Eating Disorders Among Utah Women

Eating Disorders (EDs) are “behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions.” EDs frequently co-occur with other mental health disorders, such as mood disorders, anxiety disorders, obsessive compulsive disorders, and substance abuse problems, as well as neurodevelopmental disorders such as autism spectrum disorder and attention-deficit/hyperactivity disorder. LGBTQ+ individuals are also more vulnerable. Importantly, EDs are recognized as one of the most fatal mental illnesses in the US. A recent US study estimated that between 2018 and 2019, one person died from an ED every 51.5 minutes. The report projected that 28.8 million US people will suffer from an ED at some point in their lifetime, and women were two times more likely to have an ED than men. Furthermore, the financial cost per year associated with EDs—including health system costs, productivity and efficiency losses, and informal care—is estimated to be $64.7 billion. Conversion estimates predict that 278,266 Utahns (or 9.0%) will experience an ED. Given the mortality risk, higher rates among women, and the predicted prevalence of EDs in Utah, the Utah Women & Leadership Project (UWLP) seeks to better understand what may be affecting this public health crisis in our state. This research snapshot focuses on the following key areas:  

1. An overview of EDs among women—globally, in the US, and in Utah;  
2. Factors affecting women with EDs; and  
3. Recommendations to prevent and treat EDs in Utah. 

Overview of EDs 

• Types of EDs: The various types of EDs include anorexia nervosa (referred to as anorexia), bulimia nervosa (bulimia), binge-eating disorder (BED), avoidant restrictive food intake disorders (ARFID), other specified feeding or eating disorders (OSFED; formerly known as eating disorders not otherwise specified, or EDNOS), pica, and rumination-regurgitation disorders. 
• Global Prevalence: A global review of more than 90 studies identified a trend of increasing prevalence of EDs. The ED point prevalence (proportion of EDs during a specific period) increased from 3.5% for the 2000–2006 period to 7.8% for the 2013–2018 period. 
• National Prevalence: The National Eating Disorders Association (NEDA), a nonprofit advocacy organization, estimated that 20 million women and 10 million men in the US will experience an ED at some point in their lifetime. 
• Utah Prevalence: Statewide epidemiological data about Utahns diagnosed with an ED are very limited, but several recent publications provide some indication of ED trends. For example, a 2018 report provided by Utah’s county authorities (or Local Mental Health Authorities) indicated that 0.2% of their clients 18 years and older were diagnosed with EDs. 

Factors Affecting Women with EDs 

It is critical to understand what factors affect ED development and treatment trajectories, particularly among women. 

• Media Influence: Regardless of race, ethnicity, gender identity, or other biological factors, EDs can affect anyone at any life course stage. Nevertheless, it is theorized that EDs are a more common mental health illness among girls and women in the US because of unrealistic beauty standards toward girls and women in our society. 
• Social Media: A recent Australian study warned that adolescents who engage in photo-based social media behaviors (e.g., photo manipulation, posting selfies) may have an elevated risk of EDs. 
• Trauma: Traumatic life events in adulthood (e.g., sexual harassment, relationship problems) are identified as ED risk factors. 
• Pregnancy and Marriage: Marriage and female-specific experiences such as pregnancy can impact EDs. A recent study estimated approximately one of 20 (5.1-7.5%) pregnant women in developed countries were at risk for EDs. 
• Suicidality: Suicide, a rising concern in the US and certainly in Utah, is often associated with various psychiatric illnesses. A recent study estimated a much higher prevalence of suicide attempts in US adults, predominantly women, with histories of EDs. 
• Healthcare Access: For proper care, individuals diagnosed with EDs need treatment teams comprised of ED-trained therapists, medical providers, and registered dieticians. However, the data suggests access to care is significantly inadequate. 

Recommendations for Utah 

EDs disrupt critical developmental years for many Utahns. The following recommendations provide ideas about how Utah can develop and increase efforts to prevent and treat EDs among women and men. 

First: Early intervention efforts must be in place by high school, at the latest, before the typical onset of EDs. It is recommended that schools, colleges, and universities implement evidence-based ED prevention programs or intuitive eating training. 

Second: It is critical to increase the number of medical, psychiatric, psychological, and dietary providers who are specifically trained to treat EDs, as generalists may not be trained to treat these complex disorders effectively and may, instead, lead to harm. 

Third: Resources must be easily accessible for Utah women. 

Fourth: Increased awareness is necessary to shift from the thin-ideal and weight-focused culture through strategic outreach to Utah’s parents; school counselors, teachers, and administrators; and public health educators about ED-related prevention programs and resources. 

Fifth: Local lawmakers, public health officials, and health departments can team up to increase efforts that address issues related to EDs. 

Conclusion 

Mental illness is progressively detrimental to one’s wellbeing if left untreated, and EDs are no exception. It is necessary to improve ED prevention and treatment initiatives in Utah and implement evidence-based prevention programs in Utah schools. Additionally, coordinated efforts are needed to track prevalence in the state. Taking these essential steps will improve the mental health and physical wellbeing of girls and women throughout Utah, which will strengthen their impact in their homes, communities, and in our state. 

To learn more about eating disorders among Utah women, read the full snapshot.