The hidden burden of eating disorders: an extension of estimates from the Global Burden of Disease Study 2019

Why is this research important?

Binge eating disorder and other specified feeding or eating disorder (OSFED) are the most common eating disorders, however, they have often been omitted from research regarding the prevalence and burden of eating disorders. This study fills this gap in the literature as it estimates the prevalence and burden of binge eating disorder and OSFED globally. The study found that binge eating disorder and OSFED were the most prevalent eating disorders globally and that their relative contribution to eating disorder prevalence increased with age. The authors estimate that there were 41.9 million cases of binge eating disorder and OSFED globally in 2019

The burden of the eating disorder was estimated using ‘disability-adjusted life-years’. This is a measure of the amount of time (in years) that is ‘lost’ due to imperfect health from a particular cause, taking into account both premature death and time lived in a state of ill-health (termed disability). It also incorporates a rating for the severity of the disability. Together, binge eating disorder and OSFED were estimated to cause 3.7 million disability-adjusted life-years globally.

This study demonstrates the importance of future research into the prevalence of binge eating disorder and OSFED through large-scale nationally representative surveys. It also highlights the importance of including these prevalent eating disorders (i.e. binge eating disorder and OSFED) in treatment and service planning as well as policy, to work towards reducing this significant burden.

Authors:  Damian F Santomauro, Sarah Melen, Deborah Mitchison, Theo Vos, Harvey Whiteford, Alize J Ferrari


Background: Anorexia nervosa and bulimia nervosa are the only eating disorders included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, yet binge-eating disorder and other specified feeding or eating disorder (OSFED) are more prevalent. This study sought to estimate the prevalence and burden of binge-eating disorder and OSFED globally and present a case for their inclusion in GBD.

Methods: We sourced studies from the GBD 2019 anorexia nervosa and bulimia nervosa epidemiological databases, two systematic reviews that included studies with epidemiological estimates of binge-eating disorder and OSFED, and experts in the field. Studies, published between Jan 1, 1998, and March 1, 2019, were included if they reported non-zero prevalence of two or more eating disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder, or OSFED) and diagnosed cases according to DSM-IV or DSM-5. The proportions of total eating disorder cases that met diagnostic criteria for each individual eating disorder were estimated via network meta-regression and simulation using studies reporting eating disorder prevalence. The global cases unrepresented in GBD 2019 were estimated using the proportions from the simulation and the GBD 2019 eating disorder prevalence. Disability weights for binge-eating disorder and OSFED were then estimated along with disability-adjusted life-years (DALYs). Estimates are presented with 95% uncertainty intervals (UIs).

Findings: 54 studies, of which 36 were from high-income countries, were included in the analysis. The number of global eating disorder cases in 2019 that were unrepresented in GBD 2019 was 41·9 million (95% UI 27·9–59·0), and consisted of 17·3 million (11·3–24·9) people with binge-eating disorder and 24·6 million (14·7–39·7) people with OSFED (vs 13·6 million [10·2–17·5] people with eating disorders in GBD 2019). Together, binge-eating disorder and OSFED caused 3·7 million (95% UI 2·0–6·5) DALYs globally, bringing the total eating disorder DALYs to 6·6 million (3·8–10·6) in 2019.

Interpretation: Binge-eating disorder and OSFED accounted for the majority of eating disorder cases and DALYs globally. These findings warrant the inclusion of binge-eating disorder and OSFED in future iterations of GBD, which will bring the burden experienced by people living with these disorders to the attention of policy makers with the means to target this burden.

Access: Open access


Citation: Santomauro, D. F., Melen, S., Mitchison, D., Vos, T., Whiteford, H., & Ferrari, A. J. (2021). The hidden burden of eating disorders: an extension of estimates from the Global Burden of Disease Study 2019. The Lancet Psychiatry, 8(4), 320-328.


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