Epidemiology of eating disorders in persons other than the high-risk group of young Western females.

Most studies on the epidemiology of eating dis-orders have focused on young females in Westerncountries,beingthehigh-riskgroupforthedevelop-ment of eating disorders. However, eating disordersdo occur in older women and in men and they alsodo occur in persons in nonwestern countries, as thereviews in this issue show [Raevuori et al. (pp. 000–000), Mangweth-Matzek et al. (pp. 000–000), Pikeetal.(pp.000–000)].Disorderedeatingbehaviorandeating disorders also do occur more frequentlyamong obese people and even more among severelyobese people waiting for weight loss surgery thanamong healthy weight people [Marcus and Wildes(pp. 000–000), Green et al. (pp. 000–000)]. The fivearticles on eating disorders in this journal reviewnew findings on eating disorders and disturbedeatingbehavioramongthesenontraditionalgroups,such as men, older women, persons in nonwesterncountries and obese persons [Raevuori et al.(pp. 000–000), Mangweth-Matzek et al. (pp. 000–000), Pike et al. (pp. 000–000), Marcus and Wildes(pp. 000–000), Green et al. (pp. 000–000)].Last year, the articles in the eating disordersection in this journal addressed the changes inthe Diagnostic and statistical manual of mentaldisorders (5th ed) regarding feeding and eating dis-order criteria compared with those in DSM-IV [1,2].Throughout the DSM-5, the influence of develop-ment, sex and culture on the presentation of psy-chiatric disorders was given more attention than inany previous edition of the DSM [2], which mightfacilitate the classification of eating disordersamong men, older women and among people innonwestern countries. In DSM-5, the diagnosticcriteria for anorexia nervosa and bulimia nervosawere broadened, and binge eating disorder wasincluded as an official diagnostic entity [1]. Thishas particular relevance for men and older women,whose eating disordersymptoms tend not to fit intostringent categories [Raevuori et al. (pp. 000–000),Mangweth-Matzek et al. (pp. 000–000)]. ComparedwithDSM-IV,DSM-5allowsmoreeatingdisordersinmen to be identified by a specific diagnosis, insteadof a residual category such as ‘eating disorder nototherwise specified’ [Raevuori et al. (pp. 000–000)].For example, the elimination of the amenorrhearequirement [1] and more permissive wording ofthe weight criterion might facilitate a diagnosis ofanorexia nervosa in men [Raevuori et al. (pp. 000–000)]. Anorexia nervosa – usually considered as theprototype of an eating disorder, but a relatively raredisorder in the general population – was alreadyincluded in DSM-I in 1952. Obesity – at the otherend of the weight spectrum as anorexia nervosa anda relatively common condition – has never beenclassified in the DSM-system. In fact, the DSM-5Eating Disorders Work Group was asked to considerwhether obesity should be included in the DSM as amentaldisorder,butconcludedthattherewasinsuf-ficient evidence to include obesity [3]. Obesity is aheterogeneous and potentially harmful conditionthat is caused by a complex interplay of host andenvironmental factors, but it is not necessarily amental disorder [3,4]. Although there are manypathways to obesity, there is substantial evidencethat disordered eating can be a significant factor inits development and maintenance [Marcus andWildes (pp. 000–000)].Raevuori et al. (pp. 000–000) estimate the life-time prevalence of anorexia nervosa among men as0.2–0.3%, bulimia nervosa as 0.1–0.5% and bingeeating disorder as a minimum 1% up to as high as3%. Epidemiological studies report rate ratios oflifetime prevalence in men vs. women for anorexia