Working with people with eating disorders over the years, I have a front row seat to the costs of these illnesses – namely, the personal suffering. In psychotherapy, the costs that feel most meaningful to a patient – a lost semester in college, relationship changes, a medical leave from work, fertility problems or recurrent bone break injuries – can be used to understand personal values. They help us identify meaningful motivators for change and set goals. Working at the level of the individual rather than the population, I think less often about the “big picture” burden of these diseases. World Mental Health Day offers a moment to pause, step back, and reflect.
What is the Global Burden of Disease study?
The best understanding that we have about the cost of eating disorders comes from the Global Burden of Disease study. This is an enormous, scientific initiative that collects information on the rates, health effects, and costs of different diseases and injuries across the world and over time. The Institute of Health Metrics and Evaluation runs the study. Data are regularly updated and used by officials to guide health policies, globally and nationally. Scientists also rely on the data to develop and evaluate plans to improve health outcomes.
The Global Burden of Disease study began in the 1990s. But it did not collect information about eating disorders until 2010. Doing so has dramatically enhanced our understanding of the distribution and burden of eating disorders. Findings reinforce that these problems do not discriminate by geography, socioeconomic status, or other demographics.
Burden of disease represents the gap between current actual health and ideal health (i.e., living into old age without disease or disability). The measure used to communicate the burden, or cost, is a DALY. DALY stands for disability adjusted life-years. Essentially, one DALY equates to one lost year of healthy life due to either disability or death. DALYs are calculated based on an algorithm that incorporates years lived with the disorder, degree of impairment due to the disorder, and other related variables.
Key Findings
Reports from the Global Burden Disease study indicate:
- Of 306 health conditions, anorexia nervosa and bulimia nervosa combined are the 12th leading cause of DALYs in females ages 15 to 19 in high-income countries.
- Within low- and middle-income countries, eating disorders are becoming more costly.
- Nearly 80% of countries across the globe showed higher prevalence and burden (DALYs) of eating disorders in 2021 compared to earlier waves of data collection.
- Globally and across all socioeconomic regions, the burden of eating disorders increased nearly 100% for women of childbearing age (ages 15 to 49).
Some Limitations
The inclusion of anorexia nervosa and bulimia nervosa into the study in 2010 was an important moment of recognition for eating disorders by the global health community. Yet, knowledge about the costs of eating disorders has been limited by a lack of information collected about other eating disorder diagnoses. To date, information on binge eating disorder, avoidant/restrictive food intake disorder, or other specified feeding and eating disorders such as atypical anorexia nervosa has not been collected.
Researchers estimate that omitting binge eating disorder and other specified feeding and eating disorders in the latest Global Burden of Disease study reports led to a very large underrepresentation of cases, to the tune of approximately 41.9 million. When included in the analysis of burden, these diagnoses contributed to 3.7 million DALYs globally and raised the total eating disorder DALYs to 6.6 million. The scientific community is recommending including these eating disorders in future versions of the study. This will bring the experience of people living with these particular conditions more into policymakers’ spotlight.
Other Related Research Findings
Other research on the costs of eating disorders rounds out the picture of these illnesses’ impacts in important ways. Yearly healthcare costs are estimated to be 48 percent higher for people with eating disorders than the general population and associated with lower annual income. Quality of life – a concept defined as overall physical and emotional well-being and satisfaction with life – is also lower for those with eating disorders than others.
Sit with an individual with lived experience of an eating disorder, and you will hear specific examples of the burden of these diseases on the individual and their loved ones. World Mental Health Day is a reminder that we must also sit with the cumulative impact of these disorders.
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