An investigation examines whether a key report on global health trends is hugely underestimating eating disorder cases.
Disordered eating is unfortunately a fact of life for many children and adolescents. A solid understanding of the prevalence of eating disorders could be a huge benefit for clinicians who treat them, but the Global Burden of Diseases, Injuries, and Risk Factors Study, a large scale investigation that includes data on disease, injury, death, and other health trends in over 145 countries, only includes anorexia nervosa and bulimia nervosa in the eating disorders section. The exclusion of both binge-eating disorder and other specified feeding or eating disorder (OSFED) could mean that a more accurate understanding of the prevalence of eating disorders is unknown. A report in Lancet Psychiatry sought to explore just how much was missed.1
The investigators used studies from the Global Burden of Diseases, Injuries, and Risk Factors Study epidemiological databases for anorexia nervosa and bulimia nervosa as well as 2 systematic reviews that included studies of epidemiological estimates of binge-eating disorder and OSFED.
A total of 54 studies, 36 from high-income countries, were included in the analysis. The investigators found that the number of eating disorder cases in 2019 that had not been included in in the 2019 Global Burden of Diseases, Injuries, and Risk Factors Study numbered at roughly 41.9 million cases (95% uncertainty interval [UI] 27.9–59.0), with 17.3 (95% UI 11.3–24.9) million cases of binge-eating disorder and 24.6 million cases of OFSED (95% UI 14.7–39.7). In comparison, there were 13.6 million (95% UI 10.2-17.5) cases of either anorexia nervosa or bulimia nervosa reported in the 2019 Global Burden of Diseases, Injuries, and Risk Factors Study. Both binge-eating disorder and OSFED were responsible for 3.7 million disability-adjusted life-years (DALYs) globally. DALYs are used in the Global Burden of Diseases, Injuries, and Risk Factors Study to represent the burden of a condition and represent 1 lost year of healthy life either because of mortality or disability. When added to the DALY information for anorexia nervosa and bulimia nervosa, the total eating disorder DALYs were 6.6 million (95% UI 3.8-10.6) in 2019.
The investigators concluded that the number of eating disorder cases as well as the burden caused by them are underrepresented in one of the most important global health studies, which can have a major impact of whether public health policies are made to tackle them. The underrepresentation could also have an impact on available programming.
1. Santomauro D, Melen S, Mitchison D, Vos T, Whiteford H, Ferrari A. The hidden burden of eating disorders: an extension of estimates from the Global Burden of Disease Study 2019. The Lancet Psychiatry. March 2, 2021. Epub ahead of print. doi:10.1016/s2215-0366(21)00040-7