors for Eating Disorders and Suicidality. Current Psychiatry Rep 20(9):77.   

Strauss, P., Cook, A., Winter, s., Watson, V., Wright D., & Lin, A. (2017). Trans pathways: the mental health experiences and care pathways of trans young people. Summary of results, Perth: Telethon Kids Institute.    

Strother, E., Lemberg, R., Stanford, S.C. &Tubervillea, D. (2012). Eating disorders in men: underdiagnosed, undertreated and misunderstood . Eating Disorders, 20(5), 346-355.   

Swinbourne, J.M. and Touyz, S.W. (2007). The co‐morbidity of eating disorders and anxiety disorders: A review. European Eating Disorders Review: The Professional Journal of the Eating Disorders Association, 15(4), 253-274.   

Touyzs, S., Lacey, H., & Hay, P. (2020). Eating disorders in the time of COVID-19. Journal of Eating Disorders, 8(1), 19.   

Trace, S. E., Baker, J. H., Peñas-Lledó, E., & Bulik, C. M. (2013). The genetics of eating disorders. Annual Review of Clinical Psychology, 9, 589-620.   

Tucci, J., Mitchell, J., & Goddard, C. (2007).  Modern children in Australia . Melbourne: Australian Childhood Foundation.   

Volpe, U., Tortorella, A., Manchia, M., Monteleone, A.M., Albert, U., & Monteleone, P. (2016). Eating disorders: What age at onset? Psychiatry Research. April. 225-227.   

Wabich, J., Bellaguarda, E., Joyce, C., Keefer, L., & Kinsinger, S. (2020). Disordered Eating, Body Dissatisfaction, and Psychological Distress in Patients with Inflammatory Bowel Disease (IBD).  Journal of Clinical Psychology in Medical Settings, 27(2), 310-317.   

Watson, R.J, Veale, J.F., Saewyc, E.M. (2017). Disordered eating behaviors among transgender youth: probability profiles from risk and protective factors. International Journal of Eating Disorders 50:515–522.   

Witcomb, G. L., Bouman, W. P., Brewin, N., Richards, C., Fernandez-Aranda, F., & Arcelus, J. (2015). Body image dissatisfaction and eating related psychopathology in trans individuals: A matched control study. European Eating Disorders Review, 23, 287–293.   

Wells, K. R., Jeacocke, N. A., Appaneal, R., Smith, H. D., Vlahovich, N., Burke, L.M, & Hughes, D. (2020). The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement on disordered eating in high performance sport.  British Journal of Sports Medicine,  54 (21), 1247–1258.    

Yeo, M, Hughes, E. (2011)  Eating disorders: early identification in general practice . Australian Family Physician 40(30), 108-111.  

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Special Report: Youth With Eating Disorders—Time Is of the Essence in Achieving Remission

• Brittany Matheson , Ph.D. ,
• Nandini Datta , Ph.D. ,
• James Lock , M.D., Ph.D.

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Given that the symptoms of eating disorders may emerge over time and stay undetected even by loved ones and friends, early identification and treatment of children and adolescents are imperative.

Trivia time: imagine you are on a popular game show—you know, the one with the catchy theme song we can’t name due to copyright issues. The category “Psychiatric Disorders” comes up and you start to feel pretty confident you’ll get this one right. Suddenly, the clue is revealed: “This disorder has one of the highest mortality rates in all of psychiatry, with 12 times higher death rates in 15- to 24-year olds than any other cause.”

The theme show music starts as you rack your brain for the name of the disorder. The most deadly? By 12 times more? Your mind begins to race back through your coursework, trainings, clinical rotations, readings, and patient interactions, which leaves you with a number of potential answers. Perhaps major depressive disorder, or psychosis with command hallucinations, or substance use? Anything else? Aahh—time is running out. Quick, quick—what’s your final answer?

Did eating disorders come to mind? Because if they did, you would be correct (and hopefully win big in this fictional game show!). Eating disorders—in particular, anorexia nervosa—have one of the highest mortality rates of any psychiatric disorder, due in part to associated medical complications as well as an increased risk of suicide. Research suggests that 1 in 5 deaths from anorexia nervosa is the result of suicide. For children and adolescents, eating disorders are the third most common chronic health condition, behind only asthma and obesity in numbers. An estimated 1 in 30 people will develop an eating disorder at some point in life.

Eating Disorders Can Be Life Threatening Yet Underresearched

Eating disorders can severely impact just about every organ system in the body, including the cardiovascular system; cause diminished muscles, growth potential, and bone density; disrupt the endocrine and gastrointestinal systems; and can affect the brain. (Did you know the brain is the fattiest organ in the body?) While most of the medical complications of eating disorders resolve with improved nutrition and resolution of the eating disorder, not all damage is reversible, depending on the severity of symptoms and length of illness. Importantly, research suggests that after about three years of an eating disorder such as anorexia nervosa, for example, chances of full recovery diminish greatly. That’s three years from the onset of symptoms. Given that symptoms may emerge slowly over time and can stay undetected even by loved ones and friends, time is of the essence to identify and treat children and adolescents for eating disorders.

Despite these shocking statistics, eating disorder research has historically been significantly underfunded. For example, recent estimates of U.S. federal funding amounted to just $.73 per person impacted with an eating disorder, compared with almost $87 per person for schizophrenia and $59 per person for autism spectrum disorder. In Canada, estimates ranged from $0.11 to $0.61 per person impacted with an eating disorder, compared with nearly $47 for schizophrenia research and $54 for autism spectrum disorder. In addition, it can be challenging for patients and families to access expert medical and psychological care, which is often uniquely available in large, urban areas or in connection to academic medical centers. Access to telehealth options, videoconferencing platforms, and online treatments has helped alleviate this burden and broaden access to care, though finding qualified providers or programs with availability continues to be difficult. Obtaining training and certification in evidence-based treatment modalities also poses challenges for private practice or community-based providers who may not have convenient access to trainings and supervision needed to learn these treatments.

Our research team is currently exploring solutions to this hurdle by testing the effectiveness of online asynchronous clinical trainings in family-based treatment (FBT) for clinicians in private practice (NCT04428580; study still recruiting). Results of this implementation study as well as further work in this area will inform intervention training practices with the goal of improving access to expert, high-quality, and effective treatments for youth with eating disorders.

Fighting Myths and Misconceptions

Eating disorders represent a heterogenous category of diagnostic criteria, from restrictive undereating to disinhibited, overeating behaviors. And not all eating disorders are driven by concerns over shape and weight. In fact, avoidant restrictive food intake disorder (ARFID)—characterized by difficulty with maintaining adequate nutritional intake resulting in physical and psychosocial impairment—is not related to body image or weight concerns at all and can begin in much younger children. One shared trait that all eating disorders have in common? They are incredibly disruptive, distressing, and dangerous to the person suffering from one.

Although not every psychiatrist will be directly involved in providing eating disorder treatment, we all play an important role in recognizing the signs and symptoms of disordered eating while also disrupting myths about eating disorders that have become pervasive in today’s society. For example, it is not possible to look at someone and know the person has an eating disorder. A person’s outward physical appearance communicates little to no data about overall health. Moreover, eating disorders may impact anyone. Outdated myths that eating disorders affect only cis-gender, White, affluent females fuel harmful stereotypes and impede care for individuals who are suffering. Eating disorders are prevalent among gender-diverse youth and individuals who are from diverse racial and ethnic backgrounds. A 2011 study by Daniel Eisenberg, Ph.D., and colleagues in the Journal of American College Health found that 1 out of every 4 college students with an eating disorder identified as male. Another study by Michelle Goeree, Ph.D., and colleagues reported in a 2012 paper from the University of Zurich that female youth from low-income families were more than 150% more likely to have bulimia nervosa than female youth from high-income families.

Most important, eating disorders are not choices; they are not volitional. This is one of the biggest misconceptions about eating disorders. A teenager cannot simply wake up one morning and choose to have an eating disorder. Rather, there are strong biological and genetic influences that interact with individual differences, personality traits, neurobiological processes, and environmental contexts to result in an eating disorder. In our clinical care of adolescents with eating disorders, the number one question we get asked over and over is, “How did my child develop this? Where did it come from?”

The truth is that we don’t know. Research is underway to examine this very question, and perhaps one day, we’ll be able to posit a solution to this perplexing question. The good news is that we don’t need to know the “why” to treat patients with the disorder. And until we know more about the “why,” we encourage families to act quickly to help their young person overcome this terrible illness. Hemming and hawing over the “why” often delays families from focusing on the task at hand—and recovery from an eating disorder is a monumental task.

Sometimes we use the following analogy to help families better understand our “agnostic” stance. We might say, “Imagine you were just diagnosed with cancer. You are meeting with your oncologist and have just learned this devastating news. Would you ask your oncologist to hold off on talking about treatment options and therapeutic approaches until everyone figures out exactly how or why you got cancer?” Of course not. Instead, the conversation would immediately turn to treatment planning and next steps. An eating disorder diagnosis should be no different; the conversation must focus on how someone is going to start the recovery process. Although we may never truly understand the “why” for each individual patient, we do have effective treatment options for eating disorders in youth. And we need to get started right away.

Our team is composed of experts in the assessment and treatment of children and adolescents with eating disorders, and thus the information we present below is curated for this population. Importantly, there are key distinctions in the presentation and treatment options for youth compared with adults with eating disorders. For example, eating disorders in youth are more likely to be non-chronic and more responsive to intervention, and they rely heavily on family support in recovery efforts. We provide a brief overview of anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant restrictive food intake disorder with a tailored focus on the current evidence-based interventions as well as promising future research directions. These are also outlined for you in Table 1.

Anorexia Nervosa (AN)

Diagnostic criteria for AN includes restriction of energy intake driven by an intense fear of weight gain and shape/weight concerns. Individuals may be diagnosed with AN, restricting subtype (F50.01), or AN, binge-eating/purging subtype (F50.02). Common comorbidities include mood disorders, anxiety disorders, and obsessive-compulsive disorder. AN occurs across genders; socioeconomic statuses; and racial, ethnic, and cultural backgrounds, and it presents with the same preoccupations with weight, thinness, dieting, and overexercise that, if left untreated, results in significant medical consequences. Youth with AN require ongoing medical monitoring to ensure vital sign stability. With food restriction and malnutrition, all systems of the body are impacted, including the heart and brain. Common medical complications of AN include bradycardia—slowed heart rate, orthostatic changes in blood pressure from lying to standing, and electrolyte imbalances. At times, an inpatient hospitalization may be warranted for medical stabilization. AN has significant psychosocial implications for youth as well. Frequently, adolescents with AN withdraw from family and friends, becoming less social and engaged with their life outside of AN preoccupations.

Individuals who meet criteria for atypical AN report the same preoccupations with thinness, body image, and weight and engage in restriction, yet are not underweight by body mass index or growth chart standards. Not uncommonly, patients with atypical AN may also need to restore lost weight to promote vital sign stability and cognitive recovery from the eating disorder. The use of the word “atypical” is hotly debated and perhaps does not communicate the appropriate graveness and severity to families and clinicians.

For youth with AN, family-based treatment (FBT) is a well-established Level I treatment. It is the first-line treatment recommended by international guidelines and practice standards. In FBT, all family members who eat together in the home—parents/guardians, patient, siblings, even grandparents if applicable—attend hour-long outpatient treatment sessions with a certified therapist. FBT consists of three phases:

Phase 1, which consists of weekly sessions focused on parental involvement in renourishment, disrupting eating disorder behaviors, and establishing regular nonrestricting eating patterns.

Weight gain is often a target early in treatment, as research studies suggest that adolescents who gain 2.3 kg by session 4 of FBT have a 70% to 90% chance of achieving symptom remission by the end of treatment. Given that research trials of FBT typically achieve 40% to 50% remission rates, this marker of early response is critical for therapists, families, and patients to all work toward to promote improved outcomes.

Phase 2, which consists of biweekly sessions focused on transitioning independence with eating back to the adolescent while also working on social eating goals.

Phase 3, which consists of monthly sessions focused on an adolescent development task that the family has identified to work on together. The second session of FBT during this phase includes a family meal during which the family eats together with the therapist to learn new strategies to help the child overcome AN at mealtimes.

Adaptations and augmentations of FBT have been developed, including separate parent-only FBT and adding extra intensive parental coaching sessions for adolescents who do not respond to FBT within the first month of treatment. Based on clinical experience and supervision, virtual delivery of FBT looks quite similar to in-person treatment, though research studies have yet to directly compare outcomes across these two delivery formats. Guided self-help (GSH) adaptations for FBT are also in development, which, if found to be effective in adequately powered clinical trials, could significantly improve efficacy of treatment and reduce further barriers to accessing evidence-based care. Other evidence-based treatment modalities for AN are explored and briefly described in Table 1. More information about these treatment modalities can be found in our team’s evidence-based update for children and adolescents with eating disorders , published in the Journal of Clinical Child and Adolescent Psychology on August 11, 2022.

Bulimia Nervosa (BN)

The diagnostic criteria for BN include binge-eating episodes (loss of control eating plus consuming an objectively large amount of food within a discrete period of time) as well as use of compensatory behaviors at a frequency of approximately once a week for three months. Common comorbidities including mood disorders, obsessive-compulsive disorder, posttraumatic stress disorder, substance use disorders, and emotion regulation difficulties. Oftentimes, adolescents with BN report distress over their eating disorder symptoms and are typically more motivated to engage in care compared with adolescents with AN, given the egodystonic nature of BN.

FBT is a well-established outpatient treatment for adolescents with BN. Early response markers suggesting reduction in purging behaviors by session 2 and binge eating by session 4 may predict abstinence rates at the end of treatment. However, to date, there have been only four randomized clinical treatment trials for adolescent BN, with a total of 376 participants across the trials. As such, significantly more research is needed to replicate previous study outcomes as well as include a greater number of diverse individuals to improve generalizability.

Binge Eating Disorder (BED)

BED is the most commonly diagnosed eating disorder in adult populations, with a mean age of onset estimated to be about 23 years old. Individuals with BED report experiencing a sense of loss of control eating (LOC eating) while consuming an objectively large amount of food in a discrete period of time, often within two hours. Additionally, to meet diagnostic criteria, these eating episodes must be accompanied by marked distress and at least three of the following: eating rapidly; eating until uncomfortably full; eating when not feeling hungry; eating alone due to shame or embarrassment about how much one is consuming; and feeling disgusted with oneself, depressed, or guilty about the eating episode. Among children and adolescents, research has suggested that the experience of LOC eating correlates with anxiety, depression, marked distress, and poorer quality of life, independent of the amount of food consumed during these eating episodes. Prevalence estimates of LOC eating vary widely, from 8% to 30%, and may be greater among youth with obesity. LOC eating in childhood or adolescence may be a risk factor for the development of BED and/or BN.

To date, there are no Level I well-established treatments or Level II possibly efficacious treatments for binge eating in youth. Research studies have examined a range of treatment approaches within randomized clinical trials and small case series, including dialectical behavioral therapy, interpersonal psychotherapy, cognitive-behavioral therapy, and guided self-help cognitive-behavioral therapy. Evidence-based treatments for binge eating in adults may not directly translate to youth, given age and developmental differences as well as the child’s embedment within the family system. Thus, additional research into this area is needed.

Avoidant Restrictive Food Intake Disorder (ARFID)

A recently recognized eating disorder that was added to DSM in its fifth edition, ARFID is a selective eating disorder characterized by difficulties in maintaining adequate nutritional intake resulting in medical and/or psychosocial impairments. Individuals with ARFID do not express body image concerns despite engaging in restrictive eating behaviors, which uniquely separates this disorder from the others in the same category. Rather, eating behavior in ARFID is driven by three noninclusive subtypes: a lack of interest in eating/pervasively low appetite, sensory sensitivity (these kids know the difference between two seemingly identical boxes of Cheerios), and/or fear of aversive consequences such as vomiting or choking.

Individuals with lack of interest/low appetite presentation often present with longstanding histories of undereating and difficulties maintaining adequate intake, typically from very early on in life. It is not uncommon for youth with this presentation to forget to eat, be easily distracted by other activities, and report not feeling hungry. They may have difficulty receiving and interpreting internal hunger cues. Youth with the sensory sensitivity profile of ARFID report restrictive eating patterns based on sensory aspects of food and eating, which may include texture, temperature, smell, taste, color, or other aspects of appearance.

Children with ARFID may eat only a very narrow range of foods and often have strong preferences for specific brands or styles of food preparation. Varying from a preferred, known brand or preparation style may result in refusal to eat; for example, a child may eat chicken nuggets from McDonald’s without difficulty but will not eat chicken nuggets from other restaurants or those made at home. Children with this presentation may miss certain key nutritional elements due to their restrictive food range or may miss out on engaging in social events, such as birthday parties, traveling, sleepovers, family gatherings, or celebrations involving food.

For youth with fear of aversion consequences, their ARFID typically onsets after an event, such as choking on a hotdog, throwing up repeatedly due to food poisoning, or even experiencing pain while eating after orthodontic work. Children then become concerned about eating foods and may even go as far as to restrict all solid foods in an effort to avoid whatever unpleasant outcome they are afraid may happen after eating. This presentation often has a more rapid onset than the other subtypes and usually occurs later in childhood or early adolescence, though not always. Children with ARFID often don’t fall neatly into one of these categories, instead falling into two or even all three categories.

With any presentation of ARFID, families often feel significant pressure and stress regarding feeding their child. Parents can easily fall into the role of short-order cook. Also the adage “Your child will eat if hungry enough” simply does not hold true for many families’ experiences of a child with ARFID, particularly those within the low appetite subtype who will happily forgo eating. Parents report feeling frustrated, isolated, and guilty, fearful they have done something that caused their child’s eating difficulties. Parents may feel additional stress and worry if their child is not growing as expected or experiences medical complications stemming from their difficulties with eating, necessitating the consideration of enteral feeding. Although the recognition of ARFID as a psychological disorder is growing, it can still be missed or misdiagnosed by physicians who may assume it is a form of “picky eating” that the child will eventually outgrow without intervention.

Treatments for youth with ARFID are in development; the research is still in its infancy. To date, cognitive-behavioral therapy, FBT, and interoceptive-based exposure approaches have been explored in case series and small clinical trials. Our team is currently comparing FBT for ARFID with a psychoeducational and motivational treatment (PMT) in an adequately powered randomized clinical trial for children 6 to 12 years old (NCT04450771). This study is actively recruiting from a nationwide sample, with data collection underway; if you have patients interested in participating, please send an email to [email protected] .

Key Takeaways and Next Steps

Eating disorders in children and adolescents represent a broad range of symptoms with various medical and psychological sequalae. It is important to act quickly and aggressively to treat these disorders before they become chronic or intractable. In youth particularly, eating disorders may threaten to disrupt windows for growth and opportunities for adolescent development and individuation. While many advances have been made in the past decade in treatment development and implementation, there is definite room for growth. There is an active effort to increase the diversity of youth in study samples to ensure cultural sensitivity and efficacy across diverse populations. We aspire to continue learning, developing, implementing, and disseminating treatment efforts to increase access to care and help treat youth with this dangerous category of illnesses. ■

References for Further Reading

Nandini Datta, Ph.D., Brittany E. Matheson, Ph.D., et al. Evidence Based Update on Psychosocial Treatments for Eating Disorders i3n Children and Adolescents . Journal of Clinical Child & Adolescent Psychology . August 11, 2022.

Daniel Eisenberg, Ph.D., et al. Eating Disorder Symptoms Among College Students: Prevalence, Persistence, Correlates, and Treatment-Seeking . Journal of American College Health . September 27, 2011.

Michelle Goeree, Ph.D., John Ham, Ph.D., Daniela Iorio, Ph.D. Race, Social Class, and Bulimia Nervosa . Working Paper, No. 86, University of Zurich, Department of Economics, Zurich, 2012.

All three authors work in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine.

Brittany Matheson, Ph.D., is a licensed clinical psychologist and faculty scholar.

Nandini Datta, Ph.D., is a postdoctoral fellow on the Eating Disorders Research Team.

James Lock, M.D., Ph.D., is the Eric Rothenberg Professor and senior associate chair of the department and has conducted seminal research on eating disorders for over two decades. He is the editor of Pocket Guide for the Assessment and Treatment of Eating Disorders from APA Publishing from APA Publishing. APA members may purchase the book at a discount.

Eating Disorder Statistics & Trends 

Eating disorders affect a small percentage of the overall population, but that still translates to millions of people who are impacted by these conditions. 

And research suggests that many more people silently struggle with an eating disorder without ever being officially diagnosed.

Further Reading

Anorexia Statistics Bulimia Statistics 5 Bulimia Facts Anorexia Facts and Myths A Guide to Size Diversity

Most upsettingly, many people who need help for their ailment never receive it for a number of reasons. But there are many treatment options available for eating disorders, which can help all types of people make a full recovery.

Key Factors to Consider

There are several reasons why it can be difficult to get a true understanding of the impact of eating disorders . 

There is no official authority for keeping track of these cases. Eating disorder statistics mostly come piecemeal, relying on any number of different studies that use any number of different metrics or measurements to evaluate who gets diagnosed with an eating disorder and what constitutes recovery.

For a majority of the time these disorders have been studied, researchers have focused on a specific portion of the population—namely, young, white females—which can serve to skew numbers or hide trends taking hold in other groups of people.

And on top of those who may be overlooked by studies, many people choose to never disclose their disordered eating behavior at all, making true numbers impossible to determine.

Still, researchers do their best to understand all angles of the problem, and over the years, their work has uncovered several trends. 

Eating Disorder Trends

9% of americans will have an eating disorder at some point in their lives..

Some studies have attempted to estimate how many people, overall, will deal with an eating disorder at some point in their lives. One recent analysis done by Harvard’s School of Public Health put the number at 9% of Americans—or 28.8 million people. [1] 

That shocking statistic was supported by another study conducted in 2021, which showed a jump in the prevalence of eating disorders worldwide. 

While 3.5% of the global population was estimated to struggle with an eating disorder between 2000 to 2006, that number rose to 7.8% between 2013 to 2018, the study found. One of the biggest changes quoted by the authors was the number of men reporting disordered eating patterns. [2]

These numbers bear out anecdotally, as well. Almost half of all Americans in one poll reported knowing someone with an eating disorder. [3] 

Anorexia Statistics

Anorexia nervosa (AN)—a condition revolving around severely limited food intake—is one of the most common eating disorders and also one of the most frequently studied. 

It’s estimated that up to 0.4% of young women and 0.1% of young men will struggle with AN at any given time. [4] In fact, anorexia nervosa is considered the third most common chronic illness among adolescents. [3] 

Anorexia is the third-most common chronic illness among adolescents. [3]

While many factors can contribute to the development of this eating disorder, co-occurring mental health conditions often play a role. For example, 20% of women with anorexia also express traits of autism. [5] Depression and anxiety are other commonly occurring co-diagnoses.

Tragically, anorexia nervosa also often leads to premature death . Some studies show that as many as 20% of people with AN die early from complications of the condition, including suicide and heart problems. [3]

Bulimia Statistics

People with bulimia nervosa (BN) bounce between two dangerous behaviors, engaging in episodes of binge eating, which are followed by episodes of purging. 

It’s estimated that 0.3% of the U.S. population struggles with bulimia nervosa. And while anyone can develop the condition, it’s been found five times more often in women compared to men. [6]

Racial disparities in bulimia exist too. Some research shows that Black teenagers are 50% more likely than white teens to binge eat and purge. [7] 

Still, not all the numbers are quite as bleak. 

While bulimia nervosa rates increased during the 1980s and early 1990s, the number has mostly flattened out since then or even slightly dipped, according to some studies. [4] 

Binge Eating Disorder Statistics

People with binge eating disorder (BED) take in large amounts of food in one sitting, similar to binge eating episodes of BN. But they don’t use compensatory behaviors to expel excess food and calories from their system. 

