Epidemiology of eating disorders: population, prevalence, disease burden and quality of life informing public policy in Australia—a rapid review
Authors: Hay Phillipa , Aouad Phillip , Le Anvi , Marks Peta , Maloney Danielle ,   National Eating Disorder Research Consortium, Barakat Sarah , Boakes Robert , Brennan Leah , Bryant Emma , Byrne Susan , Caldwell Belinda , Calvert Shannon , Carroll Bronny , Castle David , Caterson Ian , Chelius Belinda , Chiem Lyn , Clarke Simon , Conti Janet , Crouch Lexi , Dammery Genevieve , Dzajkovski Natasha , Fardouly Jasmine , Feneley John , Foroughi Nasim , Fuller-Tyszkiewicz Mathew , Fursland Anthea , Gonzalez-Arce Veronica , Gouldthorp Bethanie , Griffin Kelly , Griffiths Scott , Hambleton Ashlea , Hannigan Amy , Hart Mel , Hart Susan , Hickie Ian , Kay-Lambkin Francis , King Ross , Kohn Michael , Koreshe Eyza , Krug Isabel , Linardon Jake , Long Randall , Long Amanda , Madden Sloane , McLean Siân , Meddick Thy , Miskovic-Wheatley Jane , Mitchison Deborah , O’Kearney Richard , Paterson Roger , Paxton Susan , Pehlivan Melissa , Pepin Genevieve , Phillipou Andrea , Piccone Judith , Pinkus Rebecca , Raykos Bronwyn , Rhodes Paul , Rieger Elizabeth , Rockett Karen , Rodan Sarah , Russell Janice , Russell Haley , Salter Fiona , Sawyer Susan , Shelton Beth , Singh Urvashnee , Smith Sophie , Smith Evelyn , Spielman Karen , Squire Sarah , Thomson Juliette , Tiggemann Marika , Utpala Ranjani , Vartanian Lenny , Wallis Andrew , Ward Warren , Wells Sarah , Wertheim Eleanor , Wilksch Simon , Williams Michelle , Touyz Stephen , Maguire Sarah 
Published: February 2023

Abstract
Background
Understanding of the epidemiology and health burden of eating disorders has progressed significantly in the last 2 decades. It was considered one of seven key areas to inform the Australian Government commissioned National Eating Disorder Research and Translation Strategy 2021–2031, as emerging research had highlighted a rise in eating disorder prevalence and worsening burden-of-illness. The aim of this review was to better understand the global epidemiology and impact of eating disorders to inform policy decision-making.

Methods
Using a systematic Rapid Review methodology, ScienceDirect, PubMed and Medline (Ovid) were searched for peer-reviewed studies published between 2009 and 2021. Clear inclusion criteria were developed in consultation with experts in the field. Purposive sampling of literature was conducted, which predominately focused on higher-level evidence (meta-analyses, systematic reviews, and large epidemiological studies), synthesised, and narratively analysed.

Results
135 studies were deemed eligible for inclusion in this review (N = 1324). Prevalence estimates varied. Global Lifetime prevalence of any eating disorder ranged from 0.74 to 2.2% in males, and 2.58–8.4% in females. Australian 3-month point-prevalence of broadly defined disorders was around 16% in females. Eating disorders appeared more prevalent in young people and adolescents, particularly females (in Australia: eating disorders ~ 22.2%; disordered eating ~ 25.7%). Limited evidence was found on sex, sexuality and gender diverse (LGBTQI +) individuals, particularly males, who had a six-fold increase in prevalence compared to the general male population, with increased illness impact. Similarly, limited evidence on First Australian’s (Aboriginal and Torres Strait Islander) suggests prevalence rates similar to non-Indigenous Australians. No prevalence studies were identified specifically assessing culturally and linguistically diverse populations. Global disease burden of any eating disorder was 43.4 age-standardised disability-adjusted-life-years per 100,000; increasing by 9.4% between 2007 and 2017. Australian’s total economic cost was estimated at $84 billion from years-of-life lost due to disability and death, and annual lost earnings ~ $1.646 billion.”

Conclusions
There is no doubt that eating disorder prevalence and impact are on the rise, particularly in at-risk and understudied populations. Much of the evidence came from female-only samples, and Western, high-income countries which more readily have access to specialised services. Future research should examine more representative samples. There is an urgent need for more refined epidemiological methods to better understand these complex illnesses over time, to guide health policy and development-of-care.