Eating Problems in Young People

• NHS report explores eating problems and clinically impairing eating disorders in 11 to 25-year-olds in England.
• The report analyzes prevalence, trends, and gender differences using the Development and Well-Being Assessment (DAWBA) module data.

Possible Eating Problems

• Broader eating difficulties are identified via screening questions, but not necessarily meeting clinical criteria for eating disorders.
• In 2023, prevalence rates for possible eating problems were:
  • 11-16 years: 12.3% screened positive
  • 17-19 years: 59.4% screened positive
  • 20-25 years: 57.2% screened positive
• Gender differences:
  • Similar rates for boys and girls aged 11–16 years
  • Higher rates in young women than young men:
    • 17-19 years: 77.5% (women) vs. 42.3% (men)
    • 20-25 years: 72.3% (women) vs. 43.0% (men)
• Increased rates among children aged 11–16 years from 6.7% in 2017 to 13.0% in 2021, with stability since.
• Rates for young people aged 17–19 years rose from 44.6% in 2017 to 58.2% in 2021, remaining stable thereafter.

Eating Disorders

• Clinically impairing conditions such as anorexia or bulimia, diagnosed using ICD-10 criteria.
• In 2023, prevalence rates:
  • 11-16 years: 2.6%, higher in girls (4.3%) than boys (1.0%)
  • 17-19 years: 12.5%, higher in young women (20.8%) than young men (5.1%)
  • 20-25 years: 5.9%, similar rates for men and women
• Types of Eating Disorders in 2023:
  • Anorexia: Low prevalence across all age groups (<0.5% for children, ~3% for older adolescents)
  • Bulimia: Slightly higher prevalence, especially among older adolescents
  • Other Eating Disorders (e.g., atypical anorexia): Most common type across all age groups
• For children aged 11–16 years, the prevalence of eating disorders rose from 0.5% in 2017 to 2.6% in 2023, driven by an increase among girls.
• For young people aged 17–19 years, the prevalence rose from 0.8% in 2017 to ~12.5% in recent data, with a significant rise among young women.
• Rising rates highlight the need for early intervention and targeted support, particularly for adolescent girls and young women.
• Continued monitoring is essential to address gender disparities and inform prevention strategies.

Types of Eating Disorders

• Anorexia Nervosa (AN) has the following diagnosis criteria:
  • Intense fear of gaining weight
  • Undue influence of body shape and weight on self-evaluation
  • Disturbance in how body is perceived
  • Lack of recognition of severity of low body weight
  • May not perceive themselves as being thing despite being told by doctors/family
  • Persistent restriction of energy intake leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health
  • Low BMI controversy around using BMI for diagnosing
  • Weight and Shape Concerns
• Restrictive type: Dieting, fasting meals, excluding certain food groups and excessive or compulsive exercising
• Binge-Purge type: Dieting, fasting meals, excluding certain food groups, excessive or compulsive exercising, self-induced vomiting/laxatives/diet pills, and binge-eating
• Bulimia Nervosa (BN) has the following diagnosis criteria:
  • Undue influence of body shape and weight on self-evaluation
  • Binge-eating episodes, i.e., eating a large amount of food in a short period with a sense of loss of control (once/week for at least three months)
  • Compensatory behaviors
• The Purging type involves self-induced vomiting, laxative abuse, and diet pills. The Non-Purging type involves dieting, fasting, skipping meals, and excessive/compulsive exercising.
• Binge-Eating Disorder (BED) has the following diagnosis criteria:
  • Binge-eating episodes, i.e., eating a large amount of food in a short period with a sense of loss of control (once/week for at least three months)
  • Absence of recurrent compensatory behaviors
  • Marked distress regarding binge eating
  • High BMI
  • Weight and Shape Concerns
• Requires you to have at least three of the following:
• Eating alone due to embarrassment about the amount of food consumed
• Eating until feeling uncomfortably full
• Eating much more rapidly than usual
• Eating large amounts of food when not feeling physically hungry
• Feeling disgusted, depressed, or guilty afterward
• Other Specified Feeding & Eating Disorders:
  • Umbrella term for individuals who don't meet full diagnostic criteria
  • Atypical AN: no underweight BMI
  • Sub-Threshold BN/BED: Frequency criteria not met
  • Purging Disorder: Purging behaviors occur in the absence of binge-eating
  • Night Eating Syndrome: Eating after awakening from sleep or excessive food consumption after the evening meal
• Unspecified Feeding & Eating Disorders: Everyone else who doesn't meet the threshold
• PICA: Eating non-food substances, e.g., soil, which can be common in pregnancy
• Avoidance/Restrictive Food Intake Disorder (ARFID): characterized by:
  • An eating or feeding disturbance (apparent lack of interest in eating or food, avoidance based on sensory characteristics or concern about aversive consequences of eating), manifested by persistent failure to meet appropriate nutritional needs
  • Significant weight loss, nutritional deficiency, dependence on enteral feeding or supplements, marked impairment
  • Not explained by another medical condition, anorexia or bulimia nervosa, or cultural practices
  • More likely to start in childhood and is a very understudied disorder

Epidemiology of EDs

• Commonly start in childhood, sometimes at a very early onset.
• In general they start around early adolescence, with Anorexia Nervosa (AN) having the earliest onset.
• BED and subthreshold BED becomes most common.
• Not many new cases of AN post diagnoses after 30 years of age.
• Disordered eating is more common than actual eating disorders.
• Point Prevalence - NHS Digital, 2023 found that young people aged 11 to 25 years and parents of children aged 8 to 16 years completed 5 screening questions from the ‘Development and Well-Being Assessment (DAWBA) Eating Disorder module'.
• Higher prevalence eating disorders were found in girls/women (20% in 17-19 year olds)
• There were more individuals with possible eating problems from 2017-2023 and this was particularly seen in young women
• HSE 2019 showed that women overall screened higher prevalence for eating disorder, largest increase in boys from 16-24 to 25-34 years (13% to 18%)

Factors that Increase ED Risk

• Higher incidence in 13-16 & 17-19 year olds and an increase are seen in 13-16 year old girls whereas boys consistently have low incidence
• A dramatic drop was seen immediately after the lockdown was imposed in both girls and boys
• Incidence begins much lower for boys; after lockdown, it drops dramatically, then slowly rises, but remains below expected levels.
• Incidence begins much lower for boys - then dramatic drop immediately after lockdown, then slow rise but remains below expected levels
• Sex: Anorexia Nervosa → 1:6 to 1:12, Bulimia Nervosa → 1:6 to 1:18, Binge Eating Disorder → 1:3 to 1:6 (male : female ratio)
• Comparable or higher levels of disordered eating behaviors; higher in migrants
• Fewer people from ethnic minority backgrounds are diagnosed compared to white people
• EDs in primary care 2004-2014, has different patterns depending on socio-economic
• Young people and adults from bisexual/gender minority have higher rates of ED diagnosis
• There is limited variation across heterosexual, mostly sexual and gay/bisexual people regarding desire for bigger muscles, toned/defined muscles or attempts to gain weight