Cases of anorexia and bulimia have risen by 71 per cent since 1990 and mainly affect young people and women, according to a global study

Is the study of good quality? Are the conclusions supported by sound data?

“The manuscript is of very high quality, both in terms of methodology and the evidence on which it is based: a large international sample and validated, robust epidemiological methods. The main conclusions are supported by the available data. Whilst specialist groups in eating disorders are virtually unrepresented, internationally renowned groups in both epidemiology and public health are well represented.”

How does this work fit in with the existing evidence?

“It confirms the global increase in eating disorders and reaffirms that women and young people are most affected, in line with current studies. It shows a significant rise in non-Western countries, particularly in Asia. We are paying particular attention to this in the wake of the COVID-19 pandemic and the substantial global increase in EDs.”

What impact does the prevalence of anorexia and bulimia have, according to this research?

“There are approximately 18 million people affected in 2023, representing a 71 per cent increase in the number of cases since 1990. Current evidence supports this. The greatest burden is concentrated amongst adolescents and young adults. We are currently seeing an increasing number of older adults: 25 per cent of our cases are aged over 45, and this proportion has been rising over the years.

Bulimia accounts for a greater proportion of overall disability than anorexia.”

Are there any significant limitations that should be taken into account?

“It does not include binge-eating disorder (BED), which is becoming more widespread in the general population, nor other eating disorders (OSFED). There is a lack of data in some low- and middle-income countries. Some of the estimates rely on statistical models, and the projections for 2050 should be interpreted with caution.”

What are the implications?

“It justifies strengthening early detection and specialised treatment, and supports the need for more resources for eating disorders. It reinforces the view that obesity and eating disorders share risk factors and transdiagnostic mechanisms, and should therefore be addressed in an increasingly integrated manner.”

The article is of very high methodological quality, with conclusions based on data that may have limitations due to the quality of the records in different regions. This could underestimate the scale of the health problem in areas where data are scarce. A particular strength is the up-to-date nature of the data and the forecast of a likely increase in these disorders.

With regard to the results, a higher prevalence of these disorders among women and in the 15–35 age group was to be expected given current knowledge, although the extremely high prevalence of these disorders in Australasia is noteworthy, most likely driven by the gradual rise in socio-economic status.

Finally, I would like to point out that, according to this research, these eating disorders have not only failed to decrease but are on the rise (particularly bulimia nervosa), which is why special attention should be paid to the role of social media. They can undoubtedly be a double-edged sword: on the one hand, they can raise awareness of these problems, which remain prevalent and are on the rise; but, on the other hand, they can send the wrong messages to the very age group where prevalence is highest and where social media is used most extensively.