Estimated prevalence of eating disorders in Singapore

A cultural models approach to understanding body fatness perceptions and disordered eating in young South Korean men

OBJECTIVE

The eating disorders field has been limited by a predominant focus on White, Western women, and there is growing recognition of the need to understand cross-cultural variation in key constructs (i.e., ideal body types). A transdisciplinary, cultural models approach systematizes the incorporation of an "emic" perspective (a culture's own understandings of phenomena) into assessments of relationships between body shapes and eating disorders.

METHOD

Eighty-one young South Korean men aged 19-34 years living in Seoul participated in this research. A cultural model of body fatness was identified using cultural consensus analysis during 18 months of ethnographic, mixed-methods fieldwork. Participants also completed questionnaires assessing age, height, weight, sexual identity, university prestige, body dissatisfaction, eating disorder symptoms, and cultural consonance with the Korean cultural model of the ideal male body. Variation in these factors was analyzed using a series of chi-squares and analyses of variance with the culturally defined categories of body fatness as the independent variables.

RESULTS

Cultural consensus analysis found that young South Korean men are consistent in identifying categories of "too thin," "balanced," and "too fat." The "balanced" category contained the lowest proportion of high-prestige university attendees and the highest average cultural consonance. The "too fat" category was characterized by the highest levels of body dissatisfaction and dieting, as well as proportion of probable eating disorders.

DISCUSSION

A cultural models approach identified culturally important factors and patterns in disordered eating among young South Korean men and may be effective for understanding eating disorders in other populations not typically studied.

PUBLIC SIGNIFICANCE

This study applies a systematic, "emic" perspective to young South Korean men's body ideals. Young Korean men share a cultural model of body fatness, and this model frames how they experience risk for eating disorders. This study demonstrates a method for incorporating culture into research on eating disorder risk.

The need for more inclusive measurement to advance equity in eating disorders prevention

Eating disorder (ED) research and practice have been shaped by prevailing stereotypes about who EDs are most likely to affect. Subsequently, the field has prioritized the needs and concerns of affluent, cisgender, heterosexual, white girls and women to the exclusion of others, especially people marginalized based on their race, ethnicity, sexual orientation, and/or gender identity. However, EDs exist across diverse groups and actually occur with elevated prevalence in several marginalized groups. Growing research points to differences in the drivers of EDs in such groups (e.g. desire to attain the curvy rather than thin ideal; dietary restraint due to food insecurity rather than weight/shape concerns), yet tools typically used for screening and intervention evaluation do not capture eating pathology driven by such factors. In this commentary, we describe gaps in existing ED assessment tools and argue these gaps likely underestimate EDs among marginalized groups, bias who is invited, participates in, and benefits from ED prevention programs, and obscure potential group differences in the efficacy of such programs. We also discuss the potential of these ramifications to exacerbate inequities in EDs. Finally, we outline recommendations to overcome existing gaps in measurement and, consequently, advance equity in the realm of ED prevention.

Avoidant/restrictive food intake disorder (ARFID) in New Zealand and Australia: a scoping review

BACKGROUND

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder that involves restrictive or avoidant eating behaviour not related to weight or body image concerns. It was first included in the Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5) in 2013. ARFID frequently begins in childhood and can have serious psychosocial impacts and detrimental health consequences when nutritional and energy needs are persistently unmet. This systematic scoping review focuses on Australasia, synthesizing the current literature landscape on ARFID, and offering recommendations for targeted, actionable research directions for both funders and researchers.

METHODS

Online databases and university thesis repositories were systematically searched for studies examining ARFID in the New Zealand or Australian population since 2013. Database search results were exported to Rayyan software, and two independent reviewers screened all identified sources, prior to extraction of key data.

