Christian Counselor Seattle
Plenty of stereotypes and assumptions exist about eating disorders. Here are five eating disorders statistics to set the record straight.
5 Eating Disorders Statistics
1) “Anorexia Nervosa has the highest mortality rate of any mental illness” (Arcelus, Mitchel, Wales & Nelson, 2011).
Compared to the vast array of research and literature on many other mental health illnesses, there is a glaring lack of research on eating disorders, especially research that goes beyond the traditional conceptualization of eating disorders.
It is imperative to be aware of this statistic in order to more fully grasp the dangers of eating disorders as well as to spur us on in action to prevent and treat these highly lethal diagnoses.
One reason that anorexia has such a devastating impact on physical health is because starvation and lack of proper nutrition negatively affect every system in the body (www.newbridge-health.org.uk).
These physical symptoms are further complicated if an individual also engages in other behaviors, such as purging or laxative use, which can lead to deterioration in the esophagus and intestines, and can create an imbalance in electrolytes.
It is crucial to understand eating disorders from a perspective that encompasses both mental and physical well-being in order to properly support and treat individuals with these symptoms.
This section focuses on anorexia specifically because it has the highest mortality rate, but it is important to keep in mind that every eating disorder diagnosis can be associated with significant negative impacts on physical health.
With regards to anorexia, heart failure is one of the primary physical health concerns (www.newbridge-health.org.uk). This is because when the body is starved, blood pressure drops and the heart muscle can actually shrink in size. This is dangerous in itself, and the risk increases as an individual continues to restrict food intake.
Additionally, due to low blood pressure and a smaller physical heart size, it can also be dangerous for an individual to suddenly increase their food intake; refeeding syndrome can occur if not properly monitored.
Refeeding syndrome is the potentially fatal result of a body being so harmed by lack of food that it is unable to properly function when an individual increases their food intake. That said, weight restoration is often a crucial component of recovery for individuals with anorexia and can certainly be safely accomplished with proper monitoring by a physician (www.eatingdisorderhope.com).
Other physical ailments associated with anorexia include low blood sugar, bone loss, impaired kidney function, muscle deterioration, and anemia. Over time, the body responds to starvation by slowing down metabolism to conserve energy and preserve vital organs.
As a result, “non-essential” bodily functions get shut down, which leads to further complications. For example, the body starts to decrease the production of red and white blood cells and platelets. There can even be structural changes in the brain, which can lead to difficulties functioning cognitively as well as seizures (www.newbridge-health.org.uk).
In addition to the dangerous impact on body systems, death by suicide is far more prevalent among individuals with an eating disorder diagnosis compared to those without an eating disorder diagnosis.
Studies have suggested that individuals with anorexia are up to 31 times more likely to die by suicide (www.nedc.com.au). This staggering statistic highlights the urgency to treat not only eating disorders, but to also be aware of and treat potentially co-occurring diagnoses, as discussed in the next section.
2) Research has shown that between 55% and 97% of individuals who were diagnosed with an eating disorder also receive at least one other mental health diagnosis (www.nedc.com.au).
The co-morbidity of eating disorders with other mental health diagnoses is quite high. One study, called the National Comorbidity Survey Replication (NCS-R), was a follow-up study to the original National Comorbidity Survey that surveyed a large-scale sample of individuals across the United States with a variety of questions about mental health diagnoses (Kessler and Merikangas, 2004).The NCS-R found that 56.2% of survey participants with anorexia nervosa, 94.5% with bulimia nervosa, and 78.9% with binge eating disorder met criteria for at least one other diagnosis (www.nimh.nih.gov).
While anorexia, bulimia, and binge eating disorder are not the only recognized eating disorder diagnoses, these statistics shed light on the high rates of comorbidity among individuals with eating disorders.
Some of the comorbidities often associated with eating disorders include depression, bipolar disorder, panic and anxiety disorders, post-traumatic stress disorder, obsessive compulsive disorder, borderline personality disorder, and substance use disorders.
This, of course, is not an exhaustive list, nor is it indicative of every individual’s experience with an eating disorder. However, this information is important for the treatment of eating disorders because dual diagnoses may impact the presentation of symptoms and behaviors, and may influence which treatments are most effective. (www.eatingdisorderhope.com)
3) Doctors are far less likely to assess people of color for eating disorder symptoms, even when individuals report eating and weight concerns (Becker, 2003).
Along with the myth that eating disorders are a “straight, female diagnosis” is the myth that eating disorders are a “white” diagnosis. However, this is not the case. One study (Goeree, Sovinsky, & Iorio, 2011) indicated that black teenagers were 50% more likely than white teenagers to engage in eating disorder behaviors associated with bulimia.
