Eating Disorders: What Are They, and Who Is Most at Risk?

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Breanna Anderson

MPH, Nutritional Sciences, Students, Dietetics, Nutrition

December 12, 2017

The lifetime prevalence of eating disorders, or the proportion of people that experience these conditions at some point in their lives, is .5%, 1.1%, and 2.6% for Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder, respectively,1 making them of significant public health concern. All three eating disorders (ED) are health problems that increase mortality, health complications, concerns with comorbidities, impairment in daily life, and suicidality2 as well as shifts in brain and gastrointestinal function3. But what are the most common eating disorders, and who is most at risk? Knowing these concepts is crucial for shaping effective prevention and treatment efforts. The most common ED diagnoses include:

  • Anorexia Nervosa(AN): restriction of energy intake, significantly low body weight, intense fear of gaining weight, behaviors to prevent weight gain, and disturbance in the way one's body is experienced.4
  • Bulimia Nervosa(BN): binge eating (defined as eating a very large amount of food in brief period compared to what a person would normally eat, accompanied by loss of control) alongside compensatory behaviors (i.e. excessive exercise, laxative or diuretic use, diet pills, vomiting). Also includes self-evaluation focused on the body.4
  • Binge Eating Disorder(BED): Binge eating (without compensatory behavior), distress over the behavior, and three or more of: rapid eating, uncomfortable fullness, eating when not hungry, eating alone due to embarrassment, or disgust towards self.4

Risk factors for eating disorders fall under a variety of categories, from personal factors to social and biological factors. The following are major risks for ED:

  • Dieting, weight concern, and desire to look like women in the media5
  • Teasing and negative comments from peers and family members5
  • Family history of disordered eating or anxiety disorders5 / genetics3
  • For AN, specifically: Personality factors, including perfectionism, harm avoidance, rigidness, difficulty adjusting to change, and being over or under controlled3. Additionally, having an anxiety disorder or family history of anxiety disorders3
  • ED risk can vary across race/ethnicity, education status, and sexual orientation6

ED receive more stigma than major depressive disorder (MDD) as they are often thought to be more controllable, and BED receives more stigma than AN and BN7. This is problematic, as ED are mental disorders, and are not a decision made by the individual. In fact, many individuals do not realize that they have an ED or understand the severity of their diagnosis. Individuals with AN, for example, often deny symptoms or view them positively8. This, along with stigma, can lead to underreporting of ED. The majority of cases do not seek treatment. Additional stigma for males drives reported prevalence lower9, contributing to the misconception that ED are primarily female disorders.

Being aware of these risk factors and barriers to treatment is important for knowing where to target prevention efforts, and who is most at risk. Common themes among successful programs include body acceptance, media literacy and sociocultural ideals, and nutrition10. Due to the severity, prevalence, and the nutritional and mental health concerns of eating disorders, it is important that future dietitians and other health professionals are aware of eating disorders and work to prevent their onset.

Check out the National Eating Disorders (NEDA) website here for more information on eating disorders. If you or someone you know may be experiencing an eating disorder, contact your doctor or a health professional. For urgent concerns, contact the (NEDA) Information and Referral Helpline: 1-800-931-2237 or text the NEDA Crisis Text Line by texting "NEDA" to 741741.

References

  1. 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), 348–358. https://www.biologicalpsychiatryjournal.com/article/S0006-3223(06)00474-4/fulltext
  2. Swanson, S.A., Crow, S.J., Le Grange, D., Swendsen, J., Merikangas, K.R. (2011). Prevalence and Correlates of Eating Disorders in Adolescents. Arch Gen Psychiatry 68(7). 714-723.
  3. Arnold, C. (2013). Decoding anorexia: how breakthroughs in science offer hope for eating disorders. New York: Routledge.
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.)
  5. Field, A.E., Javaras, K.M., Aneja, P., Kitos, N., Camargo, C.A., Taylor, C.B., Laird, N.M. (2008). Family, Peer, and Media Predictors of Becoming Eating Disordered. Arch Pediatr Adolesc Med. 162(6). 574–579.
  6. Lipson, S.K., Sonneville, K.R. (2016). Eating Disorder symptoms among undergraduate and graduate students at 12 U.S. colleges and universities. Eating Behaviors. 24, 81-88.
  7. Griffiths, S., Mond, J., Gunatilake, S., Murray, S.B., Sheffield, J., Touyz, S. (2015). Self-Stigma of Seeking Treatment and Being Male Predict and Increased Likelihood of Having an Undiagnosed Eating Disorder. International Journal of Eating Disorders. 48(6). 775-778.
  8. Ebneter, D.S. and Latner J (2013). Stigmatizing Attitudes Differ Across Mental Health Disorders: A Comparison of Stigma Across Eating Disorders, Obesity, and Major Depressive Disorder. The Journal of Nervous and Mental Disease. 201(4). 281-285.
  9. Griffiths, S., Mond, J. M., Murray, S. B., & Touyz, S. (2015). Positive beliefs about anorexia nervosa and muscle dysmorphia are associated with eating disorder symptomatology. Australian & New Zealand Journal of Psychiatry, 49(9), 812-820.
  10. Ciao, A.C., Loth, K., Neumark-Sztainer, D. (2014). Preventing Eating Disorder Pathology: Common and Unique Features of Successful Eating Disorders Prevention Programs. 16(453).

About the Author

Breanna AndersonBreanna Anderson is an MPH student studying Nutritional Sciences at the University of Michigan School of Public Health, concentrating in Dietetics. She attended the University of Michigan as an undergraduate, majoring in Ecology and Evolutionary Biology with a minor in Sustainable Food Systems. Breanna is interested in eating disorders, and works with Michigan Dining to address allergens across campus. She is currently a member of the Public Health Student Assembly and Nutritional Sciences Student Association.

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