RESULTS

Twenty-nine studies and one thesis from 138 screened sources were eligible for inclusion. Frequent study types were treatment interventions and cross-sectional studies, with populations including individuals with ARFID, ED service populations, parents/caregivers, health professionals, and non-clinical populations. ARFID presents in a range of settings and is associated with poorer quality of life and significant functional impairment. Assessment of ARFID was varied, and no specific treatment guidelines for ARFID have been written as yet.

CONCLUSION

This review calls for more accurate prevalence estimates of ARFID in children and larger-scale studies in all ages using validated measures. It emphasizes the need for education and training of healthcare professionals, and interdisciplinary collaboration. Established interventions like behaviour analytics should be considered, and more comprehensive research is needed on interventions for ARFID, including controlled trials and longitudinal studies. Urgent research is needed to improve outcomes for those affected by ARFID.

The prevalence and burden of avoidant/restrictive food intake disorder (ARFID) in a general adolescent population

BACKGROUND

Little is known about the prevalence and impairment associated with possible Avoidant/restrictive food intake disorder (ARFID) in community adolescent populations. We aimed to investigate the prevalence, health-related quality of life (HRQoL), and psychological distress associated with possible ARFID in a sample of adolescents from the general population in New South Wales, Australia.

METHODS

A representative sample of 5072 secondary school students aged between 11 and 19 years completed the online EveryBODY survey in 2017. The survey included demographic data, eating behaviours, psychological distress and both physical and psychosocial health-related quality of life.

RESULTS

The prevalence of possible ARFID was 1.98% (95% CI 1.63-2.41) and did not differ significantly across school years 7-12. The weight status of participants with possible ARFID did not differ significantly from those without possible ARFID. When measuring gender identity, the ratio of males to females with possible ARFID was 1:1.7. This was statistically significant, however, the effect size was very small. Psychological distress and HRQoL did not differ significantly between the possible ARFID and non-ARFID group.

CONCLUSIONS

The prevalence of possible ARFID was found to be similar to that of anorexia nervosa and binge eating disorder in the general adolescent population. Adolescents who identify as girls rather than boys may be more likely to develop ARFID, replication with new samples is required to confirm these findings. The impact of ARFID on HRQoL may be minimal in adolescence and become more significant in adulthood, further research using longitudinal design, healthy control groups and/or diagnostic interviews is required.

Current evidence for avoidant restrictive food intake disorder: Implications for clinical practice and future directions

Background

ARFID (avoidant restrictive food intake disorder) is a relatively new diagnostic term covering a number of well-recognised, clinically significant disturbances in eating behaviour unrelated to body weight/shape concerns. Its phenotypic heterogeneity combined with much about the condition remaining unknown, can contribute to uncertainties about best practice. While other reviews of the evidence base for ARFID exist, few specifically target health care professionals and implications for clinical practice.

Methods

A narrative review was conducted to synthesise the findings of ARFID papers in scientific journals focussing on four key areas relevant to clinical practice: prevalence, assessment and characterisation of clinical presentations, treatment, and service delivery. Freely available online databases were searched for case studies and series, research reports, review articles, and meta-analyses. Findings were reviewed and practice implications considered, resulting in proposed clinical recommendations and future research directions.

Results

We discuss what is currently known about the four key areas included in this review. Based on available evidence as well as gaps identified in the literature, recommendations for clinical practice are derived and practice-related research priorities are proposed for each of the four of the areas explored.

Conclusion

Prevalence studies highlight the need for referral and care pathways to be embedded across a range of health care services. While research into ARFID is increasing, further studies across all areas of ARFID are required and there remains a pressing need for guidance on systematic assessment, evidence-based management, and optimal service delivery models. Informed clinical practice is currently predominantly reliant on expert consensus and small-scale studies, with ongoing routine clinical data capture, robust treatment trials and evaluation of clinical pathways all required. Despite this, a number a positive practice points emerge.