Perhaps due to the lack of this second extreme behavior, BED is one of the most prevalent eating disorders in America, experienced by 3.5% of women and 2% of men. All told, the condition is estimated to be three times more common than anorexia nervosa and bulimia nervosa combined. [4] 

Binge eating disorder is 3x more common than anorexia and bulimia combined. [4]

Still, BED is also one of the most recently-recognized eating disorders, and it’s possible many people may deal with the condition without being diagnosed.

Other Specified Feeding or Eating Disorder Statistics

While some eating disorders have been specifically defined by a number of traits or other factors, there are many other types of disordered eating behavior that don’t meet these criteria. 

Doctors call this other specified feeding or eating disorders (OSFED). 

For years, OSFED—previously called eating disorder not otherwise specified, or EDNOS—was considered a more “mild” form of an eating disorder. Now, doctors know these disordered eating behaviors can still present serious issues.

Sadly, people with OSFED have been found just as likely to die from complications of their eating disorder as people with anorexia nervosa or bulimia nervosa. [8] Regardless of their specific behavior, they’re still at a generally higher risk of developing obesity-related complications, nutritional deficiencies, or other health problems. 

And the condition is sadly not uncommon. In one study, OSFED was found to be the second-most-prevalent eating disorder diagnosis. [9] 

Statistics on Eating Disorder Treatment 

Thankfully, all types of eating disorders are treatable . The combination of medical therapies, psychotherapy, and medication, along with nutritional counseling and education, have been found to help people make both a physical and mental recovery. 

Unfortunately, far too many people with eating disorders don’t get help at all. Researchers say only 1 out of every 10 people with eating disorders gets treatment. [3] 

Shame keeps many people from disclosing their eating habits to loved ones or medical professionals. And some people aren’t aware that their disordered eating behavior qualifies as a mental health issue.

Studies found that only about a third of people with AN, and roughly 43% each of people with BN and BED sought treatment specifically for their eating disorder between 2001 and 2004. [6]

This ratio can be even higher in some populations.

It’s been estimated that athletes, overall, are less likely to seek out help for an eating disorder.[5] And some studies indicate that people of color are half as likely to get an eating disorder diagnosis or treatment. [1] 

People in larger bodies are also thought to be about half as likely as those in smaller bodies to be diagnosed with an eating disorder. [5]

Finding Help for Eating Disorders

While it’s important to understand how many people have eating disorders and the number who get treated, it’s even more important to put yourself among the group of those who seek help. 

If you or a loved one are struggling with disordered eating behavior, you can start by reaching out to your primary care physician or therapist. These healthcare professionals can listen to your concerns and help give you the right diagnosis or find the best possible treatment program . 

If you’re worried about talking with your doctor, ask a family member or trusted friend to go with you to the appointment. Added support could help you feel more comfortable speaking freely about your eating disorder and the life you want to lead. 

This person can also offer you ongoing support as you begin your journey in treatment and ongoing recovery. But the most important thing to remember is that treatment—and recovery—are always possible.

• Report: Economic Costs of Eating Disorders . Harvard School of Public Health. Accessed September 28, 2022.
• Graber, E. (2021, February 22). Eating Disorders Are on the Rise. American Society for Nutrition. Accessed September 28, 2022.
• Eating Disorder Statistics . South Carolina Department of Mental Health. Retrieved September 28, 2022.
• Statistics and Research on Eating Disorders . (2022). National Eating Disorders Association. Accessed September 28, 2022.
• Eating Disorder Statistics . (2021). National Association of Anorexia Nervosa and Associated Disorders. Accessed September 28, 2022.
• Eating Disorders . National Institute of Mental Health. Retrieved September 28, 2022.
• Becker, A. E., Franko, D. L., Speck, A., & Herzog, D. B. (2003). Ethnicity and differential access to care for eating disorder symptoms . The International journal of eating disorders; 33 (2):205–212.
• Other Specified Feeding or Eating Disorder . (2022). National Eating Disorders Association. Retrieved September 28, 2022.
• Jenkins, Z. M., Mancuso, S. G., Phillipou, A., & Castle, D. J. (2021). What is OSFED? The predicament of classifying ‘other’ eating disorders. BJPsych open; 7 (5):e147.

Last Update | 01 - 23 - 2023

Medical Disclaimer

Any information provided on the bulimia.com is for educational purposes only. The information on this site should not substitute for professional medical advice. Please consult with a medical professional if you are seeking medical advice, a diagnosis or any treatment solutions. Bulimia.com is not liable for any issues associated with acting upon any information on this site.

Calls to this number are answered by Within Health, a virtual eating disorder treatment provider. There is no obligation or cost to call this number and all calls are private and confidential.

Additional eating disorder treatment providers can be found at  samhsa.gov .

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Research offers hope and reassurance for adults with eating disorders

by Curtin University

New Curtin University research has found an inpatient treatment approach can help adults with eating disorders improve not only their physical health, but also their psychological health. The research is published in the Journal of Eating Disorders .

"High-energy refeeding" is frequently used to treat malnourished adolescents with anorexia nervosa and involves patients consuming a progressively higher energy intake over a short period of time, to quickly restore their nutritional health.

It's been thought this approach could prove problematic when treating adults with the same condition. However, this may not be the case.

Researchers from Curtin's School of Population Health investigated 97 voluntary hospital inpatients (55 adults and 42 adolescents) with eating disorders, the majority anorexia nervosa, who were treated using a high-energy refeeding protocol.

The team found both age groups responded well to high-energy refeeding, reporting very similar positive weight change and improvements in measurements of their psychological health .

Masters student and study lead Fiona Salter said there had been previous concerns that adult patients undergoing high-energy refeeding could be at increased risk of developing refeeding syndrome, a potentially fatal condition which can occur when a severely malnourished person starts eating again and causes a sudden shift in fluid and electrolytes.

"In addition, more frequent mental health issues in adult patients could complicate their medical care ," Ms. Salter said. "However, only one adult participant in our study did not tolerate the high-energy protocol due to oedema, which is an excess of fluid accumulating in body tissues."

Study co-author Dr. Emily Jeffery said the findings indicate high-energy refeeding in adults who are mildly and moderately malnourished can be administered safely and has both nutritional and psychological benefits.

"However, clinicians need to be aware [that] severely malnourished adults may require adjustments to prevent complications," Dr. Jeffery said.

Ms. Salter said the improvements in adult patients ' psychological well-being were critically important in using high-energy refeeding in the future.

"There was some concern feeding too quickly could put them under too much distress, which is why we wanted to measure these psychological scores," Ms. Salter said.

"We found psychosocial questionnaire scores improved significantly over the hospital admission, but psychological recovery from an eating disorder takes months and years, so while it's great we can physically restore someone's nutritional health quite quickly, the important thing is to keep that going. It needs to be maintained after they leave hospital for their longer-term psychological recovery."

With this in mind, Ms. Salter said the next step was to see how patients with a similar severity of illness respond to high-energy refeeding in a less structured environment, such as an intensive treatment day program.

"We'll be investigating whether a similar high energy refeeding protocol to that used in the hospital study has the same outcomes when patient meals are only partially supervised," she said.

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Current Discoveries and Future Implications of Eating Disorders

1 Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA 70808, USA

Jerney Harms

2 Biology Department, Centenary College of Louisiana, Shreveport, LA 71104, USA

3 The Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The University of Illinois at Chicago, Chicago, IL 60612, USA

Associated Data

Not applicable.

Eating disorders (EDs) are characterized by severe disturbances in eating behaviors and can sometimes be fatal. Eating disorders are also associated with distressing thoughts and emotions. They can be severe conditions affecting physical, psychological, and social functions. Preoccupation with food, body weight, and shape may also play an important role in the regulation of eating disorders. Common eating disorders have three major types: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). In some cases, EDs can have serious consequences for an individual’s physical and mental health. These disorders often develop during adolescence or early adulthood and affect both males and females, although they are more commonly diagnosed in young adult females. Treatment for EDs typically involves a combination of therapy, nutrition counseling, and medical care. In this narrative review, the authors summarized what is known of EDs and discussed the future directions that may be worth exploring in this emerging area.

1. Introduction

Eating disorders (EDs) are serious mental illnesses marked by dysfunctional eating behaviors and distorted body image [ 1 ]. Seven different eating disorders are identified in the list of international disease classification systems. These EDs include the well-known anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) ( Figure 1 ), and three other disorders: rumination disorder, pica, and avoidant food intake disorder. Some otherwise specified feeding or eating disorders are listed in another category [ 2 ]. Worldwide, the three most frequent eating disorders in humans are AN, BN, and BED [ 3 , 4 ]. AN is defined as disturbing experiences of weight or size, inappropriate influence of size and weight on self-assessment, or persistent lack of awareness of the seriousness of current low body weight [ 3 ]. BN is defined by repeated and inappropriate compensatory behaviors to avoid weight gain [ 5 ]. BED is delineated by eating more food in short time periods than most people would eat in similar time periods and in similar circumstances [ 3 , 6 ]. Most people affected by these eating disorders are young women in Western countries, suggesting that the existence of sex-related problems in the etiology of EDs is irrefutable [ 7 ]. The studies have shown that, although data regarding the incidence of EDs on the community level are limited, the broad occurrence of AN among women might be 1–4%, and 1–2% for BN and BED [ 1 ].

Three major eating disorders and their symptoms in human subjects (AN: anorexia nervosa; BN: bulimia nervosa; BED: binge eating disorder).

More than fifty years of records on EDs show that less than fifty percent of patients experience complete remission, about thirty percent experience residual symptoms, and twenty percent develop chronic disease [ 8 ]. Additionally, pressure from families and medical staff further exacerbates concerns about body image and food [ 9 ]. The Lancet Psychiatry Committee’s recent synthesis report stated that people with mental disorders will have significantly higher chances of developing obesity, diabetes, and metabolic syndrome and close to two times increased risk of metabolic disease compared with individuals not diagnosed with mental disorders [ 10 ]. Eating disorders are complex disorders with increasing prevalence and are a physical and mental health concern [ 11 ]. Many genetic, environmental, and social factors lead to the development of eating disorders. Biological risk factors for eating disorders include genetic factors and the psychological element of an eating disorder that coincides with a diagnosis of another disorder. Environmental factors include the dynamics surrounding the individual, which may consist of family dynamics.

This review aims to summarize and discuss the current discoveries and future direction of three different eating disorders, AN, BN, and BED. By gathering and analyzing the most recent research and clinical evidence, this review can provide a comprehensive overview of the current state of understanding on eating disorders. It will increase public awareness and understanding of the importance of etiology and management of eating disorders. Clinicians and researchers can use the information provided in this narrative review to improve their understanding of eating disorders and develop more effective treatment strategies. In conclusion, this review can be an important tool for clinicians, researchers, and the general public in improving their understanding and treatment of these complex eating disorders.

A rapid scoping review focused on eating disorders was conducted. The definition adopted here was to map the existing literature to determine the volume and coverage of the topic, ascertain the types of literature available, and identify the gaps in the current eating disorder research. The authors searched PubMed and PsycINFO databases using keywords such as “eating disorders,” “anorexia nervosa,” “bulimia nervosa,” “binge eating disorder,” and “treatments” and included studies published in English between 2000 and 2023 that focused on eating disorders. The authors present the findings on eating disorders in tables, figures, and narrative summaries. This narrative review was reported following the PRISMA Scoping Reviews’ (PRISMA-ScR) Checklist.

3. Current Discoveries of Eating Disorders

3.1. anorexia nervosa (an).

AN is an eating disorder that is characterized by strict restrictions of food intake, leading to abnormally low body weight and an intense fear of gaining weight [ 12 ]. While past epidemiological studies have focused on young women in Western countries, anorexia nervosa has been reported in men and women of all ages worldwide. This eating disorder may increase the risk of death fivefold or more [ 5 ]. AN is seen as a result of its psychological profile: the drive toward thinness and physical dissatisfaction. AN shows significant heritability as family studies have shown a substantial prevalence of AN in the first-degree relatives of a proband, who are about 11 times more likely to develop AN than controls [ 13 ]. Many concepts have been suggested by different scientists to explain and understand how AN is developed and maintained [ 14 ].

AN results in a notable reduction in bone mineral density (BMD) in approximately 40% of patients and a three times increased lifetime fracture risk [ 12 ]. Another noticeable skeletal phenotype concerning anorexia is the increased number and size of bone marrow adipocytes despite a lipodystrophic response. Clinically, there is a general negative correlation between BMD and bone marrow adipose tissue (BMAT). Unique fat depots are of particular interest in AN study [ 12 ]. Bone health in adolescents with AN has been extensively reviewed [ 15 ]. It is reported that non-stress fractures are more common in women with AN and stress fractures are more common in oligomenorrhea athletes with AN [ 16 ].

AN is an eating disorder characterized by chronic energy deprivation leading to suppression of the hypothalamic–pituitary–gonadal (HPG) axis owing to decreased gonadotropin-releasing hormone (GnRH) secretion, as observed in functional hypothalamic amenorrhea (FHA) [ 13 ]. Common variants of neurotrophic signaling genes, including brain-derived neurotrophic factor (BDNF), NTRK2, and NTRK3, appear to lead to receptivity to eating disorders [ 17 ]. Given the close association between FHA and AN and the evidence that food restriction is one of the major risk factors for the development of FHA, it can be hypothesized that genetic variants involved in satiety, appetite, and weight regulation may be responsible for the physical and/or psychological effects, as well as the differential response to stressors and the consequent suppression of the FPG axis [ 13 ].

AN is associated with neuroendocrine and immune system abnormalities. For example, leptin, an essential appetite modulator involved in AN development, also regulates immune responses through microglia-induced inflammation by increasing the expression of tumor necrosis factor-α (TNF-α) and interleukin-1b (IL-1b) [ 18 ]. Additionally, activity-based anorexia (ABA), an AN model in rodents, reduces cortical astrocyte density, suggesting that astrocyte loss and subsequent neuroinflammation may be involved in the neurobiology of anorexia [ 19 , 20 ]. Astrocytes may participate in eating disorders through their regulation of neurotransmitters such as dopamine and serotonin, which are known to play a role in the regulation of appetite and food intake. Astrocytes can regulate these neurotransmitters by taking up dopamine or serotonin and releasing it if necessary. Astrocytes can also modulate the activity of the dopamine neurons or serotonin neurons that produce them. Conversely, restoring glia-mediated neuroinflammation has been shown to increase glutamate transporter expression and ameliorate diet-induced anorexia (DIA) and ABA vulnerability in rodents [ 21 ]. Based on evidence from mouse models of anorexia nervosa, glial cells have been suggested as potential therapeutic targets for AN [ 19 , 20 , 22 ]. Some other therapeutic targets that focused on neurons were also reported. A recent study that focused on dopamine (DA) and serotonin (5-HT) neurons revealed that feeding behavior is regulated by intensity-dependent interactions between 5-HT neurons and DA, which could contribute to the pathophysiology of AN [ 23 ]. Hickey et. al. reported that agouti-related peptide (AgRP) releasing neuron activity in ABA animals showed a poor inhibitory response to food, independent of changes in basal activity [ 24 ]. AN may also be conceptualized as a form of genetic resistance to hunger, thus allowing for a particularly strong personal commitment to perpetuate food restriction [ 25 ]. High circulating leptin concentrations indicate that a positive metabolic balance associated with endocrine changes significantly and rapidly improves several symptoms of anorexia, including increased body agitation and the impulse to move. The proposed hypothesis is testable and could be incorporated into the design of future double-blind placebo-controlled studies using leptin as a treatment strategy in AN [ 26 , 27 ].

Both anxiety and depressive disorders may predispose human subjects to AN according to epidemiological data and genome-wide association studies. Furthermore, genome-wide association studies have shown that metabolic factors play a key role in AN [ 14 ]. Based on current knowledge, it is reasonable to hypothesize that the gut microbiota–brain (GMB) axis disturbance is the core pathology of AN, and that alterations in the gut microbiota caused by malnutrition could be an early step in the pathogenesis of AN. Understanding the effectiveness of interventions designed to restore normal regulation of eating behaviors in patients with AN is critical [ 14 ].

In conclusion, AN has been an eating disorder epidemic in adolescent and adult women worldwide for decades. AN requires more surveys and scholarly investigations to allow us a more comprehensive understanding. Overall, there is still much we do not understand about AN, and further research is required to improve our understanding of the disorder and to develop more effective treatments. Future studies could also investigate other neural mechanisms that will explain more unknowns in the field of AN.

3.2. Bulimia Nervosa (BN)

In 1979, bulimia nervosa (BN) was first described by British psychiatrist Gerald Russell as a chronic phase of anorexia nervosa. BN is characterized by binge eating followed by compensatory mechanisms including self-induced vomiting, prolonged starvation, laxatives, etc. It was reported that the estimated lifetime prevalence of BN ranges between about 0.3% and 1.6% according to the studies conducted in the USA [ 28 ]. A systematic review reported a lifetime prevalence of 0.8% for BN. Females and young adults are more prevalent in all eating disorders, with a female-to-male ratio between 3:1 and 8:1 [ 29 , 30 ].

BN is characterized by occasional binge eating and purging behavior. Neural processes of self-regulation, gustatory reward, and body image are thought to be implicated in the pathogenesis of BN. The study by Wang et al. showed that patients with BN exhibited abnormal increases in multiple left nodes in the mesolimbic reward circuit, lateral temporo-occipital cortex, precuneus, and right nodes in the dorsolateral prefrontal cortex [ 31 ]. A decrease in global efficiency was observed in cortical limbic circuits and somatosensory and visuospatial systems. Several corticolimbic nodules were significantly associated with BN symptoms. Their study showed BN-related changes in prefrontal control, mesolimbic reward, somatosensory structures, and white matter connectivity in the visuospatial system [ 32 ]. The aversive interoceptive experiences may be specifically associated with the pathophysiology of BN because it is well documented that there is link between avoidance of unpleasant physical sensations and BN symptoms. During aversive homeostatic perturbations, excessive anticipatory responses and abnormally reduced responses have been shown to promote hallmark binge eating behaviors such as overeating, dietary restriction, and purging [ 33 ]. Several studies give support for homeostatic instability in BN, and these altered brain activation patterns may become new targets for pharmacology, neuromodulators, and behavioral interventions [ 33 ].

When subjected to food stimulation, BN patients display less inhibitory control. Binge eating can also be used for the diagnosis of BN in clinical studies. Thus, some appetite-related hormones that regulate feeding behavior have also been extensively studied [ 34 ]. It has been suggested that abnormal ghrelin responses to satiety may lead to binge eating behaviors in patients with BN. Another hormone called leptin is produced by fat cells. Leptin suppresses appetite and causes satiety. Many findings have shown that leptin levels are significantly lower in BN patients than in healthy controls [ 35 , 36 ]. In the acute fasting and refeeding trials, plasma leptin levels were consistently significantly lower in BN patients than in healthy controls. Notably, fasting-induced reduction in circulating leptin is also significantly different, with 58% in healthy control women and only 7% in women with BN. These studies suggest that ghrelin and leptin are important in the development of BN, opening the door to further understanding of how appetite-related hormones interact with BN [ 37 ]. Besides ghrelin and leptin, asprosin, a novel orexigenic adipokine, may also contribute to the development of BN. Hu et al. first reported plasma asprosin concentrations in BN patients, and their study showed that overeating and uncontrolled eating are associated with increasing asprosin concentrations. In addition, increases in asprosin levels and increased depression may explain the increased frequency of loss of control [ 37 ].

Further, some additional references have reported that a neurotransmitter can be used in the treatment of BN. Mihov et al. presented the first evidence for increased metabotropic glutamate receptor subtype 5 (mGlu5), which plays a vital role in addiction distribution-to-volume ratio (DVR) in BN [ 38 ]. Their findings suggested that drugs that inhibit mGlu5 may have therapeutic potential for BN.

Subcortical shape abnormalities were examined in a large sample of adolescent and adult BN patients by Berner et al.’s study [ 33 ]. Their findings suggested a link between morphological changes in the basal ganglia structure and BN symptoms. This precise localization of subcortical morphometric changes may ultimately aid in the identification of risk markers and BN persistence, which is the first step in determining the trajectory of BN or specific structural markers for maintenance from adolescence to adulthood [ 39 , 40 ].

BN is a severe mental illness with prospectively dangerous complications. Family relationships play a critical role in the development or persistence of the condition. To gain a better grasp of the role of food in family interactions among BN adolescents, Lecomte et al. studied the dynamics of their families in contrast to those of adolescents with anorexia nervosa. It confirmed the need for a systemic approach beyond individual therapy and the benefits of establishing family interactions that do not involve food to rebuild communication, including those with siblings [ 41 ].

It appears that changes in the microbiota modulate appetite regulation in patients with BN. Unlike AN, BN is noticeably lacking in data. Although BN is also a life-threatening disease, studies have assessed the part of the microbiome in BN that focused only on the bacterial ClpB protein in patients and did not investigate differences in gut microbiota from healthy control groups. Like AN, patients had higher plasma ClpB levels than in healthy control groups. E. coli-produced ClpB can mimic α-MSH and stimulate autoimmune responses. BN differs from AN in the switching of IgG autoantibody epitopes that form immune complexes in BN patients [ 28 , 42 ].

Data proves that, except for BN, the prevalence of food addiction (FA) is higher in binge eating disorders than in other EDs. People affected by eating disorders were more likely to be addicted than those with bulimia, even though the results were not statistically significant. BN, FA, and BED have overlapping symptoms that may lead to these outcomes. Several studies support the description of BN as an addiction-like eating behavior, reinforcing the addictive nature of the disorder [ 43 , 44 , 45 ].

In summary, BN is a severe, potentially life-threatening eating disorder with less known pathophysiology mechanisms. BN is hard to beat but effective treatment can help individuals eat healthier, reverse serious complications, and feel better. More deep research is needed to improve our understanding of BN and to develop more effective treatments for the BN disorder.

3.3. Binge Eating Disorder (BED)

BED is described as the intake of lots of food in a short time, typically with a preference for highly palatable foods, affecting about 5% of American adults [ 46 ]. It is unclear what causes binge eating in humans, and there are limited effective treatments for BED patients. In the development of BED in humans, impaired brain serotonin (5-HT) signaling has been observed. For example, increased brain 5-HT re-uptake was found in binge eating patients, thus lowering 5-HT content [ 47 ]. In addition, the role of the 5-HT precursor L-tryptophan is significantly diminished in binge eating patients, possibly because of dysfunction of the 5-HT receptor and/or tryptophan hydroxylase-2 (TPH2), the enzyme that synthesizes 5-HT in the brain [ 48 ].

Binge eating is an important public health problem because of its close relation to other medical and psychiatric disorders, especially obesity and depression. Developing more effective binge eating treatments is an urgent need [ 46 ]. The neuronal matrix of binge eating can sometimes contribute to obesity, but the mechanism is not yet known. Zhang et. al. discovered [ 49 ] that optogenetic activation of immediate overeating was caused by γ-aminobutyric acid (GABA) neurons or their axonal projections to paraventricular thalamic (PVT) excitatory neurons in the amorphous zone (ZI) of mice [ 50 ]. Minimal intermittent stimulation of ZI GABA neurons resulted in weight gain, while ablation of these neurons reduced weight. Additionally, stimulation of excitatory axons from the hypothalamic nucleus to the paraventricular thalamic neurons or direct stimulation of paraventricular thalamic glutamate neurons reduced food intake. Their data suggest that ZI GABA neurons have unexpected orexigenic potential [ 49 , 51 ].

