Prevalence of Eating Disorders: A Comparison of Western and Non-Western Countries

Mariko Makino, MD, PhD; Koji Tsuboi, MD, PhD; Lorraine Dennerstein, AO MBBS, PhD, DPM, FRANZCP

Abstract and Introduction

Abstract

Objective: To compare the prevalence of eating disorders between Western and non-Western countries.
Method: Potential references were identified through an English-language literature search using Medline and Medscape articles.
Results: Prevalence rates in Western countries for anorexia nervosa ranged from 0.1% to 5.7% in female subjects. Prevalence rates for bulimia nervosa ranged from 0% to 2.1% in males and from 0.3% to 7.3% in female subjects in Western countries. Prevalence rates in non-Western countries for bulimia nervosa ranged from 0.46% to 3.2% in female subjects. Studies of eating attitudes indicate abnormal eating attitudes in non-Western countries have been gradually increasing.
Conclusion: The prevalence of eating disorders in non-Western countries is lower than that of the Western countries but appears to be increasing.

Introduction

Eating disorders, namely anorexia nervosa and bulimia nervosa, are characterized by clinical disturbances in body image and eating behaviors.^[1] For example, anorexia nervosa sufferers have the feeling of being fat even when emaciated.^[1] They deny the seriousness of low body weight and have a morbid fear of weight gain with the relentless pursuit of thinness.^[1] Bulimia nervosa is defined by an overvaluation of weight shape and the behavioral symptoms of recurrent binge eating accompanied by purging and fasting.^[2] The Eating Disorders Not Otherwise Specified (EDNOS) category reflects the many cases of eating disorder that can be quite severe but do not meet the diagnostic criteria for anorexia nervosa and bulimia nervosa.^[1]

There have been many reports about eating disorders in Western countries in the late 20th century.^[3,4,5] It has been claimed that those with eating disorders have mostly been white women and that few cases have been seen in non-Western countries other than Japan.^[6] Recently, eating disorders have been reported in non-Western countries, such as the Middle East and the People's Republic of China.^[7,8,9] These recent studies suggest that the prevalence of eating disorders has been rising among non-Western countries as well. However, eating disorders may present differently in different cultures, and diagnostic criteria based on Western norms may not always be appropriate.

One of the reported explanations for the development of eating disorders is the social pressure resulting from the standards of female beauty imposed by modern industrial society or Western culture.^[10] The increasing globalization and exposure to Western media have been suggested to increase the rate of eating disorders in non-Western countries.

This article summarizes our review of the literature to determine the prevalence of eating disorders in non-Western countries and to compare the prevalence of eating disorders between Western and non-Western countries. We also examined differences in attitudes toward eating between Western and non-Western countries.

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Cite this: Prevalence of Eating Disorders: A Comparison of Western and Non-Western Countries - Medscape - Sep 27, 2004.

Abstract and Introduction
Method
Results
Discussion
References

Table 1. Prevalence of Eating Disorders in Western Countries
Country Studied (Year)	Sample	Prevalence of Anorexia	Prevalence of Bulimia	Author (Year of Publication)
USA	The residents of Rochester by the Mayo Clinic and the Olmsted Medical group	(Incidence)		Lucas et al (1999)^[15]
(1935-1949)	Medical group
	15-19 male	0.000082
	15-19 female	0.000492
	20-24 male	0.000077
(1950-1959)	20-24 female	0.000111
	15-19 male	0
	15-19 female	0.000306
	20-24 male	0
(1960-1969)	20-24 female	0.00031
	15-19 male	0
	15-19 female	0.000679
	20-24 male	0.000086
(1970-1979)	20-24 female	0.000427
	15-19 male	0.000095
	15-19 female	0.000658
	20-24 male	0
(1980-1989)	20-24 female	0.000288
	15-19 male	0.000091
	15-19 female	0.001357
	20-24 male	0.000042
	20-24 female	0.000324
USA (1982)	276 men		1.1%	Heatherton et al (1995)^[20]
USA (1982)	625 women		7.2%	Heatherton et al (1995)^[20]
Hungary (1989)	University students - number not given			Rathner et al (2001)^[23]
	Male		0% to 0.8%
	Female		1% to 1.3%
USA (1990)	1152 students			Pemberton et al (1996)^[21]
	Male		0.2%
	Female		1.3%
Germany (1990)	4285 adults			Westenhoefer (2001)^[24]
	Male		2.1%
	Female		2.4%
UK (1992)	519,900 adults (15-19 yrs)			Rooney et al (1995)^[18]
	Total	0.02%
	Female	0.1%
USA (1992)	235 men		0.4%	Heatherton et al (1995)^[20]
USA (1992)	564 women		5.1%	Heatherton et al (1995)^[20]
Italy (1993)	517 female (11-20 yrs)	1.3%		Rathner (1993)^[17]
Hungary (1994)	538 medical student			Tury et al (1994)^[19]
	248 male		0%
	290 female		0.3%
France (1995)	447 women		0.7%	Basdevant et al (1995)^[61]
Norway (1995)	517 girls (15-20 yrs)	2.6%	0.87%	Gotestam (1995)^[16]
	19067 psychiatric outpatients
	Male	0.8%	0.7%
	Female	5.7%	7.3%
Canada (1995)	8116 adults			Garfinkel et al (1995)^[62]
	Male		0.1%
	Female		1.1%
Germany (1997)	4285 adults			Westenhoefer (2001)^[24]
	Male		1.1%
	Female		1.6%
Australia (1998)	4200 students(15 yrs)			Hay et al (1998)^[63]
Australia (1998)	Male and female		0.3%	Hay et al (1998)^[63]
Austria (1998)	1000 adult females		1.3%	Kinzl et al (1999)^[64]

