New research reveals Australia has the world's highest estimated prevalence of anorexia and bulimia, raising concerns about missed diagnoses and barriers to treatment.
Australia has recorded the world’s highest estimated prevalence of anorexia nervosa and bulimia nervosa, prompting experts to urge GPs to look beyond traditional eating disorder stereotypes and improve early identification.
A major Global Burden of Disease (GBD) analysis, published in JAMA Psychiatry, found Australia’s age-standardised prevalence of the two disorders reached 1026.5 cases per 100,000 people in 2023, more than four times the global average of 225.6.
The findings have renewed concerns about gaps in GP training, missed diagnoses, and barriers to accessing multidisciplinary treatment, despite the availability of Medicare-funded eating disorder treatment plans.
Globally, an estimated 18.1 million people were living with anorexia nervosa or bulimia nervosa in 2023, a 71% increase since 1990. Researchers forecast that number will rise to 21.8 million by 2050.
The analysis examined data from 204 countries and territories between 1990 and 2023, finding the highest age-standardised prevalence rates in high-income regions, particularly Australasia and Western Europe.
Danielle Dougherty, director of the Butterfly Foundation’s residential eating disorder treatment facility Wandi Nerida, said GPs needed to recognise that eating disorders could present in patients who did not fit conventional expectations.
“It’s important for GPs to remember that eating disorders don’t have a ‘look’ – these mental illnesses can impact anyone, of any age, gender, weight, body size, ethnicity, and socioeconomic background,” she told The Medical Republic.
“Additionally, some people may not disclose an eating disorder because they feel ambivalent about recovery, or they may deny that a problem exists.”
Ms Dougherty said physical warning signs included fatigue, dizziness, fainting, cold intolerance, heart palpitations, menstrual irregularities, gastrointestinal complaints, dental erosion, recurrent sporting injuries, and unexplained electrolyte abnormalities, particularly low potassium.
Psychological presentations could include anxiety, depression, obsessive-compulsive symptoms, preoccupation with food or body image, heightened anxiety around mealtimes, and rigid thinking about eating.
Behavioural indicators included dieting, requests for weight-loss medications or appetite suppressants, and restrictive eating patterns, including those associated with reported food intolerances.
Ms Dougherty warned that eating disorders in people living in larger bodies were particularly likely to be overlooked.
“Don’t assume that someone in a larger body isn’t struggling with an eating disorder,” she said.
She said people living in larger bodies accounted for more than half of Australians with eating disorders, yet frequently experienced delayed identification, misdiagnosis, inappropriate treatment, and stigma.
The findings also highlighted the importance of recognising eating disorders in younger patients.
Globally, 41.2% of people living with anorexia nervosa or bulimia nervosa were aged between 10 and 24 years, while females accounted for 69.4% of cases and males 30.6%.
Of the 18.1 million people affected worldwide, approximately 3.92 million were living with anorexia nervosa and 14.2 million with bulimia nervosa.
Together, the disorders accounted for 3.83 million disability-adjusted life-years (DALYs), reflecting the substantial health burden associated with these conditions.
Between 1990 and 2023, the global age-standardised prevalence rate increased by 20.6%, while the age-standardised DALY rate rose by 20.5%.
Although high-income regions recorded the highest prevalence, the largest relative increases occurred in East Asia, South Asia, and Southeast Asia.
However, the analysis included only anorexia nervosa and bulimia nervosa, excluding other conditions such as binge eating disorder and other specified feeding or eating disorders (OSFED).
The researchers acknowledged that the estimates therefore did not capture the total burden of eating disorders.
The researchers said the findings demonstrated the need for stronger mental health surveillance, earlier detection, and improved integration of eating disorder care into health systems.
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Ms Dougherty said insufficient education about eating disorders was contributing to difficulties with recognition and management across the healthcare workforce.
She pointed to the National Eating Disorders Collaboration’s scoping review of tertiary education, which identified inadequate eating disorder content in many Australian medicine, psychology, dietetics, and nursing courses.
“This means it often requires a healthcare professional with a special interest in eating disorders to learn more and ensure they are equipped to provide effective treatment,” she said.
“With eating disorders rising and over 1.1 million people impacted every year, we absolutely need to see further tertiary education around these mental illnesses.”
However, she said GPs could access additional professional development through the National Eating Disorders Collaboration’s eLearning resources and the InsideOut Institute’s GP Hub, which provides guidance on diagnosis and treatment planning.
Access to treatment remained another significant challenge.
Ms Dougherty said many Australians experiencing eating disorders were facing lengthy waiting lists or were unable to access appropriate care because of inadequate funding.
She highlighted findings from an evaluation of the Medicare Benefits Schedule eating disorder items, which identified substantial gaps between treatment eligibility and actual service use.
According to the evaluation figures cited by the Butterfly Foundation, only about one in five people with an eating disorder accessed an eating disorder treatment plan.
Approximately one-third of people with a plan did not access any treatment sessions, while around one in three required treatment beyond the initial 12-month plan.
These findings raised questions about whether existing Medicare arrangements were adequately supporting patients requiring ongoing multidisciplinary care.
The foundation, through the Eating Disorders Alliance, has called for changes to the MBS eating disorder items to address structural, financial, and eligibility barriers.
The organisation is also advocating for increased government investment in intensive treatment options, including residential care.
“Residential treatment sits between outpatient care and an inpatient hospital admission,” Ms Dougherty said.
“It can suit people who are medically stable but need sustained, structured support to make progress in their recovery.”
At Wandi Nerida, Queensland Health currently funds eight of the facility’s 13 beds, providing fully funded stays of 60 to 90 days for eligible Queensland residents.
Ms Dougherty said discussions were continuing with the Queensland Government and other states to expand access.
“With rates of eating disorders forecasted to rise, Australia needs more treatment options, and they need to be affordable,” she said.
The facility’s latest outcomes data, covering July to September 2026, showed that participants had a median illness duration of 11 years.
Among those completing treatment, eating disorder symptoms decreased by more than half between admission and discharge, while depression, anxiety, and stress symptoms fell by approximately 60%.
The organisation said broader investment was needed across prevention, early intervention, and specialist treatment.
Sarah Cox, clinical psychologist and manager of the Butterfly National Helpline, said the global findings reinforced concerns raised by patients, families, and healthcare professionals.
“This study confirms what people with lived experience, their families and healthcare professionals have been telling us for years,” she said.
“Eating disorders are serious mental illnesses that affect a significant number of people in Australia, and the number of people affected is growing.”
Ms Cox acknowledged that Australia’s international ranking partly reflected the strength of its research and data collection.
“But it also tells us that eating disorders are not a niche issue,” she said.
“They affect people of all ages, genders, body sizes and cultural backgrounds, and they deserve a response that matches their impact.”
The researchers cautioned that differences in data availability and quality between countries could influence international comparisons, while the exclusion of other eating disorders meant the overall burden was likely underestimated.
“Anorexia nervosa and bulimia nervosa contribute substantially to global health loss, and their prevalence is forecast to continue increasing,” they concluded.
“These findings support strengthening prevention, early detection, and evidence-based treatment capacity, particularly in regions experiencing rapid growth in case numbers, and integrating eating-disorder care into broader mental health strategies.”
For confidential and free support with eating disorders or body image concerns, contact the Butterfly National Helpline on 1800 ED HOPE (1800 33 4673) or visit the Butterfly Foundation to chat online or email.
The foundation has dedicated resources available for healthcare professionals here.