As the most diagnosed eating disorder, BED affects more than three times the number of women than men. A gut-secreted hunger hormone called ghrelin is altered in BED. Prins et al.’s research showed that ghrelin deficiency affects behavior and metabolism in binge eating mice [ 52 ]. Ghrelin deficiency does not affect the development of BED; it will alter the timing of food intake, motor activity, and metabolism. However, the interaction of ghrelin and BED in different sexes has not been fully elucidated [ 52 ]. When overweight human subjects were compared to normal weight subjects during and after the Trier Social Stress Test (TSST), Micioni Di Bonaventura et al. found BED patients had increased ghrelin levels [ 53 ]. The ghrelin system and ghrelin O-acyltransferase (GOAT) enzymes are increasingly complex regulations involving food regulation, and hunger stimuli, food choice, and obesity may play a key role in bulimia, triggering reinforcement mechanisms associated with food rewards and impulsive behavior [ 53 , 54 ].

Dopamine is another peptide that may be involved in BED. Yu et al. reviewed some important parameters of dopamine in BED animals and humans including dopamine receptor availability/affinity, dopamine activity, and dopamine modulator levels/activity [ 55 ]. While most studies supported these changes, the direction of the change is unclear. In future studies, it will be beneficial to carefully control for confounding variables. More importantly, some vertical studies are needed to test if a transition from a dopaminergic to a hypodopaminergic state occurs during BED development. If possible, researchers could test whether genotype modulates the relationship between BED and dopamine [ 55 ].

Binge eating episodes, characterized by uncontrollable and painful consumption of large amounts of palatable food, are the cardinal features of binge eating disorder. The inflammatory markers are altered in discrete brain regions that could contribute to food intake. Alboni et al. found that binge-like eating significantly downregulated the IL-18 or receptor system, as reflected by increased expression of the pro-inflammatory cytokine IL18 inhibitor and reduced expression of the IL-18 binding chain 18 receptors, and increased the expression of iNOS by threefold, particularly in the anterior tuberculous region of the animals’ hypothalamus [ 56 ]. Their data suggest the therapeutic potential to centrally target selected markers of inflammation to prevent the development of eating disorders.

BED is also very common in obesity and type 2 diabetes (T2DM) patients and is often associated with higher BMI [ 57 ]. Studies have shown that up to 20% of people with T2DM have an underlying BED. The prevalence of BED appears to be much higher in patients with T2DM than the prevalence of 2% to 3.5% in the general population [ 58 ]. Researchers have found medications that significantly decrease the frequency of binge eating and overweight. Abbott et al. demonstrated that a significant proportion of adults with pre-existing T2DM have clinical BED [ 57 ]. More studies are needed in exploring the importance of BED in the treatment of T2DM and development of long-term diabetic complications. If health providers are able to screen and diagnose eating disorders in human subjects in the early stage, they could provide novel antidiabetic therapies for them [ 57 ].

Recent randomized controlled findings have suggested improvements not only in overeating and purging episodes related to the diagnostic dimensions implicated in BED but also in food-related emotional responses in terms of anxiety and food cravings [ 59 , 60 ]. Although BED is common and limited treatment options exist, recurrence rates after treatment are often high. However, the neurobiological mechanism of BED is still less understood [ 50 ]. Hildebrandt and Ahmari examined preclinical approaches by breaking them down into two clinically significant bulk food components: short-term food consumption and loss of dietary control [ 50 ]. They suggested that the guidelines identify the most common and effective methods for modeling components of BED behavior using preclinical methods. How current preclinical models can be combined with techniques using targeted neurobiological approaches are discussed in their work. They suggested that proposed ways are needed to improve the translation of preclinical work into human studies of BED to enhance understanding of BED behavior [ 50 , 61 ].

Obesity is a major global public health problem, and its prevalence has been steadily increasing over the past few decades. The World Health Organization reported that more than 1.9 billion adults worldwide are overweight, and more than 650 million of them are obese. In addition, an estimated 41 million children under the age of five are overweight or obese. It was reported that obesity is a major risk factor for premature mortality [ 62 , 63 ]. In addition, obesity is associated with a higher risk of developing several chronic conditions that can lead to premature death, such as cardiovascular disease, type II diabetes, and some cancers [ 64 , 65 ]. Based on the scientific evidence presented so far, tailored comprehensive multidisciplinary treatment is essential to provide adequate care for patients with obesity and BED by addressing their overweight and its consequences. This interdisciplinary approach should combine a structured lifestyle treatment plan with healthy meal planning, PA, and behavioral interventions, according to a multidisciplinary team of experts [ 66 , 67 ]. They suggested that measurements for multidisciplinary interventions of adolescents with BED should consider weight loss as well as behavioral and mental improvements. More research should focus on the physical and mental effects of different forms of exercise [ 68 , 69 ]. Binge eating may be a behavior designed to reduce chronic stress resulting from repetitive negative thinking focused on eating or not dependent on eating. Although clinical models may partially support these hypotheses, further research is needed to directly test these hypotheses [ 70 , 71 , 72 ].

Lisdexamfetamine dimesylate (LDX) is currently the only drug approved by the FDA for the treatment of BED [ 73 ]. Still, little is known about the behavioral mechanisms underpinning the effect of LDX in the treatment of BED. Schneider et al. were the first to document the behavioral and neurological characteristics of the effects of a dose of 50 mg Lisdexamfetamine dimesylate in binge eating women [ 74 ]. They found that LDX has multiple effects on enhancing satiety, reducing responses related to food rewards, and improving cognitive control. Their results underscored the potential effect of the thalamus in mediating LDX to reduce appetite. This was achieved by altering the balance of extrinsic and interoceptive control. These data support the conclusion that new drugs (such as LDX) used for BED treatment may be most effective if their effects on satiety, reward, and cognitive processes are combined [ 74 , 75 ]. Based on the current range of studies, new drugs to treat BED are expeditiously needed. Heal et al. discussed the similarities in the psychopathology of attention deficit hyperactivity disorder (ADHD) and BED, and the pharmacology of drugs that have been shown to be effective in the treatment of both disorders [ 76 ]. Drugs that enhance noradrenergic and dopaminergic neurotransmission and/or are effective in ADHD are the most promising areas for new treatments for BED, analysis suggests. The lipid-derived messenger oleoylethanolamide (OEA) acts through central noradrenergic and oxytocinergic neurons to signal satiety that inhibits food intake. A recent study investigated the anti-binge effects of OEA in a rat model of binge-like eating. The results showed that systemically administered OEA prevents overeating in a dose-dependent manner [ 77 ]. They provided evidence that OEA may be a new potential pharmacological target for the treatment of binge eating behavior.

To summarize, BED is a severe mental illness worldwide. It is the most common eating disorder in the USA and can have serious physical and mental consequences. Risk factors for developing BED include a history of dieting, body dissatisfaction, and a family history of eating disorders or other psychological health conditions. Antidepressant medications may help reduce binge eating behaviors in some people with BED. However, more research is needed to develop more effective treatments for BED with fewer side effects.

3.4. Treatments of Eating Disorders

Over the past 20 years, the eating disorders field has made significant progress in successfully translating basic eating disorders risk factor research into preventive interventions with significant potential to reduce its risk factors, symptoms, and future ED episodes. Efficacy has been documented in multiple randomized controlled trials [ 78 , 79 ]. Treatment for eating disorders often involves a combination of psychotherapy, medication, and nutritional counseling ( Table 1 ). Specifically, cognitive–behavioral therapy is a common form of psychotherapy that can help individuals with eating disorders change their negative thought patterns and behaviors related to food and body image. Antidepressant and antipsychotic medications may also be prescribed to help manage the emotional and psychological symptoms of the disorder.

Treatments of different eating disorders.

4. Discussion

4.1. limitations of the current eating disorders research.

In recent decades, there has been significant progress achieved in eating disorder research through both basic and clinical research. On the one hand, several animal models have been developed for AN and BED. Research has also shown that there are biological factors that contribute to the development of eating disorders. For instance, researchers have found that individuals with anorexia nervosa have alterations in brain structure and function, as well as abnormal levels of certain hormones and neurotransmitters. More and more studies are focusing on prevention strategies for eating disorders. Body-positive curricula are used for promoting a positive body image and preventing the development of eating disorders. On the other hand, ongoing research is looking for more effective treatments for eating disorders in humans. In addition to CBT, other treatments such as family-based therapy and interpersonal psychotherapy have been shown to be effective for certain types of eating disorders. More importantly, new treatments, such as virtual reality therapy and medication have also been introduced for eating disorder treatment.

However, there are also some limitations to eating disorder research. For example, there is no good animal model for AN, BN, or BED eating disorders in basic science research. One reason could be that eating disorders are complex disorders that involve a merger of biological, psychological, and social factors. Animal models are often limited in their ability to capture the complexity of human behavior and psychology. Additionally, animal models may not fully replicate the environmental and social factors that contribute to the development of eating disorders in humans. Unlike human patients, animals cannot report their own symptoms, which makes it difficult to determine whether an animal is experiencing an eating disorder. Furthermore, the definition and classification of eating disorders in humans have evolved over time, making it difficult to establish a standardized set of criteria for an animal model. In clinical research, the limitations include small sample sizes, self-report biases, recruitment biases, and lack of diversity. More importantly, the underlying mechanisms of eating disorders are still unknown. This gap makes it very hard to move clinical research forward in a short time. While significant progress has been made in understanding the neurobiological, psychological, and environmental factors that contribute to eating disorders, there is still not much we know. Further research is needed to better understand the underlying mechanisms of eating disorders and to develop more effective treatments.

4.2. Future Direction of Eating Disorder Research

Considering the refractory nature of ED and the lack of evidence-based treatment, there is an urgent need to identify new approaches. The noncompetitive N-methyl-D-aspartate receptor antagonist ketamine, recently approved for treatment-resistant depression, has rapid and potent antidepressant effects [ 3 ]. The evidence presented by Ragnhildstveit et al. provides a conceptual but succinct summary of the use of ketamine for the treatment of ED [ 8 ]. Ketamine may provide the greatest utility in clinically unresponsive individuals who are resistant to the psychological, dietary, and pharmacological interventions used in standard practice and are prone to long-term ED disorders. Further studies are needed to explore the efficacy of ketamine on ED and its psychopathology, especially in terms of different subgroups, types of diagnostic dependency severity, and lifespan. These data can then be used to build safety profiles, optimize dosing, and provide targeted treatment strategies at the individual patient level [ 3 ].

More research is needed to discover the genetic component of eating disorders, as it is genetically linked to immune system dysfunction, which can have serious repercussions. Certain groups of people appear to be particularly susceptible to eating disorders; however, all people affected by this disorder experience severe physical manifestations. Although numerous studies have been conducted to investigate the adverse effects of eating disorders, more studies are needed to better understand the long-term effects and address the appropriate treatment of eating disorders [ 121 ]. Future research could focus on identifying specific genetic factors affecting the development of eating disorders, as well as exploring the interaction between genetics and environmental factors.

The COVID-19 pandemic, which is associated with social restrictions, has profoundly affected people’s psychological health. It can be hypothesized that the symptomatic behavior and psychological health of eating disorder patients deteriorated during this period. Future longitudinal studies are needed to determine whether increased depression or anxiety contributes to ED symptoms, or whether patients with existing mental illness use unhealthy eating behaviors as a response mechanism in the absence of a sense of control. This question has important implications for understanding how severe psychosocial stress affects ED symptoms in the entire population. An understanding of the mechanisms associated with dietary habits will guide us to make more targeted and empowered public health decisions to manage ED. In addition, methods to improve online therapy in the future should also be introduced [ 122 ]. The study by Gorrell et al. provides an overview of research focused on teletherapy in EDs, with a particular focus on how the COVID-19 pandemic has affected interest and job demand in the field [ 123 ]. Overall, larger randomized designs are needed.

Last but not least, future research could focus on developing and testing new treatments, including pharmacological, behavioral, and psychosocial interventions. It is critical to develop more new treatments for eating disorders, as most of the current treatments are not always effective for every patient. For example, researchers may develop some new medications that modulate the levels of neurotransmitters such as serotonin or dopamine. Researchers could also investigate the potential use of medications that regulate hormones such as ghrelin or leptin, which are involved in appetite regulation. More importantly, newer forms of CBT, such as enhanced CBT (ECBT), may be more effective than traditional CBT for some individuals with eating disorders.

5. Conclusions

This narrative review aims to summarize the current discoveries and progress on three different eating disorders: AN, BN, and BED. Current research on eating disorders has uncovered many important findings, including the causes, risk factors, and effective treatments for these complex mental health conditions. For example, eating disorders have multiple causes, including biological factors such as genetics and brain chemistry, mental factors such as body image and self-esteem, and social factors, for instance, societal pressure to lose weight and cultural messages about body shape and size. Early intervention and treatment for eating disorders will achieve better outcomes and reduce the risk of chronic health problems and relapse. Proper medications (e.g., antidepressants, antipsychotics, and mood stabilizers) can be helpful for the treatment of BN and BED.

Recent research on eating disorders has highlighted the complexity of these conditions including the significance of early period intervention measures in treatment, the role of genetics and social factors, and the impact of the COVID-19 pandemic. Eating disorders are associated with a range of negative health outcomes, including malnutrition, heart problems, and gastrointestinal issues. Eating disorder prevalence is increasing worldwide, with more individuals being diagnosed each year. It is important for people with eating disorders to seek professional help and for society to continue to raise awareness and provide support for those affected by these conditions.

In conclusion, eating disorders are severe mental conditions that can have serious impacts on an individual’s physical and mental health. The current discoveries on eating disorders suggest that these are complicated psychological health conditions that are influenced by a range of genetic, environmental, and psychosocial factors. Published references indicate that eating disorders affect people of all ages, genders, and cultural backgrounds. Although the exact cause of these disorders is not completely understood, a combination of genetic, environmental, and psychological factors is thought to play a role. There are several effective treatments for eating disorders, including psychotherapy, medication, and nutrition counseling, but not all individuals respond equally well to these interventions. Early intervention is key in treating eating disorders, as the longer an individual goes without treatment, the more difficult it can be to achieve full recovery.

Overall, current discoveries on eating disorders suggest the need for continued research into the underlying causes, risk factors, and effective treatments for these complex mental health conditions. With continued research, it is hoped that individuals with eating disorders will receive the support and care they need to achieve a full recovery.

Funding Statement

Y.H. is supported by institutional grants from Pennington Biomedical Research Center at Louisiana State University.

Author Contributions

Conceptualization, B.F., P.X. and Y.H.; writing—original draft preparation, B.F., J.H., E.C. and P.G.; writing—review and editing, P.X. and Y.H.; visualization, B.F. and E.C.; supervision, Y.H.; project administration, Y.H. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Informed consent statement, data availability statement, conflicts of interest.

The authors declare no conflict of interest.

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• Open access
• Published: 15 February 2023

Epidemiology of eating disorders: population, prevalence, disease burden and quality of life informing public policy in Australia—a rapid review

• Phillipa Hay 1 , 6 ,
• Phillip Aouad 2 , 3 ,
• Anvi Le 4 ,
• Peta Marks 2 ,
• Danielle Maloney 2 , 5 ,
• National Eating Disorder Research Consortium ,
• Stephen Touyz 2 &
• Sarah Maguire 2  

Journal of Eating Disorders volume  11 , Article number:  23 ( 2023 ) Cite this article

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Understanding of the epidemiology and health burden of eating disorders has progressed significantly in the last 2 decades. It was considered one of seven key areas to inform the Australian Government commissioned National Eating Disorder Research and Translation Strategy 2021–2031, as emerging research had highlighted a rise in eating disorder prevalence and worsening burden-of-illness. The aim of this review was to better understand the global epidemiology and impact of eating disorders to inform policy decision-making.

Using a systematic Rapid Review methodology, ScienceDirect, PubMed and Medline (Ovid) were searched for peer-reviewed studies published between 2009 and 2021. Clear inclusion criteria were developed in consultation with experts in the field. Purposive sampling of literature was conducted, which predominately focused on higher-level evidence (meta-analyses, systematic reviews, and large epidemiological studies), synthesised, and narratively analysed.

135 studies were deemed eligible for inclusion in this review (N = 1324). Prevalence estimates varied. Global Lifetime prevalence of any eating disorder ranged from 0.74 to 2.2% in males, and 2.58–8.4% in females. Australian 3-month point-prevalence of broadly defined disorders was around 16% in females. Eating disorders appeared more prevalent in young people and adolescents, particularly females (in Australia: eating disorders ~ 22.2%; disordered eating ~ 25.7%). Limited evidence was found on sex, sexuality and gender diverse (LGBTQI +) individuals, particularly males, who had a six-fold increase in prevalence compared to the general male population, with increased illness impact. Similarly, limited evidence on First Australian’s (Aboriginal and Torres Strait Islander) suggests prevalence rates similar to non-Indigenous Australians. No prevalence studies were identified specifically assessing culturally and linguistically diverse populations. Global disease burden of any eating disorder was 43.4 age-standardised disability-adjusted-life-years per 100,000; increasing by 9.4% between 2007 and 2017. Australian’s total economic cost was estimated at $84 billion from years-of-life lost due to disability and death, and annual lost earnings ~ $1.646 billion.”

Conclusions

There is no doubt that eating disorder prevalence and impact are on the rise, particularly in at-risk and understudied populations. Much of the evidence came from female-only samples, and Western, high-income countries which more readily have access to specialised services. Future research should examine more representative samples. There is an urgent need for more refined epidemiological methods to better understand these complex illnesses over time, to guide health policy and development-of-care.

Plain English summary

Our understanding of the prevalence and impact of eating disorders has improved significantly over the past 20-years. Research highlights that rates of eating disorders are increasing. To inform the development of the Eating Disorder Research and Translation Strategy 2021–2031 this review aimed to better understand the global change in prevalence and impact of eating disorders to inform policy decision-making.

Three scholarly databases were systematically searched for related research published between 2009 and 2021. Searches identified 135 studies which met our inclusion criteria. Estimates in lifetime eating disorder prevalence varied from 2.58 to 8.4% in women and girls. Findings indicated that eating disorders appeared more prevalent in young people and adolescents, particularly young women, while sexuality diverse (LGBTQI +) individuals were six-times more likely to have an eating disorder compared to the general male population. The little research suggests moderate to high prevalence of eating disorders in First Australian peoples, Australia’s spending on eating disorders was estimated at ~ $84 billion due to disability or death. There is no doubt that eating disorder prevalence and impact are on the rise. Future research should include more diverse populations to increase estimate accuracy and improve care for all.

Introduction

The epidemiology of eating disorders (EDs) has advanced in recent years to encompass both the ‘core’ well-specified EDs, namely Anorexia Nervosa (AN; ICD-11 Code: 6B80), Bulimia Nervosa (BN; ICD-11 Code: 6B81) and Binge Eating Disorder (BED; ICD-11 Code: 6B82) but also the spectrum of Other Specified (ICD-11 Code: 6B8Y) and Unspecified (ICD-11 Code: 6B8Z) Feeding and Eating Disorders (OSFED and UFED) and Avoidant Restrictive Food Intake Disorder or ARFID (ICD-11 Code: 6B83) [ 1 ]. Nevertheless, AN, BN and BED continue to have the largest evidence base and are commonly reported together in prevalence studies. BED and ARFID were only introduced as standalone disorders in the 2013 fifth edition of the Diagnostic and Statistical Manual of Mental Disorders [ 1 , 2 ]. Prior to the DSM-5, BED (ICD-11 Code: 6B82) was described as a subtype of Eating Disorder Not Otherwise Specified (EDNOS) [ 1 , 3 ]. Other Specified Feeding and Eating Disorders (OSFED; ICD-11 Code: 6B8Y) as defined in the DSM-5 include Atypical AN (A-AN); Subthreshold BN (S-BN); Subthreshold BED (S-BED); Night Eating Syndrome (NES), and Purging disorder (PD) [ 1 ].

The understanding of the population distribution and community burden of EDs has shifted notably in the last 2 decades. No longer can it be said that EDs are a problem only for young women from the developed world, a perception dating from the times of Bruch, who wrote that anorexia nervosa (AN) “… affects young and healthy girls who have been raised in privileged, even luxurious circumstances ” [ 4 ]. There is a growing body of evidence that EDs and their related behaviours are prevalent amongst peoples from lower-income groups, non-Western cultures, and of diverse gender [ 5 , 6 , 7 , 8 ]. Alongside this is research indicating a rise in prevalence and global burden of EDs [ 9 ]. In consideration of this, the prevalence and burden of EDs was considered one of seven key areas to inform the Australian Federal Government’s commissioning of The Australian Eating Disorder Research and Translation Strategy (AEDRTS) that aimed to identify strategic priorities and targets for building research capacity and outputs in Australia [ 10 ].

EDs are often chronic in nature and typically have an early age of onset with periods of recovery and relapse across the lifespan [ 11 , 12 ]. There is substantial evidence that almost all first-time cases of well-specified EDs occur before the ages of 20 to 30 [ 11 , 13 , 14 ]. Therefore, the measured prevalence rates between age groups vary significantly. The highest prevalence rates are observed in children and adolescents. However, there is emerging evidence that prevalence of well-specified EDs is increasing among older adults [ 15 ].

The present paper is one of a series of Rapid Reviews, with the focus of the current paper on the epidemiology of EDs, specifically their prevalence and incidence, sociodemographic and ethnic distribution, and disease burden and impact on quality of life. The rapid reviews featured in this series, were conducted to guide the AEDRTS, and were completed over 2019–2021, in parallel and synergy with a multi-layered, multi-phased nation-wide co-designed strategy development process. Thus, the current paper aims to better understand the global epidemiology and impact of eating disorders to inform policy decision-making.

The Australian Government funded the InsideOut Institute for Eating Disorders (IOI) to develop the AEDRTS 2021–2031 [ 16 ] in partnership with state and national stakeholders including clinicians, service providers, researchers, and experts by lived experience (encompassing consumers and families/carers). Developed through a 2-year national consultation and collaboration process, the strategy provides a roadmap to establishing EDs as national research priority and is the first disorder-specific strategy to be developed in consultation with the National Mental Health Commission. To inform the strategy, IOI commissioned Healthcare Management Advisors (HMA) to conduct a series of Rapid Reviews (RRs) to assess the current research base across the full spectrum of EDs; including knowledge gaps in ED (1) epidemiology; (2) risk factors; (3) comorbidities and medical complications; (4) screening and diagnosis; (5) prevention and early intervention; (6) psychotherapies; (7) models of care; (8) pharmacotherapies and (9) outcomes. The current paper presents the findings related to the epidemiology of EDs specifically on population trends and incidence, prevalence, disease burden and quality of life.

A RR protocol [ 17 ] was utilised to synthesise evidence in order to provide timely guidance to public policy and decision-making [ 18 ]. This approach has been adopted by several leading health organisations including the World Health Organisation [ 19 ] and the Canadian Agency for Drugs and Technologies in Health Rapid Response Service [ 20 ], to build a strong evidence base in a timely and accelerated manner, without compromising quality. A RR is not designed to be as comprehensive as a systematic review—it is purposive rather than exhaustive and provides actionable evidence to guide health policy [ 21 ].

The RR is a narrative synthesis and sought to adhere to the PRISMA guidelines [ 22 ]. It is divided by topic area and presented as a series of papers. Three research databases were searched: ScienceDirect, PubMed and Ovid/Medline. Included studies were published between 2009 and 2021, in English, and conducted within Western healthcare systems or health systems comparable to Australia in terms of structure and resourcing. Purposive sampling focused on high-level evidence studies such as: meta-analyses; systematic reviews; moderately sized randomised controlled studies (RCTs) ( n  > 50); moderately sized controlled-cohort studies ( n  > 50), and population studies ( n  > 500). Grey literature, such as clinical or practice guidelines, protocol papers (without results) and Masters’ theses or dissertations, was excluded. Instrument validation studies and studies commenting on the current Diagnostic and Statistical Manual of Mental Disorders ( DSM-5 ) criteria for EDs were also excluded as they were not seen to be relevant to the patient-care focus of the review. Other sources included the personal libraries of authors, which yielded four additional studies (Fig.  1 ). This was conducted in line with the PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews [ 23 ].

