Eating Disorder Cases Rose During the Pandemic, But They’ve Been Costing Governments Billions for Decades
CW/TW mention of calories in relation to global treatment intake recommendations
I’ve watched in horror from recovery’s fragile safety as eating disorders skyrocketed globally during pandemic lockdowns. Isolation, lack of structure, and enclosure gave eating disorders room to thrive. In the UK, U.S., and Argentina, demand for eating disorder treatment increased 116%, 70% and 57% respectively in 2020. I was part of that statistic, starting treatment that November.
I am an anorexia survivor. My decade-long eating disorder hit rock bottom during college as I moved from New York, to California, Hong Kong, and Milan. Anorexia was my purpose. My college classes were the only situation I excused stillness; I exercised while DuoLingo’ing Mandarin and Italian. As for my global experience, I restricted through three world-class foodie cities.
Because I started recovery during junior year in Milan, my uni years are intrinsically tied to reckoning with my mental illness and, ultimately, reconciling my health. I fought to achieve recovery with a contradictory vengeance; fearful to leave anorexia’s illusion of safety behind, and yet more optimistic than I’ve felt in years. I was lucky to access telehealth treatment. I never went inpatient, but it’s terrifying to see what those who did experienced: Treatment centers are not built for the pandemic-driven surge in demand.
It’s a global capacity problem. The largest inpatient facilities in China and Japan only have capacity for 250 and 200 inpatients. Public Italian hospitals were only built to handle 60% of national demand for eating disorder care. This leaves many to seek care from nonprofits — which are also full. Demand for nonprofit eating disorder treatment increased $4.56B (54%) in the UK since COVID-19 began, but faced a $13.53B funding deficit.
In the US, Project HEAL increased its community support 3216% between 2020 and 2023 to keep up with demand, and 100% of its beneficiaries report being impacted by the pandemic.
The U.S. faced $400B total eating disorder-related costs in 2019 — $326.5B economic impact from lost productivity and well-being and premature death increases, plus $64.7B directly for eating disorder treatments. This quantifies the price per person at $11,808. A 2012 Australian report explicitly states eating disorder costs are a conservative estimate at $69.7B — contrasting $41.2B for anxiety and depression. It’s interesting that Australia’s economic toll is shockingly higher than the U.S.’, with only 913,000 eating disorder cases compared to 30 million. This cost discrepancy highlights a research gap on the true crisis of eating disorders and their harmful impacts.
Here in the EU, scientists estimate that 20 million people suffer from eating disorders each year, costing $1.3T annually: $281B for the economy and $860B for treatment. In Germany, 63% of total eating disorder costs are from a loss of productivity due to premature anorexia deaths in adolescents, and 32.7% of bulimia-related costs were due to wasted food from binging and purging.
The cost crisis is two-fold: Inadequate treatment and a sharp rise in cases. Eating disorders are incredibly difficult to treat because they require a prolonged array of physical, behavioral, and mental care, and research is severely underfunded compared to the range of other mental illnesses.
In 2019, Canada spent only $0.70 per eating disorder diagnosis ($1M total), compared with $50.17 per schizophrenia ($17M total) — even though each eating disorder case puts twice the economic burden on the government. Canada also spent $4.3M for bipolar disorder and $20.1M for autism. This trend is similar globally. Eating disorder research is only 0.4% of the UK's total psychiatric spending, compared with 7.2% for depression. This is a problem because it does not neutralize, or even attempt to resolve, the high eating disorder costs that burden society.
The second cost problem is how steeply cases have increased across the globe. Eating disorders are not just a Western phenomenon — rates of sufferers in South America and Asia match those in Western countries. But there is still a discerning lack of data in those regions. Eating disorders are found in around 30% of Argentinians, and 12% of Chileans. These reports are further complicated because a cross-continent study indicates that eating disorders only impact 4.8% of the Latin American population. These examples conclude that eating disorders are a problem across the world, but the true depth of the issue is currently unknown.
One common thread amongst all these countries is their government’s misguided common enemy: obesity. In April 2022 the UK began requiring all restaurants, cafes, and food labels to include calorie counts. Japan’s even stricter 2008 “Metabo Law” requires 56 million citizens aged 40 to 75, to keep under certain waist measurements. But these measures only serve to perpetuate eating disorders and stigma, which indicates why two-thirds of severely ill Japanese people with eating disorders will not seek hospital treatment.
Governments choose to aggressively fight against obesity because of longstanding unscientific beliefs that wrongly equate BMI with health. BMI was not even created by a doctor or health expert. It was founded by a mid-19th century Belgian astrologer, Lambert Adolphe Jacques Quetelet. In 1812, he wrote A Treatise on Man and the Development of His Faculties about the perfect weight-to-height ratio for a white European man.
As governments fight obesity, they also unproductively reinforce fatphobia and weight bias, harming global physical and mental health.
Atypical anorexia nervosa, for example, is the fatphobic title for non-underweight individuals who are experiencing all the same mental symptoms as anorexia nervosa. It’s important to reiterate that eating disorders are not weight disorders; they are behavior disorders. This means all different people in all body sizes can use disordered behaviors and experience the resulting harmful complications.
(CW/TW) The U.S. FDA’s 2,000 calorie is a misleading reference label that further complicates the issue. The UN reports the global average daily caloric consumption at 2,800, which far exceeds the FDA’s one-size-fits-all nutritional recommendation (1,600- 2,200 for women; 2,000-3,200 for men). These ranges are wide by design because individual needs vary based on genetics, age, activity level, and hormones.
But the general public is not educated on nutrition facts, which points to one of the reasons why the “obesity fight” is largely unproductive. Average consumers cannot use the available resources to make informed nutritional choices. Without education, we cannot unlearn fatphobia’s scientifically unfound messages, and we cannot collectively move towards a healthier mind-and-body future.
Instead, we must take a different approach, focusing on mental and physical health. One of the ways to eradicate fatphobic stigma is education about how weight is not necessarily correlated to whole body health. Health at Every Size (HAES) seeks to do just that. The movement tackles weight bias by informing practitioners why other measurements besides weight, like blood pressure and cholesterol, are better health indicators than BMI. HAES indicates that people with optimal metabolic blood tests can be physically healthy at any body size.
HAES further amplifies a greater societal message about more holistic equitable healthcare. It essentially encourages doctors to consider the facts about a patient before commenting on or making medical recommendations based on their body size.
HAES was created to support fat acceptance, since fat people systemically experience the most violence against their bodies, but since it's conception, it has become so much more than that. HAES, to me, is also about making room for all bodies and giving them space to peacefully be – as they are, without weight restrictions.
As we emerge from the pandemic, I hope our governments prioritize mental health, and do not forget about eating disorders. The “obesity fight” ultimately distracts from a larger societal issue — our culture’s values of thinness over true health, while eating disorders are costing governments trillions of dollars. I decided to write my university thesis on unequal socio-economic burdens in eating disorder care, and six professors rejected my proposal. Four of them told me they were more interested in me writing about the “harmful impacts” of obesity. People don’t know that eating disorders and fatphobia are the true crises, and until they do I’ll be here prioritizing writing for mental health over topics that perpetuate fatphobia and stigma.