Social media, traditional media, and other body image influences and disordered eating and cosmetic procedures in Malaysia, Singapore, Thailand, and Hong Kong

In this study, we investigated the association between perceived sociocultural influences and the 3-month prevalence of disordered weight-control behaviors and lifetime prevalence of cosmetic procedures in four Asian countries, and if these associations were modified by gender. We conducted a cross-sectional online survey in September 2020 among adults ages 18-91 years (N = 5294) in Malaysia, Singapore, Thailand and Hong Kong. The 3-month prevalence of disordered weight control behaviors ranged from 25.2 % (Singapore) to 42.3 % (Malaysia), while the lifetime prevalence of cosmetic procedures ranged from 8.7 % (Singapore) to 21.3 % (Thailand). Participants who perceived their body image to be influenced by sociocultural factors were more likely to engage in disordered weight control behaviors (RRs ranged from 2.05 to 2.12) and have cosmetic procedures (RRs ranged from 2.91 to 3.89) compared to participants who perceived no sociocultural influence. Men who were influenced by traditional or social media were more likely to engage in disordered weight control behaviors and have cosmetic procedures than similarly influenced women. The high 3-month prevalence of disordered weight control behaviors and lifetime prevalence of cosmetic procedures in Asia is concerning. More research is needed to develop effective preventive interventions in Asia for men and women to promote a healthy body image.

What do we know about the epidemiology of avoidant/restrictive food intake disorder in children and adolescents? A systematic review of the literature

BACKGROUND

Avoidant/restrictive food intake disorder (ARFID) was a new diagnosis in DSM-5. This systematic review explores what is known to date about the epidemiology of ARFID in children and adolescents.

METHOD

Embase, Medline and PsycInfo were used to identify studies meeting inclusion criteria. PRISMA guidelines were followed.

RESULTS

Thirty studies met inclusion criteria, with most coming from specialised eating disorder services where prevalence rates were 5%-22.5%. Three studies from specialist feeding clinics showed the highest prevalence rates, ranging from 32% to 64%. Studies from non-clinical samples reported ARFID prevalence estimates ranging from 0.3% to 15.5%. One study, using national surveillance methodology, reported the incidence of ARFID in children and adolescents reaching clinical care to be 2.02 per 100,000 patients. Psychiatric comorbidity was common, especially anxiety disorders (9.1%-72%) and autism spectrum disorder (8.2%-54.75%).

CONCLUSION

The current literature on the epidemiology of ARFID in children and adolescents is limited. Studies are heterogeneous with regard to setting and sample characteristics, with a wide range of prevalence estimates. Further studies, especially using surveillance methodology, will help to better understand the nature of this disorder and estimate clinical service needs.

Avoidant restrictive food intake disorder and suicidal ideation

Most DSM-5 eating disorder diagnoses are associated with elevated suicide risk; however, little is known about the relationship between Avoidant/Restrictive Food Intake Disorder (ARFID) and suicidal ideation. The aim of the current study was to examine suicidal ideation within an adult ARFID sample. Patients with eating disorders (N = 936), some of whom met criteria for a current DSM-5 diagnosis of ARFID (n = 79), completed the Beck Depression Inventory II Item 9, regarding suicidal ideation. The study was conducted within an eating disorder treatment facility that offers inpatient, residential, partial hospitalization program, and intensive outpatient levels of care. Findings suggest no significant pairwise differences in suicidal ideation prevalence between participants with ARFID and those with any other ED diagnosis. Thorough screening for suicidal thoughts and risk among those with ARFID is warranted at all levels of care. We suggest that future research expand upon this work in a larger adult ARFID sample.

Worldwide prevalence of DSM-5 eating disorders among young people

PURPOSE OF REVIEW

Eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder, and other eating disorders) affect young people worldwide. This narrative review summarizes key studies conducted on the prevalence of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) eating disorders among young people in 2013-22.