Another study (Swanson, 2011) found that adolescents of Hispanic origins were significantly more likely to meet criteria for bulimia than non-Hispanic adolescents. This same study identified an overall higher rate of binge eating disorder reported across minority groups. The list goes on, and study after study points to the fact that eating disorders are not isolated to one racial or ethnic group.Tragically, people of color are far less likely to receive help, or to even be offered help, for eating disorders. In one research project (Gordon, Brattole, Wingate, & Joiner, 2006) researchers gave a case study to clinicians that described symptoms and behaviors exhibited by a fictitious female.
Every clinician received the same case study; the only difference was the female’s race. Clinicians were asked to assess the symptoms and behaviors. When the individual in the case study was white, 44% of clinicians identified the behaviors as problematic.
When the individual in the case study was Hispanic, 41% of clinicians identified the behaviors as problematic. And when the individual was Black, only 17% of clinicians identified the behavior as problematic, and they were less likely to recommend professional help.
This study sheds light on some of the gross injustices and problems associated with the medical and mental health systems. Specifically with eating disorders, the pervasive stereotypes perpetuate inequality and block access to treatment. This knowledge combined with the high mortality rate of eating disorders ought to heighten our urgency to increase awareness and access to treatment.
4) “Binge Eating Disorder is over three times more common than anorexia and bulimia combined” (freedeatingdisorders.org).
Frequently, anorexia and bulimia are the diagnoses that come to mind when someone thinks of an eating disorder. Because discussion often focuses on anorexia and bulimia, binge eating disorder and other eating disorders can be overlooked or even ignored.
However, a 2007 study published in Biological Psychiatry shared that 3.5% of women and 2.0% of men had binge eating disorder at some point in their life (Hudson, HIripi, Pope, & Kessler, 2007). To put these numbers in perspective, this means that binge eating disorder is more prevalent than breast cancer, HIV, and schizophrenia (freedeatingdisorders.org).
That said, anorexia, bulimia, and binge eating disorders are not the only eating disorder diagnoses. Other eating disorders and subclinical eating disorders include compulsive overeating, avoidant/restrictive food intake disorder (ARFID), orthorexia, pica, rumination disorder, night eating syndrome, and other specified feeding or eating disorders (OSFED).
This is not an exhaustive list, and The Diagnostic and Statistical Manual of Mental Disorders is regularly revised, edited, and updated. These diagnostic changes frequently impact eating disorder diagnoses, and more diagnoses and subclinical disorders may become identified over time.
It’s important to be aware of the variety of ways that eating disorder behaviors may manifest, so that we do not overlook symptoms when they do not fall into the categories of anorexia or bulimia.
One of the unfortunate reasons that binge eating disorder is often overlooked is because of societal stereotypes of what an eating disorder looks like. Frequently, medical professionals prescribe “healthy eating” or “dieting” to individuals in larger bodies, rather than taking time to assess whether binge eating disorder or another eating disorder could be an appropriate diagnosis.
Eating disorders are not effectively treated by healthy eating or dieting, and prescribing these regiments can actually exacerbate symptoms of an eating disorder. For this reason, greater awareness of the variety of eating disorder diagnoses as well as a better understanding of weight and health are crucial to improving care.
5) Research indicates that “5 pounds ‘underweight’ is more dangerous than 75 pounds ‘overweight’” (Campos, 2004 and Flegal, Graubard, Williamson, and Gail, 2007).
Due to stigma, bias, and myths about health, there is a widely held belief in Western cultures that people in larger bodies are less healthy than people in smaller bodies. The BMI is a common tool used to measure health and to put people in various categories regarding weight.
However, an overwhelming amount of research suggests that weight and BMI are inaccurate and misleading assessments of health and wellness. There are a number of inherent flaws in the BMI calculation, including its lack of scientific evidence, its history of discrimination, and its misleading conclusions.For example, focusing on height and weight overlooks other crucial factors that influence health. One jarring statistic, according to www.sizediversityandhealth.org, is that over half of adults labeled “overweight” by their BMI are actually metabolically healthy, while 1 in 4 adults labeled “normal weight” are actually metabolically unhealthy (Wildman, et al., 2008).
The targeting and labeling of adults in bigger bodies as “unhealthy” and the overlooking of adults in smaller bodies as “healthy” is great cause for concern, especially regarding eating disorders.