PRISMA flow-chart of included studies

Full methodological details including eligibility criteria, search strategy and terms, consort diagram, and data analysis are published in a separate protocol paper, which included a total of 1320 studies [ 10 ]. Data from included studies relating to Epidemiology are presented in the current review.

Study characteristics and quality overview of included studies

The search identified 135 papers (Table 1 ) related to the epidemiology of EDs, of which four were meta-analyses of ED global prevalence, including in non-western populations [ 9 , 24 , 25 , 26 ]. One systematic review was identified that provided prevalence ranges from reviewed studies [ 27 ]. The search also found 31 primary studies of prevalence which are summarised in Additional file 1 : Table S1 (range of population measures for EDs) and Additional file 1 : Table S2 (trial features). Findings comprised a wide range of studies conducted in both community-based samples as well as clinical samples. Thus, the estimates derived in this RR show a wide variance in reported prevalence and incidence rates. Other factors contributing to the varied ranges reported include different methods of measurement (e.g., self-report, diagnostic interviews or formal diagnoses obtained through health system registries) and study designs.

Sampled populations were from predominately developed Western countries, with a majority of studies (N = 179) coming from the United States of America (n = 40, 22.3%), Europe (n = 87, 48.6%), and Australia (n = 11, 6.1%). Figure  2 presents a breakdown of included studies by country.

Countries included in meta-analyses and review of global prevalence rates

Diversity of study design and quality considerations

Additional file 1 : Table S1 highlights that, as may be expected, studies that used self-report to identify cases reported higher prevalence and those that employed interviews demonstrate more consistent prevalence rates. Of the included reviews, Dahlgren et al. [ 27 ] presented prevalence across design types examining studies that used a 2-stage design, interview and self-report data. Galmiche et al. [ 9 ] commented that although the majority (51%) of included studies in their meta-analyses (shown in Table 2 ) did not present pooled data by study design, the majority had used an interview assessment. Notably, 13% used the Structured Clinical Interview for DSM Disorders (SCID); 12% the Composite International Diagnostic Interview (CIDI); and 11% the Eating Disorder Examination. Furthermore, changes to diagnostic criteria have contributed to shifting prevalence rates even within the same study population.

Notwithstanding the variability in the incidence and prevalence of different EDs in the Australian and global population, it is clear that EDs have a significant effect on the health and quality of life of a wide range of individuals across all demographic categories. Evidence presented in this RR is by life stage (“children and young people” and “adults and older people”) to allow for more direct comparison between study populations. We also present evidence (or lack thereof) for specific population cohorts of interest including well-specified EDs in males, Aboriginal and Torres Strait Islander people, and among the LGBTQI + community. No studies could be identified that reported on the prevalence of well-specified EDs in the culturally and linguistically diverse (CALD) communities of Australia. It is particularly important to consider these populations, as observed longitudinal trends from 1997 to 2010 suggest that patients presenting to ED services are increasingly male and non-Caucasian [ 112 ].

Ages of participants included in studies were generally consistent across studies, including children and adolescents from the age of 11 to 19 or 20. Exceptions were two cohorts, one from Finland (Nagl et al.) where participants were aged 14 to 24, and the other from the US (Rozzell et al.) where participants were significantly younger, aged 9 and 10 [ 108 , 118 ].

Incidence and prevalence

Most information on incidence is derived from clinical registries and surveillance samples and needs to be interpreted in the context of the age range of the sample. A longitudinal Swedish study (n = 286,232) reported a peak age of onset between 15 and17 years, with an incidence rate for all EDs, of 698/100,000 years in females and 55/100,000 years in males [ 34 ]. A longitudinal registry study of older adolescents in Denmark (n = 966,141) reported peak ED incidence between 16 and 20 years with a rate of 7.84/10,000 years for AN; the peak age of onset was younger in men than women for both AN (ICD-11 Code: 6B80) and BN (ICD-11 Code: 6B81) [ 146 ]. In younger children and adolescents, the peak mean age of ED onset has been reported to be between the ages of 12 and 13 years old for ARFID (ICD-11 Code: 6B83) and for the other main EDs [ 52 , 81 , 110 ].

In a 14-month national surveillance study of UK children ≤ 13 years old, Nicholls et al. [ 110 ] reported an incidence rate of 3.1 per 100,000 person years Footnote 1 (PYs). Further analysis by age group found that incidence peaked between ages 12 and 13 years, with an incidence rate of 9.5 per 100,000 PY; this led the authors to conclude that mean age of ED onset may be getting younger overtime in the UK [ 110 ]. Similarly, in Canadian children (n = 2453, aged 5–12 years) the highest incidence rate of restrictive type EDs was in girls aged 10–12 years (9.4/100,000 PYs) [ 114 ]. The lowest incidence rate was in boys aged 5–9 years (0.4/100,000 person years) [ 114 ]. An Australian national paediatric surveillance sample also reported a younger age of onset as low as 8, and even 5, years old [ 90 ]. Additionally, this latter study found that approximately one-quarter of all new cases were male; furthermore, no significant differences were found between boys and girls in terms of age of onset, symptomology, family history or outcome [ 90 ].

Global prevalence

Table 2 summarises the prevalence estimates from the four meta-analyses and systematic reviews [ 9 , 24 , 25 , 26 ]. It should be noted that the meta-analyses by Kessler et al. [ 24 ] and Erskine and Whiteford [ 26 ] reported on BED (ICD-11 Code: 6B82) prevalence alone and not in the context of other ED. Only one study—by Galmiche et al. [ 9 ]—provided a more thorough estimate of global ED prevalence. Studies by Kessler et al. [ 24 ] and Erskine and Whiteford [ 26 ] both used data from World Health Organization (WHO) Mental Health Surveys and analysed these data against national income categories as defined by the World Bank. While findings from Kessler et al. [ 24 ] suggest that prevalence of BN (ICD-11 Code: 6B81) and BED (ICD-11 Code: 6B82) is higher in upper-middle-income countries than in high-income and lower-middle-income countries, it is limited by the inclusion of far fewer samples from lower-middle-income countries (n = 1) and upper-middle-income countries (n = 3) compared with high-income countries (n = 10) [ 24 ].

Consistent with the findings from Kessler et al. [ 24 ] a subsequent meta-analysis conducted by Erskine and Whiteford [ 26 ] found no significant differences in prevalence of BED between high-income countries and lower-middle-income countries [ 24 , 26 ]. Nonetheless, the authors did note that populations from the lower-middle-income countries included in the sample had higher obesity relative to other lower-middle-income countries, potentially contributing to the increased detection of BED (ICD-11 Code: 6B82) in these populations [ 26 ]. Reported 12-month prevalence Footnote 2 for both genders were consistent between the Kessler et al. [ 24 ] and Erskine and Whiteford [ 26 ] meta-analyses: 0.7% and 0.8%, respectively.

A systematic review of ED prevalence (as defined by the DSM-5 in non-clinical samples) in high-income countries conducted by Dahlgren et al. [ 27 ] reported prevalence ranges for AN (ICD-11 Code: 6B80), BN (ICD-11 Code: 6B81), BED (ICD-11 Code: 6B82), OSFED (ICD-11 Code: 6B8Y) and UFED (ICD-11 Code: 6B8Z) (see Additional file 1 : Table S1). Dahlgren et al. [ 27 ] noted that updates to diagnostic criteria contained in the DSM-5 resulted in an increase in individuals meeting criteria for a ‘full-threshold’ disorder. This in turn increased the prevalence of AN, BN, and BED and significantly decreased the prevalence of OSFED (previously EDNOS) [ 27 ]. Removal of the amenorrhea criterion increased diagnostic sensitivity for cases of male AN, which is also likely to have contributed to the increase in prevalence of AN following the introduction of the DSM-5 [ 27 , 149 ]. It was noted that the lower limits of prevalence ranges reported in Table 2 tend to reflect studies of all-male samples while the upper limits of ranges tend to reflect all-female samples.

Prevalence of recently specified or reclassified disorders

Ednos, osfed and ufed.

There is a much smaller evidence base for less well specified EDs compared with AN (ICD-11 Code: 6B80), BN (ICD-11 Code: 6B81), and BED (ICD-11 Code: 6B82). Table 3 shows prevalence of OSFED (ICD-11 Code: 6B8Y) and UFED (ICED-11 Code: 6B8Z) observed in all community-based studies included in this RR. Findings indicated a considerable variation across OSFED/EDNOS community prevalence studies. General population prevalence studies in adolescents (n = 9244) and adults (n = 879) conducted in the US found the lifetime prevalence of EDNOS to be 4.8% in adults and 4.6% in adolescents [ 89 ]. Even with changes to diagnostic criteria, OSFED and UFED are still common EDs.

Little evidence was available on ARFID (ICD-11 Code: 6B83) in the general population, and prevalence is generally considered uncertain [ 36 ]. Hay et al. [ 72 ] found a 3-month prevalence of 0.3% for ARFID in the Australian population. In a Swiss study involving 1444 children aged 8 to 13, the prevalence of ARFID features was 3.2% (n = 46) [ 84 ]. However, Kurz et al. [ 84 ] noted these children may not meet full DSM-5 criteria [ 84 ]. The remaining studies assessing prevalence of ARFID were conducted within North American clinical samples (Canada and the US) and none were conducted in adults. Additional file 1 : Table S2 provides a summary of prevalence rates ascertained in clinical settings.

Night Eating Syndrome (NES)

In contrast to other types of OSFED (ICD-11 Code: 6B8Y), the recently defined NES has a limited body of evidence relating to its prevalence. It has been found to range from 0.7% in adult men [ 58 ] and up to 4.9% in adolescent boys [ 150 ] (See Additional file 1 : Table S3 for a summary of prevalence rates from the four NES studies reviewed).

Purging disorder

Only one study has reported lifetime prevalence of PD, which is estimated to be at 2.1% [ 97 ]. Period- and point- prevalence is reported in Table 4 and as shown PD is more prevalent among females.

Sociodemographic distribution

In this section we present research with a primary focus on the prevalence of the main EDs.

Aboriginal and Torres Strait Islander individuals

The RR identified limited data pertinent to EDs in Aboriginal and Torres Strait Islander people [ 39 , 71 ]. Within a sample of 3047 adults randomly selected to participate in a South Australian household survey, there were a total of 159 Aboriginal and Torres Strait Islander respondents. Results indicated that ED symptoms within this group, particularly rates of binge eating, were higher than in non-indigenous people (17% compared with 6.9% for non-Indigenous people) [ 71 ]. A smaller prevalence study corroborated findings that EDs were very prevalent in First Australians, and often associated with increased binge-eating frequency, lower Mental Health Related Quality of Life (MHQoL), and higher levels of overvaluation of body shape and weight compared to other Australian’s [ 39 ].

Children and adolescents

Due to their early age of onset, there has been considerable attention to EDs in children and adolescents. As mentioned above, there is also evidence suggesting the age of onset for EDs is getting younger [ 112 , 151 ]. Data from national surveys has found that ED behaviours, including rarely studied behaviours such as chew and spit (ChSp), are widespread among Australian adolescents [ 150 , 152 ]. In one study more than one-quarter (n = 628, 25.7%) of participants (aged between 13 and 17 years old) were assessed as having disordered eating, while 11% (n = 267) had a suspected ED and 0.9% had a lifetime ED [ 124 ]. The prevalence of fear of weight gain and overvaluation of body weight were also high at 14.3% to 25.7% in 3270 Australians aged 14 and 15 [ 75 ]. However, the prevalence of binge eating, and compensatory behaviours has been reported to be low (0.5% and 3.7%) [ 75 ].

Compared with adult and older populations, more comprehensive evidence exists for the prevalence of newly defined DSM-5 disorders in samples of children and adolescents. Lifetime prevalence of any ED has been estimated to be 6.7% in children and adolescents [ 108 ]. Table 5 gives a summary of point prevalence estimates from community-based samples across six studies: BN (ICD-11 Code: 6B81) is one of the most prevalent of the well-specified disorders [ 9 , 30 , 150 ]. A prospective longitudinal study of adolescents by Allen et al. [ 30 ] found a significant increase in ED prevalence between ages 14 (8.5%) and 17 (15.2%) and remaining steady to age 20 (15.2%). Age 17 was the peak age for all ED diagnoses (not necessarily onset), except for BED (ICD-11 Code: 6B82), which peaked at age 20 (4.1%) [ 30 ].

The studies by Mitchison et al. and Allen et al. were conducted in Australian populations, with cross-sectional and longitudinal cohort designs, respectively. Mitchison et al. [ 150 ] tracked adolescents aged from 11 to 19, while Allen et al. [ 30 ] measured point prevalence at ages 14, 17 and 20. Notably, rates reported by Mitchison et al. [ 150 ] were classified as ‘probable’ and the need to apply the clinical significance criterion Footnote 3 when assessing population-based ED prevalence was emphasised [ 150 ]. Strict application of this criterion reduced prevalence of any ED from 22.2% in the sample population to 13.6%, still considerably higher than rates reported in Canada and the Netherlands [ 60 , 123 ]. Researchers argued that, without application of this criterion, ED prevalence may be overestimated in population studies for most EDs, aside from AN (ICD-11 Code: 6B80) and atypical AN. Percentages presented in Table 5 are those reported by Mitchison et al. [ 150 ] without clinical significance criteria applied, to allow for comparison with other prevalence studies. Despite the relatively high prevalence in the Australian compared to the Canadian sample (n = 3020) [ 60 ] and the Dutch sample (n = 2230) [ 60 , 123 ] the Australian’s data were comparable to findings from a German study (n = 1654) [ 69 ] (see Table 5 ).

Adults and older people

Several studies suggest that EDs are becoming more prevalent across a range of socio-demographic profiles [ 9 , 24 , 73 , 99 ]. Studies measuring trends in ED behaviours (as distinct from diagnosis) in the Australian population across 1995 (n = 3001), 1998 (n = 3010), 2005 (n = 3047) and 2008 (n = 3034), indicated that both binge eating and strict dieting had increased significantly in men and women, particularly binge eating in individuals > 45 years old [ 48 , 99 ]. Significant increases in purging behaviours were also observed among people aged over 45 years and in males of any age [ 99 ]. Measurement of objective binge eating Footnote 4 episodes over a 17-year period (1998 to 2015) in a large sample of Australians (n = 15,126) found 3-month prevalence increased from 2.7% (n = 80) to 13% (n = 390), and twice weekly objectively measured binge eating increased from 1.1% (n = 33) to 5.3% (n = 158) [ 47 , 101 ].

Increased engagement in ED behaviours within the population could potentially translate to an increase in individuals diagnosed with EDs, especially those characterised by bingeing and purging. This is reflected in 3-month prevalence estimates of well-specified disorders in Australians aged 15 and over in two studies—Hay et al. [ 73 ] (n = 6041) and Hay et al. [ 72 ] (n = 5737) [ 72 , 73 ]. Both studies used a cross-sectional design, with the earlier sample measuring ED levels in 2008 and 2009 and the later study in 2014 and 2015.

Middle aged and older people

Few community studies have reported EDs in populations over the age of 40 years, and even fewer in older men. This is despite findings by Ackard et al. [ 15 ] that the prevalence in people middle-aged or older has increased over time. Point prevalence studies indicate that, while EDs are less common among older individuals, they continue to be a health concern for this group [ 33 ]. Additionally, cross-sectional studies have identified individuals aged 45 to 54 as being at particular risk of experiencing ED symptomology [ 33 ].

Evidence presented in a study of women aged between 40 and 60 in Austria (n = 436) by Mangweth-Matzek et al. [ 92 ] has suggested that menopause, like puberty, may be a period of risk for ED onset [ 92 ]. Research also suggests that in older adults with EDs, comorbidities are more frequent, ED symptoms are less severe, and purging and self-harm are less frequent [ 37 , 53 , 98 ]. Older adults with an ED typically experienced early onset and developed a persistent ED with no period of remission [ 33 , 97 ].

There are inconsistent findings in regard to how the prevalence of ED in older adults compares (i.e., is less than) to the prevalence in younger age groups [ 37 , 53 , 98 ]. A review of community samples by Baker and Runfola [ 33 ] found the lifetime prevalence of EDs in women aged ≥ 45 to be 0.17% for AN (ICD-11 Code: 6B80), 0.21% for BN (ICD-11 Code: 6B81), 0.61% for BED (ICD-11 Code: 6B82), and 4% for any ED. A further systematic review of EDs in people aged over 50 years found AN (ICD-11 Code: 6B80) to be the most common ED among older individuals seeking treatment, with one study reporting that AN accounted for 81% (n = 39), BN (ICD-11 Code: 6B81) in 10% (n = 5) of cases, BED (ICD-11 Code: 6B82) 2% (n = 1) and EDNOS (DSM criteria used), 6% (n = 3) [ 86 , 103 , 133 , 136 ].

A distinctive study with a large two-phase retrospective longitudinal cohort study design involving 5658 women living in the UK, indicated that 15.3% (n = 332) had met the diagnostic criteria for an ED by the age of 40. Weighted 12-month prevalence of any ED in the cohort was 3.6% (n = 108) [ 97 ]. Prevalence rates by ED diagnosis and subtype are summarised in Table 6 . This study also found the median age of onset for AN-restricting type to be 16 years (lowest), while women with BED had the highest median age of onset at 26 [ 97 ]. This finding is consistent with existing evidence that AN (ICD-11 Code: 6B80) has the youngest age of onset followed by BN (ICD-11 Code: 6B81) and then BED (ICD-11 Code: 6B82). Rates of AN in this cohort are considerably higher than in other community-based populations, while reported prevalence estimates for BED were lower [ 97 ].

Men and LGBTQI + samples

There is growing recognition of the impact of ED in males. It is estimated that one in four paediatric patients in Australia presenting to an ED service are male, as are one in three in the UK [ 7 ]. Few large-scale studies have focused on male prevalence in community-based populations. In their review of several Western countries, Murray et al. [ 7 ] reported community point prevalence of AN (0.1–0.3%), BN (0.1–1.6%), and BED (0.3–2.0%) in men.

LGBTQI  +  communities

Research indicates that EDs have higher prevalence in LGBTQI + individuals. EDs are more typically associated with individuals identifying as male within the LGBTQI + community, although there is growing evidence that it also has a heightened impact on females in this group [ 96 ], and there is a small volume of emerging evidence on prevalence in other genders. A systematic review suggested that greater overall ED symptomology is displayed by sexual minority males, females, and transgender individuals compared with heterosexual males and females [ 8 ]. A small study of transgender youth in Canada (n = 97) also found that risk of ED was higher among transgender males than in females, while both groups were more at risk than the general population [ 56 ].

Adolescence is a particularly risky time for ED development in LGBTQI + people [ 31 ]. A study conducted in 46 schools (n = 2429) in the US found that gay males were 12.6 times more likely to engage in fasting, vomiting or taking pills to lose weight than heterosexual males, and 2.4 times more likely to exercise or eat less to lose weight. Bisexual females were two times more likely to report fasting, vomiting or taking pills than heterosexual females, but less likely than heterosexual females to exercise or eat less to lose weight [ 153 ]. Similar trends in binge/purge behaviours among homosexual and bisexual males and females was also observed in a much larger US youth sample (n = 55,597) by Watson et al. [ 139 ]. Watson et al. [ 138 ], in a separate study (n = 26,002), found that rates of diet pill use, vomiting and fasting among lesbian females was particularly prevalent in those aged 12 to 18 [ 138 ].

In an Australian and New Zealand sample, high rates of body and muscle dysmorphia were detected among gay and bisexual men (n = 2733), who are more likely to participate in anabolic steroid use to build muscle [ 68 ]. Results from the UK (n = 5048), indicate that body dissatisfaction and dysfunctional eating behaviours in sexual minority males was up to 12.5 times higher than in heterosexual males by the age of 16 [ 40 ].

Meneguzzo et al. [ 96 ] reported that the prevalence of EDs in LGBTQI + women may be higher compared with rates reported in heterosexual women in the community. However, findings appear to be inconsistent and were not found for any particular ED diagnosis (i.e. AN, BN, or BED) [ 96 ]. Only 7 of the 45 (16%) studies included in the synthesis reported on diagnostic status [ 96 ].

Disease burden and impact on quality of life

EDs represent a significant proportion of the global disease burden from psychiatric illnesses, with associated high levels of psychological stress and impairment, as well as a profound impact on physical health [ 154 ]. A systematic analysis of data from 195 countries from 1990 to 2017 found that the global disease burden for any ED was 43.4 age-standardised disability adjusted life years (DALYs) Footnote 5 per 100,000. Between 2007 and 2017, global disease burden caused by EDs increased by 9.4%. AN (ICD-11 Code: 6B80) and BN (ICD-11 Code: 6B81) were the only EDs initially specified by the Global Burden of Disease Study 2017, at 9.5 and 33.8 age-standardised-DALYs per 100,000, respectively. Global disease burden attributed to AN (ICD-11 Code: 6B80) increased by 6.1% between 2007 and 2017, and for BN (ICD-11 Code: 6B81) the burden increased by 10.3% [ 155 ]. This burden further doubled when BED (ICD-11 Code: 6B82) and OSFED (ICD-11 Code: 6B8Y) were counted as part of measuring burden (disability life adjusted years), in part due to the recognition of BED and OSFED in a large global study of burden of disease [ 120 ].

Erskine et al. [ 54 ], in their review of the 2013 Global Burden of Disease Study, highlight that much of the disease burden associated with EDs is experienced by females, with reported age-standardised-DALYs due to all EDs being over twice as high for females than for males [ 54 ]. In AN, the difference was even more pronounced at over four times higher in females [ 155 ].

In Australian populations, investigation of disease burden attributable to more recently specified DSM-5 disorders indicated that individuals with BN (ICD-11 Code: 6B81) and ARFID (ICD-11 Code: 6B83) had more days out-of-role Footnote 6 than individuals without an ED and for other ED diagnoses [ 72 ]. Further, engaging in binge eating behaviours while not necessarily being diagnosed with an ED was also found to have an impact on daily functioning for Australians (n = 15,126). Mitchison et al. [ 101 ] found that participants who reported once or twice weekly objectively measured episodes of binge eating had higher role impairment than individuals who did not report objective binge eating. Observing 18-year trends, Mitchison et al. [ 101 ] also reported marked increases in binge eating within the Australian general population, potentially contributing to increased weight and poor physical health over time.

Economic impact

Two studies assessing the economic burden of EDs were identified. Agh et al. reviewed 22 studies relating to healthcare costs and economic burden associated with AN (ICD-11 Code: 6B80), BN (ICD-11 Code: 6B81) and BED (ICD-11 Code: 6B82) [ 156 ]. They found that, while individuals with BED had a higher rate of service utilisation, including inpatient, outpatient and emergency care than healthy controls, levels were comparable to individuals with other psychiatric disorders. It was also noted that very few individuals sought help specifically for their ED, but did so for comorbid psychiatric conditions or for assistance with weight loss [ 156 ]. Agh et al. reviewed the cost of services such as therapy, hospital care, diagnostic tests, and medications accessed by ED patients in the US (n = 14), the UK (n = 1), Canada (n = 1) and Germany (n = 5), including studies that measured costs from the perspective of the payer (consumer) (n = 15), hospital/health service (n = 3) or society (n = 3). A diagnosis of AN was associated with highest healthcare costs and longer periods of hospitalisation compared to other well-specified EDs [ 156 ]. Estimated annual healthcare costs were reported in Euro (€) and converted to AUD ($) for EDs. Data from the analysis by Agh et al. indicated that the high costs associated with AN were due to longer periods of hospitalisation [ 156 ].

