Access to Treatment, and Mortality in Eating Disorders

Vol. 31 / No. 1 — Eating Disorders Review

The study model also showed a high prevalence of eating disorders in the general population.

Having a better understanding of the prevalence of eating disorders over the lifetime “could help decision-makers and clinicians better target policies and programs,” according to a team of public health  researchers led by Zachary J. Ward, MPH, of Harvard’s Center for Health Decision Science, Boston (JAMA Network Open. 2019; 2[10]:e1912925).

Given the effort that studies providing data on prevalence across the lifespan would entail, the team designed an analytical model study to simulate clinical and epidemiologic eating disorders data, using a simulated nationally representative cohort of 100,000 individuals (50% male) modeled from birth to age 40 for anorexia nervosa, bulimia nervosa, binge-eating disorder, and other specified feeding and eating disorders (OSFED). The authors also sought to estimate how increasing access to treatment for eating disorders might diminish mortality. Estimates of prevalence, remission and relapse rates as well as excess mortality were drawn from the existing literature.

Eating disorders by age

The study results showed that the estimated prevalence of eating disorders was high: the highest estimated mean annual prevalence of eating disorders overall occurred at approximately 21 years of age for both males and females. The mean lifetime prevalence increased to approximately 1 in 7 males and approximately 1 in 5 females by age 40. The types of eating disorders followed a similar pattern, peaking in the late 20s and then decreasing slowly in later adulthood; in this study, most cases involved OSFED. In the model, 95% of those developing an ED did so by 25 years of age.

Treatment prevented approximately 41.7 deaths per 100,000 persons; however, increasing coverage to provide treatment to all with EDs would prevent 70.5 deaths per 100,000. Of note: total prevention of all EDs was estimated to prevent 213 deaths per 100,000.

This modeling highlights the prevalence of EDs and the mortality burden associated with ED and underscores the potential benefits of improved access to treatment.