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

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In This Article

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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