A recent study from the general population of South Australia estimated the total economic cost of all EDs was $AUD84 billion in 2018, from years of life lost due to disability and death, and annual loss of earnings accounted for $AUD1.646 billion. Furthermore, these lost earnings peaked for both males and females in the age group 35–44 years [ 130 ].

Quality of life impact

Individuals with EDs have been found to have lower Health Related Quality of Life (HRQoL) than the general population and individuals with other psychiatric disorders such as major depression [ 141 ]. Research on the impact of ED behaviours indicated that HRQoL was equally impacted by a range of ED types, including binge eating, strict dieting, and purging. Distress relating to binge eating was associated with greater functional impairment and lower QoL in trends tracked from 1998 to 2015 in the Australian population [ 99 ]. Among school-aged children in Austria (n = 3610), poorer HRQoL was found among females at high risk of ED, potentially indicating more severe symptomology in female adolescents [ 144 ].

A meta-analysis of seven studies conducted by Winkler et al. [ 141 ] comparing HRQoL between AN (ICD-11 Code: 6B80), BN (ICD-11 Code: 6B81), BED (ICD-11 Code: 6B82) and EDNOS found equally low HRQoL scores across all diagnostic groups with no significant differences between groups [ 141 ]. However, researchers noted that this finding was from a limited pool of studies that use a range of HRQoL measures both specific to ED (Eating Disorder Quality of Life, EDQoL) and generic measures [ 141 ].

Extremely low BMI experienced by individuals with AN (ICD-11 Code: 6B80) is considered to have a substantial impact on their physical health. However, the egosyntonicity of symptoms may result in lower-than-expected levels of reported mental health impact. In contrast symptoms of BN (ICD-11 Code: 6B81) and BED (ICD-11 Code: 6B82) are experienced with high levels of associated psychological distress, hence individuals with BN and BED have been found to have lower HRQoL than individuals with AN [ 32 , 93 , 141 ].

In studies conducted in the Australian population, BN (ICD-11 Code: 6B81), BED (ICD-11 Code: 6B82), and ARFID (ICD-11 Code: 6B83) were associated with lower HRQoL (particularly lower mental health quality of life, MHQoL) compared with other ED diagnoses and individuals without ED. Australians with BED (ICD-11 Code: 6B82) were found to score lower than individuals with AN (ICD-11 Code: 6B80), BN (ICD-11 Code: 6B81), OSFED (ICD-11 Code: 6B8Y) and UFED (ICD-11 Code: 6B8Z) for mental and physical HRQoL [ 72 ]. Compared with healthy Australian women (n = 232), a much higher proportion of women with EDs (n = 159) were assessed to have severe mental health impairment; at 29.8% versus 9.4% [ 104 ]. Similar impairments to physical and mental HRQoL were observed among a sample of women in New Zealand (n = 214) with more frequent binge eating associated with lower QoL [ 134 ]. Further, longitudinal observation of ED status and HRQoL in Australian women (n = 706) indicated a bi-directional relationship, whereby increasing ED symptomology leads to greater QoL impairment and conversely lower QoL contributes to ED severity over time [ 100 ].

Several studies have also reported poor HRQoL for ARFID (ICD-11 Code: 6B83) in young people (e.g. Krom et al. [ 83 ] and adults [ 72 ]). Krom et al. [ 83 ] found that patients aged 6 to 7 and 8 to 10 years with ARFID (n = 48), had significantly lower physical functioning (appetite, lungs, stomach and motor) and mental health (positive mood and liveliness). Psychosocial health and school functioning measures were also significantly lower in this group indicating that ARFID has a significant negative impact on QoL [ 83 ].

This RR presents a contemporary understanding of the epidemiology of EDs, their sociodemographic distribution, particularly across age and gender, and their comorbidity and burden. It guides the AEDRTS and policy as well as informing the field and Stakeholders more broadly.

Prevalence and incidence

Collectively, epidemiological evidence form this RR suggests that the incidence of EDs is increasing, while age of onset is decreasing. However, as incidence estimates come mainly from studies using registry or clinical data, they are likely underestimates as they only include cases that have been formally diagnosed by a health professional. For example, reported rates in the UK were considerably higher than incidence reported in Australian children aged between 5 and 13 [ 110 ]. This variance may be due to differences in methodologies, as some Australian studies, such as that by Madden et al. [ 90 ], were predominantly reported from inpatient services with only a small proportion of outpatient services.

The RR found that EDs are a global and common phenomenon but only one meta-analysis [ 9 ] provided a comprehensive synthesis of epidemiology for all EDs, and there is a paucity of evidence regarding more recently specified disorders such as ARFID (ICD-11 Code: 6B83). Prevalence rates (Table 2 ) also varied considerably between studies most probably due to differences in study design and measures used to detect EDs. Treasure et al. [ 132 , 157 ] argue that AN (ICD-11 Code: 6B80) prevalence is impacted by inconsistent use of strictly defined parameters relating to body mass index (BMI) limits, contributing to the variation. This was demonstrated by application of broad and strictly defined parameters for AN (ICD-11 Code: 6B80) to the same community-based samples of female adolescents. Application of strictly defined AN (ICD-11 Code: 6B80) parameters resulted in an observed lifetime prevalence range between 0.6 and 2.2%. However, using broadly defined AN (ICD-11 Code: 6B80) parameters in the same sample, ranges for lifetime prevalence increased to 1.7% to 4.3% [ 132 ].

With regards to prevalence for OSFED (ICD-11 Code: 6B8Y) disorders it is important to note that these appeared to be hierarchical in nature [ 9 , 25 , 27 , 54 ]. That is, only one diagnosis assigned at a time, despite potential for overlap. Thus, individuals who were diagnosed with OSFED-PD (purging in the absence of binging) could also have met DSM-5 criteria for atypical AN. It should be noted also that some studies (such as Micali et al. [ 97 ]) did not specify purging for the purpose of weight and shape concerns. However, considering the measures used (EDDS, SCID-I, LIFE) it may be assumed that PD was derived in the context of EDs, where weight and shape concerns are present. The exact diagnostic boundaries between EDNOS/OSFED/UFED are often difficult to delineate, or diagnose, in non-clinical samples as it is dependent on how researchers define these broad categories, particularly as both the DSM and ICD do not outline strict criteria for these diagnostic categories.

Increases in BN (ICD-11 Code: 6B81) and BED (ICD-11 Code: 6B82) prevalence [ 73 ] over time could be attributed to the broader DSM-5 criteria, which reduced the number of required binge eating episodes from twice weekly in the DSM-IV to once weekly. Similarly, changes in the AN (ICD-11 Code: 6B80) diagnostic criteria to remove amenorrhea and vary the weight cut-off likely also play a role in rising prevalence data. Strict diagnostic criteria specified by the DSM-IV decreased BN (ICD-11 Code: 6B81) cases by half and BED (ICD-11 Code: 6B82) cases to less than half, bringing 3-month prevalence down to the same rate detected in the earlier 2005 South Australian study using once weekly criteria [ 73 , 158 ]. This finding suggests that prevalence rates of BN (ICD-11 Code: 6B81) and BED (ICD-11 Code: 6B82) in the Australian population in 2005 were comparable to rates reported in the 2015 study but not detected using DSM-IV criteria. Further analysis of prevalence rates by participant characteristics found several key differences between studies from 2005 to 2015. In 2015 studies, the median age of participants with an ED was significantly younger than the group without an ED, particularly in AN (ICD-11 Code: 6B80) and BN (ICD-11 Code: 6B81). Further, BED (ICD-11 Code: 6B8) (57% female) and subthreshold BED (S-BED; 55% female) had the lowest sex (female-to-male) ratio of all reported EDs, and BED, S-BED and BN were found to be associated with high BMI [ 73 ].

Prevalence: child and adolescence

Reported lifetime and point prevalence rates varied considerably across studies [ 76 , 108 , 129 ]. However, despite limitations across included studies, literature indicates that less well-specified EDs may be more prevalent in children and adolescents than adult populations [ 30 , 60 , 75 , 123 , 124 , 150 ]. Whilst the prevalence of well-specified EDs (AN, BN and BED) in Australian female adolescents was generally consistent, conflicting prevalence rates were observed in studies of males for BN (1.8% [ 150 ] compared to 0.7% [ 30 ]), and BED (0.2% [ 150 ] compared to 1.2% [ 30 ]).

Prevalence: males and LGBTQI +

The literature notes that males may preference different body types than females, typically presenting with higher BMIs and a drive for muscularity instead of thinness (muscle dysmorphia versus body dysmorphia), as well as reporting less psychological distress relating to binge eating behaviours [ 7 ]. These characteristics are more commonly associated with BN (ICD-11 Code: 6B81) and BED (ICD-11 Code: 6B82) and may reflect the relatively low prevalence of AN (ICD-11 Code: 6B80) in males [ 65 , 115 ]. Males are also more likely to report overeating without loss of control while eating, commonly reported by females, resulting in a higher proportion of males with S-BED [ 103 , 115 ] and a higher proportion of females diagnosed with full syndrome BED [ 127 ]. It may be that binge eating presents differently in males and this warrants further investigation to ensure diagnostic criteria do not contain inherent bias and lead to an inaccurate estimation of prevalence.

Researchers have also observed that changes to diagnostic criteria from DSM-IV to DSM-5 resulted in apparent increases in the prevalence of EDs in females, although male prevalence was largely unchanged for the more common threshold and subthreshold EDs (e.g., AN, S-AN, S-BN). This may indicate that the diagnostic criteria remain largely female-centric even though ED symptomology and behaviours are relatively common among males [ 7 , 43 ]. For example, Compte et al. [ 43 ] observed no difference in prevalence rates comparing DSM-IV and DSM-5 diagnosed EDs in a group of university-aged men (n = 472). All observed cases in males were subthreshold AN (S-AN) (0.9%, n = 4) and subthreshold BN (S-BN) (1.1%, n = 5) [ 43 ]. However, in the same sample group, muscle dysmorphia was determined to occur in 7.0% of men [ 43 ], representing more than a six-fold increase in prevalence of eating pathology compared to other presentations in this illness category. This supports additional academic and clinical focus on ED in males given that clinical data has demonstrated that EDs have a considerable impact on males [ 121 ], accounting for 34% of all patients accessing ED services in one study [ 121 ].

There is a dearth of consistent epidemiological data on EDs in the LGBTQI + community. However, the evidence reviewed here suggests they may be a particularly vulnerable minority group for EDs and further research is needed [ 96 ].

This RR found high fiscal burden from EDs. For example, in a study modelling the cost-effectiveness of an AN prevention, the annual cost of treating an individual with AN (ICD-11 Code: 6B80) was estimated at up to $USD200,000 [ 130 ]. This review however found variation in these costs across different countries; in Australia some data suggests a higher cost for BN (ICD-11 Code: 6B81) relative to AN (ICD-11 Code: 6B80) whereas in the US it is reversed, which may be related to the differences in health systems across the two countries. The high costs of care for individuals with AN (ICD-11 Code: 6B80) are associated with lengthy hospital stays, which in Australia are often partially or completed publicly funded, whereas in the US (where a significant proportion of studies have been conducted) hospital costs tend to be paid for by the individual receiving care or under their personal insurance [ 156 , 159 ].

Quality of life

Disordered eating behaviour in general, and EDs in particular, have been consistently found to impact HRQoL in a variety of ways, in both young people and adults [ 10 , 72 , 73 , 79 , 141 , 152 , 160 ]. Variance in findings across diagnostic groups should be addressed in future research by using specific EDQoL measures [ 32 , 141 ], as generic measures and assessment tools are inefficient at detecting the unique features that impact QoL in EDs [ 79 ]. The insensitivity of self-report HRQoL measures to the egosyntonic nature of AN (ICD-11 Code: 6B80) has also been suggested as a possible reason for conflicting findings [ 79 , 141 ]—people with ED report different sorts of impacts of illness and often do not experience the traditional sort of impacts or fail to find them as distressing. Despite this, a number of studies have found a lower HRQoL in AN (ICD-11 Code: 6B80) as compared to BN (ICD-11 Code: 6B8) and EDNOS (OSFED), noting that individuals with AN (regardless of subtype or age [ 140 ]) experience greater difficulty with social life, relationships and physical mobility [ 79 ] and recognising the close association between AN (ICD-11 Code: 6B80) and suicidality. While outside the date of current review’s eligibility criteria [ 10 ] it should also be mentioned that a very recent study by Appolinario et al. [ 161 ] reported diverse and severe physical health impacts of BN (ICD-11 Code: 6B81) and BED (ICD-11 Code: 6B82), even when controlling for participants’ BMI. This corroborates similar findings of medical comorbidity in individuals with BED as noted by Udo and Grilo [ 162 ], albeit, they did not control for BMI.

Strength and limitations of included studies

A limitation of this RR is that the vast majority of the available epidemiological literature came from Western, educated, industrialized, rich, and democratic (WEIRD) countries, which more readily have access to specialised care and services. Further, much of the evidence base for the ED literature is restricted to younger and female-only samples [ 9 , 24 , 26 ]. Other limitations include wide variability in methods to ascertain ED cases, including application of different diagnostic criteria and use of self-report versus interview instruments. Nonetheless, the breadth of netted literature that met inclusion criteria provided a comprehensive overview of the topic and allowed for trends and themes to be observed, highlighting both trends and gaps in the epidemiological understanding of EDs.

Strengths and limitations of current review

Use of a rapid review methodology allowed for a timely synthesis of the current evidence base as it relates to the epidemiology of EDs. Nonetheless, as the RR was commissioned by the Australian Government to inform the focus of EDs in Australia, it did not address indigenous population in other countries. Similarly, more recently specified disorders (such as ARFID (ICD-11 Code: 6B83) and OSFED (ICD-11 Code: 6B8Y)) were not equally represented when compared to other established ED diagnoses, namely AN (ICD-11 Code: 6B80), BN (ICD-11 Code: 6B81), and BED (ICD-11 Code: 6B82). Representation of countries outside of Australia may have also impacted findings, however this was partially offset by predominantly focusing on WEIRD countries with similar sociodemographic features as Australia—allowing for some findings to be generalised.

Overall clinical implications

EDs are common, and likely increasing in incidence and prevalence in both younger and older populations. They occur across all sociodemographic groups and may be increasing in minority populations. Thus, all services at all levels need to be prepared to identify and offer care for people with EDs. There is a need to develop culturally informed and appropriate assessments and interventions for broader demographic groups, such as men, the LGBTIQ + community and Indigenous peoples.

Future research

An Australian nationally representative epidemiologic survey as well as research in economically developing nations, gender and culturally and linguistically populations are needed. There is also a need for greater use of a two-stage design and interview approach in prevalence studies, to increase accurate case identification and inclusion of OSFED (ICD-11 Code: 6B8Y) and UFED (ICD-11 Code: 6B8Z) in study methods. That also includes measurement of burden to improve the Global Burden of Disease (WHO) and other estimates, particularly those used in policy making around health, and the provision of care.

EDs are common, global, present in all age and gender groups and are associated with high fiscal and health burden. There is an urgent need to refine and harmonise epidemiological methods to improve consistency and accuracy in case estimates, for example the development of international agreements on assessment instruments amongst eating disorder organisations and publications. Publication policies can also be implemented to ensure all papers consider and present data regarding demographic diversity of participants to support greater research in minority populations and non-WEIRD populations. Such strategies would enable a better understanding of the distribution of EDs over time, plan services and guide health care policy.

Availability of data and materials

Not applicable—all citations provided.

Person years are a unit of measurement that considers the length of time (e.g., 1 year) and number of individuals enrolled in a study. For example, 10 individuals enrolled in a 10-year study would equate to 100 person years.

Proportion of a population who have had an ED in the past 12 months.

ED symptoms that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Sense of loss of control overeating within a specific timeframe during which the amount of food consumed is larger than what most people would eat under similar circumstances.

Number of potential ‘healthy’ years of life lost to premature death or years lived with disability due a specific disease or disorder.

Days for which a person is completely unable to work or carry out normal activities because of a health problem.

Abbreviations

Australian Eating Disorder Research and Translation Strategy

Anorexia Nervosa

Avoidant Restrictive Food Intake Disorder

Binge Eating Disorder (BED)

Body Mass Index

Bulimia Nervosa (BN)

Culturally and Linguistically Diverse

Disability Adjusted Life Years

Diagnostic and Statistical Manual of Mental Disorders—fifth edition

Eating Disorder

Eating Disorder not Otherwise Specified

Eating Disorder Quality of Life

Health Management Australia

Health Related Quality of Life

International Classification of Diseases

InsideOut Institute

Lesbian, Gay, Bisexual, Transgender, Queer, Intersex +

Mental Health Quality of Life

Night Eating Syndrome

Other Specified Feeding and Eating Disorders

Purging Disorder

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Person Years

Quality of Life

Rapid Review

Unspecified Feeding and Eating Disorders

Western, Educated, Industrialized, Rich and Democratic (countries)

World Health Organisation

American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Association; 2013.

Book   Google Scholar  

National Institute of Health and Care Excellence. Eating disorders: recognition and treatment. London: National Guideline Alliance (UK); 2017 23rd May 2017. Contract No.: NG69.

Brockmeyer T, Friederich H-C, Schmidt U. Advances in the treatment of anorexia nervosa: a review of established and emerging interventions. Psychol Med. 2018;48(8):1228–56.

Article   PubMed   Google Scholar  

Bruch H. The golden cage: the enigma of anorexia nervosa. Cambridge: Harvard University Press; 2001.

Google Scholar  

Hazzard VM, Loth KA, Hooper L, Becker CB. Food insecurity and eating disorders: a review of emerging evidence. Curr Psychiatry Rep. 2020;22(12):1–9.

Article   Google Scholar  

Pike KM, Dunne PE. The rise of eating disorders in Asia: a review. J Eat Disord. 2015;3(1):1–14.

Murray SB, Nagata JM, Griffiths S, Calzo JP, Brown TA, Mitchison D, et al. The enigma of male eating disorders: a critical review and synthesis. Clin Psychol Rev. 2017;57:1–11.

Calzo JP, Blashill AJ, Brown TA, Argenal RL. Eating disorders and disordered weight and shape control behaviors in sexual minority populations. Curr Psychiatry Rep. 2017;19(8):1–10.

Galmiche M, Déchelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000–2018 period: a systematic literature review. Am J Clin Nutr. 2019;109(5):1402–13.

Aouad P, Bryant E, Maloney D, Marks P, Le A, Russell H, et al. Informing the development of Australia’s National Eating Disorders Research and Translation Strategy: a rapid review methodology. J Eat Disord. 2022;10(1):1–12.

Raykos BC, McEvoy PM, Erceg-Hurn D, Byrne SM, Fursland A, Nathan P. Therapeutic alliance in enhanced cognitive behavioural therapy for bulimia nervosa: probably necessary but definitely insufficient. Behav Res Ther. 2014;57:65–71.

Turner H, Bryant-Waugh R, Marshall E. The impact of early symptom change and therapeutic alliance on treatment outcome in cognitive-behavioural therapy for eating disorders. Behav Res Ther. 2015;73:165–9.

Gale C, Gilbert P, Read N, Goss K. An evaluation of the impact of introducing compassion focused therapy to a standard treatment programme for people with eating disorders. Clin Psychol Psychother. 2014;21(1):1–12.

Accurso EC, Fitzsimmons-Craft EE, Ciao A, Cao L, Crosby RD, Smith TL, et al. Therapeutic alliance in a randomized clinical trial for bulimia nervosa. J Consult Clin Psychol. 2015;83(3):637.

Article   PubMed   PubMed Central   Google Scholar  

Ackard DM, Richter S, Frisch MJ, Mangham D, Cronemeyer CL. Eating disorder treatment among women forty and older: Increases in prevalence over time and comparisons to young adult patients. J Psychosom Res. 2013;74(2):175–8.

InsideOut Institute for Eating Disorders. Australian eating disorders research and translation strategy 2021–2031. Sydney: University of Sydney & Australian Government Department of Health; 2021.

Virginia Commonwealth University. Rapid review protocol. Virginia, USA: VCU; 2021 [updated May 5, 2021 8:25 PM; cited 2021 19 June]. https://guides.library.vcu.edu/rapidreview

Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet. 2020;395(10227):912–20.

Tricco AC, Langlois E, Straus SE, World Health Organization. Rapid reviews to strengthen health policy and systems: a practical guide. Geneva: World Health Organization; 2017.

Canadian Agency for Drugs and Technologies in Health. About the Rapid Response Service Ottawa, Canada: CADTH; 2011. https://www.cadth.ca/about-rapid-response-service

Hamel C, Michaud A, Thuku M, Skidmore B, Stevens A, Nussbaumer-Streit B, et al. Defining rapid reviews: a systematic scoping review and thematic analysis of definitions and defining characteristics of rapid reviews. J Clin Epidemiol. 2021;129:74–85.

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group*. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.

Rethlefsen ML, Kirtley S, Waffenschmidt S, Ayala AP, Moher D, Page MJ, et al. PRISMA-S: an extension to the PRISMA statement for reporting literature searches in systematic reviews. Syst Rev. 2021;10(1):1–19.

Kessler RC, Berglund PA, Chiu WT, Deitz AC, Hudson JI, Shahly V, et al. The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys. Biol Psychiat. 2013;73(9):904–14.

Qian J, Wu Y, Liu F, Zhu Y, Jin H, Zhang H, et al. An update on the prevalence of eating disorders in the general population: a systematic review and meta-analysis. Eat Weight Disord-Stud Anorex Bulim Obes. 2021. https://doi.org/10.1007/s40519-021-01162-z .

Erskine HE, Whiteford HA. Epidemiology of binge eating disorder. Curr Opin Psychiatry. 2018;31(6):462–70.

Dahlgren CL, Wisting L, Rø Ø. Feeding and eating disorders in the DSM-5 era: a systematic review of prevalence rates in non-clinical male and female samples. J Eat Disord. 2017;5(1):1–10.

Abebe DS, Lien L, Torgersen L, et al. Binge eating, purging and non-purging compensatory behaviours decrease from adolescence to adulthood: A population-based, longitudinal study. BMC Public Health. 2012;12(1):1–10.

Ágh T, Kovács G, Supina D, Pawaskar M, Herman BK, Vokó Z, Sheehan DV. A systematic review of the health-related quality of life and economic burdens of anorexia nervosa, bulimia nervosa, and binge eating disorder. Eat Weight Disord. 2016;21(3):353–64.

Allen KL, Byrne SM, Oddy WH, Crosby RD. DSM–IV–TR and DSM-5 eating disorders in adolescents: prevalence, stability, and psychosocial correlates in a population-based sample of male and female adolescents. J Abnorm Psychol. 2013;122(3):720.

Austin SB, Ziyadeh NJ, Corliss HL, Rosario M, Wypij D, Haines J, et al. Sexual orientation disparities in purging and binge eating from early to late adolescence. J Adolesc Health. 2009;45(3):238–45.

Baiano M, Salvo P, Righetti P, Cereser L, Baldissera E, Camponogara I, et al. Exploring health-related quality of life in eating disorders by a cross-sectional study and a comprehensive review. BMC Psychiatry. 2014;14(1):1–12.

Baker JH, Runfola CD. Eating disorders in midlife women: a perimenopausal eating disorder? Maturitas. 2016;85:112–6.

