Australia has the highest estimated prevalence of anorexia nervosa and bulimia nervosa of any country, according to a Global Burden of Disease analysis published in JAMA Psychiatry and reported by Medical Republic. The study put Australia's age-standardised prevalence of the two conditions at 1,026.5 cases per 100,000 people in 2023, compared with a worldwide figure of 225.6.
In response, clinicians and advocates are pressing general practitioners to widen their idea of what an eating disorder looks like, warning that missed and delayed diagnoses remain common despite Medicare-funded treatment plans being available.
Why it matters
The analysis examined data from 204 countries and territories covering 1990 to 2023. It estimated that 18.1 million people worldwide were living with anorexia or bulimia in 2023 — a rise of 71% since 1990 — and projected that the figure would reach 21.8 million by 2050.
Rates were highest in high-income regions, particularly Australasia and Western Europe, though the sharpest relative increases occurred in East Asia, South Asia and Southeast Asia. The researchers said the results pointed to a need for better mental health surveillance, earlier detection and closer integration of eating disorder care into health systems.
The study counted only anorexia nervosa and bulimia nervosa. Binge eating disorder and other specified feeding or eating disorders (OSFED) were left out, and the authors acknowledged that their estimates therefore understate the total burden.
Warning signs that go unrecognised
Danielle Dougherty, who directs Wandi Nerida, the Butterfly Foundation's residential eating disorder treatment facility, told Medical Republic that eating disorders have no single presentation and can affect people of any age, gender, weight, body size, ethnicity or socioeconomic background. She said some patients hold back from disclosing their illness because they feel conflicted about recovery or do not accept that a problem exists.
According to Medical Republic, Dougherty listed physical signals GPs might encounter: tiredness, light-headedness, fainting, sensitivity to cold, palpitations, menstrual disruption, digestive complaints, worn tooth enamel, repeated sports injuries and unexplained electrolyte abnormalities, especially low potassium.
Psychological indicators she cited included anxiety, depression, obsessive-compulsive symptoms, fixation on food or body image, distress around meals and inflexible thinking about eating. On the behavioural side she named dieting, requests for weight-loss drugs or appetite suppressants, and restrictive eating, including restriction framed around reported food intolerances.
Dougherty singled out one group as especially easy to miss: people in larger bodies. She said this group makes up more than half of Australians with eating disorders yet often faces late identification, incorrect diagnosis, unsuitable treatment and stigma. Her advice to clinicians was not to assume that someone in a larger body is not struggling with an eating disorder.
A young and heavily female population
The global figures show where the burden falls. Among the 18.1 million people affected in 2023, about 3.92 million had anorexia nervosa and 14.2 million had bulimia nervosa. People aged 10 to 24 accounted for 41.2% of cases, and females made up 69.4% compared with 30.6% for males.
Together the two disorders were responsible for 3.83 million disability-adjusted life-years, a measure of years lost to ill health, disability or early death. Between 1990 and 2023 the global age-standardised prevalence rate climbed 20.6%, and the age-standardised DALY rate rose 20.5%.
Training gaps behind late diagnosis
Dougherty attributed part of the recognition problem to thin coverage of eating disorders in Australian university courses. She cited a scoping review by the National Eating Disorders Collaboration that found insufficient content on the subject across medicine, psychology, dietetics and nursing programs.
In practice, she said, it often falls to a clinician with a personal interest in the field to seek out further learning and become equipped to treat these patients properly. With more than 1.1 million Australians affected each year and numbers rising, she argued that tertiary education needs to expand its coverage of these illnesses.
For GPs already in practice, she pointed to free professional development options: eLearning resources from the National Eating Disorders Collaboration and the InsideOut Institute's GP Hub, which offers guidance on diagnosis and treatment planning.
Access remains a separate obstacle. Dougherty said many Australians with eating disorders face long waits or cannot obtain suitable care at all because of insufficient funding.
Watch for whether the study's findings translate into changes to medical curricula and GP training requirements, and whether funding for treatment services keeps pace with demand.
