By Jana Keith-Jennings, LMSW
In an October 18, 2022 article titled “You Don’t Look Anorexic”, in the New York Times, it was noted that studies show as many as 4.9 percent of the female population, 1.2 percent of the male population, and as much as 7.5 percent of the nonbinary population (statistics on trans people were not listed) will develop anorexia in their lifetimes.1 The article focuses on the prevalence of atypical anorexia, its abysmal rates of underdiagnosis, lack of research, and the anti-fat bias in medical professionals. It also considers body mass index (BMI) specific insurance requirements that routinely deny access to care for many people in “normal” or higher BMI range bodies as one of the many factors that all contribute to significant delays in patients receiving eating disorder treatment.2 The article does not explore the full scope of how prevalent eating disorders are in general and how significantly fatal they are. It also fails to look at the full range of vulnerable populations, often unrecognized and therefore undiagnosed, that are affected by eating disorders and facing many barriers to receiving effective, evidence-based care in general.
With that thought in mind, let’s take a look at some statistics that show that eating disorders cast a wide net.
Eating disorders affect people of every age, race, gender identity, sexual orientation, ability status, and background.
According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD), eating disorders affect at least 9 percent of the overall population worldwide.3 Additionally, 9 percent of the U.S. population, or 28.8 million Americans, will have an eating disorder in their lifetime. The lifetime risk of AN in women is estimated to be .3 to 1 percent, with a greater number of patients having bulimia nervosa.
Eating disorders are among the deadliest mental illnesses, second only to opioid overdose.
Research shows that people with eating disorders have significantly elevated mortality rates, with the highest rates occurring in those with anorexia nervosa (AN). The mortality rates for bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS) are similar, though full data and research is limited. An estimated 10,200 deaths each year are the direct result of an eating disorder. That’s one death every 52 minutes. Furthermore, 26 percent of people with eating disorders attempt suicide. In fact, one in five individuals with AN who died had committed suicide.
42 percent of first grader girls want to be thinner.
81 percent of 10 year-old children are afraid of being fat. 46 percent of 9 to 11 year olds are “sometimes” or “very often” on diets. 35 to 57 percent of adolescent girls engage in crash dieting, fasting, self-induced vomiting, diet pills, or laxatives. In a college campus survey, 91 percent of the women admitted to controlling their weight through dieting.
Far too many people with eating disorders are misdiagnosed, overlooked or simply too uncomfortable to seek treatment because they may not fit established stereotypes of what eating disorders look like.
Larger body size is both a risk factor for developing an eating disorder and a common outcome for people who struggle with bulimia and binge eating disorder.
Less than 6 percent of people with eating disorders are medically diagnosed as “underweight.” People in larger bodies are half as likely as those at “normal” weight or “underweight” to be diagnosed with an eating disorder. Larger body size is both a risk factor for developing an eating disorder and a common outcome for people who struggle with bulimia and binge eating disorder.
BIPOC people are significantly less likely than white people to have been asked by a doctor about eating disorder symptoms and are half as likely to be diagnosed or to receive treatment.
Black people are less likely to be diagnosed with anorexia than white people but may experience the condition for a longer period of time. Black teenagers are 50 percent more likely than white teenagers to exhibit bulimic behavior, such as binge eating and purging. Hispanic people are significantly more likely to suffer from bulimia nervosa than their non-Hispanic peers. Asian American college students report higher rates of restriction compared to their white peers and higher rates of purging, muscle building, and cognitive restraint than their white or non-Asian, BIPOC peers. Asian American college students report higher levels of body dissatisfaction and negative attitudes toward obesity than their non-Asian, BIPOC peers.
Gay men are 7 times more likely to report binge eating and 12 times more likely to report purging than heterosexual men.
Gay and bisexual boys are significantly more likely to fast, vomit, or take laxatives or diet pills to control their weight. Transgender college students report experiencing disordered eating at approximately 4 times the rate of their cisgender classmates. 32 percent of trans people with an eating disorder believe their disorder is not related to their physical body. Gender dysphoria and body dissatisfaction in trans people is often cited as a key link to eating disorders. Non-binary people may restrict their eating to appear thin, consistent with the common stereotype of androgynous people in popular culture.
It’s important that eating disorder treatment addresses all populations and their specific needs.
Women with physical disabilities are more likely to develop eating disorders.
20 to 30 percent of adults with eating disorders also have autism. 3 to 10 percent of children and young people with eating disorders also have autism. 20 percent of women with anorexia have high levels of autistic traits. There is some evidence that these women benefit the least from current eating disorder treatment models. ADHD is the most commonly misdiagnosis in relation to disordered eating.
Athletes may be less likely to seek treatment for an eating disorder due to stigma, accessibility, and sport specific barriers.
Athletes report higher rates of excessive exercise than non-athletes. Athletes are more likely to screen positive for an eating disorder than non-athletes, but percentages across all probable eating disorder diagnoses are similar.
Body dysmorphic disorder affects 1 to 3 percent of the overall population, but 13 percent of male military members and 21.7 percent of female members are affected disproportionately.
The most common type of eating disorders among military members is bulimia nervosa. A survey of 3,000 female military members found that the majority of respondents exhibited eating disorder symptoms. One study found high rates of body dissatisfaction and previous disordered eating behaviors in a sample of young, female Marine Corps recruits.
Columbus Park is dedicated to an inclusive environment where all who join us may feel safe, welcome, valued, and understood.
We approach care with acceptance, compassion, and respect for individual self-determination. We serve people of all ages, genders, races, sexual orientations, sizes, and abilities. We battle harmful attitudes and messages that promote societal ideals that harm us all and that imply that our personal value and worth are based on physical characteristics (or other arbitrary features for that matter). We are a fat positive and anti-diet team and operate in confidence that health is possible at any size.
If you or a loved one is facing disordered eating of any kind, please don’t hesitate to schedule a complimentary call with one of Columbus Park’s experts.
This blog post is the second in a series that takes a deep dive into the impact of eating disorders. To learn more about evidence-based treatment for eating disorders, click here.
2 With average delays of: 11.6 years for people with atypical anorexia, compared to 2.5 years for typical anorexia, 4.4 years for bulimia, and 5.6 years for binge-eating disorder before receiving treatment.