Eating disorders cost US $65 billion a year: Here’s what agencies can do

These are tough times. Our health care system is overwhelmed by the COVID-19 pandemic, increasing already existing barriers to mental health care and creating a mental health epidemic of depression and anxiety. We now have good evidence that eating disorders are worsening too and our government can do something about it.

Recent survey data collected in the first few months of the pandemic confirmed that for people with eating disorders, being cut off from their normal sources of care and social support is worsening their symptoms, potentially increasing suicidality and substance use. Worse, nearly half reported they were not getting treatment for their eating disorder. Clearly, the pandemic is exacerbating the already high barriers to treatment many faced in “normal” times, and the government has taken very little action then or now to help.

Why no action? Policymakers argued they needed to see the numbers first. They asked, “Are eating disorders really that common? That deadly? That economically devastating?” The numbers are in now, and the answers are yes, yes, and yes. According to a new report:

• Nearly 30 million Americans alive today, or almost 10 percent of the population, will have an eating disorder at some point in their lifetime. They affect people of all genders, race and ethnicities, sexual orientations, and ages.

• Eating disorders are among the deadliest of mental health conditions, killing more than 10,000 Americans every year. Every 52 minutes, someone’s sister or brother, child or parent, needlessly dies from this preventable and treatable condition.

• Eating disorders are expensive, costing the U.S. economy almost $65 billion each year. Three-quarters of that cost, or almost $50 billion, is attributed to productivity losses: absenteeism or impaired work performance because of illness due to an eating disorder, needing to care for an ill family member with an eating disorder or premature death. Most people with eating disorders are in the prime of their working years, intensifying the impact on the economy. 

Now that we have the data, we need more from our government to tackle this growing problem. For instance, the CDC leads no national, ongoing data collection to monitor eating disorder symptoms or cases nationwide despite repeated urging from Congress. In fact, the only meaningful, ongoing, national monitoring of eating disorder symptoms that the CDC produced (via the Youth Risk Behavioral Surveillance System) was eliminated in 2015. In 2017, the NIH funded research for eating disorders at a meager $1 per affected person vs. Alzheimer’s disease at roughly $239 per affected person, autism at $109, and schizophrenia at $69.

The new data offers a sobering reality check on the profound social and economic burden of eating disorders, which is now compounded by the pandemic as cases rise and solutions are unknown. But, what we do know, is that eating disorders are treatable and their costs to society and burden on our medical system can be prevented.

• First, the CDC should launch systematic, longitudinal, national monitoring of eating disorders so we have more data about them in our arsenal for eliminating barriers to care.

• Second, more support is needed for eating disorder scientists and research funding through the development of an actionable plan by NIH.

• Last, evaluating and correcting insurance coverage gaps is needed within Medicaid, Medicare, TRICARE, and the Indian Health Service to ensure comprehensive eating disorders treatment coverage. 

Policymakers, you now have the numbers, and it is time to act. With an escalating mental health crisis during this pandemic, $65 billion lost annually to the economy due to eating disorders, and most troubling, a life lost every 52 minutes to the condition, we can’t afford to wait.

S. Bryn Austin is a professor at the Harvard T.H. Chan School of Public Health and Boston Children’s Hospital, founding Director of the Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED), and the past president of the Academy for Eating Disorders. Christine M. Peat, Ph.D., is an associate professor of psychiatry at the University of North Carolina at Chapel Hill, and the director of the National Center of Excellence in Eating Disorders. Cynthia M. Bulik, Ph.D., is a distinguished professor of Eating Disorders at the University of North Carolina at Chapel Hill and founding director of UNC Center of Excellence for Eating Disorders.