RECENT FINDINGS

In Western settings, a substantial proportion of young people have reported an eating disorder. Overall, 5.5--17.9% of young women and 0.6-2.4% of young men have experienced a DSM-5 eating disorder by early adulthood. Lifetime DSM-5 anorexia nervosa was reported by 0.8-6.3% of women and 0.1-0.3% of men, bulimia nervosa by 0.8-2.6% of women and 0.1-0.2% of men, binge eating disorder by 0.6-6.1% of women and 0.3-0.7% of men, other specified feeding or eating disorders by 0.6-11.5% of women and 0.2-0.3% of men, and unspecified feeding or eating disorders 0.2-4.7% of women and 0-1.6% of men. Gender and sexual minorities were at particularly high risk. Emerging studies from Eastern Europe, Asia, and Latin America show similar high prevalences. During the COVID-19 pandemic, the incidence of eating disorders has still increased.

SUMMARY

Eating disorders are a global health concern among young people. Improved detection, management, and prevention methods are urgently needed.

An update on the epidemiology of eating disorders in Latin America: current findings and future challenges

PURPOSE OF REVIEW

We systematically reviewed the recent literature on the epidemiology of eating disorders in Latin America.

RECENT FINDINGS

Most screened articles only investigated risk for eating disorders or disordered eating behaviors. Four studies reported prevalence for eating disorders. One study reported age-standardized prevalence ranging from 0.04% [95% confidence interval, CI (0.03, 0.06)] to 0.09% [95% CI (0.07, 0.13)] for anorexia nervosa and from 0.13% [95% CI (0.08, 0.17)] to 0.27% [95% CI (0.18, 0.37)] for bulimia nervosa. Three additional studies conducted in Brazil identified a general eating disorder point-prevalence of 0.40% in children aged 6--14 years and a point-prevalence of 0.7 % [95% CI (0.34, 1.55)] for bulimia nervosa, 1.4% [95% CI (0.81, 2.43)] for binge-eating disorder and 6.2% [95% CI (3.10, 5.27)] for recurrent binge eating.

SUMMARY

Since 2020, only few studies were published on the epidemiology of full-threshold eating disorders in Latin America. Prevalence was in a comparable range to previous findings. No studies regarding new DSM-5 eating disorder diagnoses were identified, and studies investigating the impact of the COVID-19 pandemic on prevalence or incidence of eating disorders in these countries are needed.

Parent and clinician perspectives on virtual guided self-help family-based treatment (GSH-FBT) for adolescents with anorexia nervosa

PURPOSE

Guided self-help (GSH) treatments have the capacity to expand access to care, decrease costs, and increase dissemination compared to traditional therapist-directed treatment approaches. However, little is known about parent and clinician perspectives about the acceptability of GSH for adolescents with eating disorders.

METHODS

This study utilized a mixed methods approach to obtain qualitative and quantitative data regarding clinician and participants' experiences with GSH. Parent participants were enrolled in a randomized trial comparing GSH family-based treatment (GSH-FBT) to family-based treatment delivered via videoconferencing (FBT-V) for adolescents (12-18 years old) with a DSM-5 diagnosis of anorexia nervosa (AN). Parent participants provided qualitative feedback using the Helping Alliances Questionnaire about their experience of treatment. Clinician participants were six master's or PhD-level therapists. These clinicians were trained in and provided both treatments (GSH-FBT and FBT-V). They provided responses to questionnaires and participated in a 1-h focus group about their experience as treatment providers.

RESULTS

Regardless of treatment condition, parents listed more improvement than worsening of symptoms in their child with AN. Clinicians reported lower scores on competency and comfort metrics with GSH-FBT compared to FBT-V. Qualitatively, clinicians reported both advantages and disadvantages of delivering GSH-FBT.

CONCLUSION

Further studies are needed to better understand how GSH interventions can be disseminated to patients and families, particularly those with limited access to specialized eating disorder treatment centers. Level of evidence Level I, data collected as part of a randomized controlled trial.

Evolution of paediatric eating disorders in Singapore: a historical cohort study

OBJECTIVE

Most eating disorders (EDs) develop during adolescence, impacting a critical period of development. There is limited research on EDs in children in Singapore or the rest of South-East (SE) Asia.

