Eating disorders: identification of risk factors needed

Future epidemiological research in eating disorders should focus on the identification of specific risk factors, the author of a recent review recommends.In his review the author discusses recent research focusing on the incidence and prevalence of eating disorders and the associated mortality.The author states that many incidence studies of anorexia nervosa conducted to date have recruited subjects from psychiatric case registers or hospital records and as a result are likely to underestimate the incidence in the community. As a result, it is not clear whether the reported increase in cases of anorexia in healthcare facilities is due to an actual increase in the incidence in the community or to improved methods of case detection or wider availability of services.The registered incidence rate of anorexia is up to 8.3 per 100,000 persons per year with the highest incidence rates seen in young females. The incidence rate of anorexia, particularly in females aged 15 to 24 years, increased during the 20th century until the 1970s when it appeared to stabilise.Few studies have focused on anorexia in males - from those that have it appears that the incidence rate is below 1 per 100,000 persons per year.Prevalence rates for anorexia vary from study to study. The average prevalence rate for anorexia in young females is reported to be around 0.3%.Prevalence studies using two-stage selection of cases show that one-year period prevalence rates are greater in the community than in primary care or mental healthcare, suggesting that most patients with anorexia in the community do not enter the mental healthcare system.Recent studies have confirmed beliefs that anorexia is associated with high mortality rates. Anorexia is far more common in white females than in black females - in a US study anorexia was not found in black women compared with a 1.5% lifetime prevalence rate among white women.The incidence of bulimia nervosa appears to have decreased during the latter half of the 1990s, and is currently estimated at up to 13 per 100,000 persons per year. Average prevalence rates of 1% are reported in young females.As for anorexia, the results of two-stage prevalence studies indicated that only a small minority of bulimia cases in the community (around 6%) enter the mental healthcare system.In outpatient settings eating disorder not otherwise specified (EDNOS) is estimated to account for an average of 60% of all cases, compared with 14.5% for anorexia and 25.5% for bulimia.The author concludes that the challenge for the future will be to identify risk factors specific for eating disorders and to make an effort to control them.Reference...