Table 1. Prevalence of Eating Disorders in Western Countries
Country Studied (Year)	Sample	Prevalence of Anorexia	Prevalence of Bulimia	Author (Year of Publication)
USA	The residents of Rochester by the Mayo Clinic and the Olmsted Medical group	(Incidence)		Lucas et al (1999)^[15]
(1935-1949)	Medical group
	15-19 male	0.000082
	15-19 female	0.000492
	20-24 male	0.000077
(1950-1959)	20-24 female	0.000111
	15-19 male	0
	15-19 female	0.000306
	20-24 male	0
(1960-1969)	20-24 female	0.00031
	15-19 male	0
	15-19 female	0.000679
	20-24 male	0.000086
(1970-1979)	20-24 female	0.000427
	15-19 male	0.000095
	15-19 female	0.000658
	20-24 male	0
(1980-1989)	20-24 female	0.000288
	15-19 male	0.000091
	15-19 female	0.001357
	20-24 male	0.000042
	20-24 female	0.000324
USA (1982)	276 men		1.1%	Heatherton et al (1995)^[20]
USA (1982)	625 women		7.2%	Heatherton et al (1995)^[20]
Hungary (1989)	University students - number not given			Rathner et al (2001)^[23]
	Male		0% to 0.8%
	Female		1% to 1.3%
USA (1990)	1152 students			Pemberton et al (1996)^[21]
	Male		0.2%
	Female		1.3%
Germany (1990)	4285 adults			Westenhoefer (2001)^[24]
	Male		2.1%
	Female		2.4%
UK (1992)	519,900 adults (15-19 yrs)			Rooney et al (1995)^[18]
	Total	0.02%
	Female	0.1%
USA (1992)	235 men		0.4%	Heatherton et al (1995)^[20]
USA (1992)	564 women		5.1%	Heatherton et al (1995)^[20]
Italy (1993)	517 female (11-20 yrs)	1.3%		Rathner (1993)^[17]
Hungary (1994)	538 medical student			Tury et al (1994)^[19]
	248 male		0%
	290 female		0.3%
France (1995)	447 women		0.7%	Basdevant et al (1995)^[61]
Norway (1995)	517 girls (15-20 yrs)	2.6%	0.87%	Gotestam (1995)^[16]
	19067 psychiatric outpatients
	Male	0.8%	0.7%
	Female	5.7%	7.3%
Canada (1995)	8116 adults			Garfinkel et al (1995)^[62]
	Male		0.1%
	Female		1.1%
Germany (1997)	4285 adults			Westenhoefer (2001)^[24]
	Male		1.1%
	Female		1.6%
Australia (1998)	4200 students(15 yrs)			Hay et al (1998)^[63]
Australia (1998)	Male and female		0.3%	Hay et al (1998)^[63]
Austria (1998)	1000 adult females		1.3%	Kinzl et al (1999)^[64]

Table 2. Prevalence of Eating Disorders in Non-Western Countries
Country Studied (Year)	Sample	Prevalence of Anorexia	Prevalence of Bulimia	Author (Year of Publication)
Malaysia (1981)	6000 psychiatric patients	0.05%		Buhrich (1989)^[25]
Japan (1985)	732 hospitals			Kuboki et al (1996)^[22]
	Male and female	0.0036%
	Female	0.0063%
Japan (1998)	456 women (18-21 yrs)		2.9%	Kiriike et al (1998)^[57]
Hong Kong (1989)	500,0000 adults	0.002%		Lee et al (1993)^[29]
Hong Kong (1991)	1020 college students		0.46%	Lee et al (1993)^[29]
Japan (1992)	732 hospitals			Kuboki et al (1996)^[22]
	Male and female	0.0045%
	Female	0.0097%
Egypt (1994)	351 school girls		1.2%	Nassar (1994)^[65]
Japan (1993)	259 students (15-18 yrs)			Suzuki et al (1995)^[66]
	Male		0.7%
	Female		1.9%
Japan (1997)	130 hospitals and 1326 clinics (female)	0.0048%	0.01%	Nakamura et al (2000)^[27]
Iran (2000)	3100 school girls (15-18 yrs)	0.9%	3.2%	Nobakht and Dezhkam (2000)^[28]