DESIGN

We analysed a hospital-based cohort of paediatric patients (≤18 years) with EDs (n=177) in Singapore between 2011 and 2021. Historical trends, over three decades, were obtained by comparison with two previously published Singapore studies.

RESULTS

Of the 177 patients, the majority 158 (89%) were females, with anorexia nervosa (AN) 151 (85%). The mean age at diagnosis was 14.6 (SD 1.8) years. For AN, the mean duration of illness before diagnosis was 8.3 (SD 6.3) months and this has decreased by 8.4 months (95% CI 4.5 to 12.3 months, p=<0.0001) from the 2003 to 2010 cohort, and 17.7 months (95% CI 12.6 to 22.8 months, p=<0.0001) from the 1994 to 2002 cohort. Avoidant/restrictive food intake disorder (ARFID) cases are increasing, and the clinical profile differs from other EDs. Since family-based therapy (FBT) was introduced for patients with AN, the remission rate at 1 year improved from 30% to 79%, and time to remission has decreased from 16 to 7.5 months.

CONCLUSIONS

AN is the most common ED in paediatric patients in Singapore. Over the past three decades, EDs are being diagnosed earlier. FBT has emerged as the most effective treatment for AN. ARFID is being diagnosed more frequently. Data suggest that EDs are prevalent and increasing among adolescents in SE Asia. Singapore is a good test case for SE Asia, but research and attention to the problem in the region is needed.

Estimated prevalence of eating disorders in Malaysia based on a diagnostic screen

Eating disorders (EDs) are debilitating health conditions and common across cultures. Recent reports suggest that about 14.0% of university students in Malaysia are at risk for developing an ED, and that prevalence may differ by ethnicity and gender. However, less is known about the prevalence of EDs in nonuniversity populations.

OBJECTIVE

The current study seeks to (1) estimate the prevalence of EDs and ED risk status among adults in Malaysia using an established diagnostic screen; (2) examine gender and ethnic differences between ED diagnostic/risk status groups; and (3) characterize the clinical profile of individuals who screen positive for an ED.

METHOD

We administered the Stanford-Washington University Eating Disorder Screen, an online ED screening tool, to adults in Malaysia in September 2020.

RESULTS

ED risk/diagnostic categories were assigned to 818 participants (ages 18-73 years) of which, 0.8% screened positive for anorexia nervosa, 1.4% for bulimia nervosa, 0.1% for binge-ED, 51.4% for other specified feeding or ED, and 4.8% for avoidant/restrictive food intake disorder. There was gender parity in the high risk and the overall ED categories. The point prevalence of positive eating pathology screening among Malays was significantly higher than Chinese but no different from Indians.

DISCUSSION

This is the first study to estimate the prevalence of EDs using a diagnostic screen in a population-based sample of Malaysians. It is concerning that over 50% of Malaysians reported symptoms of EDs. This study highlights the need to invest more resources in understanding and managing eating pathology in Malaysia.

PUBLIC SIGNIFICANCE

This study estimates the prevalence of EDs among adults in Malaysia using an online EDs screen. Over 50% of Malaysians report symptoms of EDs. The study highlights the need for more resources and funding to address this important public health issue through surveillance, prevention, and treatment of EDs in Malaysia.

