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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We searched (Medline and Medscape, 1982-2003) for English-language literature related to the prevalence rate of eating disorders. The reference lists of the medical journal articles found were also examined. An Eating Attitudes Test-26 (EAT-26) was developed by Garner and colleagues[11] to examine the level of abnormal eating attitudes, and this test is also used as a predictive measure of development of eating disorders. We examined those surveys using EAT-26, in order to compare the difference between Western countries and non-Western countries with regard to attitudes toward eating.

Methodologic Issues

There were many methodologic issues in the epidemiologic studies of eating disorders, including diagnostic criteria and case detection methods.[12,13] In non-Western countries, researchers used translated versions of questionnaires developed in the Western hemisphere. The Diagnostic Statistical Manual of Mental Disorders (DSM-IV) or the International Classification of Diseases 10 (ICD-10) was used to clinically diagnose eating disorders. Larger samples are needed to obtain accurate prevalence figures in non-Western countries because of their lower rates of eating disorders.[14] Many studies were conducted using convenience samples, such as community groups, high school or university students, or patients of hospital or clinics. It was very difficult to find studies that are truly population based.

There are instruments to assess eating disorders other than EAT-26. For example, Eating Disorder Inventory (EDI) and Bulimic Investigatory Test and the Edinburgh (BITE) are other Western instruments used to assess eating disorders. These tools and the EAT-26 are culturally based and may not reflect the full spectrum of eating disorders in other cultures. In addition, these tools may have a number of false positives, and translated versions of these scales may not give invariant meanings in different cultures.


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