By Lian Folger, BA

Although the previous statistic quoted on the rate of eating disorder mortality was “every 62 minutes someone in the United States dies as a result of an eating disorder,”¹ we have new evidence that the rate is even higher. It is now estimated to be every 52 minutes—in other words, more than one death per hour. This frightening, but motivating, statistic is the product of a year-long initiative by Harvard’s Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED),² in collaboration with the Academy for Eating Disorders (AED)³ and Deloitte Access Economics.

On June 24, 2020, the team hosted a virtual press conference⁴ and released a 92-page report⁵ on this initiative, titled “The Social and Economic Cost of Eating Disorders in the U. S.” This comprehensive report on the national burden of eating disorders is the first of its kind in the U.S. and follows similar initiatives completed in Australia⁶ and the United Kingdom.⁷ The initiative specifically reported on data for the year 2018-2019 (also referred to in the report as the 2019 fiscal year), in order to obtain the most recent cost and prevalence estimates for a single year. Data such as these are essential for spurring and guiding policy to address eating disorders at the national level. The study puts definitive numbers to what many in the eating disorders field have always known: eating disorders are expensive and have financial tolls far beyond just the direct health care costs of treating individuals with these illnesses.^4,5

Below are highlights from the report:

Economic Costs of Eating Disorders

• In 2018-2019, eating disorders cost the U.S. economy $64.7 billion.
  • 75% of the cost was due to productivity losses, which include work absenteeism, reduced employment, reduced performance at work due to illness, or loss of future income due to premature death.
  • The second largest proportion of financial costs (10.4%) came from informal care (i.e., productivity costs for caregivers who are caring for loved ones with an eating disorder).
  • Although eating disorder treatment is often costly, health system costs accounted for just 7% of the total cost of eating disorders in the U.S., highlighting the importance of measuring financial costs beyond direct healthcare expenditures.

• 36% of the costs of eating disorders in the U.S. were borne by individuals living with eating disorders and their loved ones. Government and employers bore the next largest proportions of costs, at 28 and 25% each.⁴

Prevalence of Eating Disorders

• In 2018-19, there were an estimated 5.5 million people with eating disorders (one-year prevalence) in the U.S (1.66% of the U.S. population).⁴
  • 47% of those with eating disorders in the U.S. were under the age of 30, and 83% were of working age (>14 years).⁴
    • These numbers highlight why productivity losses likely comprise such a large proportion of the total costs of eating disorders in the U.S. economy.
  • 44% of the eating disorder cases in the U.S. were classified as Other Specified Feeding or Eating Disorder (OSFED), 37% were binge-eating disorder, 11% bulimia nervosa, and 7% anorexia nervosa.

• Approximately 21 million people (6.4% of the population— 8.6% of females, 4.1% of males) reported having had an eating disorder at some point in their life (‘lifetime prevalence’).⁴
  • Based on the lifetime prevalence (above), an estimated 28.8 million Americans alive in 2018-2019 will have an eating disorder at some point in their lives, whether in the past, present, or future.⁵

• An estimated 10,200 deaths in the U.S. in 2018-19 were due to eating disorders.⁴

In summary, eating disorders have substantial economic and social costs for the U. S.. A full 8.6% of females in the U.S. have had an eating disorder at some point in their lives, and over 10,000 lives were lost in just one year due to these pernicious illnesses. Although anorexia and bulimia nervosa are the most well-known eating disorders, this report highlights the huge burden of binge-eating disorder and OSFED, which accounted for a clear majority of eating disorder cases in 2018-2019, at 81%. 

