Overview of eating disorders today

• The number of people in Australia with an eating disorder at any given time is estimated to be 913,986, or approximately 4% of the population (Butterfly Foundation, 2012).
• Of these people, 47% have binge eating disorder, 12% bulimia nervosa, 3% anorexia nervosa and 38% other eating disorders (Butterfly Foundation, 2012).
• Females comprise around 64% of people with an eating disorder (Butterfly Foundation, 2012).
• In comparison to the general population, mortality rates are almost twice as high for people with eating disorders; this rises to 5.86 times higher for people with anorexia (Arcelus et al., 2011).
• Suicide has been identified as a major cause of death for people with an eating disorder (Pompili et al., 2006).
• Between 1995 and 2005 a South Australian study showed the prevalence of disordered eating behaviours doubled among both males and females aged 15 and older (Hay et al., 2008).
• The prevalence of eating disorders is increasing amongst boys and men (NEDC, 2012a).
• Approximately 15% of women will experience an eating disorder at some point during their life (Wade, 2006).
• An estimated 20% of females have an undiagnosed eating disorder (NEDC, 2012b).
• Eating disorders are the 3rd most common chronic illness in young women (Yeo & Hughes, 2011).
  
  

Cormorbidity

• People with eating disorders experience higher rates of other mental disorders with reports of up to 97% having a comorbid condition. The most common of these are depression and anxiety disorders, followed by substance abuse and personality disorders (NEDC, 2010b, 2012a)
• Adults with eating disorders experience significantly higher levels of anxiety disorders, cardiovascular disease, chronic fatigue, depressive disorders, neurological symptoms and suicide attempts (NEDC, 2012a).
• Anxiety disorders are experienced by 64% of individuals with an eating disorder. Typically, the anxiety disorder presents before the eating disorder, often in childhood. The most common type of anxiety disorder is obsessive compulsive disorder (Kaye et al. 2004).
• Personality disorders are experienced by 58% of people with an eating disorder (NEDC, 2010b)
• Adolescents with diabetes may have a 2.4- fold higher risk of developing an eating disorder (Pereira and Alvarenga, 2007).
  
  

Anorexia

• Based on international data, the lifetime prevalence for womenis between .3% and 1.5%, and between 0.1% and 0.5% in men (NEDC, 2010a).
• The onset of anorexia occurs most commonly during adolescence or young adulthood (American Psychiatric Association, 2013).
• Many people have a period of changed eating behaviour prior to meeting the full criteria for anorexia nervosa (American Psychiatric Association, 2013).
• Anorexia has the highest mortality rate of any psychiatric disorder (NEDC, 2012b).
• Anorexia has a standardised mortality rate that is 12 times higher than the annual death rate from all causes in females aged 15 to 24 (NEDC, 2010b).
• The crude mortality rate for anorexia is approximately 5% per decade. Death most commonly results from medical complications or from suicide (American Psychiatric Association, 2013).
• A twin study published in the American Journal of Psychiatry found that genetic factors have a significant influence on the development of Anorexia nervosa, with an estimated hereditability of 58% (Wade et al. 2000).
  
  

Bulimia

• Based on international data, the lifetime prevalence in women is between .9% and 2.1%, and <.1% to 1.1% in men (NEDC, 2010a).
• The onset of bulimia nervosa is most comon in adolescence or young adulthood. Binge eating frequently begins during or after an episode of weight loss dieting. Experiencing multiple stressful life events may also precipitate the onset of bulimia (American Psychiatric Association, 2013).
• The crude mortality rate for bulimia is nearly 2% per decade (American Psychiatric Association, 2013).
• True incidence estimated to be 1 in 5 amongst students and women (NEDC, 2012a).
• It is common for people suffering from bulimia to keep their disorder hidden, at great cost to their physical and psychological health.
  
  

Binge Eating Disorder

• Based on international data, the lifetime prevalence in females is between 2.5% and 4.5%, and 1.0% and 3.0% in males (NEDC, 2010a).
• The onset of binge eating disorder is most typical in adolescence or young adulthood, but can begin in later adulthood. Individuals seeking treatment for binge eating disorder are likely to be older than individuals seeking help for anorexia or bulimia (American Psychiatric Association, 2013).
• Binge eating disorder is more common than anorexia or bulimia, and is at least as chronic and stable as these disorders (Hudson et al., 2007).
• Binge eating disorder is distinct from obesity. Most obese individuals do not meet the criteria for binge eating disorder (American Psychiatric Association, 2013).
• The incidence of binge eating disorder in males and females is almost equal (Paxton, 1998).
  
  

Weight Loss Dieting

• Adolescent girls who diet at a severe level are 18 times more likely to develop an eating disorder within six months and have a 20% chance of developing an eating disorder after 12 months of extreme dieting (Grigg et al., 1996).
• Women who diet frequently (more than 5 times) are 75% more likely to experience depression (Mond et al., 2006)
• A Sydney study of adolescents aged 11 to 15 reported that 16% of the girls and 7% of the boys had already employed at least one potentially dangerous method of weight reduction, including starvation, vomiting and laxative abuse.
• A sample of women from the general population aged 18 to 42 years found the point prevalence for the regular use of specific weight control methods was 4.9% for excessive exercise, 3.4% for extreme restrictive eating, 2.2% for diet pills, 1.4% for self-induced vomiting, 1.0% for laxative misuse, and .3% for diuretic misuse (Mond et al., 2006).
• 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).
  
