Some of the burden of eating disorders is still hidden.
Some of the burden of eating disorders is still hidden.
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DOI：
10.1016/s2215-0366(21)00080-8
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发表时间：
2021-04
影响因子：
64.3
通讯作者：
Becker, Kendra R.
中科院分区：
文献类型：
--
作者：
Thomas, Jennifer J.;Becker, Kendra R.
In The Lancet Psychiatry, Damian Santomauro and colleagues1 make a stunning claim: the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 20192 underestimated the prevalence of eating disorders by 41· 9 million (95% uncertainty interval [UI] 27· 9–59· 0) cases. By training its focus solely on anorexia nervosa and bulimia nervosa (the tip of the iceberg when it comes to eating disorders), GBD 2019 overlooked 17· 3 million (95% UI 11· 3–24· 9) individuals with binge-eating disorder and 24· 6 million (14· 7–39· 7) people with other specified feeding or eating disorder, who together accounted for 3· 7 million (2· 0–6· 5) disability-adjusted life-years in 2019. 1 This landmark paper highlights that eating disorders are four times more common than previously thought and associated with double the disability burden. The results show that binge-eating disorder and other specified feeding or eating disorder are especially frequent with increasing age, and also more fully describe the burden of eating disorders in males, shattering the inaccurate but entrenched stereotype that eating disorders affect only thin, young, white women. The study applies innovative, rigorous, and reproducible methods that make the best use of global data to challenge misconceptions about the rarity of eating disorders across countries represented in GBD. That said, for two reasons, the global burden of eating disorders is almost certainly greater than their already remarkable findings suggest. First, the authors note that avoidant/restrictive food intake disorder, rumination disorder, and pica could not be included in their analysis because the prevalence of these disorders is unknown. It is true that rigorous epidemiological studies on the full spectrum of DSM-5 Feeding and Eating Disorders are scarce, but growing evidence from school and community samples suggests that these disorders are common. In one study of 1444 elementary school children in Switzerland aged 8–13 years, 3· 2% endorsed symptoms consistent with avoidant/restrictive food intake disorder (characterised by limiting food intake due to one or more of the following: sensory sensitivity, fear of aversive consequences, or lack of interest in eating or food) on a self-report questionnaire. 3 Similarly, in a questionnairebased study of 797 adults aged 21–77 years in Singapore, 4· 1% screened positive for avoidant/restrictive food intake disorder. 4 In the same study of Swiss school children, 1· 7% endorsed behaviours consistent with rumination disorder (regurgitating food and then chewing, re-swallowing, or spitting it out), 3· 8% endorsed behaviours consistent with pica (consuming nonnutritive, non-food substances), and 1· 1% endorsed behaviours consistent with both disorders. 5 Avoidant/restrictive food intake disorder in particular carries risk for psychiatric (eg, suicidality6) and medical (eg, low bone density7) complications, suggesting that the burden in disability-adjusted life-years could be substantial. Second, to estimate disability-adjusted life-years, Santomauro and colleagues made the assumption that subthreshold eating disorders (eg, subthreshold bulimia nervosa) are only half as impairing as their full-threshold counterparts (eg, bulimia nervosa), and that atypical anorexia nervosa (in which individuals restrict their food intake but are not underweight) carries disability equal to that of anorexia nervosa minus the effect of being underweight. This approach makes sense mathematically and is arguably the only way that the authors could have estimated disabilityadjusted life-years in their sample. However, it almost certainly underestimates burden. Individuals with
