Australia Records World's Highest Rate of Anorexia and Bulimia as Global Cases Rise 71 Percent

A study published in JAMA Psychiatry has put a number on something clinicians and families in Australia have described for years. About 18.1 million people worldwide were living with anorexia or bulimia nervosa in 2023, a 71 per cent rise since 1990. Australia has the highest rate of any country: an estimated 1,026.5 people per 100,000 have one of the two disorders.

The figures come from the Global Burden of Disease study, the largest health research project in the world, which also measures the toll of mental disorders on whole populations. Damian Santomauro, an epidemiologist at the University of Queensland and the study's senior author, said the project was the first to show that mental disorders can be as burdensome as some physical ones, or more so. Of the global total, the researchers estimated 3.92 million people had anorexia and 14.2 million had bulimia. Together the two conditions accounted for a loss of 3.81 million disability adjusted life years.

The researchers built their estimates from surveys rather than treatment records, so that people who cannot get care are still counted. That approach lets them compare countries back to 1990, when the study began. Santomauro called Australia's ranking surprising and concerning. High-income countries usually show higher prevalence, he said, but he did not expect Australia to sit so far above the United States or Western Europe.

Both Santomauro and others caution against reading the ranking too literally. He noted that nearly all Australian surveys use a different methodology from those elsewhere, though he did not think that explained the result entirely. Sarah Cox, a clinical psychologist with the Butterfly Helpline, suggested Australia may simply have more research and data, so that it sees the problem more clearly than other countries do.

The burden falls unevenly. Females made up nearly 70 per cent of the 18.1 million cases, and about 41 per cent of all cases were in people aged 10 to 24. Santomauro said he was not surprised by the global rise. He pointed to one hypothesis among many factors: more time online. He said he would expect prevalence to worsen in recent years because of social media and the body image pressures young people face on platforms such as Instagram. The largest relative increases in new cases, though, were in East Asia, South Asia and South-East Asia, not in Australia.

Jeanette Chan, an economist and public policy professional with lived experience of an eating disorder, said migrants and people from non-Western backgrounds may find it harder to get help. Growing up as a migrant, they said, they had little language or understanding around mental health. They added that eating disorders are often a Western way of framing problems with food and eating, which shapes what people in a multicultural society recognise as a problem. Chan did receive help, but said investment in eating disorders in Australia over recent years has not been enough.

The study also has limits. It has gaps in mortality data for bulimia and less information from some low-income countries. Because it covers only anorexia and bulimia, Santomauro said, it captures a small share of the total eating disorder burden. Binge eating disorder and unspecified feeding or eating disorders are not counted. Cox said more than 1.1 million people in Australia experience an eating disorder in any given year, and called for research to cover those conditions too.

The researchers forecast that cases will keep growing globally through to 2050. Cox said that makes funding for early treatment and prevention urgent. Getting help early improves the chances of recovery, she said, but many people face barriers including cost, living in regional areas and stigma, and many never get treatment at all.