Bould H, Sovio U, Koupil I, Dalman C, Micali N, Lewis G, et al. Do eating disorders in parents predict eating disorders in children? Evidence from a Swedish cohort. Acta Psychiatr Scand. 2015;132(1):51–9.

Bourne L, Bryant-Waugh R, Cook J, Mandy W. Avoidant/restrictive food intake disorder: A systematic scoping review of the current literature. Psychiatry Res. 2020;288:112961.

Bryant-Waugh R. Avoidant/restrictive food intake disorder. Child Adolesc Psychiatr Clin. 2019;28(4):557–65.

Bueno B, Krug I, Bulik CM, Jiménez-Murcia S, Granero R, Thornton L, et al. Late onset eating disorders in Spain: clinical characteristics and therapeutic implications. J Clin Psychol. 2014;70(1):1–17.

Burke NL, Hazzard VM, Karvay YG, Schaefer LM, Lipson SK, Rodgers RF. Eating disorder prevalence among multiracial US undergraduate and graduate students: Is multiracial risk different than the sum of each identity? Eating Behav. 2021;41:101501.

Burt A, Mannan H, Touyz S, Hay P. Prevalence of DSM-5 diagnostic threshold eating disorders and features amongst Aboriginal and Torres Strait islander peoples (First Australians). BMC Psychiatry. 2020;20(1):1–8.

Calzo JP, Austin SB, Micali N. Sexual orientation disparities in eating disorder symptoms among adolescent boys and girls in the UK. Eur Child Adolesc Psychiatry. 2018;27(11):1483–90.

Carta MG, Preti A, Moro MF, Aguglia E, Balestrieri M, Caraci F, Dell'Osso L, Di Sciascio G, Drago F, Faravelli C, Hardoy MC, D'Aloja E, Cossu G, Calò S, Palumbo G, Bhugra D. Eating disorders as a public health issue: prevalence and attributable impairment of quality of life in an Italian community sample. Int Rev Psychiatry. 2014;26(4):486–92.

Ng IS, Cheung KC, Chou KL. Correlates of eating disorder in middle-aged and older adults: evidence from 2007 British National Psychiatric Morbidity Survey. J Aging Health. 2013;25(7):1106–20.

Compte EJ, Sepulveda AR, Torrente F. A two-stage epidemiological study of eating disorders and muscle dysmorphia in male university students in Buenos Aires. Int J Eat Disord. 2015;48(8):1092–101.

Conceição EM, Gomes FVS, Vaz AR, Pinto-Bastos A, Machado PPP. Prevalence of eating disorders and picking/nibbling in elderly women. Int J Eat Disord. 2017;50(7):793–800.

Cooney M, Lieberman M, Guimond T, Katzman DK. Clinical and psychological features of children and adolescents diagnosed with avoidant/restrictive food intake disorder in a pediatric tertiary care eating disorder program: a descriptive study. J Eat Disord. 2018;6:7.

Cossrow N, Pawaskar M, Witt EA, Ming EE, Victor TW, Herman BK, Wadden TA, Erder MH. Estimating the prevalence of binge eating disorder in a community sample from the United States: comparing DSM-IV-TR and DSM-5 Criteria. J Clin Psychiatry. 2016;77(8):e968-74.

Da Luz F, Sainsbury A, Mannan H, Touyz S, Mitchison D, Hay P. Prevalence of obesity and comorbid eating disorder behaviors in South Australia from 1995 to 2015. Int J Obes. 2017;41(7):1148–53.

Darby A, Hay P, Mond J, Quirk F, Buttner P, Kennedy L. The rising prevalence of comorbid obesity and eating disorder behaviors from 1995 to 2005. Int J Eat Disord. 2009;42(2):104–8.

de Zwaan M, Müller A, Allison KC, Brähler E, Hilbert A. Prevalence and correlates of night eating in the German general population. PLoS One. 2014;9(5):e97667.

Dubovi AS, Li Y, Martin JL. Breaking the Silence: Disordered Eating and Big Five Traits in College Men. Am J Mens Health. 2016;10(6):NP118–NP126.

Duncan AE, Ziobrowski HN, Nicol G. The Prevalence of Past 12-Month and Lifetime DSM-IV Eating Disorders by BMI Category in US Men and Women. Eur Eat Disord Rev. 2017;25(3):165–171.

Eddy KT, Thomas JJ, Hastings E, Edkins K, Lamont E, Nevins CM, et al. Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network. Int J Eat Disord. 2015;48(5):464–70.

Elran-Barak R, Fitzsimmons-Craft EE, Benyamini Y, Crow SJ, Peterson CB, Hill LL, et al. Anorexia nervosa, bulimia nervosa, and binge eating disorder in midlife and beyond. J Nerv Ment Dis. 2015;203(8):583–90.

Erskine HE, Whiteford HA, Pike KM. The global burden of eating disorders. Curr Opin Psychiatry. 2016;29(6):346–53.

Fairweather-Schmidt AK, Wade TD. DSM-5 eating disorders and other specified eating and feeding disorders: Is there a meaningful differentiation? Int J Eat Disord. 2014;47(5):524–33.

Feder S, Isserlin L, Seale E, Hammond N, Norris ML. Exploring the association between eating disorders and gender dysphoria in youth. Eat Disord. 2017;25(4):310–7.

Feldman MB, Meyer IH. Comorbidity and age of onset of eating disorders in gay men, lesbians, and bisexuals. Psychiatry Res. 2010;180(2-3):126–31.

Fischer S, Meyer AH, Hermann E, Tuch A, Munsch S. Night eating syndrome in young adults: delineation from other eating disorders and clinical significance. Psychiatry Res. 2012;200(2–3):494–501.

Fisher MM, Rosen DS, Ornstein RM, Mammel KA, Katzman DK, Rome ES, Callahan ST, Malizio J, Kearney S, Walsh BT. Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a "new disorder" in DSM-5. J Adolesc Health. 2014;55(1):49–52.

Flament MF, Henderson K, Buchholz A, Obeid N, Nguyen HN, Birmingham M, et al. Weight status and DSM-5 diagnoses of eating disorders in adolescents from the community. J Am Acad Child Adolesc Psychiatry. 2015;54(5):403–11.

Folope V, Chapelle C, Grigioni S, Coëffier M, Déchelotte P. Impact of eating disorders and psychological distress on the quality of life of obese people. Nutrition. 2012;28;7–8:e7–e13.

Fornaro M, Daray FM, Hunter F, Anastasia A, Stubbs B, De Berardis D, Shin JI, Husain MI, Dragioti E, Fusar-Poli P, Solmi M, Berk M, Vieta E, Carvalho AF. The prevalence, odds and predictors of lifespan comorbid eating disorder among people with a primary diagnosis of bipolar disorders, and vice-versa: systematic review and meta-analysis. J Affect Disord. 2021;280:409-431.

Gammelmark C, Jensen SO, Plessen KJ, Skadhede S, Larsen JT, Munk-Jørgensen P. Incidence of eating disorders in Danish psychiatric secondary healthcare 1970-2008. Aust N Z J Psychiatry. 2015;49(8):724–30.

Gatt L, Jan S, Mondraty N, Horsfield S, Hart S, Russell J, Laba TL, Essue B. The household economic burden of eating disorders and adherence to treatment in Australia. BMC Psychiatry. 2014;14:338.

Gauvin L, Steiger H, Brodeur JM. Eating-disorder symptoms and syndromes in a sample of urban-dwelling Canadian women: contributions toward a population health perspective. Int J Eat Disord. 2009;42(2):158–65.

Kyu HH, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. GBD 2017 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1859–1922.

Goldberg HR, Katzman DK, Allen L, Martin S, Sheehan C, Kaiserman J, Macdonald G, Kives S. The prevalence of children and adolescents at risk for avoidant restrictive food intake disorder in a pediatric and adolescent gynecology clinic. J Pediatr Adolesc Gynecol. 2020;33(5):466-469.

Griffiths S, Murray SB, Dunn M, Blashill AJ. Anabolic steroid use among gay and bisexual men living in Australia and New Zealand: associations with demographics, body dissatisfaction, eating disorder psychopathology, and quality of life. Drug Alcohol Depend. 2017;181:170–6.

Hammerle F, Huss M, Ernst V, Bürger A. Thinking dimensional: prevalence of DSM-5 early adolescent full syndrome, partial and subthreshold eating disorders in a cross-sectional survey in German schools. BMJ Open. 2016;6(5): e010843.

Harrop EN, Mensinger JL, Moore M, Lindhorst T. Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature. Int J Eat Disord. 2021;54(8):1328-1357.

Hay PJ, Carriage C. Eating disorder features in indigenous Aboriginal and Torres Strait islander Australian peoples. BMC Public Health. 2012;12(1):1–6.

Hay P, Mitchison D, Collado AEL, González-Chica DA, Stocks N, Touyz S. Burden and health-related quality of life of eating disorders, including Avoidant/Restrictive Food Intake Disorder (ARFID), in the Australian population. J Eat Disord. 2017;5(1):1–10.

Hay P, Girosi F, Mond J. Prevalence and sociodemographic correlates of DSM-5 eating disorders in the Australian population. J Eat Disord. 2015;3(1):1–7.

Heriseanu AI, Hay P, Touyz S. Grazing behaviour and associations with obesity, eating disorders, and health-related quality of life in the Australian population. Appetite. 2019;143:104396.

Hughes EK, Kerr JA, Patton GC, Sawyer SM, Wake M, Le Grange D, et al. Eating disorder symptoms across the weight spectrum in Australian adolescents. Int J Eat Disord. 2019;52(8):885–94.

Isomaa R, Isomaa AL, Marttunen M, Kaltiala-Heino R, Björkqvist K. The prevalence, incidence and development of eating disorders in Finnish adolescents—a two-step 3-year follow-up Study. Eur Eat Disord Rev: Prof J Eat Disord Assoc. 2009;17(3):199–207.

Jaite C, Hoffmann F, Glaeske G, Bachmann CJ. Prevalence, comorbidities and outpatient treatment of anorexia and bulimia nervosa in German children and adolescents. Eat Weight Disord. 2013;18(2):157-65.

Javaras KN, Runfola CD, Thornton LM, Agerbo E, Birgegård A, Norring C, Yao S, Råstam M, Larsson H, Lichtenstein P, Bulik CM. Sex- and age-specific incidence of healthcare-register-recorded eating disorders in the complete swedish 1979-2001 birth cohort. Int J Eat Disord. 2015;48(8):1070–81.

Jenkins PE, Hoste RR, Meyer C, Blissett JM. Eating disorders and quality of life: a review of the literature. Clin Psychol Rev. 2011;31(1):113–21.

Kambanis PE, Bottera AR, De Young KP. Eating disorder prevalence among Amazon MTurk workers assessed using a rigorous online, self-report anthropometric assessment. Eat Behav. 2021;41:101481.

Keski-Rahkonen A, Hoek H, Linna M, Raevuori A, Sihvola E, Bulik C, et al. Incidence and outcomes of bulimia nervosa: a nationwide population-based study. Psychol Med. 2009;39(5):823–31.

Kovacic K, Rein LE, Szabo A, Kommareddy S, Bhagavatula P, Goday PS. Pediatric Feeding Disorder: A Nationwide Prevalence Study. J Pediatr. 2021;228:126-131.e3.

Krom H, van der Sluijs VL, van Zundert S, Otten MA, Benninga M, Haverman L, et al. Health related quality of life of infants and children with avoidant restrictive food intake disorder. Int J Eat Disord. 2019;52(4):410–8.

Kurz S, Van Dyck Z, Dremmel D, Munsch S, Hilbert A. Early-onset restrictive eating disturbances in primary school boys and girls. Eur Child Adolesc Psychiatry. 2015;24(7):779–85.

Lähteenmäki S, Saarni S, Suokas J, Saarni S, Perälä J, Lönnqvist J, et al. Prevalence and correlates of eating disorders among young adults in Finland. Nord J Psychiatry. 2014;68(3):196–203.

Lapid MI, Prom MC, Burton MC, McAlpine DE, Sutor B, Rummans TA. Eating disorders in the elderly. Int Psychogeriatr. 2010;22(4):523–36.

Larrañaga A, Docet MF, García-Mayor RV. High prevalence of eating disorders not otherwise specified in northwestern Spain: population-based study. Soc Psychiatry Psychiatr Epidemiol. 2012;47(10):1669-73.

Le LK, Barendregt JJ, Hay P, Sawyer SM, Paxton SJ, Mihalopoulos C. The modelled cost-effectiveness of cognitive dissonance for the prevention of anorexia nervosa and bulimia nervosa in adolescent girls in Australia. Int J Eat Disord. 2017;50(7):834-841.

Le Grange D, Swanson SA, Crow SJ, Merikangas KR. Eating disorder not otherwise specified presentation in the US population. Int J Eat Disord. 2012;45(5):711–8.

Madden S, Morris A, Zurynski YA, Kohn M, Elliot EJ. Burden of eating disorders in 5–13-year-old children in Australia. Med J Aust. 2009;190(8):410–4.

Mancuso SG, Newton JR, Bosanac P, Rossell SL, Nesci JB, Castle DJ. Classification of eating disorders: comparison of relative prevalence rates using DSM-IV and DSM-5 criteria. Br J Psychiatry. 2015;206(6):519–20.

Mangweth-Matzek B, Hoek HW, Rupp CI, Kemmler G, Pope HG Jr, Kinzl J. The menopausal transition—a possible window of vulnerability for eating pathology. Int J Eat Disord. 2013;46(6):609–16.

Martin J, Padierna A, Lorono A, Munoz P, Quintana J. Predictors of quality of life in patients with eating disorders. Eur Psychiatry. 2017;45:182–9.

Martínez-González L, Fernández-Villa T, Molina AJ, Delgado-Rodríguez M, Martín V. Incidence of Anorexia Nervosa in Women: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2020;17(11):3824.

Masheb R, White MA. Bulimia nervosa in overweight and normal-weight women. Compr Psychiatry. 2012;53(2):181-6.

Meneguzzo P, Collantoni E, Gallicchio D, Busetto P, Solmi M, Santonastaso P, et al. Eating disorders symptoms in sexual minority women: a systematic review. Eur Eat Disord Rev. 2018;26(4):275–92.

Micali N, Martini MG, Thomas JJ, Eddy KT, Kothari R, Russell E, et al. Lifetime and 12-month prevalence of eating disorders amongst women in mid-life: a population-based study of diagnoses and risk factors. BMC Med. 2017;15(1):1–10.

Midlarsky E, Marotta AK, Pirutinsky S, Morin RT, McGowan JC. Psychological predictors of eating pathology in older adult women. J Women Aging. 2018;30(2):145–57.

Mitchison D, Hay P, Slewa-Younan S, Mond J. The changing demographic profile of eating disorder behaviors in the community. BMC Public Health. 2014;14(1):1–9.

Mitchison D, Morin A, Mond J, Slewa-Younan S, Hay P. The bidirectional relationship between quality of life and eating disorder symptoms: a 9-year community-based study of Australian women. PLoS ONE. 2015;10(3): e0120591.

Mitchison D, Touyz S, González-Chica DA, Stocks N, Hay P. How abnormal is binge eating? 18-year time trends in population prevalence and burden. Acta Psychiatr Scand. 2017;136(2):147–55.

Mitchison D, Mond J, Bussey K, Griffiths S, Trompeter N, Lonergan A, Pike KM, Murray SB, Hay P. DSM-5 full syndrome, other specified, and unspecified eating disorders in Australian adolescents: prevalence and clinical significance. Psychol Med. 2020;50(6):981–990.

Mohler-Kuo M, Schnyder U, Dermota P, Wei W, Milos G. The prevalence, correlates, and help-seeking of eating disorders in Switzerland. Psychol Med. 2016;46(13):2749–58.

Mond J, Hay P, Rodgers B, Owen C. Quality of life impairment in a community sample of women with eating disorders. Aust N Z J Psychiatry. 2012;46(6):561–8.

Mustelin L, Raevuori A, Hoek HW, Kaprio J, Keski-Rahkonen A. Incidence and weight trajectories of binge eating disorder among young women in the community. Int J Eat Disord. 2015;48(8):1106-12. https://doi.org/10.1002/eat.22409 .

Mustelin L, Lehtokari VL, Keski-Rahkonen A. Other specified and unspecified feeding or eating disorders among women in the community. Int J Eat Disord. 2016;49(11):1010–7.

Nagata JM, Ganson KT, Austin SB. Emerging trends in eating disorders among sexual and gender minorities. Curr Opin Psychiatry. 2020;33(6):562-567.

Nagl M, Jacobi C, Paul M, Beesdo-Baum K, Höfler M, Lieb R, et al. Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults. Eur Child Adolesc Psychiatry. 2016;25(8):903–18.

Nicely TA, Lane-Loney S, Masciulli E, Hollenbeak CS, Ornstein RM. Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders. J Eat Disord. 2014;2(1):21.

Nicholls DE, Lynn R, Viner RM. Childhood eating disorders: British national surveillance study. Br J Psychiatry. 2011;198(4):295–301.

Olsen EM, Koch SV, Skovgaard AM, Strandberg-Larsen K. Self-reported symptoms of binge-eating disorder among adolescents in a community-based Danish cohort-A study of prevalence, correlates, and impact. Int J Eat Disord. 2021;54(4):492-505.

Pasold TL, Portilla MG. Eating disorders in Arkansas: trends observed over fourteen years. J Ark Med Soc. 2012;108(12):274–6.

PubMed   Google Scholar  

Perez M, Warren CS. The relationship between quality of life, binge-eating disorder, and obesity status in an ethnically diverse sample. Obesity (Silver Spring). 2012;20(4):879–85.

Pinhas L, Morris A, Crosby RD, Katzman DK. Incidence and age-specific presentation of restrictive eating disorders in children: a Canadian Paediatric Surveillance Program study. Arch Pediatr Adolesc Med. 2011;165(10):895–9.

Preti A, de Girolamo G, Vilagut G, Alonso J, de Graaf R, Bruffaerts R, et al. The epidemiology of eating disorders in six European countries: results of the ESEMeD-WMH project. J Psychiatr Res. 2009;43(14):1125–32.

Reas DL, Rø Ø. Time trends in healthcare-detected incidence of anorexia nervosa and bulimia nervosa in the Norwegian National Patient Register (2010-2016). Int J Eat Disord. 2018;51(10):1144–1152.

Ribeiro M, Conceição E, Vaz AR, Machado PP. The prevalence of binge eating disorder in a sample of college students in the north of Portugal. Eur Eat Disord Rev. 2014;22(3):185–90.

Rozzell K, Klimek P, Brown T, Blashill AJ. Prevalence of eating disorders among US children aged 9 to 10 years: Data from the adolescent brain cognitive development (ABCD) study. JAMA Pediatr. 2019;173(1):100–1.

Runfola CD, Allison KC, Hardy KK, Lock J, Peebles R. Prevalence and clinical significance of night eating syndrome in university students. J Adolesc Health. 2014;55(1):41–8.

Santomauro DF, Melen S, Mitchison D, Vos T, Whiteford H, Ferrari AJ. The hidden burden of eating disorders: an extension of estimates from the Global Burden of Disease Study 2019. Lancet Psychiatry. 2021;8(4):320–8.

Shu CY, Limburg K, Harris C, McCormack J, Hoiles KJ, Hamilton MJ, et al. Clinical presentation of eating disorders in young males at a tertiary setting. J Eat Disord. 2015;3(1):1–7.

Silén Y, Sipilä PN, Raevuori A, Mustelin L, Marttunen M, Kaprio J, Keski-Rahkonen A. Detection, treatment, and course of eating disorders in Finland: A population-based study of adolescent and young adult females and males. Eur Eat Disord Rev. 2021;29(5):720–732.

Smink FR, van Hoeken D, Oldehinkel AJ, Hoek HW. Prevalence and severity of DSM-5 eating disorders in a community cohort of adolescents. Int J Eat Disord. 2014;47(6):610–9.

Sparti C, Santomauro D, Cruwys T, Burgess P, Harris M. Disordered eating among Australian adolescents: prevalence, functioning, and help received. Int J Eat Disord. 2019;52(3):246–54.

Støving RK, Andries A, Brixen KT, Bilenberg N, Lichtenstein MB, Hørder K. Purging behavior in anorexia nervosa and eating disorder not otherwise specified: a retrospective cohort study. Psychiatry Res. 2012;198(2):253-8.

Streatfeild J, Hickson J, Austin SB, Hutcheson R, Kandel JS, Lampert JG, Myers EM, Richmond TK, Samnaliev M, Velasquez K, Weissman RS, Pezzullo L. Social and economic cost of eating disorders in the United States: Evidence to inform policy action. Int J Eat Disord. 2021;54(5):851-868.

Striegel-Moore RH, Rosselli F, Perrin N, DeBar L, Wilson GT, May A, et al. Gender difference in the prevalence of eating disorder symptoms. Int J Eat Disord. 2009;42(5):471–4.

Striegel Weissman R, Rosselli F. Reducing the burden of suffering from eating disorders: Unmet treatment needs, cost of illness, and the quest for cost-effectiveness. Behav Res Ther. 2017;88:49–64.

Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR. Prevalence and correlates of eating disorders in adolescents: results from the national comorbidity survey replication adolescent supplement. Arch Gen Psychiatry. 2011;68(7):714–23.

Tannous WK, Hay P, Girosi F, Heriseanu AI, Ahmed MU, Touyz S. The economic cost of bulimia nervosa and binge eating disorder: a population-based study. Psychol Med. 2021. https://doi.org/10.1017/S0033291721000775 .

Tholin S, Lindroos A, Tynelius P, Akerstedt T, Stunkard AJ, Bulik CM, Rasmussen F. Prevalence of night eating in obese and nonobese twins. Obesity (Silver Spring). 2009;17(5):1050–5.

Treasure J, Zipfel S, Micali N, Wade T, Stice E, Claudino A, et al. Anorexia nervosa. Nat Rev Dis Primers. 2015;1(1):15074.

Udo T, Grilo CM. Prevalence and correlates of DSM-5—defined eating disorders in a nationally representative sample of US adults. Biol Psychiat. 2018;84(5):345–54.

Vallance JK, Latner JD, Gleaves DH. The relationship between eating disorder psychopathology and health-related quality of life within a community sample. Qual Life Res. 2011;20(5):675–82.

van Hoeken D, Hoek HW. Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden. Curr Opin Psychiatry. 2020;33(6):521–527.

Ward ZJ, Rodriguez P, Wright DR, Austin SB, Long MW. Estimation of eating disorders prevalence by age and associations with mortality in a simulated nationally representative US cohort. JAMA Netw Open. 2019;2(10):e1912925-e.

Watson HJ, Von Holle A, Hamer RM, Knoph Berg C, Torgersen L, Magnus P, Stoltenberg C, Sullivan P, Reichborn-Kjennerud T, Bulik CM. Remission, continuation and incidence of eating disorders during early pregnancy: a validation study in a population-based birth cohort. Psychol Med. 2013;43(8):1723–34.

Watson RJ, Adjei J, Saewyc E, Homma Y, Goodenow C. Trends and disparities in disordered eating among heterosexual and sexual minority adolescents. Int J Eat Disord. 2017;50(1):22–31.

Watson RJ, VanKim NA, Rose HA, Porta CM, Gahagan J, Eisenberg ME. Unhealthy weight control behaviors among youth: sex of sexual partner is linked to important differences. Eat Disord. 2018;26(5):448–63.

Weigel A, König HH, Gumz A, Löwe B, Brettschneider C. Correlates of health related quality of life in anorexia nervosa. Int J Eat Disord. 2016;49(6):630–4.

Winkler LA-D, Christiansen E, Lichtenstein MB, Hansen NB, Bilenberg N, Støving RK. Quality of life in eating disorders: a meta-analysis. Psychiatry Res. 2014;219(1):1–9.