This information is not meant to be used to swing to the other extreme and label people in smaller bodies as unhealthy. Rather, this information is meant to challenge the common misconception that you can judge an individual’s health simply by looking at them. There are far too many components that contribute to the health of an individual to be able to determine someone’s health by their weight.
As mentioned earlier, one major problem with the assumptions and stereotypes associated with larger bodies is that individuals in larger bodies who are suffering from an eating disorder are often told to diet.
Because dieting is often not sustainable or realistic, dieting is associated with a number of physical health risks associated with weight cycling including slower metabolism, hormone disruption, cardiovascular damage, reduced bone mass, and hypertension.
Moreover, dieting is often linked to mental health challenges such as depression, preoccupation with food, and guilt. This emphasis on dieting not only perpetuates disordered eating behaviors, but also denies individuals with eating disorders effective treatment and support (www.sizediversityandhealth.org and www.opalfoodandbody.com).
Health at Every Size
One approach that has been shown to be highly effective when incorporated in eating disorder treatment is the Health At Every Size (HAES) approach. Health At Every Size focuses on five core principles: weight inclusivity, health enhancement, respectful care, eating for well-being, and life-enhancing movement (www.opalfoodandbody.com).
A number of research studies have supported the effectiveness of this approach. One study (Bacon, VanLoan, Stern, Keim, 2005) compared a HAES/non-diet group to a diet group, and the results demonstrated more sustained improvement after two years in the HAES group compared to the diet group.
These improvements took into account several measurements of health including mental health as well as physical health markers indicated by lab tests. Contrary to what some critics posit, HAES does not endorse the idea that weight, nutrition, and exercise have no impact on health, or that all people are healthy.
Rather, “It supports people of all sizes in addressing health directly by adopting healthy behaviors. It is an inclusive movement, recognizing that our social characteristics, such as our size, race, national origin, sexuality, gender, disability status, and other attributes, are assets, and acknowledges and challenges the structural and systemic forces that impinge on living well” (https://haescommunity.com/). This approach to health has been highly effective in supporting individuals with eating disorders.
The problem with myths about eating disorders is that they can prevent people from accessing the treatment and support they deserve. By understanding eating disorders statistics and facts, we can shed light on these myths and promote a greater understanding of the truth about eating disorders, who they affect, and why it is so urgent to connect people with effective treatments.
There is no single treatment that works best for everyone, but a variety of treatment modalities and avenues to seek help are available. If you or a loved one is suffering from an eating disorder, I encourage you to reach out to myself or another provider. We can discuss treatment options, work with you, or help connect you to resources in your journey to recovery.
Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with Anorexia Nervosa and other eating disorders. Archives of General Psychiatry, 68(7), 724-731.
Bacon, L, VanLoan M , Stern JS, Keim N. Size acceptance and intuitive eating improve health for obese Female chronic dieters. J of Amer Dietetic Assoc 2005;105:929-936.
Becker AE, Franko DL, Speck A, Herzog DB. Ethnicity and differential access to care for eating disorder symptoms. International Journal of Eating Disorders. 2003;33:205–212.
Campos P (2004). The Obesity Myth. New York: Gotham Books.
Flegal, KM, Graubard, BI, Williamson, DF, Gail, MF (2007). Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA, 298(17), 2028-3037.
Goeree, Michelle Sovinsky, Ham, John C., & Iorio, Daniela. (2011). Race, Social Class, and Bulimia Nervosa. IZA Discussion Paper No. 5823. Retrieved from http://ftp.iza.org/dp5823.pdf.
Gordon, K. H., Brattole, M. M., Wingate, L. R., & Joiner, T. E. (2006). The Impact of Client Race on Clinician Detection of Eating Disorders. Behavior Therapy, 37(4), 319-325. doi:10.1016/j.beth.2005.12.002.
Hudson, J.I., HIripi, E., Pope, H.G., & Kessler, R.C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3), 348-58. doi: 10.1016/j.biopsych.2006.03.040
Kessler, R. C. and Merikangas, K. R. (2004), The National Comorbidity Survey Replication (NCS‐R): background and aims. Int. J. Methods Psychiatr. Res., 13: 60-68. doi:10.1002/mpr.166
Swanson SA, Crow SJ, Le Grange D, Swendsen J, and Merikangas KR. (2011). Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry, 68(7):714-23.
Wildman RP, et al. (2008). The obese without cardiometabolic risk factor clustering and normal weight with cardiometabolic risk factor clustering: Prevalence and correlates of 2 phenotypes among the US population (NHANES 1999-2004). Archives of Internal Medicine, Aug 11, 168(15):1617-24.
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