  

Body image

• In Australians aged 11-24, approximately 28% of males and 35% of females are dissatisfied with their appearance (NEDC, 2010a).
• The Mission Australia National Youth Survey has revealed that body image has been listed in the top 3 concerns for young Australians from 2009-2015.
• The Longitudinal Study on Women’s Health, found that only 22% of women within a normal healthy weight range reported being happy with their weight. Almost three quarters (74%) desired to weigh less, including 68% of healthy weight and 25% underweight women (Kenardy et al., 2001).
• Poor body image is associated with an increased probability of engaging in dangerous dietary practices and weight control methods, excessive exercise, substance abuse and unnecessary surgery to alter appearance (NEDC, 2010a).
• Beyond Stereotypes, the 2005 study commissioned by Dove surveyed 3,300 girls and women between the ages of 15 and 64 in 10 countries. They found that 67% of all women 15 to 64 withdraw from life-engaging activities due to feeling badly about their looks (Etcoff et al., 2006).
  
  

Body image pressure on young people (a socio-cultural risk factor)

• A large number (41%) of children are specifically worried about the way they look with 35% concerned about being overweight (44% of girls and 27% of boys) and 16% being too skinny (Etcoff et al., 2006).
• A 2007 Sydney University study of nearly 9,000 adolescents showed one in five teenage girls starved themselves or vomit up their food to control their weight. 8% of girls used smoking for weight control (Wade, 2006).
• Body image and eating disorders are one of the primary reasons that young people access the email-based counselling service offered through Kids Helpline (NEDC, 2010a).
• In a recent study, 34% of 5-year-old girls showed a moderate level of dietary restraint, while half showed internalisation of the thin ideal. Sociocultural factors, including media exposure and peer conversations, were stronger predictors of dietary restraint than individual factors (Damiano et al., 2015).
• Amongst 12 to 17 year olds, 90% of females and 68% of males have been on a diet of some kind (Tucci et al., 2007).
  
  

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References

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.)
2. Arcelus, J. M., Mitchell, A., Wales, J., Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Arch RCH Gen Psychiatry 68(7), 724-731.
3. Butterfly Foundation. (2012). Paying the price: the economic and social impact of eating disorders in Australia. Melbourne: Butterfly Foundation.
4. Carrotte, E. R., Vella, A. M., & Lim, M. S. (2015). Predictors of “Liking” Three Types of Health and Fitness-Related Content on Social Media: A Cross-Sectional Study. Journal of Medical Internet Research, 17(8), e205. http://doi.org/10.2196/jmir.4803
5. 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. http://doi.org/10.1186/2050-2974-3-S1-O23
6. Etcoff, N., Orbach, S., Scott, J., D'Agostino, H. (2006). Beyond stereotypes: Rebuilding the foundation of beauty beliefs: Findings of the 2005 global study. Dove, Unilever PLC.
7. Grigg, M., Bowman, J., & Redman, S. (1996). Disordered eating and unhealthy weight reduction practices among adolescent females.Preventive Medicine 25, 748-756.
8. Hay PJ, Mond J, Buttner P, Darby A (2008) Eating Disorder Behaviors Are Increasing: Findings from Two Sequential Community Surveys in South Australia. PLoS ONE 3(2): e1541. doi:10.1371/journal.pone.0001541
9. 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.
10. Kaye, W. H., Bulik, C. M., Thornton, L., Barbarich, N., Masters, K., Price Foundation Collaborative Group. (2004). Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry. 161(12), 2215-2221.
11. Kenardy, J., Brown, W. J., & Vogt, E. (2001). Dieting and health in young Australian women. European Eating Disorders Review 9, 242-254.
12. Mond, J. M., Hay, P. J., Rodgers, B., & Owen, C. (2006). Eating Disorder Examination Questionnaire (EDE-Q): Norms for young adult women. Behaviour Research and Therapy 44, 53-62.
13. Paxton, S. (1998). Do men get eating disorders? Everybody Newsletter of Body Image and Health Inc., 41.
14. Pereira, R. F., & Alvarenga, M. (2007). Disordered Eating : Identifying, Treating, Preventing, and Differentiating It From Eating Disorders. Diabetes Spectrum 20(3), 141–148.
15. Pompili M1, Girardi P, Tatarelli G, Ruberto A, Tatarelli R. (2006). Suicide and attempted suicide in eating disorders, obesity and weight-image concern. Eating behaviors 7(4):384-94.
16. The National Eating Disorders Collaboration (2010a). Eating disorders prevention, treatment & management: An evidence review. Sydney: NEDC.
17. The National Eating Disorders Collaboration (2010b). Eating disorders: The way forward: An Australian national framework. Sydney: NEDC.
18. The National Eating Disorders Collaboration. (2012a). An integrated response to complexity – National eating disorders framework 2012. Sydney: NEDC.
19. The National Eating Disorders Collaboration. (2012b). Eating disorders in Australia. Sydney: NEDC.
20. Sundgot-Borgen J, Torstveit MK. (2004). Prevalence of eating disorders in elite athletes is higher than in the general population. Clin J Sport Med. 14(1), 25-32.
21. Tucci, J., Mitchell, J., & Goddard, C. (2007). Modern children in Australia. Melbourne: Australian Childhood Foundation.
22. Wade, T. D. (2010). Genetic influences on eating disorders. In Agras, W. S (Ed), Oxford handbook of eating disorders. New York: Oxford University Press.
23. Wade, T.D, Bulik, C.M., Neale, M., Kendler, K.D. (2000)Anorexia Nervosa and Major Depression: Shared Genetic and Environmental Risk Factors. American Journal of Psychiatry 157(3), 469-471
24. Yeo, M, Hughes, E. (2011) Eating disorders: early identification in general practice. Australian Family Physician 40(30), 108-111