Table 3. The Reports of EAT-26 in Western Countries
Country Studied (Year)	Samples	Scores Above Cutoff Point (Male)	Scores Above Cutoff Point (Female)	Authors
Canada (1993)	181 female students (11-18 yrs)		14.2%	Leichner et al^[39]
Canada (1994)	High school - number not given		14.1%	Leichner et al^[39]
Switzerland (1996)	College students - number not given	1.5%	8.3%	Buddeberg-Ficher et al^[34]
Poland (1996)	747 school girls (14-16 yrs)		11.5%	Wlodarczyk-Bisaga and Dolan^[67]
Germany (1998) (EAT-40)	Public ballet school students - number not given		21.6%	Neumarker et al^[40]
USA (1999)	College students	10%	20%	Nelson et al^[68]
USA (2000)	865 college students		20.17%	Anstine et al^[69]
Canada (2001)	1739 girls			Jones et al^[35]
	12-14 yrs		13%
	15-18 yrs		16%
USA (2002)	College students - number not given	4%	10.9%	Hoerr et al^[36]
Spain (2002)	1025 students (14-19 yrs)	0.4%	16.9%	Ballester et al^[33]
UK (2002)	Female students - number not given			Szweda and Thorne^[41]
	Medical		20%
	Nursing		19%
	Arts		21%
USA (2003)	155 female (16-22 yrs)		26%	Graber et al^[37]

Table 3. The Reports of EAT-26 in Western Countries
Country Studied (Year)	Samples	Scores Above Cutoff Point (Male)	Scores Above Cutoff Point (Female)	Authors
Canada (1993)	181 female students (11-18 yrs)		14.2%	Leichner et al^[39]
Canada (1994)	High school - number not given		14.1%	Leichner et al^[39]
Switzerland (1996)	College students - number not given	1.5%	8.3%	Buddeberg-Ficher et al^[34]
Poland (1996)	747 school girls (14-16 yrs)		11.5%	Wlodarczyk-Bisaga and Dolan^[67]
Germany (1998) (EAT-40)	Public ballet school students - number not given		21.6%	Neumarker et al^[40]
USA (1999)	College students	10%	20%	Nelson et al^[68]
USA (2000)	865 college students		20.17%	Anstine et al^[69]
Canada (2001)	1739 girls			Jones et al^[35]
	12-14 yrs		13%
	15-18 yrs		16%
USA (2002)	College students - number not given	4%	10.9%	Hoerr et al^[36]
Spain (2002)	1025 students (14-19 yrs)	0.4%	16.9%	Ballester et al^[33]
UK (2002)	Female students - number not given			Szweda and Thorne^[41]
	Medical		20%
	Nursing		19%
	Arts		21%
USA (2003)	155 female (16-22 yrs)		26%	Graber et al^[37]

Table 4. The Report of EAT-26 in Non-Western Countries
Country Studied (Year)	Samples	Scores Above Cutoff Point (Male)	Scores Above Cutoff Point (Female)	Authors
Nigeria (1992)	Female students - number not given			Oyewumi and Kazarian^[42]
	High school		18.6%
	College		9.1%
	University		21.7%
Hong Kong (1996)	Adult females - number not given		6.5%	Lee and Lee^[47]
South Africa (1997)	High school - number not given			Szabo and Hollands^[38]
	Black		37.5%
	White		20.67%
Korea (1998)	3062 subjects	8.5% (including female)	8.5% (including male)	Lee et al^[48]
Japan (1999)	Numbers not given			Nakamura et al^[44]
	In 20s		1.9%
	In 30s		0.8%
Japan (1999)	2685 high school students		5.4%	Nakamura et al^[44]
Turkey (2000)	253 undergraduates		7.9%	Elal et al^[70]
China (2000)	Medical students			Makino et al^[46]
	217 male	6.0%
	177 female		6.2%
Japan (2000)	College students			Makino et al^[46]
	3129 male	2.5%
	2527 female		4.1%
South Africa (2001)	228 high school		18.8%	Caradas et al^[43]
Oman (2002)	Teenagers - numbers not given	10.9%	13.7%	Al-Adawi et al^[8]
Pakistan (2002)	Medical students - numbers not given			Babar et al^[49]
	1st year		27.7%
	2nd year		14.9%
	3rd year		16%
	4th year		21.3%

	Nursing college students - number not given
	1st year		39.5%
	2nd year		26.7%
	3rd year		31.4%
	4th year		2.4%
Japan (2003)	High school students	2.4%	11.2%	Nishizawa et al^[45]

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Prevalence of Eating Disorders: A Comparison of Western and Non-Western Countries

Abstract and Introduction

Abstract

Introduction

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