Potential Triggers for Risking the Development of Eating Disorders in Non-Clinical Higher-Education Students in Emerging Adulthood

Nowadays, eating disorders (ED) among individuals during emerging adulthood have become a crucial challenge to public health, taking into account the fact that the global prevalence of the ED risk in student-aged populations already stands at 10.4% and has been sharply increasing during the COVID-19 pandemic. In all, from 50% to 80% of all the ED cases go undetected or are not correctly diagnosed; moreover, these individuals do not receive specialized treatment. Therefore, early diagnosis detected via screening questionnaires for ED is highly recommended. This study aimed to identify the triggers for ED risk development in emerging-adulthood individuals and to reveal the factors significant not only for ED prevention but also for assessing individuals with subthreshold symptoms. This cross-sectional study provides the results for the ED symptom screening in 1716 Lithuanian higher-education students aged 21.2 ± 3.9, during emerging adulthood. According to the results of this study, 19.2% of students were at risk for ED. Potential risk factors such as sex (odds ratio (OR): 3.1, 95% CI: 1.9–4.9), body weight (self-reported body mass index) (adjusted (A) OR: 1.4; 95% CI: 1.2–1.7) and comorbidities such as smoking (AOR: 2.1; 95% CI: 1.6–2.8), and perceived stress during the pandemic (AOR: 1.4; 95% CI: 1.1–1.8) are involved in anticipating the symptomatology of ED during emerging adulthood. Regular initial screenings with universally adopted questionnaires and further referral to a psychiatrist must be applied to promote both the diagnosis of early-onset symptomatology and the treatment of these ED in student-aged populations. Preventive programs for reducing the prevalence of overweight or obesity among students during emerging adulthood should focus on integration directions for the development of a positive body image.

How genetic analysis may contribute to the understanding of avoidant/restrictive food intake disorder (ARFID)

Avoidant/restrictive food intake disorder (ARFID) was introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Unlike anorexia nervosa, ARFID is characterised by avoidant or restricted food intake that is not driven by weight or body shape-related concerns. As with other eating disorders, it is expected that ARFID will have a significant genetic risk component; however, sufficiently large-scale genetic investigations are yet to be performed in this group of patients. This narrative review considers the current literature on the diagnosis, presentation, and course of ARFID, including evidence for different presentations, and identifies fundamental questions about how ARFID might fit into the fluid landscape of other eating and mental disorders. In the absence of large ARFID GWAS, we consider genetic research on related conditions to point to possible features or mechanisms relevant to future ARFID investigations, and discuss the theoretical and clinical implications an ARFID GWAS. An argument for a collaborative approach to recruit ARFID participants for genome-wide association study is presented, as understanding the underlying genomic architecture of ARFID will be a key step in clarifying the biological mechanisms involved, and the development of interventions and treatments for this serious, and often debilitating disorder.

Assessment of avoidant restrictive food intake disorder, pica and rumination disorder: interview and questionnaire measures

PURPOSE OF REVIEW

This article reviews available assessment instruments for three of the feeding and eating disorder diagnostic categories: avoidant restrictive food intake disorder (ARFID), pica, and rumination disorder (RD). It includes an overview of the current status of screening tools, questionnaire measures, and diagnostic instruments.

RECENT FINDINGS

Screening instruments are available for all three disorders; however, for pica and RD, these typically include single screening items only and do not cover any specific features of these presentations. Only one questionnaire suitable for clinical populations is included, covering ARFID only. Standardized diagnostic interviews are limited to two covering both pica and RD, only one of which provides further clinical information. Of the five diagnostic instruments for ARFID described here, two include diagnostic items as well as allowing more detailed assessment of clinical features.

SUMMARY

There are a limited number of assessment measures available for all three disorders, with instruments for ARFID being the greatest in number and widest in terms of scope. A commonly encountered difficulty is that many assessment instruments do not adequately cover diagnostic exclusion criteria, which raises the likelihood of false positive findings. All currently available measures require further study to determine their reliability and validity.

The Association of Body Image Self-Discrepancy With Female Gender, Calorie-Restricted Diet, and Psychological Symptoms Among Healthy Junior High School Students in Japan

Background: Body image self-discrepancy reflects a preference for weight loss regardless of normal body size and is a distorted cognition that may be a precursor to eating disorders. The aim of this study was to investigate factors associated with body image self-discrepancy among healthy junior high school students in Japan.

