Abstract
SummaryBackgroundAnorexia 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.MethodsWe 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).Findings54 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.InterpretationBinge-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.FundingQueensland Health, Australian National Health and Medical Research Council, and Bill & Melinda Gates Foundation.
Highlights
Eating disorders manifest as persistent disordered eating behaviours that interfere with daily social and psy chological functioning.[1]
Implications of all the available evidence Our results show that the formal inclusion of binge-eating disorder and OSFED in GBD is both feasible and important, and in turn will lead to better representation of eating disorder burden globally
115 studies were identified from the GBD 2019 anorexia nervosa epidemiological database, 99 from the GBD 2019 bulimia nervosa epidemiological database, 42 from two systematic reviews, and four by experts in the field
Summary
Eating disorders manifest as persistent disordered eating behaviours that interfere with daily social and psy chological functioning.[1]. Accurate epidemiological and burden estimates are crucial for understanding the effect of eating disorders on population health, and planning for health systems’ response in terms of both prevention interventions and improvement of access to optimal treatment.[6,7,8] The Global Burden of Diseases, Injuries, and Risk Factors. Study (GBD) is an epidemiological study that quantifies mortality and disability from diseases, injuries, and risk factors at global, regional, and national levels. GBD uses the disability-adjusted life-year (DALY) as a metric for burden. One DALY equates to one lost year of healthy life due to either mortality or disability. It is calculated by summing the fatal burden measured in years of life lost (YLLs) with the non-fatal burden measured in years lived with disability (YLDs)
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