Australia ranks first globally for anorexia and bulimia: JAMA study

A global analysis published this week in JAMA Psychiatry found that Australia has the highest rate of anorexia and bulimia nervosa of any country in the world. The figure is 1,026.5 cases per 100,000 people — higher than the United States, higher than Western Europe, higher than any other comparable healthcare system. Globally, cases have risen 71 per cent since 1990.

Those numbers reach people’s lives in ways that do not always translate through a statistic. An eating disorder at 35 or 45 — the demographic likely reading this — often looks different from the adolescent presentation that most clinical training and most media coverage defaults to. It is quieter, more entrenched, more likely to be managed rather than treated, and more likely to be invisible to the GP who sees that person for something else entirely.

The study

The Global Burden of Disease analysis, published in JAMA Psychiatry and led by University of Queensland epidemiologist Damian Santomauro, covered data from 1990 onward for anorexia nervosa and bulimia nervosa. The key methodological distinction is that researchers used population surveys rather than treatment records. That means people who never received treatment — the majority of people with an eating disorder — are included in the count.

Globally, 18.1 million people were living with anorexia or bulimia in 2023. Of those, 3.92 million had anorexia nervosa and 14.2 million had bulimia nervosa. The disability burden was 3.81 million disability-adjusted life years. Cases are projected to keep rising through to 2050.

Females make up nearly 70 per cent of all cases. About 41 per cent of cases are in people aged 10 to 24. Those two figures are the demographic most commonly associated with eating disorders in clinical training. They are not the whole picture.

The Australian figure

Australia’s rate of 1,026.5 per 100,000 people surprised the researchers themselves. Santomauro called it “surprising and concerning” and noted that Australia’s survey methodology may be more sensitive than methods used in other countries — but said he does not believe that is the whole explanation.

Butterfly Helpline clinical psychologist Sarah Cox offered a more grounded read: Australia may be seeing the problem more clearly because it has more research infrastructure. That framing is worth sitting with. Countries with less epidemiological capacity are not at lower risk — they are less visible in the data. More than 1.1 million Australians experience an eating disorder in any given year, making this one of the most prevalent mental health conditions in the country.

What the study does not capture: binge eating disorder, avoidant-restrictive food intake disorder, and other specified feeding or eating disorders are not counted. The 1.1 million figure from the Butterfly Foundation is a broader net. The JAMA study is almost certainly an undercount.

Why the rates may be rising

Santomauro pointed to increased time online and social media as a possible driver, specifically body-image pressure on young people. That is a consistent theme in the research literature, and it is not resolved by any current policy or platform response.

Jeanette Chan, an economist with lived experience, raised a dimension the headline figures tend to underweight: migrants and people from non-Western cultural backgrounds may find it harder to access care and may not have their presentations recognised, because eating disorders are often framed as a Western condition. That framing is wrong, and the rising rates in East Asia, South-East Asia and South Asia — which the study flagged as among the largest relative increases — are part of why it needs to be retired.

Both-and: data quality and real burden

The both-and here is between what the high Australian rate means and what it does not mean.

It may partly reflect methodology — Australia’s surveys are thorough, and more rigorous detection means more cases counted. That is not the same as the problem being more severe here than anywhere else. It could mean the problem is equally severe elsewhere and less visible.

But here is the other side: if Australia’s rate reflects better detection, then the global 18.1 million figure is a floor, not a ceiling. The real global burden is larger than what the data can see. And the fact that Australia counts well does not reduce the number of Australians who need care and cannot access it. Cox was direct: cost, regional access, and stigma are the main barriers, and many people with an eating disorder never receive treatment.

2 cents: the GP consultation that matters

Early identification is the intervention with the clearest evidence behind it. A GP who asks about eating patterns, body image, and relationship with food — at the right moment, with the right framing — can be the first point of contact that opens a pathway to care. The question is often not asked because the presentation doesn’t fit the template: not a 15-year-old, not underweight, not obviously unwell.

The Butterfly Foundation helpline (1800 33 4673) offers GP support resources and can advise on local referral options. The National Eating Disorders Collaboration (nedc.com.au) has GP fact sheets. For patients where you suspect medical complications — electrolyte disturbance, cardiac arrhythmia, bone density loss — early physician review should run in parallel with the mental health pathway.

For patients in their 40s who are in the consulting room for something else: the question is worth asking. The data says they may be there.

Verdict: yes — Australia topping the global eating disorder rate table in a JAMA Psychiatry study is a public health signal with direct GP practice implications, particularly for identification of presentations in adults that fall outside the classic demographic template.

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Sources cited

1. Australia has highest rates of anorexia and bulimia in world — ABC Health, 29 October 2026
2. Global burden of anorexia and bulimia 1990–2023 — JAMA Psychiatry, 2026
3. Butterfly Foundation — eating disorder support and GP resources