This report had a few limitations. For example, the number of sexual and gender minority individuals with an eating disorder was not reported, likely due to the limitations of the data from prior studies that were used to derive these new estimates. Another limitation was the absence of information related to the emotional toll of eating disorders. In the press conference, the presenters noted that the financial costs attributed to informal care cannot fully capture the emotional toll these disorders can take on loved ones, such as caregiver wellbeing—which extends far beyond lost work productivity due to caregiving responsibilities.^8,9 Though caregiving occurs for those with eating disorders of all ages, the caregiving responsibilities can be particularly substantial for parents of those ages 10-19, who comprise 17% of those with eating disorders in the U.S.⁵ In addition, eating disorders have physical, mental, and emotional impacts far beyond the period when someone has an active eating disorder, so the sizeable lifetime prevalence numbers offer an estimate of the scale of long-term effects and costs of eating disorders. The long-term impacts of eating disorders were not calculated in the financial cost section of this study, but they were noted as a fruitful area for future study given the many lasting effects of these illnesses.

Implications

The data provided in this study can be used to motivate policy makers and others in charge of research and healthcare funding in the U.S. to make funding eating disorders treatment and research more of a priority. The report also reinforces the message that eating disorders are a substantial public health problem in this country.^10,11 Along with the policy implications of the work, this is a starting point for identifying future research priorities related to treatment, such as which types of intervention or prevention may have the largest social and financial benefits, as well improving the cost estimates by including long-term effect costs and the costs associated with medical and psychiatric comorbidities to eating disorders.⁴

References

1. Eating Disorders Coalition. (2016). Facts about Eating Disorders: What the Research Shows. http://eatingdisorderscoalition.org.s208556.gridserver.com/couch/uploads/file/fact-sheet_2016.pdf
2.  STRIPED. Report: Economic Costs of Eating Disorders. Harvard T.H. Chan School of Public Health. https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/
3.  Academy for Eating Disorders (AED). Social and Economic Cost of Eating Disorders in the United States. https://www.aedweb.org/about-aed/social–economic-cost-of-eds-in-the-us?utm_source=What%27s+Going+On+at+AED+-+July+2020&utm_campaign=What%27s+Going+On+at+AED+in+July+2020&utm_medium=email
4. Deloitte Study Press Conference – Social and Economic Cost of Eating Disorders in the United States. 24 June 2020. https://vimeo.com/aedweb/review/432476890/ac610ec6fd
5.  Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020. Available at: https://cdn1.sph.harvard.edu/wp-content/uploads/sites/1267/2020/07/Social-Economic-Cost-of-Eating-Disorders-in-US.pdf
6.  The Butterfly Foundation for Eating Disorders. (2012) Paying the price: The economic and social impact of eating disorders in Australia, The Butterfly Report. Crows Nest, NSW, Australia. Available at: https://www.pc.gov.au/__data/assets/pdf_file/0017/215540/sub0078-ndis-costs-attachmenta.pdf
7.  BEAT and Pro Bono Economics. (2012). Costs of eating disorders in England: Economic impacts of anorexia nervosa, bulimia nervosa and other disorders, focusing on young people. Available at: https://www.probonoeconomics.com/sites/default/files/files/BEAT%20report.pdf
8. Fox JR, Dean M, Whittlesea A. The Experience of Caring For or Living with an Individual with an Eating Disorder: A Meta-Synthesis of Qualitative Studies. Clin Psychol Psychother. 2017;24(1):103-125.
9. Stefanini MC, Troiani MR, Caselli M, et al. Living with someone with an eating disorder: factors affecting the caregivers’ burden. Eat Weight Disord. 2019;24(6):1209-1214.
10.  **Austin SB, Peat CM, Bulik CM. Eating disorders cost US $65 billion a year: Here’s what agencies can do. 22 July 2020. The Hill. https://thehill.com/opinion/healthcare/508483-eating-disorders-cost-us-65-billion-a-year-heres-what-federal-agencies-can

**Please note, some readers may find the comments section following this article distressing.

11. Keel PK. How the healthcare system is failing people with eating disorders. 10 Aug 2020. OUPblog: Oxford University Press’s Academic Insights for the Thinking World. https://blog.oup.com/2020/08/how-the-healthcare-system-is-failing-people-with-eating-disorders/?fbclid=IwAR2WSzMWcYHluJoIRyrp3wqi9F4ESmWkyc7hmgMOtjiwQlf5GTtXiDyr-bI