Review of the worldwide epidemiology of eating disorders

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In the eating disorder section in this issue, Keski-Rahkonen and Mustelin state that a basic requirement for advances in the detection and treatment of eating disorders is a better understanding of their epidemiology [1]. They compare epidemiologists with news reporters, who also attempt to answer five basic questions: who, what, when, where, and why? [1]. In previous years, the review articles in the eating disorder section in this journal showed that eating disorders most frequently occur in the high-risk group of young Western females, but do occur in older women, in men and in persons in non-Western countries [2,3]. In 2014, Pike et al. found that eating disorders appear to be increasing in Arab and Asian countries in conjunction with increasing industrialization, urbanization, and globalization [4]. This year, the articles in the section on eating disorders try to address a global perspective and reviewed the worldwide epidemiology of eating disorders, with a special focus on understudied areas of the world.THE GLOBAL BURDEN OF DISEASEErskine et al. describe the inclusion of eating disorders in the Global Burden of Disease Study (GBD) as a watershed moment in the recognition of these disorders in the wider global health community [5]. Of 306 physical and mental disorders, anorexia nervosa and bulimia nervosa combined ranked as the 12th leading cause of disability-adjusted life years (DALYs) in females aged 15–19 years in high-income countries, responsible for 2.2% of all DALYs [5,6]. Although globally this ranking did not change a great deal between 1990 and 2013 (moving from 13th in 1990 to 12th in 2013), the ranking in low-income and middle-income countries increased from 58th in 1990 to 46th in 2013 [5]. This was largely a relative increase because of improvements in prevention and treatment of communicable diseases in these countries, which increased the proportion of total burden attributed to eating disorders despite the absence of a time trend in absolute numbers [5].In the GBD 2013 the number of DALYs per 100 000 of the population is highest in Western countries [5–7]. In Europe, anorexia nervosa is reported by 1–4%, bulimia nervosa by 1–2%, and binge eating disorder (BED) by 1–4% of women; 0.3–0.7% of European men report eating disorders [1].However, it is worth remembering that – as is the case with most diseases – because of their large population size India with over 1.32 billion and China with over 1.38 billion people, lead the world – along with the United States – as countries with the highest contributions of total DALYs caused by eating disorders among women aged 15–49 years [7]. Thomas et al. describe that notwithstanding evidence that eating disorders have a global distribution and are associated with increasing health burdens in Asia, epidemiological data in Asia and Pacific Island countries remain sparse [7]; the same holds true for Latin America [8] and epidemiological data in Africa are even more scarce [9].PREVALENCE OF EATING DISORDERSIncidence and prevalence are the two principal measures of the distribution of a disorder in the population under study. Incidence studies on eating disorders hardly exist in most parts of the world. In the review articles on Asia, Latin America, and Africa only the prevalence is studied [7–9]. Prevalence studies of eating disorders are usually conducted in the high-risk population of young females. Most epidemiological studies report on point-prevalence, defined as the proportion of actual cases in a population at a specific point in time; a two-stage screening strategy has been widely used, even in the few studies in Africa, the most understudied continent.

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