The State of Eating Disorders in

Eating disorders are extremely common, as nearly 1 out of every 10 Americans is expected to develop one in their lifetime. 

Eating disorders involve distorted feelings and behaviors related to food and eating. They can have serious and often fatal consequences. 

What Are the Different Eating Disorders?

Eating disorders are not a lifestyle choice. They are serious mental health conditions involving disturbances in eating behaviors, emotions, and thoughts about food and eating. 

There are four main eating disorders.

• Anorexia nervosa: Anorexia involves serious restriction of food and/or calorie intake and a distorted vision of self as overweight even if underweight. 
• Bulimia nervosa: Bulimia generally follows a binge-purge pattern of eating where an individual eats a large amount of food in a binge and then compensates for this with laxatives or diuretics, forced vomiting, excessive exercise, or a combination of these actions.
• Binge eating disorder: Unlike with bulimia, binge eating disorder is not followed by purging behaviors and involves a loss of control over eating.
• Avoidant-restrictive food intake disorder (ARFID): ARFID involves severely restricting the amount or type of food eaten, but unlike with anorexia, this is not due to a distorted body image.

People with eating disorders are not always severely underweight. Eating disorders are often overlooked and under diagnosed. 

Eating disorders are commonly life-threatening, leading to medical complications related to starvation as well as high rates of suicide.

Eating Disorder Statistics

Eating disorders are common around the globe, impacting a wide range of populations and demographics. They commonly develop during adolescence, but they can impact children and older adults as well. 

While eating disorders have commonly been considered to mainly impact women and those in Western countries, studies show that men also develop eating disorders, and there is a high prevalence of eating disorders in Asia and developing Middle Eastern countries. 

Anorexia Nervosa

Anorexia more commonly impacts women than men, but both men and women can develop it. Women have a lifetime prevalence of up to 4 percent, while men have a lifetime prevalence of up to 0.3 percent. The rate of anorexia is also increasing in adolescents and young teens (those under the age of 15). 

Bulimia Nervosa

Rates of bulimia nervosa are declining over time. Currently, up to 3 percent of women and up to 1 percent of men have a lifetime incidence of bulimia. The overall prevalence of bulimia is estimated at 0.3 percent with women being five times more likely to have bulimia than men with rates of 0.5 percent and 0.1 percent respectively.

Binge Eating Disorder

Binge eating disorder impacts an estimated 1.5 percent of women and 0.3 percent of men globally. The disorder is commonly overlooked and likely underreported. 

Binge eating disorder is nearly always (94 percent of the time) accompanied with lifetime mental health symptoms and health conditions, including these:

• Mood disorders
• Substance use disorders
• Anxiety disorders
• Post-traumatic stress disorder (PTSD)
• Borderline personality disorder
• Suicidal ideations
• Type 2 diabetes
• Obesity
• Hypertension

Avoidant Restrictive Food Intake Disorder (ARFID)

ARFID is most common in children and adolescents. It is highly comorbid with anxiety disorders (around 75 percent), mood disorders (close to 33 percent), and autism spectrum disorders (close to 20 percent). 

It is considered a relatively new eating disorder, and lifetime prevalence is estimated to be between 5 percent and 13 percent. Young males most commonly struggle with ARFID. 

ARFID is often related to a fear of choking or vomiting or due to sensory issues with certain foods. 

Adolescents

Most eating disorders begin in the teen years or early adulthood, with 95 percent of first-time cases occurring by age 25. Nearly half report an onset of an eating disorder between the ages of 16 and 20. 

About half of teenage girls and a third of teenage boys engage in unhealthy behaviors and disordered eating to try and control weight. In adolescents, anorexia is one of the top three chronic illnesses. 

The mortality rate for females between the ages of 15 and 24 is 12 times higher for anorexia than any other cause of death.

College Students

Nearly all women (91 percent) surveyed on a college campus tried to control their weight through dieting, and a quarter of college-aged women binge and purge to manage their weight. Transgender college students engage in disordered eating behaviors quadruple the rate of their cisgender peers. 

The lifetime prevalence for eating disorders among teens between the ages of 13 and 18 is nearly 3 percent. Eating disorders are twice as common in females than males.

Athletes

Athletes are a specialty category of people that commonly struggle with eating disorders, especially those in sports that have a heavy emphasis on body shape, size, weight, or appearance, such as swimming, gymnastics, bodybuilding, wrestling, dancing, figure skating, horse racing, rowing, and diving. In these types of sports, more than 60 percent of women have eating disorders, and a third of male athletes do. 

