Australia has highest rates of anorexia and bulimia globally

Global cases of anorexia and bulimia nervosa have increased by 71 per cent since 1990.

Australia has the highest rates per 100,000 people for the two eating disorders in the world.

Experts suggest more needs to be done, including increasing funding to ensure the numbers do not continue rising.

Cases of anorexia and bulimia nervosa are affecting Australians at a world-leading rate.

The unenviable record comes amid a 71 per cent increase in cases of the two eating disorders globally in the past 30 years.

This jump translates to about 18.1 million people worldwide living with anorexia or bulimia as of 2023, according to a study published today in JAMA Psychiatry.

Australia has the highest rate of any country in the world, with 1,026.5 per 100,000 people estimated to have one of the two disorders.

University of Queensland epidemiologist and study senior author Damian Santomauro said Australia's ranking was "surprising and concerning".

"Usually we do see higher prevalence of eating disorders in high-income settings," he said.

"[But] I'm surprised to see it as high as it actually is compared to the US or other locations in Western Europe."

Eating disorders disproportionately affect younger people and are a mental health condition involving an unhealthy relationship with food.

Butterfly Helpline clinical psychologist Sarah Cox said the study confirmed what people with lived experience of eating disorders, their families and healthcare professionals had been reporting for years.

"Eating disorders are serious mental illnesses that affect a significant number of people in Australia, and that the number of people affected is growing," Ms Cox said.

The findings are part of the Global Burden of Disease study, the world's largest health project that includes research about the impact of mental disorders on the overall population.

"It was the first of its kind that really highlighted that mental disorders can be on par or if not more burdensome than some physical disorders," Dr Santomauro said.

To calculate the prevalence of these disorders, researchers use surveys rather than treatment data to ensure they capture people who may not have access to treatment.

This allows them to analyse data from around the world since 1990, when the study began.

Worldwide, the researchers estimated 3.92 million people had anorexia and 14.2 million had bulimia. They forecasted cases would keep growing through to 2050 globally.

They also calculated that for the two eating disorders, that led to a loss of 3.81 million disability adjusted life years around the world.

Dr Santomauro noted that Australia's high number of cases may be partially due to the way survey data was collected.

"Almost all the surveys that are done in Australia tend to use a different methodology [to the rest of the world]," he said.

"But I don't think that it's purely because of that type of data."

Ms Cox said the numbers, while high, might also mean Australia had more research and data.

"We might be seeing the problem more clearly than other countries," she said.

Dr Santomauro was not surprised cases had increased globally, and said that although there were many factors, one "hypothesis" was increased time online.

"I would expect prevalence to get worse in more recent years because of social media, the Instagram and body image issues that youth are encountering today," he said.

Females accounted for nearly 70 per cent of the 18.1 million global cases and about 41 per cent of all global cases were in young people aged 10 to 24.

Jeanette Chan, an economist and public policy professional who has lived experience with an eating disorder, said people from migrant and non-western backgrounds could have more difficulty gaining help for eating disorders.

"Growing up as a migrant, I didn't have a lot of language or understanding around what mental health was or what mental health issues were," they said.

"In Australia, we're a very multicultural society, and eating disorders are often a very Western conceptualisation of issues surrounding food and eating.

"That affects the way that we make sense of what is problematic."

While Jeanette was able to gain help for her eating disorder, they said more funding for treatment and prevention was needed.

"There's been a lot more investment, but not enough in eating disorders in Australia over the last several years," they said.

While Australia had the highest rates, the largest relative increases in the incidence of anorexia and bulimia occurred in East Asia, South Asia, and South-East Asia.

The study noted a few limitations, including data gaps for mortality related to bulimia, as well as less information from some low-income countries.

Dr Santomauro said the impact of eating disorders broadly was also underestimated since only anorexia and bulimia were included.

"The numbers … sound very, very large, but it's also really capturing a small proportion of the total eating disorder burden globally.

"There's also binge eating disorder, unspecified feeding or eating disorder and other very prevalent eating disorders that we don't capture."

"In Australia, more than 1.1 million people will experience an eating disorder in any given year," she said.

"While anorexia and bulimia are serious eating disorders worthy of attention, we also need to expand the research focus to ensure people living with … other eating disorders are included in the conversation. "

Ms Cox said projections that cases would continue to rise highlighted the need to fund early treatment and prevention.

"We can lower these numbers, and there is more that can be done," she said.

"Getting help early improves the chances of recovery, but many people face barriers to care, including cost, living in regional areas and stigma, and many people with an eating disorder never get treatment."