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

Abstract

Background 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. Methods 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. Results 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.

Preliminary identification of clinical cut-off of the vegetarian vegan eating disorder screener (V-EDS) in a community and self-reported clinical sample of vegetarians and vegans

“…Furthermore, our clinical sample was not large enough to be analysed by eating disorder diagnosis and therefore all clinical participants were grouped together. Indeed, of this sample, a large proportion of participants reported a diagnosis of anorexia nervosa (47%), which sits significantly above population prevalence rates within Australia [ 20 ]. While the prevalence of eating disorders in people who follow a vegetarian or vegan diet is very much a future research avenue to be explored using the V-EDS, it may be the case that people with a diagnosis of anorexia nervosa were interested in the present study due to the overlapping commonalities with the extensive dietary and lifestyle restrictions required to avoid animal-derived products.…”

The efficacy of transcranial direct current stimulation in the treatment of anorexia nervosa: a randomized double-blind clinical trial

“…Another limitation of our study is the decision to include only female participants. This choice was driven by the disparities in the prevalence of AN between the two genders ( 73 ), and assembling an equal-sized group of both men and women for the study would require a significant amount of time. Despite these weaknesses, our findings will contribute valuable insights into the potential effects of tDCS in AN and underscore the need for further research in this domain.…”

Anorexia nervosa through the lens of a severe and enduring experience: ‘lost in a big world’

“…Severe and enduring anorexia nervosa (SE-AN), first described in 1981 [ 1 ] as ‘chronic AN’, is a serious illness that persists beyond an ‘acceptable’ timeframe, despite ‘state of the art’ treatment [ 2 ]. AN endures in 20–50% of people [ 3 – 5 ], commensurate with profound psychosocial impairment [ 6 ] and higher mortality, carer and healthcare burden relative to schizophrenia and depression [ 7 ]. Despite this, inequities in funding for research and treatment persist [ 8 ].…”

“…Anxiolytics are underexplored and psychedelics e.g. psilocybin as well as other brain based therapies [ 31 ] are experimental in SE-AN, with preliminary evidence [ 6 ]. The efficacy and safety of repeated delivery of the same treatments over decades is not established and given that less than 63% of people with AN have achieved recovery after 22 years [ 4 ], ongoing care options are needed.…”