Few people outside the medical and psychological communities understand just how prevalent eating disorders in the United States. During the course of their life, it’s estimated 9 percent of all Americans will experience an eating disorder. This includes instances of anorexia nervosa, bulimia nervosa, and binge disorders as well as less-common disorders like ARFID and OSFED. At any one time, about 0.5% of men and 1.5 percent of women are struggling with some form of an eating disorder.
For those who aren’t currently experiencing disordered eating behaviors, there is still a risk it will develop. Among the major indicators that someone might develop an eating disorder, two are shockingly common among American women (and to a lesser extent, men).
Dieting
A disordered relationship with food and eating is often presaged by a history of dieting and food restriction to lose weight. “Fatphobia” is influenced in many cases by media presentations of what an “ideal” body should look like, and leads people to restrict food intake in an attempt to match that ideal. A preoccupation with counting calories predisposes a person to restrict intake, which can lead to anorexia nervosa symptoms, or perhaps to purge calories, which leads to bulimia nervosa. Other disordered attitudes related to dieting, such as avoiding certain types of food, can lead to ARFID (Avoidant/Restrictant Food Intake Disorder).
Body Image / Body Dysmorphia
Per the Mayo Clinic – “Body dysmorphic disorder is a mental health disorder in which you can’t stop thinking about one or more perceived defects or flaws in your appearance — a flaw that appears minor or can’t be seen by others.” Body dysmorphia is a precursor to many eating disorders. Even if it’s not a full-blown case of dysmorphia, negative body image is shockingly common. Even as early as 10th grade, almost 40 percent of girls in America are unhappy with their bodies. This can be influenced by the aforementioned media presentations of idealized bodies as well as parenting, medical instructions, or even athletic standards for sports such as figure skating or wrestling, where weight is an issue.
Making the commonality of these disorders even more troubling, eating disorders rank among the most dangerous kinds of mental health conditions. If addiction and substance abuse are counted as mental health disorders, only opioid addiction causes more deaths per year than eating disorders, but in terms of the highest mortality rate per diagnosis, anorexia nervosa claims more lives than any other. The suicide rate for people with untreated anorexia nervosa is as high as 26 percent. Clearly, eating disorders are a large health problem in the United States.
However, are eating disorders a simply Western issue? Or do they affect people in developing nations as well?
Eating Disorders in Western Countries
By most accounts, eating in Europe is more sensible than in the United States and Canada. The portions tend to be smaller, and the meals are more balanced. This includes smaller portions which also include carbohydrates, fats, and sugars – just not in the amounts available in the United States. Perhaps not coincidentally, these nations tend to have more complete media saturation including films, television, and social media, as well as prominent fashion and diet industries.
Despite this, eating disorders do happen in European countries. They tend to be more prominent in wealthier countries, with a few exceptions. Austria and France lead these nations with eating disorder incidence rates above 1.4 percent, which is less than the American total but still significant; it may lead to the theory that the wealthier a nation is, the higher rate of eating disorders will occur. There are exceptions to this rule – the Netherlands is considered to have a much lower rate of eating disorders but remains one of the wealthiest nations per capita in the world.
As a general rule, however, still-developing nations show lower rates of eating disorder incidence. Both Poland and Turkey show a reported rate of much less than one percent. These countries also tend to be less exposed to Western media, although some aspects of this mediation are virtually universal in 2020.
Eating Disorders in Asia
The tale of eating disorders in Asia is one of Westernization and wealth. Before the 1990s, eating disorders were much rarer in most of Asia, with Japan being a prominent exception (Japan was both wealthy and had strong Western influence following the American occupation of 1945 – 1952). Since the globalization of the ’90s and the rapid economic growth of several Asian countries during the same period, the incidence of eating disorders, especially anorexia nervosa and bulimia nervosa, has increased significantly.
Since the 1990’s, Singapore, Taiwan, South Korea, and India saw vastly increased economic status and decreased food insecurity. That era also saw the widespread establishment of McDonald’s and other Western fast-food franchises. This brought more cases of obesity, especially among younger people. This led some of the governments to institute fatphobic programs aimed at reducing childhood obesity, but which may have contributed to an increased rate of eating disorders such as anorexia nervosa.
A prime example of this was Singapore’s “Trim and Fit” program of the 1990s. During a later study, a significant number of former Trim and Fit members reported being teased for their weight and participation in the program and also reported disordered eating behaviors associated with anorexia nervosa.
Eating disorders are not always a result of Western influence, however. In Hong Kong, before the 90s, there was a decent-sized presence of Non-Fatphobic anorexia nervosa – a form of the disorder where the individual restricts food intake but not out of significant fear of gaining weight. After the increase in globalization, however, the more “typical” form of anorexia nervosa became much more common.
Japan also serves as a possible counter to the “Western influence” theory of increasing eating disorder incidence. Although Japan was highly Westernized as of the 1960s, there wasn’t a real increase in eating disorders reported until the 1970s, and that increase paled next to the increase in the 1990s. This indicated that wealth and lack of food insecurity may be more prominent factors in eating disorder rates.
Eating Disorders in Africa
The growing number of people in Africa with eating disorders, especially with anorexia nervosa, may also serve to belie the idea that Westernization is the cause of eating disorders. Experts are undecided about how prominent eating disorders were in traditional African societies, however. A study performed on students in 1986 found that only a small number showed significant weight loss from restricted eating behaviors. However, another study performed in 2002 in Ghana showed a higher rate, indicating that eating disorders are on the rise.
The study was performed with subjects who were financially stable and had access to food – once again food security is a prerequisite for the development of eating disorders. In the 20-plus years between the studies, in developing countries such as Ghana and South Africa, eating disorder rates have increased although there hasn’t been a significant change in wealth or Westernization.
Interestingly, the South African study also showed that the rates of anorexia nervosa-induced weight loss and other disordered eating patterns were roughly the same between the Black and white members of the study. In a similar study performed among African men who were currently in eating disorder treatment, 76% of the members were diagnosed with anorexia nervosa.
These studies provide further proof that eating disorders can affect anyone; despite the stereotype that only wealthy white women suffer from anorexia nervosa, bulimia nervosa, ARFID, OSFED, or any other disordered eating pattern.
A Universal Condition – A Worldwide Need for Care
Whether in Los Angeles or Lhasa, eating disorders are serious conditions that can devastate lives, families, and communities. The health consequences of eating disorders don’t discriminate regarding gender, race, religion, or even socioeconomic status. They affect everyone the same; untreated eating disorders can cause malnutrition, anemia, low blood pressure, even death. Fortunately, treatment is also blind to these factors.
Treatment for eating disorders normally includes a wide array of medical, psychological, and nutritional methodologies that interact with the individual’s mind, body, and soul. These can run the gamut from psychiatric medication to Cognitive Behavioral Therapy to mindfulness techniques like journaling or meditation.
No matter the country, people with eating disorders deserve the chance to reclaim their lives and their healthier selves. If you or a loved one is struggling with an eating disorder, please reach out to an eating disorder treatment center sooner rather than later – it could be your chance at a recovered life.
Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.