Wong MNT, Hay P. Exploring associations between age of onset and quality of life of people with eating disorder behaviours and weight/shape overvaluation: a general population study. Australas Psychiatry. 2020;28(6):660–663.

Wu J, Liu J, Li S, Ma H, Wang Y. Trends in the prevalence and disability-adjusted life years of eating disorders from 1990 to 2017: results from the Global Burden of Disease Study 2017. Epidemiol Psychiatr Sci. 2020;29:e191.

Zeiler M, Waldherr K, Philipp J, Nitsch M, Dür W, Karwautz A, et al. Prevalence of eating disorder risk and associations with health-related quality of life: results from a large school-based population screening. Eur Eat Disord Rev. 2016;24(1):9–18.

Zerwas S, Larsen JT, Petersen L, Thornton LM, Mortensen PB, Bulik CM. The incidence of eating disorders in a Danish register study: Associations with suicide risk and mortality. J Psychiatr Res. 2015;65:16-22.

Zerwas S, Larsen JT, Petersen L, Thornton LM, Quaranta M, Koch SV, et al. Eating disorders, autoimmune, and autoinflammatory disease. Pediatrics. 2017;140(6):e20162089.

Zickgraf HF, Murray HB, Kratz HE, Franklin ME. Characteristics of outpatients diagnosed with the selective/neophobic presentation of avoidant/restrictive food intake disorder. Int J Eat Disord. 2019;52(4):367-377.

Zullig KJ, Matthews-Ewald MR, Valois RF. Relationship between disordered eating and self-identified sexual minority youth in a sample of public high school adolescents. Eat Weight Disord. 2019;24(3):565–573.

Call C, Walsh BT, Attia E. From DSM-IV to DSM-5: changes to eating disorder diagnoses. Curr Opin Psychiatry. 2013;26(6):532–6.

Mitchison D, Mond J, Bussey K, Griffiths S, Trompeter N, Lonergan A, et al. DSM-5 full syndrome, other specified, and unspecified eating disorders in Australian adolescents: prevalence and clinical significance. Psychol Med. 2020;50(6):981–90.

Klump KL, Fowler N, Mayhall L, Sisk CL, Culbert KM, Burt SA. Estrogen moderates genetic influences on binge eating during puberty: disruption of normative processes? J Abnorm Psychol. 2018;127(5):458.

Aouad P, Hay P, Soh N, Touyz S, Mannan H, Mitchison D. Chew and spit (CHSP) in a large adolescent sample: prevalence, impact on health-related quality of life, and relation to other disordered eating features. Eat Disord. 2021;29(5):509–22.

Zullig KJ, Matthews-Ewald MR, Valois RF. Relationship between disordered eating and self-identified sexual minority youth in a sample of public high school adolescents. Eat Weight Disord-Stud Anorex Bulim Obes. 2019;24(3):565–73.

Weissman RS, Rosselli F. Reducing the burden of suffering from eating disorders: unmet treatment needs, cost of illness, and the quest for cost-effectiveness. Behav Res Ther. 2017;88:49–64.

Kyu HH, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392(10159):1859–922.

Ágh T, Kovács G, Supina D, Pawaskar M, Herman BK, Vokó Z, et al. A systematic review of the health-related quality of life and economic burdens of anorexia nervosa, bulimia nervosa, and binge eating disorder. Eat Weight Disord-Stud Anorex Bulim Obes. 2016;21(3):353–64.

Treasure J, Claudino A, Zucker N. Eating disorders. Lancet. 2011;375(7914):583–93.

Hay PJ, Mond J, Buttner P, Darby A. Eating disorder behaviors are increasing: findings from two sequential community surveys in South Australia. PLoS ONE. 2008;3(2): e1541.

Le LK-D, Mihalopoulos C, Engel L, Touyz S, González-Chica DA, Stocks N, et al. Burden and health state utility values of eating disorders: results from a population-based survey. Psychol Med. 2021;51(1):130–7.

Aouad P, Hay P, Soh N, Touyz S. Prevalence of chew and spit and its relation to other features of disordered eating in a community sample. Int J Eat Disord. 2018;51(8):968–72.

Appolinario JC, Sichieri R, Lopes CS, Moraes CE, da Veiga GV, Freitas S, et al. Correlates and impact of DSM-5 binge eating disorder, bulimia nervosa and recurrent binge eating: a representative population survey in a middle-income country. Soc Psychiatry Psychiatr Epidemiol. 2022. https://doi.org/10.1007/s00127-022-02223-z .

Udo T, Grilo CM. Psychiatric and medical correlates of DSM-5 eating disorders in a nationally representative sample of adults in the United States. Int J Eat Disord. 2019;52(1):42–50.

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Acknowledgements

The authors would like to thank and acknowledge the hard work of Healthcare Management Advisors (HMA) who were commissioned to undertake the Rapid Review. Additionally, the authors would like to thank all members of the consortium and consultation committees for their advice, input, and considerations during the development process. Further, a special thank you to the carers, consumers and lived experience consultants that provided input to the development of the Rapid Review and wider national Eating Disorders Research & Translation Strategy. Finally, thank you to the Australian Government—Department of Health for their support of the current project.

National Eating Disorder Research Consortium Members (alphabetical order of surname) [*indicates named authors]

Phillip Aouad: InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia; Sarah Barakat: InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia; Robert Boakes: School of Psychology, Faculty of Science, University of Sydney, NSW Australia; Leah Brennan: School of Psychology and Public Health, La Trobe University, Victoria, Australia; Emma Bryant*: InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia; Susan Byrne: School of Psychology, Western Australia, Perth, Australia; Belinda Caldwell: Eating Disorders Victoria, Victoria, Australia; Shannon Calvert: Perth, Western Australia, Australia; Bronny Carroll: InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia; David Castle: Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia; Ian Caterson: School of Life and Environmental Sciences, University of Sydney, Sydney, New South Wales, Australia; Belinda Chelius: Eating Disorders Queensland, Brisbane, Queensland, Australia; Lyn Chiem: Sydney Local Health District, New South Wales Health, Sydney, Australia; Simon Clarke: Westmead Hospital, Sydney, New South Wales, Australia; Janet Conti: Translational Health Research Institute, Western Sydney University, Sydney NSW Australia; Lexi Crouch: Brisbane, Queensland, Australia; Genevieve Dammery: InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia; Natasha Dzajkovski: InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia; Jasmine Fardouly: School of Psychology, University of New South Wales, Sydney, New South Wales, Australia; John Feneley: New South Wales Health, New South Wales, Australia; Nasim Foroughi: Translational Health Research Institute, Western Sydney University, Sydney NSW Australia; Mathew Fuller-Tyszkiewicz: School of Psychology, Faculty of Health, Deakin University, Victoria, Australia; Anthea Fursland: School of Population Health, Faculty of Health Sciences, Curtain University, Perth, Australia; Veronica Gonzalez-Arce: InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia; Bethanie Gouldthorp: Hollywood Clinic, Ramsay Health Care, Perth, Australia; Kelly Griffin: InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia; Scott Griffiths: Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; Ashlea Hambleton: InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia; Amy Hannigan: Queensland Eating Disorder Service, Brisbane, Queensland, Australia; Mel Hart: Hunter New England Local Health District, New South Wales, Australia; Susan Hart: St Vincent’s Hospital Network Local Health District, Sydney, New South Wales, Australia; Phillipa Hay: Translational Health Research Institute, Western Sydney University, Sydney NSW Australia; Ian Hickie: Brain and Mind Centre, University of Sydney, Sydney, Australia; Francis Kay-Lambkin: School of Medicine and Public Health, University of Newcastle, New South Wales, Australia; Ross King: School of Psychology, Faculty of Health, Deakin University, Victoria, Australia; Michael Kohn: Westmead Hospital, University of Sydney, Australia; Eyza Koreshe: InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia; Isabel Krug: Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; Anvi Li*: Healthcare Management Advisors, Victoria, Australia; Jake Linardon: School of Psychology, Faculty of Health, Deakin University, Victoria, Australia; Randall Long: College of Medicine and Public Health, Flinders University, South Australia, Australia; Amanda Long: Exchange Consultancy, Redlynch, New South Wales, Australia; Sloane Madden: Eating Disorders Service, Children’s Hospital at Westmead, Sydney, New South Wales, Australia; Sarah Maguire*: InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia; Danielle Maloney*: InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia; Peta Marks: InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia; Siân McLean: School of Psychology and Public Health, La Trobe University, Victoria, Australia; Thy Meddick: Clinical Excellence Queensland, Mental Health Alcohol and Other Drugs Branch, Brisbane, Queensland, Australia; Jane Miskovic-Wheatley*: InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia; Deborah Mitchison: Translational Health Research Institute, Western Sydney University, Sydney NSW Australia; Richard O’Kearney: College of Health & Medicine, Australian National University, Australian Capital Territory, Australia; Roger Paterson: ADHD and BED Integrated Clinic, Melbourne, Victoria, Australia; Susan Paxton: La Trobe University, Department of Psychology and Counselling, Victoria, Australia; Melissa Pehlivan*: InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia; Genevieve Pepin: School of Health & Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia; Andrea Phillipou: Swinburne Anorexia Nervosa (SWAN) Research Group, Centre for Mental Health, School of Health Sciences, Swinburne University, Victoria, Australia; Judith Piccone: Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia; Rebecca Pinkus: School of Psychology, Faculty of Science, University of Sydney, NSW Australia; Bronwyn Raykos: Centre for Clinical Interventions, Western Australia Health, Perth, Western Australia, Australia; Paul Rhodes: School of Psychology, Faculty of Science, University of Sydney, NSW Australia; Elizabeth Rieger: College of Health & Medicine, Australian National University, Australian Capital Territory, Australia; Karen Rockett: New South Wales Health, New South Wales, Australia; Sarah Rodan: InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia; Janice Russell: Central Clinical School Brain & Mind Research Institute, University of Sydney, New South Wales, Sydney; Haley Russell: InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia; Fiona Salter: Ramsay Health Care, Perth, Australia; Susan Sawyer: Department of Paediatrics, The University of Melbourne, Australia; Beth Shelton: National Eating Disorders Collaboration, Victoria, Australia; Urvashnee Singh: The Hollywood Clinic Hollywood Private Hospital, Ramsey Health, Perth, Australia; Sophie Smith: Sydney, New South Wales, Australia; Evelyn Smith: Translational Health Research Institute, Western Sydney University, Sydney NSW Australia; Karen Spielman: InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia; Sarah Squire: The Butterfly Foundation, Sydney, Australia; Juliette Thomson: The Butterfly Foundation, Sydney, Australia; Marika Tiggemann: College of Education, Psychology and Social Work, Flinders University, South Australia, Australia; Stephen Touyz*: InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia; Ranjani Utpala: The Butterfly Foundation, Sydney, Australia; Lenny Vartanian: School of Psychology, University of New South Wales, Sydney, New South Wales, Australia; Andrew Wallis: Eating Disorder Service, The Sydney Children’s Hospital Network, Westmead Campus, Sydney, Australia; Warren Ward: Department of Psychiatry, University of Queensland, Brisbane, Australia; Sarah Wells: University of Tasmania, Tasmania, Australia; Eleanor Wertheim: School of Psychology and Public Health, La Trobe University, Victoria, Australia; Simon Wilksch: College of Education, Psychology and Social Work, Flinders University, South Australia, Australia; Michelle Williams: Royal Hobart, Tasmanian Health Service, Tasmania, Australia.

The RR was in-part funded by the Australian Government Department of Health in partnership with other national and jurisdictional stakeholders. As the organisation responsible for overseeing the National Eating Disorder Research & Translation Strategy, InsideOut Institute commissioned Healthcare Management Advisors to undertake the RR as part of a larger, ongoing, project. Role of Funder: The funder was not directly involved in informing the development of the current review.

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Phillipa Hay

InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia

Phillip Aouad, Peta Marks, Danielle Maloney, Stephen Touyz & Sarah Maguire

Western Sydney University, Sydney, NSW, Australia

• Phillip Aouad

Healthcare Management Advisors, Robinson, VIC, Australia

Sydney Local Health District, New South Wales Health, Sydney, NSW, Australia

Danielle Maloney

South West Sydney Local Health District, New South Wales Health, Sydney, NSW, Australia

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National Eating Disorder Research Consortium

• , Sarah Barakat
• , Robert Boakes
• , Leah Brennan
• , Emma Bryant
• , Susan Byrne
• , Belinda Caldwell
• , Shannon Calvert
• , Bronny Carroll
• , David Castle
• , Ian Caterson
• , Belinda Chelius
• , Lyn Chiem
• , Simon Clarke
• , Janet Conti
• , Lexi Crouch
• , Genevieve Dammery
• , Natasha Dzajkovski
• , Jasmine Fardouly
• , John Feneley
• , Nasim Foroughi
• , Mathew Fuller-Tyszkiewicz
• , Anthea Fursland
• , Veronica Gonzalez-Arce
• , Bethanie Gouldthorp
• , Kelly Griffin
• , Scott Griffiths
• , Ashlea Hambleton
• , Amy Hannigan
• , Susan Hart
• , Phillipa Hay
• , Ian Hickie
• , Francis Kay-Lambkin
• , Ross King
• , Michael Kohn
• , Eyza Koreshe
• , Isabel Krug
• , Jake Linardon
• , Randall Long
• , Amanda Long
• , Sloane Madden
• , Sarah Maguire
• , Danielle Maloney
• , Peta Marks
• , Siân McLean
• , Thy Meddick
• , Jane Miskovic-Wheatley
• , Deborah Mitchison
• , Richard O’Kearney
• , Roger Paterson
• , Susan Paxton
• , Melissa Pehlivan
• , Genevieve Pepin
• , Andrea Phillipou
• , Judith Piccone
• , Rebecca Pinkus
• , Bronwyn Raykos
• , Paul Rhodes
• , Elizabeth Rieger
• , Karen Rockett
• , Sarah Rodan
• , Janice Russell
• , Haley Russell
• , Fiona Salter
• , Susan Sawyer
• , Beth Shelton
• , Urvashnee Singh
• , Sophie Smith
• , Evelyn Smith
• , Karen Spielman
• , Sarah Squire
• , Juliette Thomson
• , Marika Tiggemann
• , Stephen Touyz
• , Ranjani Utpala
• , Lenny Vartanian
• , Andrew Wallis
• , Warren Ward
• , Sarah Wells
• , Eleanor Wertheim
• , Simon Wilksch
•  & Michelle Williams

Contributions

PM, ST and SM oversaw the Rapid Review process; AL carried out and wrote the initial review; PH and PA wrote the first manuscript; all authors edited and approved the final manuscript.

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Competing interests.

ST receives royalties from Hogrefe and Huber, McGraw Hill and Taylor and Francis for published books/book chapters. He has received honoraria from the Takeda Group of Companies for consultative work, public speaking engagements and commissioned reports. He has chaired their Clinical Advisory Committee for Binge Eating Disorder. He is the Editor in Chief of the Journal of Eating Disorders. ST is a committee member of the National Eating Disorders Collaboration as well as the Technical Advisory Group for Eating Disorders. AL undertook work on this RR while employed by HMA. A/Prof Sarah Maguire, Dr. Jane Miskovic-Wheatley and Dr. Phillip Aouad are guest editors of the special issue “Improving the future by understanding the present: evidence reviews for the field of eating disorders.”

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Prevalence rates from select epidemiological studies - includes Night Eating Syndrome and Avoidant/Restrictive Food Intake Disorder.

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Hay, P., Aouad, P., Le, A. et al. Epidemiology of eating disorders: population, prevalence, disease burden and quality of life informing public policy in Australia—a rapid review. J Eat Disord 11 , 23 (2023). https://doi.org/10.1186/s40337-023-00738-7

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DOI : https://doi.org/10.1186/s40337-023-00738-7

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Ethical Considerations for Patients With Eating Disorders

What are the benefits and drawbacks of in-person or virtual relationships.

Posted May 31, 2024 | Reviewed by Tyler Woods

• What Are Eating Disorders?
• Find counselling to heal from an eating disorder

From the mid-1990s until 2014, I founded and was the Executive Director of Cedar Associates, an outpatient treatment center for eating disorders with two locations in Westchester County, New York. We were a group of qualified eating disorder specialists joined together for a common cause—to provide coordinated and expert care to our patients.

One ethical issue we pondered was whether or not we had created a cottage industry for those most vulnerable. We wondered if we were somehow taking advantage of those in need as we were part of the new 'niche' industry created by the rapid increase in the prevalence of eating disorders. There was now a steady influx of patients in desperate need of help. Having an eating disorder is terrifying, debilitating, and costly for patients and their families. Eating disorders remain the leading cause of death among all mental health conditions.

Our dilemma was about money. We simultaneously believed that we were entitled to a solid living wage and that patients were entitled to solid and expert care; both could be true and acceptable. Most healthcare practitioners struggle with healthcare services' delivery, costs, and payment. These ethical issues remain unresolved due to the politicization of healthcare, the complexity of insurance, and other factors. However, clinicians have always been able to assert their training, competency, and expertise in providing treatment unequivocally; these bona files remain ethically foundational.

We now have a choice of mental health care delivery, which has created new ethical considerations. COVID-19 set precedence for conducting sensitive meetings virtually, especially in health care. Whether to see a patient in-person or virtually is now part of the clinical decision-making mix. Deciding whether or when to treat in person versus virtually takes a mindful and clinically astute clinician.

Some factors to consider when deciding between in-person and virtual meetings:

Establishing a prudent care plan involves routinely choosing the type of treatment based on the patient's clinical needs. Eating disorders, like others with complex symptoms, occur among the most psychologically vulnerable people. Assessing the level of severity can be very difficult. Keep in mind all the factors that help in assessment: type, frequency, and use of the symptom are all important, as well as assessing the level of depression , how isolated the person is, the family dynamics, and the level of support the person has in the recovery process.

Since eating disorders manifest in many and with various constellations of symptoms, it isn't always easy to tell by looking at someone what state they are in. Patients can conceal their bodies through layered clothing and hide the truth about their behavior due to shame , anger , and fear .

• Eating disorders are also disorders of relationships—the ones we have with our self-concept and our relationships with others. (Zerbe, 2008, Scheel, 2011). Is the clinician confident that a relationship that fosters support, safety, and appropriate boundaries is possible virtually? Is the clinician comfortable not experiencing the most nuanced communication during online sessions? Since eating disorders are the vehicle for communication about relationships, internal conflicts, and lability in mood, does seeing a person virtually contribute to further relational disconnect? Is a real relationship possible virtually?
• Eating disorder clinicians often must face working with families in despair, who would never have consented to the treatment had it not been for their child, adolescent, or adult child in physical distress. The family member with the eating disorder is often the family symptom-bearer. Family members can blame and attack those who are most trying to help; they can sometimes bully school officials and therapists and can resist recommendations or, worse, manipulate or lie about therapeutic interventions to save their reputations. Is the clinician prepared to coordinate care among various professionals while being able to reduce or eliminate divisiveness among family members and other involved professionals? It can be enormously complex for family members to accept the psychological underpinnings of the eating disorder and the metaphoric use of the symptom to talk about family dynamics and issues. Will virtual sessions impede this process of discovery?

In the past, clinicians relied solely on their transparency to patients about their training in treating eating disorders. Although this remains true today, there is a certification process and credentials for clinicians to treat eating disorders, further qualifying competency and commitment to ethical treatment standards (IAEDP). Certified eating disorder specialists (CEDSs) now provide the care, and most clinicians incur additional costs in ongoing training, supervision, and personal therapy.

We need competent and expert therapists. More therapists are receiving advanced training; however, training in evidence-based treatment alone cannot allow someone to understand the complexities of a severe condition. Trauma , major depression, debilitating anxiety , borderline personality disorder, and a high degree of family dysfunction surround and underlie the development of an eating disorder. Do virtual appointments add another layer to an oversimplification of the needs of this population?

Skills in here-and-now approaches like cognitive behavioral therapy, acceptance and commitment therapy, short-term interpersonal therapies, mindfulness , and motivational approaches are insufficient in treating eating disorders. Therapists require additional training in understanding human motivation , even the use of the eating disorder as a symbol and metaphor. Are virtual appointments ethically consistent with providing a holistic treatment protocol for a patient with an eating disorder? (Freeman, 2007)

Telehealth contributions and considerations:

Telehealth has allowed vast populations to have access to mental health treatment, sometimes for the first time. Medically and psychologically home-bound people, rural communities with difficult access to larger towns, adult family members who cannot easily drive their child to treatment, and many others praise telehealth's ability to service specific populations and meet the demands of more and more people considering psychotherapy for the very first time.

• Is some form of therapy, like telehealth, better than no therapy? Absolutely, but with the caveat that these treatments are best suited for those who are not suffering from major depressive conditions, significant anxiety, personality disorders masquerading as 'merely' relationship issues, or those with severe symptoms like an eating disorder. Often, patients with minor anxiety do very well in teletherapy because of the protective veil of physical distance and how the camera orients eye contact.
• Mental health issues confront one in every five Americans (CDC). Adding a layer of disconnect via telehealth requires prudent decision-making to proceed, especially when the therapist is new to the field of eating disorders, or new to the field of treating mental health conditions.
• Serious assessment and consideration are required to determine which patients may be most suited to benefit from telehealth and those for whom it poses risks.

We are in an age of disconnect from human contact, with artificial intelligence , virtual meetings, and connections based and maintained on social media . If only we could extract our humanity from being human, we might be in better mental health living in a virtual world.

CDC.gov. Center for Disease Control: mental health statistics (2024).

Freeman, C. & Power, M. Handbook of Evidence-Based Psychotherapies: A guide for research and practice. 1st edition. Wiley. (2007).

Greenson, R. The technique and practice of psychoanalysis: Volume 1. England: Routledge Press. (1967).

iaedp.com. International association of eating disorders. certified eating disorder specialist overview. (2024)

Scheel, J. When Food is Family: A loving approach to heal eating disorders. Washington: Idyll Arbor Inc. (2011).

Zerbe, K. Integrated Treatment of Eating Disorders: Beyond the Body Betrayed. New York: W.W. Norton & Co. (2008)

Judy Scheel, Ph.D., L.C.S.W. , is the author of When Food Is Family , and is the founder and Executive Director of the Cedar Associates Foundation.

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Avoidant Restrictive Food Intake Disorder (ARFID) - More Than Just "Picky Eating"

Avoidant/Restrictive Food Intake Disorder (ARFID) is about more than "picky eating”. It stems from chronic food avoidance or restriction that leads to severe weight loss and nutritional deficiency. Unlike other eating disorders, ARFID is not related to body image.

ARFID was first introduced in 2013 in the American Psychiatric Association’s (APA) fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In 2022, the DSM-5 text revision ( DSM-5-TR ) further refined its diagnostic criteria for ARFID. The diagnosis is characterized by substantial weight loss and nutritional deficiency due to the persistent avoidance or restriction of food or eating. In children, underweight may manifest as limited growth or an inability to gain the expected weight for age. The avoidant/restrictive behaviors are not related to cultural practices or food scarcity, and the disorder interferes with psychosocial functioning. Importantly, ARFID is not related to body image or fear of weight gain.

ARFID is most often diagnosed during childhood or adolescence but can occur at any age. Compared to anorexia nervosa or bulimia nervosa , ARFID is more prevalent in younger persons, male adolescents, those with comorbid psychiatric conditions such as anxiety or autism spectrum disorders (ASD), and in people with medical conditions, including food allergies and gastrointestinal disorders that cause eating-related distress (gagging, choking, nausea, or pain).