Minorities

Minority populations are often at a higher risk for eating disorders, which can include marginalized racial and cultural groups, members of the LGBTQ+ population, and those with lower socioeconomic status. 

Studies have shown that African American teenage girls are nearly twice as likely to engage in bulimic behaviors than their Caucasian peers. Girls from low-income families struggle with bulimia more often than their peers from middle- and high-income families. Hispanic adolescents are also more likely to have bulimia than non-Hispanic teenagers. All minority groups are shown to have a higher incidence of binge eating disorder.

Members of the LGBTQ+ population commonly engage in disordered eating and have dysfunctional body images, often in an effort to fit into a specific stereotype that they believe to be “ideal.” Eating disorders are more common in gay men than in heterosexual men, for instance. Bisexual and gay boys are more likely than their peers to take laxatives, diet pills, vomit, or fast to control their weight. 

Nonbinary people also regularly restrict eating to maintain their perceived optimal androgynous stereotype reflected in popular culture. 

Men

Although women are more commonly diagnosed with eating disorders than men, and men are less likely to seek treatment for an eating disorder, nearly 10 million men will develop an eating disorder in their lifetime. Close to 20 percent of those with anorexia are men. Around a third of men with an eating disorder also have a history of sexual abuse. 

Gay men are 12 times more likely to report purging behaviors and 7 times more likely to report binge eating behaviors than straight men.

Mortality Rates

Over 10,000 people die from an eating disorder each year. More than one person dies every hour, and eating disorders have the highest mortality rate out of all mental illnesses. The mortality rate for men is twice that of women even though women more commonly have anorexia than men. 

The following are common causes of death for eating disorders:

• Cardiac complications
• Suicide
• Organ failure
• Dehydration

Prevalence

Nearly 8.5 percent of women and 2.5 percent of men have a lifetime weighted mean rate of an eating disorder diagnosis. It is estimated that nearly 30 million people in the United States have an eating disorder, and eating disorders impact around 9 percent of the world’s population. 

The 12-month prevalence of any eating disorder is 0.43 percent. More recently defined types of eating disorders, such as binge eating disorder, are more prevalent than anorexia and bulimia today. 

Eating disorder rates are also likely underreported, as many statistics only include anorexia nervosa and bulimia nervosa. Research shows that 41.9 million cases of eating disorders were underrepresented in 2019, with 17.3 million people having binge eating disorder and 24.6 million people having OSFED (other specified feeding or eating disorder) globally.

The onset of the COVID-19 pandemic has increased the onset of eating disorder behaviors, diagnoses, and the severity of symptoms and comorbidities around the world, including in North America, Europe, and Australia. Studies show that the incidence of eating disorders rose 15.3 percent in 2020 over previous years. This could be attributed to the isolation related to the pandemic, as eating disorders are often solitary conditions. 

Eating Disorder Treatment 

Early intervention and treatment for an eating disorder are key for lowering potential medical and mental health complications and improving outcomes and recovery rates. 

People with eating disorders have high rates of depression, suicide, medical complications, and additional co-occurring disorders like substance abuse and addiction. Treatment for an eating disorder should be comprehensive and include a variety of modalities aimed at treating the whole person. 

Comprehensive treatment should include the following methods:

• Individual, group, and family therapies: Behavioral therapies can help to investigate the root cause of the eating disorder to positively modify harmful and disordered patterns of thinking that lead to an unhealthy relationship with food and negative body image.
• Medical care and monitoring: People with eating disorders often have health issues related to disordered eating or food restriction. These will need to be addressed and managed during treatment by medical professionals. This can often involve refeeding, which will need to be monitored and managed with care.
• Medications: Since eating disorders commonly co-occur with other mental health disorders, such as anxiety and depression, mood stabilizers, antidepressants, and antipsychotics can be beneficial when used in conjunction with therapeutic means.
• Nutritional counseling: Eating disorders involve unhealthy relationships with food and eating behaviors. It can be helpful to include education and counseling on nutrition to reorganize thoughts and the way a person views food.
  

Resources

Support groups made up of peers who also have eating disorders or who are in recovery can provide a sense of community and resources. ANAD (National Association of Anorexia Nervosa and Associated Disorders) hosts a variety of Eating Disorder Peer Support Groups.

If you or someone you know struggles with an eating disorder, NEDA (National Eating Disorders Association) provides the NEDA Helpline. They offer referrals and information on how to get help and support.