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

Results

Prevalence of Eating Disorders in Western Countries

Table 1 shows the prevalence of eating disorders in Western countries. There are some reports on the prevalence of anorexia nervosa. In the United States, Lucas and colleagues reported a longitudinal general population-based survey from 1935-1989.[15] Their data revealed that the most vulnerable group for anorexia nervosa comprised girls and young women aged 15 to 24 years. A continual rise in incidence was observed throughout the 55 years of this study. Two studies[16,17] of female students to determine the prevalence of anorexia nervosa suggest that the prevalence is higher in Norway (2.6%)[16] than in Italy (1.3%).[17] A population-based study of anorexia nervosa in the United Kingdom[18] found that the prevalence of anorexia nervosa among females aged 15 to 19 years old was 0.1%. The prevalence rate of anorexia nervosa thus seems to be lower in the general population than among students. A study of psychiatric female outpatients in Norway reported a prevalence of anorexia nervosa of 5.7%.[16]

Our review found more bulimia sufferers than anorexia sufferers in all countries for which there are published studies (See Table 1 ). It is interesting that Hungary reported fewer sufferers than other Western countries.[19] Female subjects are more often affected than male subjects for both anorexia nervosa and bulimia nervosa.[20,21,22]

Population-based and clinic-based estimates of anorexia nervosa in Western countries ranged from 0.1%[18,23] to 5.7%[16] in female subjects, and that of bulimia nervosa ranged from 0%[17] to 2.1%[24] in male subjects and from 0.3%[19] to 7.3%[16] in female subjects.

Prevalence of Eating Disorders in Non-Western Countries

Table 2 shows the prevalence of eating disorders in non-Western countries. Buhrich[25] reported that 0.05% of the psychiatric patient sample in Malaysia were diagnosed with anorexia nervosa, and this prevalence rate had not increased for 15 years. Lee[26] reported in 1989 that anorexia sufferers were very few in Hong Kong compared with Western countries. In Japan, Kuboki[22] conducted a survey among the general and female patient population of 732 hospitals in 1988. He found that the female patient population had about 1.5 times more anorexia sufferers than the general population, although the prevalence rate was still only 0.0063%. Kuboki repeated the same survey in 1992. The prevalence of anorexia nervosa was now higher than the previous data. Among the general population, the rate had increased from 0.0036% to 0.0045%. Among the female patient population, the rate had increased from 0.0063% to 0.0097%; the proportion of anorexia nervosa sufferers among the female patient population was now twice that in the general population. Nakamura's survey suggested that the rate of anorexia sufferers was 0.0048% among 130 hospitals and 1326 clinics in Japan.[27] This figure is similar to the result derived from Kuboki's survey. Results from a questionnaire-based survey recently conducted in Iran indicate that the prevalence of anorexia nervosa is 0.9% among school girls.[28] This figure was not obtained by clinical diagnosis, however; and this is the highest rate reported among non-Western countries.

Lee[29] reported that 0.46 % of female college students had bulimia nervosa in Hong Kong in 1991, a lower rate than that found by Kiriike (2.9%) in Japan.[10] Lee[29] also reported that almost all the female students wanted to be slimmer, although they did not try to lose weight. Apart from Asian countries, there are some reports in Islamic countries of bulimia nervosa. Nasser[30] in Cairo reported that the estimated prevalence of bulimia nervosa found by administering questionnaires on disordered eating was 1.2% among the school girls; using the same type of survey as the one used in Cairo, investigators estimated that 3.2% of Iranian school girls suffer from bulimia nervosa.[28] Again, one should note that these figures were not obtained by clinical diagnosis and that the Iranian rate is the highest among non-Western countries.

Population-based and patient-based estimates of anorexia nervosa in non–Western countries thus ranged from 0.002%[29] to 0.9%[30] and that of bulimia nervosa ranged from 0.46%[29] to 3.2%.[28]

There were no population-based prevalence surveys in other non-Western countries. In Singapore in 1982, Ong and colleagues[31] published a case report on 7 Chinese females with anorexia nervosa. Ong suggested that there was a low incidence of this disorder in Singapore. Following Ong's report, Ung[32] reported in 1997 that 50 anorexia nervosa sufferers were identified, and he suggested there was an increase in the incidence of this disorder.

Eating Attitudes Test-26 (EAT-26) in Western Countries

Table 3 shows the results of EAT-26 studies in Western countries. A few studies of male subjects have been conducted in Western countries. For males, the percentage of abnormal eating attitudes ranged from 0.4% (Spain) to 10% (United States). Male samples showed a lower incidence of abnormal eating behavior than among female subjects in all countries reported here. [33-36] Among female samples, there are different prevalence rates given in US reports, with up to 26% of the female subjects having abnormal eating attitudes. [37] In Canada, 22.3% of female Canadian subjects (aged 12-20 years) in 1982 exhibited abnormal eating attitudes. [38] The percentages declined both in 1993 and in 2001. [35,39]

Our review indicates that Switzerland has the lowest incidence of abnormal eating attitudes among female subjects (college students, 8.3%) [34] (see Table 3 ). Among students in the public ballet school in Berlin in 1998, 21.6% of females showed abnormal eating attitudes. [40] This percentage was the highest in recent studies, excluding that reported for the United States. Apart from the United States and Canada's survey in 1982, students majoring in ballet, arts, medicine, and nursing in the United Kingdom had high EAT-26 scores. [41] Among females in Western countries, the percentage of abnormal eating attitudes ranged from 8.3% [40] to 26%. [37]

EAT-26 in Non-Western Countries

We did not come across many surveys using EAT-26 scores in non-Western countries ( Table 4 ). The reports are divided into 3 groups: East Asian countries, South Asian or Islamic countries, and African countries. Three surveys were conducted in African countries (1 in Nigeria, 2 in South Africa).[38,42,43] On the basis of the Szabo and Hollands survey, 37.5% of the black female high school students had abnormal eating attitudes. Among South Asian or Islamic countries (Pakistan, Oman, and Turkey), 39.5% of female nursing college students in their first year of study in Pakistan had abnormal eating attitudes, which was the highest rate among non-Western countries. Oman reported that 10.9% of male subjects had disturbed eating attitudes.[8] This was the only report for male students among South Asian countries. In Japan, according to Nakamura's results in 1999, female high school students had higher percentages of abnormal eating attitudes (5.4%) than adult females.[44] Nishizawa[45] reported in 2003 that 11.2 % of the female high school girls had abnormal eating attitudes. There were recent studies of male subjects using EAT-26 scores in Japan. Makino and colleagues[46] and Nishizawa and colleagues[45] respectively showed that 2.5% and 2.4% of the male college students had abnormal eating attitudes.

In China, only 1 study was conducted using EAT-26 scores.[46] The results suggest that the percentages of abnormal eating attitudes were almost the same for male and female college students. This result is different from that in other countries, where female subjects have higher rates than male subjects. In Hong Kong, 6.5% of the female subjects had high EAT-26 scores.[47] In Korea, 8.5% of the adults (male and female) had abnormal eating attitudes.[48]

The percentage of disturbed attitudes toward eating (EAT-26 scores) in female subjects in non-Western countries ranged from 0.8%[44] to 39.5%.[49] Those of male subjects ranged from 2.4%[45] to10.9%.[8]

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