Over the long-term, ARFID may contribute to underdevelopment in children, impaired psychosocial functioning, depression, anxiety, and an overall reduction in quality of life. In patients with severe malnutrition who require in-patient nasogastric or enteral nutrition to reach homeostasis and tolerance for oral nutrition, refeeding syndrome is an uncommon though potentially serious or even fatal complication.

How is ARFID Diagnosed?

Consider six-year-old Lauren, described in a case report . She had a prior diagnosis of ASD and separation anxiety. Other than refusing rice or pasta, her mother reported that her diet was relatively varied and balanced. When Lauren entered primary school, she developed a reluctance to eat in front of her classmates. Her weight remained stable until the end of the school year but then she acquired a throat infection that left her afraid of choking and getting food stuck in her throat.

Lauren became increasingly sensitive to the sight and smell of food, displayed irritability, and started to restrict her intake. Her pediatrician prescribed risperidone for aggressive behavior. Within a three-week period, Lauren lost three kg (6.6 lbs.) and became medically unstable and was hospitalized. She received artificial nutrition via nasogastric tube (NGT) and continued with the NGT upon discharge. She was prescribed fluoxetine for generalized anxiety and referred to psychology services for family-based treatment of an eating disorder.

The physical signs and symptoms of inadequate energy intake in cases like Lauren’s are important to note. They can range from weakness, dizziness or syncope, abdominal pain or constipation, low body temperature, dry or pale skin, hair loss, and/or amenorrhea in menstruating persons to other sequelae from malnutrition. In children, developmental abnormalities and psychological disturbances may also result from malnutrition and inhibited growth. For an ARFID diagnosis, however, these factors must occur alongside key eating-related behavior changes .

Look for changes or patterns in food repertoire, including the range of “accepted” and “avoided” foods or the narrowing or elimination of foods or entire food groups, sometimes based on smell or texture. Determine whether food avoidance is related to fear of discomfort (nausea, pain, gagging, choking), and consider the possibility of other eating-related behaviors (binge eating, rumination, regurgitation, chewing and spitting).

Try to establish the onset and duration and the extent of food-related impairment . Lauren was never a fan of rice or pasta, but her eating behaviors began to shift when she changed schools and was uneasy about eating in front of her peers. The dramatic shift toward food restriction occurred after the infection that made swallowing a source of anxiety. This was the catalyst for her shift into ARFID.

Prior to making an ARFID diagnosis, exclude conditions that may present with weight loss or decreased interest in food or eating. Rule out other eating disorders, such as anorexia nervosa which involves distorted body image and fear of weight gain that is not a feature of ARFID . Consider food allergies or gastrointestinal disorders, including gastroesophageal reflux disease (GERD) and celiac disease, that explain the presence of nutritional deficiencies and/or changes in weight or development. Bear in mind that psychiatric and neurodevelopmental disorders may also contribute to changes in eating habits or lack of interest in food that, in some cases, can result in comorbid ARFID. Lauren’s history of ASD, for example, reflects a common ARFID comorbidity.

Structured clinical interviews such the ARFID module of the Eating Disorder Examination ( EDE ) and PARDI (Pica, ARFID, and Rumination Disorder Interview) may aid in the diagnosis of ARFID but should not be the sole method for determination. Self-report questionnaires such as NIAS (Nine-Item ARFID Screen) and EDY-Q (Eating Disorder Examination - Questionnaire) may also be helpful.

Tune in next week to read about management approaches for this complex eating disorder.

For handouts and information to share with your patients, see DynaMedex Patient Information on ARFID .

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Microplastics Are Everywhere. Here’s How to Avoid Eating Them.

By Katie Okamoto

Katie Okamoto is an editor focused on the environment. She has covered the intersection of products and sustainability for more than a decade.

Microplastics and nanoplastics are everywhere.

The teeny tiny pieces of plastic have been found in everything from drinking water to chicken nuggets, apples, and broccoli.

Recent studies have linked these pollutants to heart disease , lung disorders , and more worrying health issues.

But unfortunately, microplastics are now so pervasive that they’re nearly impossible to avoid.

If you’re concerned about the health effects linked to microplastics, the experts I spoke with said that you can lower your risk by taking care of your general health: getting plenty of sleep and exercise, eating a balanced diet, lowering stress, and seeking preventative care.

Still, it’s probably a good idea to lower your exposure to microplastics even if you can’t avoid them completely. Although you can cut back your exposure in as many ways as there are sources of plastic, the experts I spoke with recommended focusing on exposures from water, food, and air.

I talked to three doctors and a research scientist for tips on how to reduce the amount of tiny plastics and their chemicals that you (or your kids ) might ingest. Here’s what they recommend.

1. Cut back on bottled water

Bottled water is a significant source of microplastics. In fact, it’s the most concentrated source , according to a study from 2019.

Researchers believe that bottled water contains many more microplastics than tap. The evidence is mounting: A study published in 2024 suggests that the typical plastic bottle of water contains two to three times the plastic than previously thought.

Drinking bottled water in a pinch isn’t the end of the world, but for a daily habit, try carrying a reusable steel or glass bottle or tumbler when out and about.

2. Get an NSF-certified water filter

Switching to tap water from plastic bottled water will likely significantly reduce your routine exposure to plastics. But while the average plastic water bottle contains more microplastics and nanoplastics than tap, research shows that tap water may also be a source of microplastics.

Several of our water filter picks are specifically NSF/American National Standards Institute–certified to reduce microplastics, which means they’ve been rigorously tested in an accredited lab. They’re certified only to reduce since the filters cannot guarantee total elimination. Our picks include under-sink filters , such as the Aquasana AQ-5200 , and the Brita Elite , a pitcher filter .

Aquasana AQ-5200

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Brita Elite Filter

Ace filtration, long lifespan.

This 10-cup, user-friendly model is rated to last six months between replacements.

Yes, it’s ironic that most NSF/ANSI-certified water filters contain plastic. But any microplastic shedding from using the plastic filter is likely to be minimal, as long as you avoid running hot water through the filter and store your water in the fridge, since heat accelerates plastic degradation.

Research suggests that boiling tap water, cooling it, and then filtering it may be especially effective at reducing microplastics, although it’s less practical for most people than simply using a filter.

3. Don’t use plastic to store food

Plastic food storage and packaging is so common that it’s difficult to avoid entirely. But your safest bet is to avoid storing food or liquid in plastic when possible and to minimize exposing any plastic (even those that say they’re BPA-free or microwave-safe) to high heat. Sunlight, acids, and physical erosion can also degrade plastic.

4. Don’t reuse single-use plastics for food and drinks

It’s great to reuse single-use plastic —just not for food. Unless you’re using the plastic in the freezer, save it for something that isn’t food storage or reheating, said Dr. Gillian Goddard, an endocrinologist and author at ParentData , a science-based online resource for parents. That means don’t reuse plastic takeout containers, breastmilk bags, or drink bottles.

5. Don’t microwave in plastic

Avoid microwaving or heating food or water in plastic—even if it says it’s microwave-safe, said Tracey Woodruff, director of the Program on Reproductive Health and the Environment at University of California San Francisco. Instead, consider glass or ceramic. The Pyrex Simply Store 18-Piece Set is our pick for the best food storage containers , and they survived our drop tests, stack neatly, and come with user-friendly lids (although you may not want to microwave the plastic lids). Our runner-up, the leakproof Glasslock 18-Piece Container Set , is another great option.

Pyrex Simply Store 18-Piece Set

The best glass container set.

The Pyrex Simply Store containers stack neatly and are made from durable tempered glass. The colorful lids make it easier to match their shape to the corresponding container, though you may need to replace them over time.

Glasslock 18-Piece Container Set

The best leakproof glass container set.

The Glasslock containers have locking lids that will prevent leaks. But these lids also put stress on the lips of the containers, so the glass may be prone to chipping over time.

6. Wash plastic by hand

Dishwasher temperatures run very hot and can degrade plastic—even dishwasher-safe plastic—and lead to microplastic shedding. Try to wash your plastic food containers by hand.

7. Use wood or bamboo cutting boards

Some research suggests that plastic cutting boards can be a significant source of microplastics in your diet, since repeated cutting on their surface can dislodge particles that adhere to food. Wood cutting boards also have some other advantages: They’re better for your knife blades and last longer than plastic when properly maintained.

Teakhaus Medium Professional Carving Board with Juice Canal 109

The best wood cutting board.

This beautiful teak board requires more careful cleaning than a plastic board, but it feels better under a knife and is easier to maintain than the other wood boards we tested.

Our cutting board pick, the Teakhaus Medium Professional Carving Board with Juice Canal 109 , is made from sustainably harvested teak. If you still prefer plastic for certain uses, use it sparingly and replace it after heavy scarring.

8. Clean your air

The air we breathe is also a potential source of microplastics, in the form of dust. Reducing airborne dust in your home, then, may reduce your exposure to inhaled microplastics.

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That means doing boring stuff, like vacuuming regularly with a bagged, sealed-system vacuum that has a HEPA or S-class filter and mopping and wiping down surfaces with a damp sponge or cloth (since dusting kicks those tiny particles back up into the air).

Coway Airmega AP-1512HH Mighty

Exceptional, efficient, affordable.

Perfect for bedrooms, playrooms, and living rooms, this air purifier is one of the highest-performing, most-durable, and most-economical models we’ve tested.

You should also take care of seasonal chores like cleaning fans and AC unit filters and changing HVAC filters, and consider getting an air purifier if you live near a busy road.

Take special steps for infants and young children

Infants may be exposed to microplastics and nanoplastics in much higher concentrations than adults. Research shows that this exposure may be cause for concern, particularly at critical stages of early development. But much like health risks to adults, it’s important to think of microplastics exposure as just one piece of a child’s overall health.

“I emphasize that before putting much energy and resources into minimizing unknown risks, it is worth attending to reducing the risks we know about,” said Dr. Carlos Lerner, a pediatrician and professor of clinical pediatrics at UCLA Health. He cited following safe sleep recommendations for infants, avoiding secondhand smoke, and practicing good nutrition as examples.

If you want to take a more precautionary approach, avoid using plastic to warm formula or breastmilk. This is the main point of advice from the experts I spoke with, as well as the Cleveland Clinic .

1. Avoid microwaving or heating formula in plastic

Recent evidence shows that polypropylene-bottle-fed babies may swallow very high levels of tiny plastics due to the high temperatures used to sterilize bottles and prepare formula, as well as shaking the bottles to mix. If you want to feed your baby warmed formula and use plastic bottles, consider premixing the formula in a glass container, then cooling it down before transferring it to the feeding bottle.

2. Rinse heat-sterilized plastic bottles before adding formula or breastmilk

If you use heat to sterilize plastic bottles, leave them to cool then rinse them several times before filling them with formula or breastmilk, Lerner suggested.

3. Consider glass or silicone over plastic bottles

If you prefer to heat formula in a microwave, consider a glass or silicone bottle. The Philips Avent Glass Natural Response Baby Bottle  is our recommendation for the best glass baby bottle.

Philips Avent Glass Natural Response Baby Bottle

Our favorite glass bottles.

With only three pieces and a large, easy-to-screw-on collar, this glass bottle is simple to use and didn’t leak in our test. But the very wide nipple may not work well for all babies.

4. Wash hands before eating

For young kids who eat with their hands, try to establish a habit of handwashing before eating, said Woodruff. While handwashing is not always possible, it can help reduce exposure from touching microplastics in dust and soil (and maybe, just maybe, stem the tide of germs).

How worried should you be about microplastics?

Scientists are still studying the exact connections between these teeny tiny pieces of plastic and human health. But it’s clear that exposure to plastic—whether it’s those tiny particles, the chemicals they leach, or a combination—is being linked to a variety of worrying health issues.

Some of those connections still require more research, such as ties to colon cancer , respiratory disease , metabolic function , and disruption to endocrine systems , while others—like a recent study that found those with levels of plastics in their arteries were at a higher risk for heart attacks, strokes, and death—seem a little more clear.

It’s important to remember that these links point to concerns about the impact of microplastics on public health, but they are not specific, predictable outcomes. “What I’m thinking about is population risk, not a risk to a specific individual,” said Goddard.

The tricky thing is that microplastics and nanoplastics are impossible to avoid, no matter how diligent you are: They’re in the air we breathe , our drinking water , and our food. But scientists aren’t sure what levels of microplastics and nanoplastics we’re each taking in from those sources.

The oft-cited estimate that the average person eats a credit card’s worth of plastic every week has been called into question . But our bodies are certainly taking in plastic, and that’s more than nature intended.

Given the growing body of evidence, it’s possible that we’ll start to see more public health measures that address microplastic pollution. Until then, taking care of your overall health is the first line of defense, followed by taking reasonable steps to reduce microplastic exposure.

This article was edited by Christine Cyr Clisset and Ben Frumin.

Tracey Woodruff, director of the Program on Reproductive Health and the Environment at UCSF , phone interview , April 25, 2024

Gillian Goddard, MD, endocrinologist and adjunct assistant professor at NYU Langone Hospital and author of “Hot Flash” newsletter from ParentData , phone interview , April 26, 2024

Carlos Lerner, MD, pediatrician at the Children’s Health Center at UCLA and professor and Jack H. Skirball endowed chair in Pediatrics at UCLA , email interview , April 26, 2024

Hayley Goldbach, MD, board-certified physician and dermatologic surgeon at Brown University , email interview , April 29, 2024

Meet your guide

Katie Okamoto

Katie Okamoto is a writer and the editor of sustainability coverage at Wirecutter. She has been covering food and design products and their intersections with environment and health issues for more than a decade. Katie has also worked in design and sustainability, and she holds a bachelor’s in environmental studies, a master’s in architecture, and a professional certificate in life cycle assessment.

Mentioned above

• With eight different picks, we’ve found water bottles suited for everyone from gym rats to frequent travelers. The 8 Best Water Bottles  
• The affordable, leak-resistant Simple Modern Classic Tumbler keeps drinks cold (or warm) for hours, and it comes with both a straw lid and a flip-top lid. The Best Tumbler  
• After more than 30 hours researching hundreds of models, we’ve found the best under-sink water filtration systems for most people. Here’s what we recommend. The Best Under-Sink Water Filter  
• Water filters and pitchers are the simplest, most affordable way to get reliable filtered water at home. The Best Water Filter Pitcher and Dispenser  
• Most plastic isn’t actually recycled. These 12 tips can help you reduce your overall plastic use—and make a difference in the global plastic pollution problem. 12 Ways to Break Up With Single-Use Plastics  
• After years of using and abusing food-storage containers, we recommend the glass Pyrex Simply Store 18-Piece Set and the Snapware Total Solution 20-Piece Set. The Best Food Storage Containers  

Further reading

Silicone Kitchen Gear Isn’t As Sustainable As Many People Think. Try These Solutions Instead.

by Katie Okamoto

We share how to get the most out of silicone items you may already own, and we recommend swaps you should consider instead of buying new tools and gadgets.

The Best Reusable Produce Bags, Beeswax Wraps, and Other Ways to Reduce Plastic Waste

by Anna Perling

Our favorite alternatives to plastic or disposable food storage include silicone food-storage bags, beeswax wraps, and cloth produce bags.

Laundry Detergent Sheets Are Poor Cleaners. And Their Sustainability Claims Are Debatable.

by Andrea Barnes

Laundry detergent sheets claim to be a more-sustainable option than traditional liquid, powder, or pod detergents. Unfortunately, they don’t clean well.

Expert Tips for Freezing Food and Reducing Food Waste

by Anna Perling and Katie Okamoto

We have the best freezer containers, plus expert advice on saving money and reducing waste by getting the most from your freezer.

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Eating Disorders: About More Than Food

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What are eating disorders?

Eating disorders are serious, biologically influenced medical illnesses marked by severe disturbances to one’s eating behaviors. Although many people may be concerned about their health, weight, or appearance from time to time, some people become fixated or obsessed with weight loss, body weight or shape, and controlling their food intake. These may be signs of an eating disorder.

Eating disorders are not a choice. These disorders can affect a person’s physical and mental health. In some cases, they can be life-threatening. With treatment, however, people can recover completely from eating disorders.

Who is at risk for eating disorders?

Eating disorders can affect people of all ages, racial and ethnic backgrounds, body weights, and genders. Even people who appear healthy, such as athletes, can have eating disorders and be extremely ill. People with eating disorders can be underweight, normal weight, or overweight. In other words, you can’t tell if someone has an eating disorder by looking at them.

The exact cause of eating disorders is not fully understood.  Research suggests a combination of genetic, biological, behavioral, psychological, and social factors can raise a person’s risk. 

What are the common types of eating disorders?

Common eating disorders include anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant restrictive food intake disorder. Each of these disorders is associated with different but sometimes overlapping symptoms. People exhibiting any combination of these symptoms may have an eating disorder and should be evaluated by a health care provider.

What is anorexia nervosa?

Anorexia nervosa is a condition where people avoid food, severely restrict food, or eat very small quantities of only certain foods. They also may weigh themselves repeatedly. Even when dangerously underweight, they may see themselves as overweight.

There are two subtypes of anorexia nervosa: a restrictive subtype and a binge-purge subtype.

Restrictive : People with the restrictive subtype of anorexia nervosa severely limit the amount and type of food they consume.

Binge-Purge : People with the binge-purge subtype of anorexia nervosa also greatly restrict the amount and type of food they consume. In addition, they may have binge-eating and purging episodes—eating large amounts of food in a short time followed by vomiting or using laxatives or diuretics to get rid of what was consumed.

Symptoms of anorexia nervosa include:

• Extremely restricted eating and/or intensive and excessive exercise
• Extreme thinness (emaciation)
• A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
• Intense fear of gaining weight
• Distorted body or self-image that is heavily influenced by perceptions of body weight and shape
• Denial of the seriousness of low body weight

Over time, anorexia nervosa can lead to numerous serious health consequences, including:

• Thinning of the bones (osteopenia or osteoporosis)
• Mild anemia
• Muscle wasting and weakness
• Brittle hair and nails
• Dry and yellowish skin
• Growth of fine hair all over the body (lanugo)
• Severe constipation
• Low blood pressure
• Slowed breathing and pulse
• Damage to the structure and function of the heart
• Drop in internal body temperature, causing a person to feel cold all the time
• Lethargy, sluggishness, or feeling tired all the time
• Infertility
• Brain damage
• Multiple organ failure

Anorexia nervosa can be fatal. It has an extremely high death (mortality) rate compared with other mental disorders. People with anorexia are at risk of dying from medical complications associated with starvation. Suicide is the second leading cause of death for people diagnosed with anorexia nervosa.

If you or someone you know is in immediate distress or is thinking about hurting themselves, call the National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255). You also can text the Crisis Text Line (HELLO to 741741) or use the Lifeline Chat on the National Suicide Prevention Lifeline   website. If you suspect a medical emergency, seek medical attention or call 911 immediately.

What is bulimia nervosa?

Bulimia nervosa is a condition where people have recurrent episodes of eating unusually large amounts of food and feeling a lack of control over their eating. This binge eating is followed by behaviors that compensate for the overeating to prevent weight gain, such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. Unlike those with anorexia nervosa, people with bulimia nervosa may maintain a normal weight or be overweight.

Symptoms and health consequences of bulimia nervosa include:

• Chronically inflamed and sore throat
• Swollen salivary glands in the neck and jaw area
• Worn tooth enamel and increasingly sensitive and decaying teeth from exposure to stomach acid when vomiting
• Acid reflux disorder and other gastrointestinal problems
• Intestinal distress and irritation from laxative abuse
• Severe dehydration from purging
• Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals), which can lead to stroke or heart attack

What is binge-eating disorder?

Binge-eating disorder is a condition where people lose control of their eating and have reoccurring episodes of eating unusually large amounts of food. Unlike bulimia nervosa, periods of binge eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder are often overweight or obese.

Symptoms of binge-eating disorder include:

• Eating unusually large amounts of food in a short amount of time, for example, within two hours
• Eating rapidly during binge episodes
• Eating even when full or not hungry
• Eating until uncomfortably full
• Eating alone or in secret to avoid embarrassment
• Feeling distressed, ashamed, or guilty about eating
• Frequently dieting, possibly without weight loss

What is avoidant restrictive food intake disorder?

Avoidant restrictive food intake disorder (ARFID), previously known as selective eating disorder, is a condition where people limit the amount or type of food eaten. Unlike anorexia nervosa, people with ARFID do not have a distorted body image or extreme fear of gaining weight. ARFID is most common in middle childhood and usually has an earlier onset than other eating disorders. Many children go through phases of picky eating, but a child with ARFID does not eat enough calories to grow and develop properly, and an adult with ARFID does not eat enough calories to maintain basic body function.

Symptoms of ARFID include:

• Dramatic restriction of types or amount of food eaten
• Lack of appetite or interest in food
• Dramatic weight loss
• Upset stomach, abdominal pain, or other gastrointestinal issues with no other known cause
• Limited range of preferred foods that becomes even more limited (“picky eating” that gets progressively worse)

How are eating disorders treated?

Eating disorders can be treated successfully. Early detection and treatment are important for a full recovery. People with eating disorders are at higher risk for suicide and medical complications.

A person’s family can play a crucial role in treatment. Family members can encourage the person with eating or body image issues to seek help. They also can provide support during treatment and can be a great ally to both the individual and the health care provider. Research suggests that incorporating the family into treatment for eating disorders can improve treatment outcomes, particularly for adolescents.

Treatment plans for eating disorders include psychotherapy, medical care and monitoring, nutritional counseling, medications, or a combination of these approaches. Typical treatment goals include:

• Restoring adequate nutrition
• Bringing weight to a healthy level
• Reducing excessive exercise
• Stopping binge-purge and binge-eating behaviors

People with eating disorders also may have other mental disorders (such as depression or anxiety) or problems with substance use. It’s critical to treat any co-occurring conditions as part of the treatment plan.

Specific forms of psychotherapy (“talk therapy”) and cognitive-behavioral approaches can treat certain eating disorders effectively. For general information about psychotherapies, visit the National Institute of Mental Health (NIMH) psychotherapies webpage .

Research also suggests that medications may help treat some eating disorders and co-occurring anxiety or depression related to eating disorders. Information about medications changes frequently, so talk to your health care provider. Visit the U.S. Food and Drug Administration (FDA) website  for the latest warnings, patient medication guides, and FDA-approved medications.

Where can I find help?

If you're unsure where to get help, your health care provider is a good place to start. Your health care provider can refer you to a qualified mental health professional, such as a psychiatrist or psychologist, who has experience treating eating disorders.

You can learn more about getting help and finding a health care provider on NIMH's Help for Mental Illnesses webpage . If you need help identifying a provider in your area, call the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline at 1-800-662-HELP (4357). You also can search SAMHSA’s online Behavioral Health Treatment Services Locator  , which lists facilities and programs that provide mental health services.

For tips on talking with your health care provider about your mental health, read NIMH’s fact sheet, Taking Control of Your Mental Health: Tips for Talking With Your Health Care Provider .

For additional resources, visit the Agency for Healthcare Research and Quality website  .

Are there clinical trials studying eating disorders?

NIMH supports a wide range of research, including clinical trials that look at new ways to prevent, detect, or treat diseases and conditions, including eating disorders. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct clinical trials with patients and healthy volunteers. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you. For more information about clinical research and how to find clinical trials being conducted around the country, visit NIMH's clinical trials webpage .

The information in this publication is in the public domain and may be reused or copied without permission. However, you may not reuse or copy images. Please cite the National Institute of Mental Health as the source. Read our copyright policy to learn more about our guidelines for reusing NIMH content.

For More Information

MedlinePlus  (National Library of Medicine) ( en español  ) ClinicalTrials.gov  ( en español  )

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health NIH Publication No. 21-MH-4901 Revised 2021