It may seem like there’s more media coverage and more shows about eating disorders than ever, with Netflix’s “To The Bone” and others.
But there hasn’t been a lot of national research done on the prevalence of these disorders, which impact more than the young caucasian female characters often portrayed in stories about anorexia, binge-eating, and bulimia.
That’s where University at Albany assistant professor Tomoko Udo steps in.
“Eating disorders affect many American adults across age groups, social demographic groups, gender, education, race/ethnicity; it affects all the groups,” Udo said.
Using a dataset collected from 36,306 adults, Udo and Carlos Grillo, a Yale professor, examined the prevalence of anorexia, bulimia, and binge eating disorders in the United States. They found that though prevalence didn’t necessarily increase for each eating disorder, prevalence was unaffected by social demographic. Their findings were recently published in “Biological Psychiatry: A Journal of Psychiatric Neuroscience and Therapeutics.”
The need to study national prevalence has increased in the last few years, particularly because there have been changes in the way these eating disorders are defined and diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (or the DSM).
“They loosened the criteria to meet all these eating disorders,” Udo said, “Binge eating was not an independent disorder, it was part of an “otherwise not specified category.”
For anorexia, a diagnosis used to require an absence of menstrual cycle and low weight (used to be 85% of age/height standard. 17.5 BMI was a cut off) but that’s gone. The requirement is now just that the weight is less than normal (less than 18.5). For bulimia and binge eating disorders, the requirement used to be twice a week for six-month occurrence and it’s currently once a week for three months.
Using the updated diagnostic definitions, Udo and Grillo calculated the percentage of people who had one of the three eating disorders over their lifetime and the percentage of people who had the disorder in the last year. Because of the loosening of the diagnostic criteria for all three, the researchers expected that prevalence was going to go up.
“But we actually didn’t find that,” Udo said.
Instead, prevalence rates were similar to previous studies and estimations. Prevalence estimates for having anorexia over the course of a lifetime was higher than previous studies, coming in at .80%. But for bulimia and binge eating disorders, it was lower than similar studies at .28% and .85% respectively.
It’s hard to pinpoint why exactly that might be the case. Udo said it could do with the different methodology or perhaps because their data set included thousands more participants than in many other studies done on the same topic. Although the prevalence didn’t quite reveal what was predicted, Udo said it was important to have the data, especially since the last time a study of this size was done was in 2007.
“One of the reasons why understanding prevalence is important is political and funding decisions will be made based on these numbers,” Udo said, “Resources may be allocated differently based on the findings so that’s part of the reason why it’s good to update everyone every once in a while.”
Yet, eating disorders are often underrepresented in national health studies. Because most research regarding eating disorders is conducted in treatment centers, Caucasian women are predominately featured in the studies.
“Those studies tend to under-represent minority women and men because Caucasian women tend to seek specialized treatment more for any mental health problem,” Udo said.
But Udo’s study found that eating disorders are just as prevalent in minority groups, except for anorexia.
“Eating disorders [are] underrecognized. It’s not as prevalent as depression, but still, the consequences of eating disorders [are] pretty severe,” Udo said. Those may include unhealthy weight loss or weight gain, seizure, fatigue, ulcers, amenorrhea, etc.
Udo argues that oftentimes, getting the right diagnosis and treatment can be difficult. If someone has a binge eating disorder, for instance, their doctor might only treat their weight issue and completely miss the real reason for the problem.
“Binge eating disorders are strongly associated with obesity and all three eating disorders are highly comorbid with other psychiatric disorders,” Udo said.
Not only are the consequences severe, but access to treatment, especially in rural communities, is seriously lacking across the country. Udo called to attention that in New York state there are only three eating disorder treatment clinics (Albany, Rochester, New York City).
In the next few months, Udo will be studying treatment utilization rate, in part building on her prevalence study.
“More needs to be done to improve access to care,” Udo said.