‘Stunning’ Report Shows Eating Disorders Are Vastly Underestimated

A “stunning” new analysis of global data on eating disorders show that they are far more prevalent and disabling than previously reported.

Investigators found the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 underestimated the prevalence of eating disorders by nearly 42 million cases, meaning these disorders are four times more common than previously reported.

“Our work highlights that eating disorders are far more prevalent and disabling than previously quantified,” lead author Damian Santomauro, PhD, University of Queensland School of Public Health and Center for Mental Health Research, Brisbane, Australia, told Medscape Medical News.

The study was published online March 3 in The Lancet Psychiatry.

Policy Implications

The GBD Study 2019 only reports the prevalence and burden of anorexia nervosa and bulimia nervosa under the umbrella of “eating disorders.”

However, binge-eating disorder (BED) and other specified feeding or eating disorder (OSFED) are more common, the investigators note.

By excluding BED and OSFED, 41.9 million cases of eating disorders were not represented in the study.

The researchers calculate that the GBD 2019 overlooked 17.3 million people with BED and 24.6 million people with OSFED.

Together, BED and OSFED accounted for 3.7 million disability-adjusted life-years (DALYs) in 2019, bringing the total eating disorder DALYs to 6.6 million in 2019, they report.

“When disorders are left out of the GBD, there is a risk that policymakers and service planners will interpret that these diseases are not prevalent or disabling and therefore not important to address,” said Santomauro.

“Our results show that the formal inclusion of binge-eating disorder and OSFED in GBD is both feasible and important and will lead to better representation of eating disorder burden globally.

“In turn, this will enhance recognition of the burden experienced by people living with these disorders and hopefully motivate increased investment in research, prevention, and treatment in future,” he added.

Landmark Article, Clarion Call for Action

In an accompanying commentary, Jennifer Thomas, PhD, and Kendra Becker, PhD, with the Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, say this “stunning” analysis highlights that eating disorders are four times more common than previously thought.

This “landmark” analysis also demonstrates that BED and OSFED are especially common with increasing age. It highlights the burden of eating disorders in men, “shattering the inaccurate but entrenched stereotype that eating disorders affect only thin, young, white women,” Thomas and Becker point out.

This article, they write, is a “clarion call” for BED and OSFED to be included in future versions of the GBD Study.

Going a step further, Thomas and Becker think the GBD Study should also include estimates of the prevalence of avoidant/restrictive food intake disorder, rumination disorder, and pica and that the investigators should obtain direct measures of the disability associated with all feeding and eating disorders included in the DSM-5.

“If they do, the reported global burden will be even greater, underscoring the clear need for increased funding to study, prevent, and treat these debilitating illnesses,” Thomas and Becker conclude.

The study was funded by Queensland Health, the Australian National Health and Medical Research Council, and the Bill & Melinda Gates Foundation. The authors have disclosed no relevant financial relationships. Disclosures for the editorialists are listed with the original article.

Lancet Psychiatry. Published March 3, 2021. Full text, Comment

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