Australia has the world’s highest anorexia and bulimia rates

CW: Eating disorders

Global cases of anorexia and bulimia have increased by 71% since 1990, a new study has found.

Australia had the highest prevalence in the world, with an estimated one in every 100 people living with anorexia or bulimia (about 4.5 times the global rate).

The study, published in JAMA Psychiatry, also found 41% of all cases were among people aged 10–24.

Here’s what you need to know.

Anorexia nervosa is characterised by restricted eating, low body weight and an intense fear of gaining weight.

Bulimia nervosa involves repeated binge eating episodes, followed by behaviours intended to compensate for the food consumed, alongside an intense concern about weight or body shape.

An international team of researchers examined rates of both conditions across 204 countries and territories between 1990 and 2023.

The study is part of the Global Burden of Disease (GBD) project, which tracks the impact of hundreds of illnesses worldwide.

Context

Researchers combined population surveys, published studies and health data to produce the first major update of GBD eating disorder estimates since 2017.

The study didn’t include other eating disorders, such as binge eating disorder.

University of Queensland epidemiologist and the study’s senior author, Associate Professor Damian Santomauro, estimates: “We’re only capturing 25% of the burden [of eating disorders] by looking only at anorexia and bulimia.”

However, he told TDA work is underway to expand the study’s scope.

Findings

An estimated 18.1 million people worldwide were living with anorexia or bulimia in 2023, a 71% increase since 1990.

“When you account for population growth and ageing, it’s about a 21% increase over time,” Santomauro explained.

In Australia and New Zealand, the rate increased by 32% over the same period, after adjusting for population growth and ageing.

Anorexia and bulimia rates rose in 156 of the 204 countries and territories studied, with the biggest increases in Asia.

The findings show bulimia is far more common than anorexia – affecting more than three times as many people (14.2 million compared with 3.9 million).

The study measured rates per 100,000 people, adjusted for age, so countries of different sizes and age profiles could be compared fairly.

Age and gender

The two disorders combined were most common among 20 to 24-year-olds.

Anorexia was most common among 15 to 19-year-olds, while bulimia peaked among 30 to 34-year-olds.

Women and girls accounted for about 70% of all cases, but cases among men and boys have increased at a slightly faster rate since 1990.

Researchers warned that eating disorders may be underdiagnosed in males.

“There’s this incorrect perception that it’s a ‘women’s issue’ so there can be a lot more taboo for men... They might be less willing to get help,” Santomauro said.

According to national eating disorder charity the Butterfly Foundation, men can “be more likely to have eating concerns tied to pursuing a lean or muscular physique.”

Signs may include rigid requirements around protein intake, ‘bulking and cutting’ eating behaviours, counting calories and eating past fullness.

Why?

Researchers suggest the findings may reflect a mix of genuine change, evolving diagnostic criteria, broader social shifts and how the data was modelled.

Santomauro said the study was “focused on addressing the scale of the problem rather than looking into the drivers of the problem.”

He added: “But my hypothesis [is] that social media has played a role in this... Cyberbullying is a big problem. It’s very prevalent among social media and it is a risk factor [for eating disorders].”

Looking ahead

The study forecasts the number of people living with anorexia or bulimia worldwide will rise to 21.8 million by 2050.

Researchers have called for eating disorders to be built into national mental health plans, including earlier detection in schools and GP clinics.

Santomauro flagged that the forecast doesn’t include information on risk factors like the impact of social media.

Rather, it’s a prediction of “what would happen if everything continued as it is, except for changes in population growth and [social and economic development].”

“This study confirms that eating disorders are not a niche issue. They affect people of all ages, genders, body sizes and cultural backgrounds, and they deserve a response that matches their impact.”

Clinical psychologist and manager of the Butterfly National Helpline, Sarah Cox, in a statement responding to the study.

Butterfly Foundation: 1800 ED HOPE (1800 33 4673)