Method: This cross-sectional study was conducted at one junior high school in Saitama, Japan, in December 2016. After excluding obese participants (defined as 20% above their ideal weight), 304 students (mean age, 13.9years; n=181 girls, 59.5%) who fell into underweight (n=22, 7.2%) and normal weight categories were selected. Body image self-discrepancy was measured using the Contour Drawing Rating Scale which includes eight separate figures representing body sizes. We then calculated the difference by subtracting ideal from current body sizes and defined body image self-discrepancy if the difference >1.

Results: Girls constituted 92% (n=49) of the 53 students with body image self-discrepancy. In all students, multivariable stepwise models demonstrated that female gender (OR, 6.92, 95% CI: 2.33–20.51), a calorie-restricted diet (OR, 5.18, 95% CI: 2.22–12.05), and psychological symptoms (OR, 1.47, 95% CI: 1.15–1.87) were significantly associated with an increased risk of body image self-discrepancy. Specifically for girls, an increased risk of body image self-discrepancy was associated with calorie-restricted suppers and psychological symptoms.

Conclusion: Body image self-discrepancy among healthy adolescents in Japan was found to be closely linked to being a girl, having a calorie-restricted diet, and having psychological symptoms.

Development of a parent-reported screening tool for avoidant/restrictive food intake disorder (ARFID): Initial validation and prevalence in 4-7-year-old Japanese children

The prevalence of avoidant/restrictive food intake disorder (ARFID) in the general child population is still largely unknown and validated screening instruments are lacking. The aims of this study were (1) to investigate the prevalence of children screening positive for ARFID in a Japanese birth cohort using a newly developed parent-reported screening tool, (2) to estimate the prevalence of children with ARFID experiencing physical versus psychosocial consequences of their eating pattern, and (3) to provide preliminary evidence for the validity of the new screening tool. Data were collected from 3728 4-7-year-old children born between 2011 and 2014 in Kochi prefecture, Japan (response rate was 56.5%); a sub-sample of the Japan Environment and Children's Study (JECS). Parents completed a questionnaire including the ARFID screener and several other measures to assess convergent validity. The point prevalence of children screening positive for ARFID was 1.3%; half of them met criteria for ARFID based on psychosocial impairment alone, while the other half met diagnostic criteria relating to physical impairment (and additional psychosocial impairment in many cases). Sensory sensitivity to food characteristics (63%) and/or lack of interest in eating (51%) were the most prevalent drivers of food avoidance. Children screening positive for ARFID were lighter in weight and shorter in height, they showed more problem behaviors related to mealtimes and nutritional intake, and they were more often selective eaters and more responsive to satiety, which together provides preliminary support for the validity of the new screening tool. This is the largest screening study to date of ARFID in children up to 7 years. Future studies should examine the diagnostic validity of the new ARFID screener using clinically ascertained cases. Further research on ARFID prevalence in the general population is needed.

Economic burden of eating disorders in South Korea

BACKGROUND

Few studies have investigated the epidemiology of eating disorders using national representative data. In this study, we investigated the treatment prevalence and economic burden of eating disorders in South Korea.

METHODS

The aim of this study was to estimate the treatment prevalence and the medical expenditure of diagnosed eating disorders (ICD F50.x) in South Korea between 2010 and 2015. We also examined the economic costs of eating disorders, including the direct medical cost, direct non-medical costs, and indirect costs, in order to calculate the economic burden of such disorders.

RESULTS

The total treatment prevalence of eating disorders in South Korea was 12.02 people (per 100,000) in 2010, and 13.28 in 2015. The cost of medical expenditures due to eating disorders increased from USD 1229724 in 2010 to USD 1843706 in 2015. The total economic cost of eating disorders was USD 5455626 in 2015. In 2015, the economic cost and prevalence of eating disorders was the highest in the 20-29 age group.

CONCLUSIONS

The results showed the eating disorders are insufficiently managed in the medical insurance system. Further research is therefore warranted to better understand the economic burdens of each type of eating disorder.